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Arslan U, Erdoğan G, Yenerçağ M, Aksan G, Uçar M, Görgün S, Akpinar ÇK, Öztürk O, Yontar OC, Karagöz A. Direct transcatheter aortic valve implantation (TAVI) decreases silent cerebral infarction when compared to routine balloon valvuloplasty. Int J Cardiovasc Imaging 2023; 39:2029-2039. [PMID: 37358708 DOI: 10.1007/s10554-023-02895-x] [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] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/05/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE Silent cerebral infarctions (SCI), as determined by neuron-specific enolase (NSE) elevations, may develop after the transcatheter aortic valve implantation (TAVI) procedure. Our aim in this study was to compare the SCI rates between patients who underwent routine pre-dilatation balloon aortic valvuloplasty (pre-BAV) and patients who underwent direct TAVI without pre-BAV. METHODS A total of 139 consecutive patients who underwent TAVI in a single center using the self-expandable Evolut-R valve (Medtronic, Minneapolis, Minnesota, USA) were included in the study. The first 70 patients were included in the pre-BAV group, and the last 69 patients were included in the direct TAVI group. SCI was detected by serum NSE measurements performed at baseline and 12 h after the TAVI. New NSE elevations > 12 ng/mL after the procedure were counted as SCI. In addition, SCI was scanned by MRI (magnetic resonance imaging) in eligible patients. RESULTS TAVI procedure was successful in all of the study population. Post-dilatation rates were higher in the direct TAVI group. Post-TAVI NSE positivity (SCI) was higher in the routine pre-BAV group (55(78.6%) vs. 43(62.3%) patients, p = 0.036) and NSE levels were also higher in this group (26.8 ± 15.0 vs. 20.5 ± 14.8 ng/ml, p = 0.015). SCI with MRI was found to be significantly higher in the pre-BAV group than direct TAVI group (39(55.1%) vs. 31(44.9%) patients). The presence of atrial fibrillation and diabetes mellitus (DM), total cusp calcification volume, calcification at arcus aorta, routine pre-BAV and failure at first try of the prosthetic valve implantation were significantly higher in SCI (+) group. In the multivariate analysis, presence of DM, total cusp calcification volume, calcification at arcus aorta, routine pre-BAV and failure at first try of the prosthetic valve implantation were significantly associated with new SCI development. CONCLUSIONS Direct TAVI procedure without pre-dilation seems to be an effective method and avoidance of pre-dilation decreases the risk of SCI development in patients undergoing TAVI with a self-expandable valve.
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Affiliation(s)
- Uğur Arslan
- Department of Cardiology, Samsun University Samsun Training and Research Hospital, Baris Bulvari, No: 199, Samsun, 55400, Turkey.
| | - Güney Erdoğan
- Department of Cardiology, Samsun University Samsun Training and Research Hospital, Baris Bulvari, No: 199, Samsun, 55400, Turkey
| | - Mustafa Yenerçağ
- Department of Cardiology, Samsun University Samsun Training and Research Hospital, Baris Bulvari, No: 199, Samsun, 55400, Turkey
| | - Gökhan Aksan
- Department of Cardiology, Samsun University Samsun Training and Research Hospital, Baris Bulvari, No: 199, Samsun, 55400, Turkey
| | - Melisa Uçar
- Department of Cardiology, Samsun University Samsun Training and Research Hospital, Baris Bulvari, No: 199, Samsun, 55400, Turkey
| | - Selim Görgün
- Department of Microbiology, Samsun University Samsun Training and Research Hospital, Samsun, Turkey
| | - Çetin Kürşat Akpinar
- Department of Neurology, Samsun University Samsun Training and Research Hospital, Samsun, Turkey
| | - Onur Öztürk
- Department of Cardiology, Samsun University Samsun Training and Research Hospital, Baris Bulvari, No: 199, Samsun, 55400, Turkey
| | - Osman Can Yontar
- Department of Cardiology, Samsun University Samsun Training and Research Hospital, Baris Bulvari, No: 199, Samsun, 55400, Turkey
| | - Ahmet Karagöz
- Department of Cardiology, Samsun University Samsun Training and Research Hospital, Baris Bulvari, No: 199, Samsun, 55400, Turkey
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Burunkaya DK, Ozeke O, Korkmaz A, Ozcan F, Kara M, Ozcan Cetin EH, Yaman M, Demirhan C, Tuncez A, Dogan U, Yontar OC, Cay S, Aras D, Topaloglu S. The Initial Part of Polymorphic Ventricular Tachycardia as a Clue for the Sustainability of Tachycardia and Ablation Success: A Varying Degree of Purkinje-Myocardial Complicity? J Innov Card Rhythm Manag 2023; 14:5472-5480. [PMID: 37388422 PMCID: PMC10306249 DOI: 10.19102/icrm.2023.14066] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/26/2022] [Indexed: 07/01/2023] Open
Abstract
The cardiac Purkinje system is capable of very rapid burst activity suggestive of its potential role in being a driver of polymorphic ventricular tachycardia (VT) (PMVT) or ventricular fibrillation (VF). It plays a pivotal role, however, not only in the triggering of but also the perpetuation of ventricular arrhythmias. A varying degree of Purkinje-myocardial complicity has been blamed in determining not only the sustained or non-sustained nature of PMVT but also the pleomorphism of the non-sustained runs. The initial part of PMVT before cascading to the whole ventricle to establish disorganized VF can give important clues for ablation of PMVT and VF. We present a case of an electrical storm after acute myocardial infarction that was successfully ablated after identifying Purkinje potentials that triggered polymorphic, monomorphic, and pleiomorphic VTs and VF.
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Affiliation(s)
| | - Ozcan Ozeke
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Ahmet Korkmaz
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Firat Ozcan
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Meryem Kara
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Elif Hande Ozcan Cetin
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Mehmet Yaman
- Department of Cardiology, Eregli Echomar Hospital, Zonguldak, Turkey
| | - Can Demirhan
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | | | - Umuttan Dogan
- Department of Cardiology, Akdeniz University, Antalya, Turkey
| | - Osman Can Yontar
- Department of Cardiology, University of Health Sciences, Samsun Education and Research Hospital, Samsun, Turkey
| | - Serkan Cay
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Dursun Aras
- Department of Cardiology, Istanbul Medipol University, Istanbul, Turkey
| | - Serkan Topaloglu
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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Erdogan G, Yenerçağ M, Uçar M, Öztürk O, Şeker OO, Yontar OC, Çakmak EÖ, Karagöz A, Şahin İ, Arslan U. Modified Glasgow Prognostıc Score May Be Useful to Predict Major Adverse Cardiac Events in Heart Failure Patients Undergone Cardiac Resynchronization Treatment. Turk Kardiyol Dern Ars 2023; 51:104-111. [PMID: 36916816 DOI: 10.5543/tkda.2022.99448] [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: 03/16/2023] Open
Abstract
OBJECTIVE Whether modified Glasgow prognostic score predicts prognosis in patients with cardiac resynchronization therapy with defibrillation is unknown. Our aim was to investigate the association of modified Glasgow prognostic score with death and hospitalization in cardiac resynchronization therapy with defibrillation patients. METHODS A total of 306 heart failure with reduced ejection fraction patients who underwent cardiac resynchronization therapy with defibrillation implantation were categorized into 3 groups based on their modified Glasgow prognostic score categorical levels. C-reactive protein >10 mg/L or albumin <35 g/L was assigned 1 point each and the patients were classified into 0, 1, and 2 points, respectively. Remodeling was determined according to the clinical event and myocardial remodeling criteria. Major adverse cardiac events were defined as mortality and/or hospitalization for heart failure. RESULTS Age, New York Heart Association functional class, modified Glasgow prognostic score prior to cardiac resynchronization therapy with defibrillation, sodium levels, and left atrial diameter were higher in the major adverse cardiac events(+) group. Age, left atrial diameter, and higher modified Glasgow prognostic score were found to be predictors of heart failure hospitalization/death in multivariable penalized Cox regression analysis. Besides, patients with lower modified Glasgow prognostic score showed better reverse left ventricular remodeling demonstrated by increase in left ventricle ejection fraction and decline in left ventricle end systolic volume. CONCLUSION Modified Glasgow prognostic score prior to cardiac resynchronization therapy with defibrillation can be used as a predictor of long-term heart failure hospitalization and death in addition to age and left atrial diameter. These results can guide the patient selection for cardiac resynchronization therapy with defibrillation therapy and highlight the importance of nutritional status.
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Affiliation(s)
- Güney Erdogan
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Cardiology Clinic, Samsun, Türkiye
| | - Mustafa Yenerçağ
- Ordu University, Training and Research Hospital, Cardiology Clinic, Ordu, Türkiye
| | - Melisa Uçar
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Cardiology Clinic, Samsun, Türkiye
| | - Onur Öztürk
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Cardiology Clinic, Samsun, Türkiye
| | - Onur Osman Şeker
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Cardiology Clinic, Samsun, Türkiye
| | - Osman Can Yontar
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Cardiology Clinic, Samsun, Türkiye
| | - Ender Özgün Çakmak
- University of Health Sciences Turkey Kartal Kosuyolu Research and Training Hospital, Cardiology Clinic,, İstanbul, Türkiye
| | - Ali Karagöz
- University of Health Sciences Turkey Kartal Kosuyolu Research and Training Hospital, Cardiology Clinic,, İstanbul, Türkiye
| | - İrfan Şahin
- University of Health Sciences, Bağcılar Training and Research Hospital, Department of Cardiology, Istanbul, Türkiye
| | - Uğur Arslan
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Cardiology Clinic, Samsun, Türkiye
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Aksan G, Yanık A, Yontar OC, Boyacı F, Uçar M, Şahin MK, Soylu K. The predictive value of galectin‐3 levels on left atrial low voltage areas assessed by high‐density mapping in patients with paroxysmal atrial fibrillation. J Arrhythm 2022; 38:353-362. [PMID: 35785368 PMCID: PMC9237302 DOI: 10.1002/joa3.12703] [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: 09/09/2021] [Revised: 02/20/2022] [Accepted: 03/13/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gökhan Aksan
- Department of Cardiology Samsun Education and Research Hospital Samsun Turkey
| | - Ahmet Yanık
- Department of Cardiology Samsun Education and Research Hospital Samsun Turkey
| | - Osman Can Yontar
- Department of Cardiology Samsun Education and Research Hospital Samsun Turkey
| | - Faruk Boyacı
- Department of Cardiology Samsun Education and Research Hospital Samsun Turkey
| | - Melisa Uçar
- Department of Cardiology Samsun Education and Research Hospital Samsun Turkey
| | - Mustafa Kürşat Şahin
- Department of Family Medicine Faculty of Medicine Ondokuz Mayıs University Samsun Turkey
| | - Korhan Soylu
- Department of Cardiology, Faculty of Medicine Ondokuz Mayis University Samsun Turkey
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Yontar OC, Erdogan G, Yenercag M, Gul S, Arslan U, Karagoz A. Relationship between Selvester ECG Score and Cardiovascular Outcomes in Patients with Non-ST Elevation Myocardial Infarction. Acta Cardiol Sin 2021; 37:580-590. [PMID: 34812231 PMCID: PMC8593486 DOI: 10.6515/acs.202111_37(6).20210602a] [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] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 06/02/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Early risk stratification plays a crucial role in the treatment of non-ST-elevation myocardial infarction (NSTEMI). Selvester score is an electrocardiography (ECG)-based method for estimating infarcted myocardial mass, however it has not been studied in NSTEMI before. In this study, we aimed to investigate the relationship between Selvester score and cardiovascular outcomes in a 1-year follow-up period in NSTEMI patients. METHODS One hundred and forty-three consecutive patients with NSTEMI were analyzed. TIMI and GRACE risk scores were calculated accordingly. Selvester score was calculated on surface ECG as reported in prior studies. Syntax score was calculated using an online calculator. The study population was divided into two groups based on a cut-off value from receiver operating characteristic curve analysis for the discriminative ability of Selvester score for mortality: low score (≤ 4), and high score (> 4) groups. RESULTS Age was higher, left ventricle ejection fraction and high-density lipoprotein-cholesterol levels were significantly lower, and TIMI, GRACE and SYNTAX scores were significantly higher in the high Selvester score group. In multivariate Cox regression analysis, ejection fraction [hazard ratio (HR): 0.926, 95% confidence interval (CI): 0.883-0.971, p = 0.002] and Selvester score > 4 (HR: 3.335, 95% CI: 1.306-8.503, p = 0.012) were found to be independent predictors of adverse events after 1 year of follow-up. CONCLUSIONS Selvester score is a fast and feasible method that has prognostic value for mortality and other major adverse outcomes in low and intermediate risk NSTEMI patients treated with urgent percutaneous coronary intervention for 12 months.
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Affiliation(s)
- Osman Can Yontar
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Cardiology Clinic, Samsun
| | - Guney Erdogan
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Cardiology Clinic, Samsun
| | - Mustafa Yenercag
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Cardiology Clinic, Samsun
| | - Sefa Gul
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Cardiology Clinic, Samsun
| | - Ugur Arslan
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Cardiology Clinic, Samsun
| | - Ali Karagoz
- Cardiology Clinic, Kosuyolu Postdoctorate Hospital, Istanbul, Turkey
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Yontar OC, Yanik A, Aksan G. Assessment of P- to delta-wave interval and its relationship with accessory pathway properties in patients with pre-excitation. Cardiovasc J Afr 2021; 32:292-296. [PMID: 34128947 PMCID: PMC8756016 DOI: 10.5830/cvja-2020-057] [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: 05/26/2020] [Accepted: 12/01/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The first clinical manifestation of the Wolff-Parkinson-White syndrome in previously asymptomatic individuals may be sudden cardiac death. The options for non-invasive risk stratification are limited in the current era beyond ambulatory rhythm monitoring and an exercise stress test. In our study, we sought to investigate whether there was a relationship between the shortest measured P- to delta-wave time interval (PDI) on the conduction properties of surface electrocardiogram and accessory pathways expressed as antegrade effective refractory period (APERP). METHODS Demographic data, symptom status, electrocardiograms (ECG) and intra-cardiac recordings of invasive electrophysiology testing of 103 patients who underwent accessory pathway ablation procedures were collected. Exclusion criteria were: (1) intermittently occurring pre-excitation, which was detected in previous ECGs, (2) delta-wave resolution on treadmill test, (3) presence of multiple accessory pathways, and (4) accessory pathway locations other than the septum. The PDI was measured as the time interval from the beginning of the P wave to the earliest upstroke or downstroke of the delta wave on V1 and V2 derivations of the surface ECG, and the shortest measurement was recorded. RESULTS Patients were grouped into two groups: group I, if APERP was < 240 ms and group II if APERP was ≥ 240 ms. PDI was significantly shorter in group II. By correlation analysis, a positive and moderate correlation between PDI and APERP (r = 0.598, p < 0.001) and PDI and age (r = 0.800, p < 0.001) was found, and a negative and moderate correlation between PDI and inducible AF (r = -492, p < 0.001). The best cut-off value for PDI to predict APERP ≥ 240 was 90.5 ms with a sensitivity of 80% and a specificity of 83%. CONCLUSIONS Our results demonstrate that there was a strong correlation between the P- to delta-wave interval and universally accepted risk factors, such as low age, low APERP and atrial fibrillation inducibility. Further studies with larger patient groups and follow-up data are needed to appraise its predictive value.
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Affiliation(s)
- Osman Can Yontar
- Department of Cardiology, Samsun Training and Research Hospital, Health Sciences University, Samsun, Turkey
| | - Ahmet Yanik
- Department of Cardiology, Samsun Training and Research Hospital, Health Sciences University, Samsun, Turkey
| | - Gokhan Aksan
- Department of Cardiology, Samsun Training and Research Hospital, Health Sciences University, Samsun, Turkey.
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Yontar OC, Gorenek B. Subclinical Atrial Fibrillation: Symptoms, Detection and Anticoagulation. Am J Cardiol 2021; 149:156-157. [PMID: 33741340 DOI: 10.1016/j.amjcard.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
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AksanAksan G, Yontar OC, Yanık A, Arslan U, Yenerçağ M. Catheter Ablation of Left Atrial Posterior Wall Tachycardia Guided by Electroanatomic Mapping in a Young Patient. J Tehran Heart Cent 2021; 15:142-146. [PMID: 33552211 PMCID: PMC7827118 DOI: 10.18502/jthc.v15i3.4226] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Focal atrial tachycardias (ATs) arising from the left atrium (LA) most commonly originate from the ostium of the pulmonary vein, the superior mitral annulus, the body of the coronary sinus, the LA septum, and the LA appendage. Focal ATs originating from the posterior wall of the LA are extremely rare. A 34-year-old male patient presented to the cardiology outpatient clinic complaining of palpitation. Electrocardiography showed a tachycardia at a ventricular rate of 150 bpm and a narrow QRS complex. Therefore, an electrophysiological study was performed, which was consistent with an AT. The patient underwent an electrophysiological study in tachycardias with narrow QRS complexes. The diagnostic electrophysiological findings were consistent with an AT. The AT cycle length was found to be 405 ms with variability in the ventriculoatrial interval. Simultaneous LA anatomical and activation mapping was performed during the AT using a 3D electroanatomic mapping system (CARTO) and a quadripolar unidirectional irrigated tip catheter. The activation mapping revealed that the earliest endocardial activation site was at the posterior wall of the LA, where the local electrogram was 72 ms and 35 ms before the coronary sinus reference and the P-wave onset, respectively. The activation mapping also showed centrifugal spreading and mid-diastolic, fractionated signals on the posterior wall. Radiofrequency ablation was successfully performed with 30-watt power at the site of the earliest atrial activation, with a fractionated electrogram terminating the tachycardia. LA posterior ATs are a rare form of AT. The electroanatomic mapping method enables the accurate localization of the LA focal tachycardia, and a high success rate is achieved with ablation therapy.
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Affiliation(s)
- Gökhan AksanAksan
- Department of Cardiology, Samsun Education and Research Hospital, Samsun, Turkey
| | - Osman Can Yontar
- Department of Cardiology, Samsun Education and Research Hospital, Samsun, Turkey
| | - Ahmet Yanık
- Department of Cardiology, Samsun Education and Research Hospital, Samsun, Turkey
| | - Uğur Arslan
- Department of Cardiology, Samsun Education and Research Hospital, Samsun, Turkey
| | - Mustafa Yenerçağ
- Department of Cardiology, Samsun Education and Research Hospital, Samsun, Turkey
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Aksan G, Yanık A, Yontar OC, Gedikli Ö, Arslan U, Soylu K. Galectin-3 levels and the prediction of atrial high-rate episodes in patients with cardiac resynchronization therapy. J Investig Med 2020; 69:20-27. [PMID: 32994201 DOI: 10.1136/jim-2020-001459] [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] [Accepted: 08/18/2020] [Indexed: 11/04/2022]
Abstract
Galectin-3 is an inflammation biomarker associated with atrial remodeling which plays a role in the development of atrial fibrillation (AF). Atrial high-rate episode (AHRE) is related to development of clinically documented AF and stroke. The present study aimed to determine the relationship between the presence of AHRE and the coronary sinus (CS) serum sampling of galectin-3 levels in the long-term follow-up of cardiac resynchronization therapy (CRT) patients. A total of 108 consecutive CRT patients were included prospectively in the study. AHREs were defined as atrial tachyarrhythmia episodes lasting at least 6 min with atrial rate >190 beats/min detected by cardiac implantable electronic device. CS blood samples were drawn from the CS guiding catheter to perform galectin-3 measurements. Galectin-3 levels were measured via ELISA. During a mean follow-up 12.6±4.9 months, AHRE was observed in 31 (28.7%) patients and not observed in 77 (72.3%) patients. CS galectin-3 levels were significantly higher in patients with AHRE than those without AHRE (18.09±2.62 vs 13.17±3.17, respectively, p<0.001). Moreover, CS galectin-3 levels showed significant positive correlation with percent of time spent in total AHRE (r=0.436, p<0.001). Multivariate logistic regression analysis demonstrated that left atrium (LA) volume and CS galectin-3 levels were significant and independent predictors for AHRE (OR=1.127, 95% CI: 1.045 to 1.216; p=0.002, OR=1.799, 95% CI: 1.388 to 2.330; p<0.001, respectively). In this study, we determined that high CS galectin-3 levels were a predictor for the development of AHRE in CRT patients.
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Affiliation(s)
- Gokhan Aksan
- Cardiology, Samsun Education and Research Hospital, Samsun, Turkey
| | - Ahmet Yanık
- Cardiology, Samsun Education and Research Hospital, Samsun, Turkey
| | - Osman Can Yontar
- Cardiology, Samsun Education and Research Hospital, Samsun, Turkey
| | - Ömer Gedikli
- Cardiology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Ugur Arslan
- Cardiology, Samsun Education and Research Hospital, Samsun, Turkey
| | - Korhan Soylu
- Cardiology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
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Yenerçağ M, Arslan U, Doğduş M, Günal Ö, Öztürk ÇE, Aksan G, Erdoğan G, Gül S, Yontar OC, Şen A. Evaluation of electrocardiographic ventricular repolarization variables in patients with newly diagnosed COVID-19. J Electrocardiol 2020; 62:5-9. [PMID: 32731139 PMCID: PMC7373019 DOI: 10.1016/j.jelectrocard.2020.07.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/08/2020] [Accepted: 07/17/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) is a newly recognized infectious disease that has spread rapidly. COVID-19 has been associated with a number of cardiovascular complications, including arrhythmias. The mechanism of ventricular arrhythmias in patients with COVID-19 is uncertain. The aim of the present study was to evaluate the ventricular repolarization by using the Tp-e interval, QT dispersion, Tp-e/QT ratio, and Tp-e/QTc ratio as candidate markers of ventricular arrhythmias in patients with newly diagnosed COVID-19. In addition, the relationship between the repolarization parameters and the CRP (C-reactive protein) was investigated. METHODS 75 newly diagnosed COVID-19 patients, 75 age and sex matched healthy subjects were included in the study between 20th March 2020 and 10th April 2020. The risk of ventricular arrhythmias was evaluated by calculating the electrocardiographic Tp-e and QT interval, Tp-e dispersion, corrected QT(QTc), QT dispersion (QTd), corrected QTd, Tp-e/QT and Tp-e/QTc ratios. CRP values were also measured in patients with newly diagnosed COVID-19. RESULTS Tp-e interval (80.7 ± 4.6 vs. 70.9 ± 4.8; p < .001), Tp-e / QT ratio (0.21 ± 0.01 vs. 0.19 ± 0.01; p < .001) and Tp-e/QTc ratio (0.19 ± 0.01 vs.0.17 ± 0.01; p < .001) were significantly higher in patients with newly diagnosed COVID-19 than the control group. There was a significant positive correlation between Tp-e interval, Tp-e/QTc ratio and CRP in patients with newly diagnosed COVID-19 (rs = 0.332, p = .005, rs = 0.397, p < .001 consecutively). During their treatment with hydroxychloroquine (HCQ), azithromycin and favipiravir, ventricular tachycardia episodes were observed in in two COVID-19 patients during their hospitalization in the intensive care unit. CONCLUSION Our study showed for the first time in literature that the Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio, which are evaluated electrocardiographically in patients with newly diagnosed COVID-19, were prolonged compared with normal healthy individuals. A positive correlation was determined between repolarization parameters and CRP. We believe that pre-treatment evaluation of repolarization parameters in newly diagnosed COVID-19 would be beneficial for predicting ventricular arrhythmia risk.
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Affiliation(s)
- Mustafa Yenerçağ
- Department of Cardiology, University of Health Sciences Samsun Training and Research Hospital, Samsun, Turkey
| | - Uğur Arslan
- Department of Cardiology, University of Health Sciences Samsun Training and Research Hospital, Samsun, Turkey.
| | - Mustafa Doğduş
- Department of Cardiology, University of Usak Training and Research Hospital, Usak, Turkey
| | - Özgür Günal
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Samsun Training and Research Hospital, Samsun, Turkey
| | - Çağatay Erman Öztürk
- Department of of Anaesthesiology and Reanimation, University of Health Sciences Samsun Training and Research Hospital, Samsun, Turkey
| | - Gökhan Aksan
- Department of Cardiology, University of Health Sciences Samsun Training and Research Hospital, Samsun, Turkey
| | - Güney Erdoğan
- Department of Cardiology, University of Health Sciences Samsun Training and Research Hospital, Samsun, Turkey
| | - Sefa Gül
- Department of Cardiology, University of Health Sciences Samsun Training and Research Hospital, Samsun, Turkey
| | - Osman Can Yontar
- Department of Cardiology, University of Health Sciences Samsun Training and Research Hospital, Samsun, Turkey
| | - Ahmet Şen
- Department of of Anaesthesiology and Reanimation, University of Health Sciences Samsun Training and Research Hospital, Samsun, Turkey
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Gul S, Yontar OC, Yenercag M, Seker OO, Erdogan G, Arslan U. Effect of angiotensin/neprilysin inhibition on ventricular repolarization and clinical arrhythmogenesis. Cardio-IT 2020. [DOI: 10.15275/cardioit.2020.0103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: The most common reason for sudden cardiac death in heart failure is malign ventricular arrhythmias. LCZ 696 improves hospitalization and sudden cardiac death outcomes in heart failure, however mechanisms in preventing sudden cardiac death are still unknown. There is little information available assessing effect of LCZ 696 on Tp-e interval and related calculations. In this study, we aimed to investigate the impact of Sacubitril/valsartan therapy on Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio in heart failure patients and its reflections on clinical arrhythmogenesis. Methods: The study was designed as a prospective observational fashion. 265 patients with implantable cardioverter-defibrillator (ICD), who were on regular follow up at Samsun Training and Research Hospital Outpatient Heart Failure Clinic, were validated for the study. Clinical, echocardiographic, electrocardiogram and device data before initiation and six months after dose optimizing were obtained. Results: Stroke volume, cardiac output and ejection fraction significantly improved after LCZ 696 treatment. T wave related parameters, QT and QTC intervals significantly diminished. Furthermore, there was a negative correlation between baseline Tp-e interval duration and the absolute percentile increase of stroke volume(r:-0.234, p: 0.042) and cardiac output (r: -0.240, p: 0.037). Conclusion: In our study, switching Renin-Angiotensin-Aldosterone-System inhibitor with Angiotensin receptor/neprilysin inhibitor was associated with increase in left ventricle performance and decrease of sustained ventricular arrhythmias that required ICD shocks. These positive findings were accompanied by improvements in surface electrocaridogram changes such as Tp-e and related indices.
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Affiliation(s)
- Sefa Gul
- Samsun training and Research Hospital
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Erdogan G, Yontar OC, Yenercag M, Gul S, Arslan U. Frontal QRS-T angle predicts syntax score in patients with non-ST elevation myocardial infarction. J Electrocardiol 2020; 61:86-91. [PMID: 32554162 DOI: 10.1016/j.jelectrocard.2020.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/30/2020] [Revised: 05/23/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Early risk stratification based on SYNTAX score plays a crucial role to identify the need for early invasive strategy in patients with NSTEMI. The predictive role of frontal QRS-T angle [f(QRS-T)] on the atherosclerotic burden of CAD is less clear in NSTEMI patients. In this study, we aimed to investigate the relationship between f(QRS-T) and SYNTAX score in NSTEMI patients. METHODS A total of consecutive 269 patients with the diagnosis of NSTEMI transferred to coronary care unit were included in the study. f(QRS-T) was calculated as the absolute value of the difference between the frontal plane QRS and T axes based on automatic report of ECG machine. Syntax score was computed using an online SYNTAX score calculator by well-experienced two cardiologists blinded to the study data. The study population was divided into two groups based on the SYNTAX score low SYNTAX score (≤23), and high SYNTAX score (>23). RESULTS Left ventricle ejection fraction (LVEF) (p = 0.001), hemoglobin (p = 0.03) and HDL-C (p = 0.04) levels were lower in the intermediate-high SYNTAX group. Age (72.1 ± 12.5 vs. 64.6 ± 9.4 respectively; p < 0.001), LAD as infarct-related artery 30 (%65.2) vs. 50 (%29.1) respectively; (p = 0.001), f(QRS-T) (100.5 ± 55.3 vs. 65.1 ± 53.1 respectively p = 0.006), troponin I peak (p = 0.06) were higher among patients with intermediate-high Syntax score. In receiver-operating characteristic (ROC) curve analysis, the value for f(QRS-T) to detect syntax score ≥ 23 with a sensitivity of 77% and specificity of 63% was 73,5° in NSTEMI patients(AUC = 0.69). Univariate logistic regression analysis identified that age, LVEF, HDL-C, hemoglobin, infarct-related artery, f(QRS-T) were significantly associated with SYNTAX score. Multivariate logistic regression analysis showed that age (OR: 1.135, 95% CI: 1.039-1.153, p = 0.045), infarct related artery-LAD (OR: 2.897, 95% CI: 1.023-8.209, p = 0.001) and f(QRS-T) (OR: 3.587, 95% CI: 1.093-11.772, p = 0.001) were the independent predictors of SYNTAX score. CONCLUSION In NSTEMI patients, f(QRS-T) has been found to be a useful decision-making tool to predict SYNTAX score to assess early invasive strategy.
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Affiliation(s)
- Guney Erdogan
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Cardiology Clinic, Samsun, Turkey
| | - Osman Can Yontar
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Cardiology Clinic, Samsun, Turkey.
| | - Mustafa Yenercag
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Cardiology Clinic, Samsun, Turkey
| | - Sefa Gul
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Cardiology Clinic, Samsun, Turkey
| | - Ugur Arslan
- University of Health Sciences Turkey, Samsun Training and Research Hospital, Cardiology Clinic, Samsun, Turkey
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13
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Dereli S, Bayramoğlu A, Yontar OC. Usefulness of platelet to lymphocyte ratio for predicting recurrence of atrial fibrillation after direct current cardioversion. Ann Noninvasive Electrocardiol 2018; 24:e12616. [PMID: 30414335 DOI: 10.1111/anec.12616] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 09/02/2018] [Accepted: 10/12/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Atrial fibrillation (AF) is the most common cardiac rhythm disorder with the associated risks of stroke and mortality. The usefulness of platelet to lymphocyte ratio (PLR), a recently described inflammatory marker, in predicting adverse cardiovascular events has been demonstrated in several studies. In the current study, we investigated the role of PLR in predicting recurrence after successful electrical cardioversion (ECV) in patients with non-valvular persistent AF. METHODS A total of 287 patients with non-valvular persistent AF achieving restoration of the sinus rhythm after successful ECV were included in this study. At study entry, complete blood count, routine biochemistry tests, and transthoracic echocardiography (TTE) were performed routinely in all subjects. Patients were followed up for 6 months following the procedure and comparisons were performed between patients who recurred and who maintained the sinus rhythm (SR). RESULTS At 6 months of follow-up, AF recurred in 108 patients, corresponding to a recurrence rate of 39%. Mean PLR values in the "AF recurrence group" (mean age 57.4 ± 12.0 years, 47.6% [n = 80] female) and in "SR maintenance" group (mean age 65.0 ± 9.4 years, 55.6% [n = 60] female) were 184.8 ± 44.2 and 103.3 ± 44.2, respectively, with a significant difference between the two groups (p < 0.001). In multiple regression analyses, PLR emerged as a risk factor associated with AF recurrence during the 6-month follow-up period after successful ECV (odds ratio [OR]: 3.029 (1.013-9.055 95% confidence interval [CI]), p = 0.047). When a cutoff value of 147 was used, the sensitivity and specificity of PLR for predicting AF recurrence were 83.3% and 84.5%, respectively. CONCLUSION Elevated PLR is a marker of increased inflammation and may serve as a practical and inexpensive predictor for recurrence during 6 months of follow-up in patients with non-valvular persistent AF who had restoration of the sinus rhythm after successful ECV.
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Affiliation(s)
- Seçkin Dereli
- Department of Cardiology, Ordu State Hospital, Ordu, Turkey
| | - Adil Bayramoğlu
- Department of Cardiology, Ordu University Faculty of Medicine, Ordu, Turkey
| | - Osman Can Yontar
- Department of Cardiology, Samsun Education and Research Hospital, Samsun, Turkey
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Dereli S, Bayramoğlu A, Yontar OC, Cerşit S, Gürsoy MO. Epicardial fat thickness: A new predictor of successful electrical cardioversion and atrial fibrillation recurrence. Echocardiography 2018; 35:1926-1931. [PMID: 30387182 DOI: 10.1111/echo.14178] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 09/16/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE In recent years, epicardial fat tissue (EFT) has been found to be strongly associated with the development of atrial fibrillation (AF) and post-ablation long-term recurrence. The current study investigated the procedural success rate of electrical cardioversion (ECV) and potential predictors of treatment failure in patients with nonvalvular persistent AF. METHODS A total of 262 nonvalvular persistent AF patients who were scheduled for elective ECV were included in this prospective study. Routine transthoracic echocardiography was performed before the procedure and EFT thickness was measured. The presence of left atrial appendage thrombus was evaluated by transesophageal echocardiography. The patients were followed up for 6 months to examine any recurrence after ECV. RESULTS The success rate of ECV was 85% and the recurrence rate was 35% during the 6-month follow-up period. The mean EFT thickness was 8.67 ± 1.2 mm in the persistent AF group with unsuccessful ECV and 6.81 ± 0.8 in the patients in whom sinus rhythm (SR) was maintained, the EFT was significantly thicker in the AF group (P = 0.001). EFT (P = 0.001) and left ventricular end-diastolic diameters (LVEDD) (P = 0.001) were significantly different between those who had maintained SR and those with recurrent AF during the 6-month follow-up period after ECV. In the multiple logistic regression analysis, LVEDD (odds ratio [OR]: 1.320 (1.023-1.703 95% confidence interval [CI]), P = 0.032)] and EFT [OR: 3.029 (1.013-9.055 95% CI), P = 0.047)] were identified as independent predictors of successful ECV. CONCLUSION Epicardial fat tissue thickness can be effectively used for the prediction of successful ECV and AF recurrence during follow-up in AF patients.
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Affiliation(s)
- Seçkin Dereli
- Department of Cardiology, Ordu State Hospital, Ordu, Turkey
| | - Adil Bayramoğlu
- Faculty of Medicine, Department of Cardiology, Ordu University, Ordu, Turkey
| | - Osman Can Yontar
- Department of Cardiology, Samsun Training and Research Hospital, Samsun, Turkey
| | - Sinan Cerşit
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, İstanbul, Turkey
| | - Mustafa Ozan Gürsoy
- Ataturk Training and Research Hospital, İzmir Katip Çelebi University, İzmir, Turkey
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Tenekecioglu E, Karaagac K, Yontar OC, Agca FV, Ozluk OA, Tutuncu A, Arslan B, Yilmaz M. Evaluation of Tp-Te Interval and Tp-Te/QT Ratio in Patients with Coronary Slow Flow Tp-Te/QT Ratio and Coronary Slow Flow. Eurasian J Med 2015; 47:104-8. [PMID: 26180494 DOI: 10.5152/eurasianjmed.2015.72] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 07/24/2014] [Accepted: 10/02/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Coronary slow flow (CSF) phenomenon is described by angiographically normal coronary arteries with delayed opacification of the distal vasculature. Several studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (Tp-Te) may correspond to the transmural dispersion of the repolarization and that increased Tp-Te interval and Tp-Te/QT ratio are associated with malignant ventricular arrhythmias. The aim of this study was to evaluate the ventricular repolarization by using Tp-Te interval and Tp-Te/QT ratio in patients with CSF. MATERIALS AND METHODS This study included 50 CSF patients (40 male, mean age 48.6±12.5 years) and 40 control individuals (23 male, mean age 47.8±12.5 years). Tp-Te interval and Tp-Te/QT ratio were measured from the 12-lead electrocardiogram. These parameters were compared in groups. RESULTS Baseline characteristics of the study groups were comparable. In electrocardiographic parameters analysis, QT and corrected QT were similar in CSF patients compared to the controls (357±35.2 vs 362±38.0 milliseconds and 419±25.8 vs 430±44.2 milliseconds, all p value >0.05). Tp-Te interval, Tp-Te/QT and Tp-Te/QTc ratio were significantly higher in CSF patients (85±13.7 vs 74±9.9 milliseconds and 0.24±0.03 vs 0.20±0.02 and 0.20±0.03 vs 0.17±0.02 all p value <0.001). CONCLUSION Our study revealed that QTd, Tp-Te interval and Tp-Te/QT ratio are prolonged in patients with CSF.
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Affiliation(s)
- Erhan Tenekecioglu
- Clinic of Cardiology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Kemal Karaagac
- Clinic of Cardiology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Osman Can Yontar
- Clinic of Cardiology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | | | - Ozlem Arican Ozluk
- Clinic of Cardiology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Ahmet Tutuncu
- Clinic of Cardiology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Burhan Arslan
- Clinic of Cardiology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Mustafa Yilmaz
- Clinic of Cardiology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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Tenekecioglu E, Yilmaz M, Demir S, Bekler A, Ozluk OA, Aydin U, Goncu T, Yontar OC. HDL-cholesterol is associated with systemic inflammation in cardiac syndrome X. Minerva Med 2015; 106:133-141. [PMID: 25028863] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM Microvascular inflammation is associated with cardiac syndrome X (CSX). High-density lipoprotein cholesterol (HDL-C) reveals antiatherogenic features with stimulating endothelial NO production, inhibiting oxidative stress and vascular inflammation. We investigated relationship between HDL-C and inflammatory markers in CSX. METHODS Hundred patients with CSX and control group of 80 subjects were evaluated. Hematologic indices, lipid levels and C-reactive protein (CRP) levels were studied in patients underwent coronary angiography. RESULTS CRP levels were higher in CSX group than control group (4.59 ± 3.82 mg/dL vs. 2.48 ± 1.32 mg/dL, P<0.001). HDL-C was significantly lower in CSX group compared to control group (36.5 ± 4.0 mg/dL vs. 47.5 ± 12.7 mg/dL, P=0.008). White blood cell (WBC) count was higher in CSX group than in control group. Neutrophil-lymphocyte ratio (NLR) was found significantly increased in CSX group as compared to control group. On multivariate linear regression, lower HDL-C was found to be a significant predictor of higher NLR in patients with CSX independent from other clinical and biochemical variables. CONCLUSION Lower HDL-C is associated with systemic inflammation in CSX. In patients with typical angina and normal epicardial coronaries,HDL-C and inflammatory markers should be investigated; one of the goals of treatment should be raising HDL-C.
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Affiliation(s)
- E Tenekecioglu
- Department of Cardiology, Bursa Yuksek Ihtisas Education and Research Hospital,Ankara Yolu, Yildirim/Bursa, Bursa, Turkey -
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Tenekecioglu E, Yilmaz M, Yontar OC, Bekler A, Peker T, Karaagac K, Ozluk OA, Agca FV, Kuzeytemiz M, Senturk M, Aslan B, Topal D. Red blood cell distribution width is associated with myocardial injury in non-ST-elevation acute coronary syndrome. Clinics (Sao Paulo) 2015; 70:18-23. [PMID: 25672424 PMCID: PMC4311120 DOI: 10.6061/clinics/2015(01)04] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/07/2014] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The red blood cell distribution width has been associated with an increased risk of cardiovascular events. In the present study, we assessed the relationship between red cell distribution width values and cardiac troponin I levels in patients admitted with non-ST-elevation acute coronary syndrome. METHODS We analyzed blood parameters in 251 adult patients who were consecutively admitted to the intensive coronary care unit with non-ST-elevation acute coronary syndrome over a 1-year period. For all patients, a baseline blood sample was collected for routine hematological testing. Cardiac troponin I was measured at baseline and after 6 h. The patients were diagnosed with non-ST-elevation myocardial infarction or unstable angina based on the elevation of cardiac troponin I levels. RESULTS The red cell distribution width was higher in the group with non-ST-elevation myocardial infarction compared with the patient group with unstable angina (14.6±1.0 vs 13.06±1.7, respectively; p = 0.006). Coronary thrombus was detected more frequently in the group of patients with non-ST-elevation myocardial infarction than in the patients with unstable angina (72% vs 51%, respectively; p = 0.007). Using receiver operating characteristic curve analysis for the prediction of non-ST-elevation myocardial infarction based on the red cell distribution width, the area under the curve was 0.649 (95% confidence interval: 0.546-0.753; p = 0.006), suggesting a modest model for the prediction of non-ST-elevation myocardial infarction using the red cell distribution width. At a cut-off value of 14%, the sensitivity and specificity of the red cell distribution width were 73% and 59%, respectively. Additionally, the red cell distribution width was positively correlated with cardiac troponin I (r = 0.19; p = 0.006). CONCLUSION A greater baseline red cell distribution width value was associated with myocardial injury and elevated cardiac troponin I levels in non-ST-elevation acute coronary syndrome. Therefore, the red cell distribution width could be considered for risk stratification of acute coronary syndrome patients admitted to emergency departments.
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Affiliation(s)
| | - Mustafa Yilmaz
- Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey
| | - Osman Can Yontar
- Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey
| | - Adem Bekler
- Medicine School, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Tezcan Peker
- Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey
| | - Kemal Karaagac
- Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey
| | | | | | | | - Muhammed Senturk
- Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey
| | - Burhan Aslan
- Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey
| | - Dursun Topal
- Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey
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Tenekecioglu E, Yilmaz M, Yontar OC, Karaagac K, Agca FV, Tutuncu A, Kuzeytemiz M, Bekler A, Senturk M, Aydin U, Demir Ş. Microalbuminuria in untreated prehypertension and hypertension without diabetes. Int J Clin Exp Med 2014; 7:3420-3429. [PMID: 25419378 PMCID: PMC4238513] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 08/29/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Hypertension (HT) and prehypertension (preHT) were independent predictors of cardiovascular diseases. Urinary albumin leakage is a manifestation of generalized vascular damage. B-type natriuretic peptide (BNP) is a vasoactive peptide secreted by left ventricle in response to myocytic stretch. We aimed to investigate relationship between microalbuminuria (MA) and BNP in untreated elevated blood pressures. METHODS Of 105 untreated prehypertensive subjects (53 men, 52 women), 100 hypertensive subjects (51 men, 49 women) and 57 normotensive subjects (32 men, 25 women) none had history of diabetes. Urine albumin excretion was measured by immunoradiometric assay in morning urine sample. RESULTS The prevalence of MA was higher in hypertensive group than in prehypertensive group and in normotensive group (Hypertensive group; 33.9%, prehypertensive; 25.9%, normotensive; 10%). Subjects with HT had higher prevalence of microalbminuria; larger body mass index, higher levels of triglycerides, blood glucose and creatinin were more common in subjects with HT than in those with preHT. In hypertensive group; patients with microalbuminuria had higher systolic blood pressure (SBP), BNP, LVMI and lower eGFR as compared to those without MA. MA was significantly correlated with LVMI, BNP and SBP. In multivariate regression analysis, SBP (β: 0.361; P < 0.001), LVMII (β: 0.267; P = 0.011) and BNP (β: 0.284; P = 0.005) were independent variables associated with MA in hypertensives. In prehypertensive group; patients with microalbuminuria had higher SBP, BNP, LVMI and lower eGFR as compared to those without MA. MA was significantly correlated with LVMI, BNP and SBP. In multivariate regression analysis, SBP (β: 0.264; P = 0.002), LVMI (β: 0.293; P = 0.001) and BNP (β: 0.168; P = 0.045) were associated with MA in prehypertensives. CONCLUSIONS In preHT and HT, SBP, BNP and LVMI are associated with MA. In the evaluation of increased blood pressures, in case of increased BNP and LVMI, MA should be investigated even in prehypertensive stages. The subjects with increased blood pressures should get medical treatment to prevent the effects on vascular structure and myocardium even in prehypertensive phase.
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Affiliation(s)
- Erhan Tenekecioglu
- Bursa Yuksek Ihtisas Education and Research Hospital, CardiologyBursa, Turkey
| | - Mustafa Yilmaz
- Bursa Yuksek Ihtisas Education and Research Hospital, CardiologyBursa, Turkey
| | - Osman Can Yontar
- Bursa Yuksek Ihtisas Education and Research Hospital, CardiologyBursa, Turkey
| | - Kemal Karaagac
- Bursa Yuksek Ihtisas Education and Research Hospital, CardiologyBursa, Turkey
| | | | - Ahmet Tutuncu
- Bursa Yuksek Ihtisas Education and Research Hospital, CardiologyBursa, Turkey
| | - Mustafa Kuzeytemiz
- Bursa Yuksek Ihtisas Education and Research Hospital, CardiologyBursa, Turkey
| | - Adem Bekler
- Çanakkale Onsekiz Mart University, CardiologyÇanakkale, Turkey
| | - Muhammed Senturk
- Bursa Yuksek Ihtisas Education and Research Hospital, CardiologyBursa, Turkey
| | - Ufuk Aydin
- Bursa Yuksek Ihtisas Education and Resarch Hospital, Cardiovascular SurgeryBursa, Turkey
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Karaagac K, Yontar OC, Tenekecioglu E, Vatansever F, Ozluk OA, Tutuncu A, Yagcioglu P, Yilmaz M. Evaluation of Tp-Te interval and Tp-Te/QTc ratio in patients with coronary artery ectasia. Int J Clin Exp Med 2014; 7:2865-2870. [PMID: 25356150 PMCID: PMC4211800] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 05/17/2014] [Indexed: 06/04/2023]
Abstract
AIM Coronary artery ectasia (CAE) is commonly defined as local or generalized dilatation of a coronary vessel up to 1.5 times the diameter of an adjacent vessel. Tp-Te interval and Tp-Te/QT ratio have emerged as novel electrocardiographic markers of increased dispersion of ventricular repolarization. The aim of this study was to evaluate ventricular repolarization by using Tp-Te interval and Tp-Te/QT ratio in patients with CAE. MATERIALS AND METHODS Patients' records were retrospectively analyzed. Electrocardiogram of 28 patients, who were diagnosed as CAE were obtained and scanned. T wave peak to end interval, QT and corrected QT intervals and some other ECG intervals were measured. Electrocardiograms of age and sex matched 22 control individuals were also analyzed for comparison. Patients with critical coronary stenosis, moderate or severe valve disease, left and/or right heart failure, left and/or right ventricle hypertrophy, atrial fibrillation, moderate or severely abnormal electrolytes, right or left bundle block or patients who got pacemaker or ICD implanted and who undergo hemodialyses were excluded. RESULTS Baseline characteristics and QT, QTc intervals were similar in both groups. Tp-Te (97.71 ± 8.7 vs 85.23 ± 7.1; p < 0.001) and Tp-Te/QT (0.22 ± 0.0 vs 0.20 ± 0.0; p < 0.001) were significantly worse in CAE group. CONCLUSIONS T wave peak to end interval is a measure of transmural dispersion of repolarization in the left ventricle and accepted as a surrogate for increased ventricular arrhythmogenesis risk. Tp-Te and Tp-Te/QT are relatively new markers which also indicate repolarization defects. Our results show that CAE patients significantly higher values of Tp-Te and Tp-Te/QT than controls. These measurements may indicate increased arrhythmogenesis risk for individuals with CAE.
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Affiliation(s)
- Kemal Karaagac
- Department of Cardiology, Bursa Yuksek Ihtisas Education and Research Hospital Bursa, Turkey
| | - Osman Can Yontar
- Department of Cardiology, Bursa Yuksek Ihtisas Education and Research Hospital Bursa, Turkey
| | - Erhan Tenekecioglu
- Department of Cardiology, Bursa Yuksek Ihtisas Education and Research Hospital Bursa, Turkey
| | - Fahriye Vatansever
- Department of Cardiology, Bursa Yuksek Ihtisas Education and Research Hospital Bursa, Turkey
| | - Ozlem Arican Ozluk
- Department of Cardiology, Bursa Yuksek Ihtisas Education and Research Hospital Bursa, Turkey
| | - Ahmet Tutuncu
- Department of Cardiology, Bursa Yuksek Ihtisas Education and Research Hospital Bursa, Turkey
| | - Pinar Yagcioglu
- Department of Cardiology, Bursa Yuksek Ihtisas Education and Research Hospital Bursa, Turkey
| | - Mustafa Yilmaz
- Department of Cardiology, Bursa Yuksek Ihtisas Education and Research Hospital Bursa, Turkey
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Karaagac K, Emul A, Tenekecioglu E, Agca FV, Ozluk OA, Tutuncu A, Yontar OC, Yilmaz M. The Effects of Metabolic Syndrome on TpTe Interval and TpTe/QT Ratio in Patients with Normal Coronary Arteries. Eurasian J Med 2014; 46:182-6. [PMID: 25610322 DOI: 10.5152/eajm.2014.48] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 10/02/2013] [Accepted: 02/02/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE T wave peak to T wave end (TpTe) interval and TpTe/QT have been accepted as predictors of ventricular arrythmia. In this study our aim is to investigate the effect of metabolic syndome on these parameters in patients with angiographically normal coronary arteries. MATERIALS AND METHODS Thirty patients with metabolic syndrome (4 male, mean age 52±7.8 years) and twenty patients without metabolic syndrome as control group (8 male, mean age 54±9.3 years) were included. TpTe interval and TpTe/QT ratio were measured from the 12-lead electrocardiogram. These parameters were compared between the groups. RESULTS When compared with to the control group the systolic and diastolic blood pressure, pulse pressure, waist circumference, triglyceride and fasting plasma glucose levels were higher and HDL cholesterol level was lower in the metabolic syndrome group. In the analysis of electrocardiography, QT dispersion (QTd) and corrected QTd were significantly increased in metabolic syndrome group as compared to the controls group (44±14 versus 30±12 ms and 433±10 versus 405±4 ms, all p value p=0.01). TpTe interval and TpTe/QT ratio were also significantly higher in patient with metabolic syndrome (112±10 versus 91±10 ms and 0.25±0.02 versus 0.22±0.01, all p value p=0.01). CONCLUSION According to these results, we supposed that TpTe/QT ratio and TpTe interval is prolonged and those patients with metabolic syndrome may be at greater risk of ventricular arrhythmias.
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Affiliation(s)
- Kemal Karaagac
- Clinic of Cardiology, Bursa Training and Research Hospital, Bursa, Turkey
| | - Ali Emul
- Clinic of Cardiology, Bursa Sevket Yilmaz Training and Research Hospital, Bursa, Turkey
| | - Erhan Tenekecioglu
- Clinic of Cardiology, Bursa Training and Research Hospital, Bursa, Turkey
| | | | - Ozlem Arican Ozluk
- Clinic of Cardiology, Bursa Training and Research Hospital, Bursa, Turkey
| | - Ahmet Tutuncu
- Clinic of Cardiology, Bursa Training and Research Hospital, Bursa, Turkey
| | - Osman Can Yontar
- Clinic of Cardiology, Bursa Training and Research Hospital, Bursa, Turkey
| | - Mustafa Yilmaz
- Clinic of Cardiology, Bursa Training and Research Hospital, Bursa, Turkey
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Yontar OC, Karaagac K, Tenekecioglu E, Tutuncu A, Demir M, Melek M. Assessment of ventricular repolarization inhomogeneity in patients with mitral valve prolapse: value of T wave peak to end interval. Int J Clin Exp Med 2014; 7:2173-8. [PMID: 25232403 PMCID: PMC4161563] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 07/07/2014] [Indexed: 06/03/2023]
Abstract
Mitral valve prolapse (MVP) has been long known for causing susceptibility for ventricular arrhythmogenesis, and this risk was evaluated by various methods, mostly by using QT interval related measurements on surface electrocardiogram. T wave peak to end (Tp-e) interval is a relatively new marker for ventricular arrhythmogenesis and repolarization heterogeneity. Prolongation of this interval represents a period of potential vulnerability to re-entrant ventricular arrhythmias. However, there is no information available assessing the Tp-e interval and related calculations in patients with MVP. The aim of this study was to assess ventricular repolarization in patients with MVP by using QT, corrected QT (QTc) and Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio. Electrocardiogram of consecutive 72 patients, who were followed by outpatient clinic because of mitral valve prolapse, were obtained and scanned. Electrocardiograms of age and sex matched 60 healthy control individuals were also gained for comparison. QT, QTc, Tp-e/QT and Tp-e/QTc were calculated. Baseline characteristics were similar in both groups. QT (405.1±64.3 vs. 362.1±39.1; p<0.001), QTc (457.6±44.4 vs. 428.3±44.7; p<0.001), Tp-e (100.2±22.1 vs. 74.6±10.2; p<0.001) and Tp-e/QT (0.24 vs. 0.20; p<0.001) and Tp-e/QTc (0.21 vs. 0.17; p<0.001) were significantly worse in MVP group. Our study revealed that Tp-e interval and Tp-e/QT ratio were increased in MVP patients. Tp-e interval and Tp-e/QT ratio might be a useful marker of cardiovascular morbidity and mortality due to ventricular arrhythmias in patients with MVP.
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Affiliation(s)
- Osman Can Yontar
- Cardiology Clinic, Bursa Postdoctorate Training and Research Hospital Bursa, Turkey
| | - Kemal Karaagac
- Cardiology Clinic, Bursa Postdoctorate Training and Research Hospital Bursa, Turkey
| | - Erhan Tenekecioglu
- Cardiology Clinic, Bursa Postdoctorate Training and Research Hospital Bursa, Turkey
| | - Ahmet Tutuncu
- Cardiology Clinic, Bursa Postdoctorate Training and Research Hospital Bursa, Turkey
| | - Mehmet Demir
- Cardiology Clinic, Bursa Postdoctorate Training and Research Hospital Bursa, Turkey
| | - Mehmet Melek
- Cardiology Clinic, Bursa Postdoctorate Training and Research Hospital Bursa, Turkey
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Yontar OC, Tenekecioglu E, Karaagac K, Tutuncu A. Polymorphic ventricular tachycardia on a young patient. Asian J Med Sci 2014. [DOI: 10.3126/ajms.v6i1.10804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Twelve-lead electrocardiogram is the most frequently utilized device for cardiologists. Although it is a basic device, great attention must be paid when it comes to give vital decisions. DOI: http://dx.doi.org/10.3126/ajms.v6i1.10804 Asian Journal of Medical Sciences Vol.6(1) 2015 127-128
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Yontar OC, Tenekecioglu E, Karaagac K, Tutuncu A. Intermittent delta waves mimicking inferior myocardial infarction. Asian J Med Sci 2014. [DOI: 10.3126/ajms.v6i1.10802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Wolff-Parkinson-White syndrome is recognized with existence of delta waves and a short PR interval on electrocardiogram. Delta waves may appear positive or negative deviated on different derivations corresponding to the location of accessory pathway. In some cases, delta waves mimic Q waves which should be distinguished by physicians. DOI: http://dx.doi.org/10.3126/ajms.v6i1.10802 Asian Journal of Medical Sciences Vol.6(1) 2015 115-116
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Yontar OC, Tenekecioglu E, Karaagac K, Tutuncu A. Unusual cause for pacemaker threshold elevation. Asian J Med Sci 2014. [DOI: 10.3126/ajms.v6i1.10801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Pacing threshold is an important entity which should be tested during pacemaker follow up. Abnormal elevation of pacing threshold would end up with early exhaustion of pacemaker battery. In this report, we described a patient with an unusual cause for threshold elevation. Learning objective: Pacemaker follow-up has its own routines. Telecardiogram is one of them, however it is mostly underrated nowadays. Our objective is to teach value of this quick and inexpensive test for pacemaker patients. DOI: http://dx.doi.org/10.3126/ajms.v6i1.10801 Asian Journal of Medical Sciences Vol.6(1) 2015 106-107
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Karaagac K, Demir M, Yontar OC, Tenekecioglu E, Vatansever F, Arican Ozluk O, Tutuncu A, Arslan B, Yilmaz M. P697Evaluation of tp-te interval and tp-te/qt ratio in patients with coronary slow flow tp-te/qt ratio and coronary slow flow: Table 1. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu098.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Yontar OC, Tutuncu A, Karaagac K, Karakus A, Yontar ONUR, Melek M. P636T wave peak to t wave end interval is prolonged in patients with atrioventricular nodal reentry:. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu098.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Karaagac K, Yontar OC, Tenekecioglu E, Vatansever F, Arican Ozluk O, Tutuncu A, Yagcioglu P, Yilmaz M. P431Evaluation of tpe-te interval and tpe-te/QTc ratio in patients with coronary artery ectasia:. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu091.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Karaagac K, Tenekecioglu E, Yontar OC, Kuzeytemiz M, Vatansever F, Tutuncu A, Ozluk OA, Yilmaz M, Demir M. Effect of non-dipper and dipper blood pressure patterns on Tp-Te interval and Tp-Te/QT ratio in patients with metabolic syndrome. Int J Clin Exp Med 2014; 7:1397-403. [PMID: 24995102 PMCID: PMC4073763] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 04/19/2014] [Indexed: 06/03/2023]
Abstract
The purpose of this study was to evaluate the effect of blood pressure (BP) rhythm on the values of Tp-Te interval and Tp-Te/QT ratio in patients with metabolic syndrome. Seventy patients with newly diagnosed hypertension who fulfilled the metabolic syndrome criteria according to the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP/ATP-III) were evaluated with 24-hour blood pressure holter monitoring. According to blood pressure rhythm, 35 patients with dipper blood pressure pattern and 35 patients with non-dipper blood pressure pattern were enrolled as two groups in our study. QT, corrected QT (QTc), Tp-Te interval and Tp-Te/QT ratio were measured from the 12-lead electrocardiogram. These parameters were compared between the groups. The nocturnal systolic and diastolic blood pressures were significantly higher in non-dipper patients than the dipper group. Baseline characteristics and QT, QTc intervals were similar in both groups. Tp-Te (91±12.24 vs 74±9.96; p < 0.001), Tp-Te/QT (0.24±0.027 vs 0.20±0.025; p < 0.001) and Tp-Te/QTc (0.22±0.023 vs 0.18±0.023; p < 0.001) were significantly increased in non-dipper group. These findings suggest that Tp-Te interval, Tp-Te/QT ratio end Tp-Te/QTc ratio were prominently increased in non-dipper hypertensive patients than dippers with metabolic syndrome.
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Affiliation(s)
- Kemal Karaagac
- Department of Cardiology, Bursa Yuksek Ihtisas Education and Research Hospital Bursa, Turkey
| | - Erhan Tenekecioglu
- Department of Cardiology, Bursa Yuksek Ihtisas Education and Research Hospital Bursa, Turkey
| | - Osman Can Yontar
- Department of Cardiology, Bursa Yuksek Ihtisas Education and Research Hospital Bursa, Turkey
| | - Mustafa Kuzeytemiz
- Department of Cardiology, Bursa Yuksek Ihtisas Education and Research Hospital Bursa, Turkey
| | - Fahriye Vatansever
- Department of Cardiology, Bursa Yuksek Ihtisas Education and Research Hospital Bursa, Turkey
| | - Ahmet Tutuncu
- Department of Cardiology, Bursa Yuksek Ihtisas Education and Research Hospital Bursa, Turkey
| | - Ozlem Arican Ozluk
- Department of Cardiology, Bursa Yuksek Ihtisas Education and Research Hospital Bursa, Turkey
| | - Mustafa Yilmaz
- Department of Cardiology, Bursa Yuksek Ihtisas Education and Research Hospital Bursa, Turkey
| | - Mehmet Demir
- Department of Cardiology, Bursa Yuksek Ihtisas Education and Research Hospital Bursa, Turkey
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Erdem A, Dogan OT, Yontar OC, Epozturk K, Ozlu MF, Ozturk S, Ayhan SS, Erdem FH, Yazici M, Akkurt I, Talay F. The pure effects of obstructive sleep apnea syndrome on cardiac autonomic functions: heart rate turbulence analysis. Eur Rev Med Pharmacol Sci 2013; 17:2778-2783. [PMID: 24174360] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To demonstrate the pure effect of obstructive sleep apnea syndrome (OSAS) on cardiac autonomic function (CAF) using heart rate turbulence (HRT) parameters. PATIENTS AND METHODS A total of 64 patients with OSAS and 30 age- and gender-matched healthy subjects were enrolled. All subjects had normal coronary arteries and were free from diabetes mellitus (DM) and hypertension (HT). The HRT parameters (TO, turbulence onset; TS, turbulence slope) were obtained from 24-h ambulatory electrocardiogram (ECG) recordings. HRT parameters were compared between groups, and the relationship between HRT and the apnea-hypopnea index (AHI) was examined. RESULTS No between-group differences were found in age or gender. Mean TO was significantly higher in the OSAS group than in healthy controls (0.89 ± 0.5, -0.08 ± 0.26; p < 0.001; respectively). The mean TS did not differ between the two groups (2.81 ± 3.06 versus 3.14 ± 2.33; p = 0.212). The AHI was positively correlated with TO (r = 0.845, p < 0.001). The multiple logistic regression analysis revealed that after adjustment for other variables, TO was a significant and independent predictor of AHI, OR 2.394 (95% CI: 1.596-3.591). CONCLUSIONS HRT (TO in particular) is correlated with AHI. Thus, impaired HRT may be an important factor underlying the occurrence of arrhythmia and sudden cardiac death in patients with OSAS.
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Affiliation(s)
- A Erdem
- Department of Cardiology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey.
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Erdem A, Yontar OC, Öztürk S, Ayhan SS, Özlü MF, Erdem FH, Yazıcı M. A relationship between mitral valve prolapse and subtypes of supraventricular tachycardia. J Interv Card Electrophysiol 2012; 35:243-6; discussion 246. [DOI: 10.1007/s10840-012-9714-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 07/11/2012] [Indexed: 10/28/2022]
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Yildirim O, Yontar OC, Semiz M, Erdem A, Canan F, Yontar G, Kuğu N. The effect of radiofrequency ablation treatment on quality of life and anxiety in patients with supraventricular tachycardia. Eur Rev Med Pharmacol Sci 2012; 16:2108-2112. [PMID: 23280027] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM Paroxysmal supraventricular tachycardia (PSVT) has been shown to be associated with poor outcome in psychological status and quality of life. This study aimed to assess the quality-of-life and anxiety in patients with PSVT and to investigate the influence of radiofrequency ablation (RFA) treatment on these parameters. MATERIALS AND METHODS Fifty patients with newly diagnosed PSVT with electrophysiologic study and treated with RFA, were enrolled in the study and 50 healthy age-and sex-matched individuals. The brief version of World Health Organization Quality of Life Scale and the state-trait anxiety inventory were administered to controls and all patients before and three months after the RFA procedure. RESULTS At baseline, in comparison with the control group, the patients with PSVT exhibited greater anxiety average scores (p < 0.05). After RFA procedure, the patients with PSVT exhibited significant improvement in anxiety, quality of life and health satisfaction scores. Statistically significant difference between the controls and the patients in respect to state and trait anxiety average scores disappeared after treatment (p > 0.05). CONCLUSIONS In this study, normalization of anxiety and quality of life is associated with RFA treatment for patients with PSVT. This finding need to be confirmed by larger scale clinical trials with long-term quality of life follow-up in higher number of patients.
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Affiliation(s)
- O Yildirim
- Department of Psychiatry, Abant Izzet Baysal University, Bolu, Turkey
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Zorlu A, Yücel H, Yontar OC, Karahan O, Tandogan I, Katrancioglu N, Yilmaz MB. Effect of levosimendan in patients with severe systolic heart failure and worsening renal function. Arq Bras Cardiol 2012; 98:537-43. [PMID: 22641390 DOI: 10.1590/s0066-782x2012005000048] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 02/17/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Levosimendan, a calcium sensitizer, increases the sensitivity of the heart to calcium, thus increasing myocardial contractility without a rise in intracellular calcium. It was recently shown that levosimendan is beneficial in improving renal function. However, it remains to be established that the beneficial effect is differentially related to renal status during index event. OBJECTIVE The purpose of the current study was to determine whether levosimendan could improve renal outcome in acute decompensated heart failure patients with and without worsening renal function. METHODS Forty-five consecutive patients who had a reduced glomerular filtration rate and had at least two consecutive data regarding renal function prior to administration of levosimendan were enrolled in the study. Patients were classified into two groups as those with and without worsening renal function based on an increase in serum creatinine >0.3 mg/dL. RESULTS A significant improvement was noted in renal function in patients with worsening renal function (serum creatinine from 1.4 ± 0.16 to 1.21 ± 0.23 mg/dL, p=0.001 and glomerular filtration rate level from 48.9 ± 15 to 59.3 ± 21.8 mL/min/m², p=0.011), while there was no significant improvement in those without worsening renal function (serum creatinine from 1.29 ± 0.33 to 1.37 ± 0.66 mg/dL, p=0.240 and glomerular filtration rate level from 53.7 ± 17.6 to 52.9 ± 21.4 mL/min/m², p=0.850). CONCLUSION Levosimendan appears to provide a renal-enhancing effect in patients with severe, acute decompensated systolic heart failure and worsening renal function. Consideration of this differential effect might help obtain beneficial renal outcomes.
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Affiliation(s)
- Ali Zorlu
- Department of Cardiology, Cumhuriyet University School of Medicine, Sivas, Turkey
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Yontar OC, Abdel-Wahab A, Erdem A, Tandoğan I. [Ventricular tachycardia caused by a left ventricular aneurysm in a patient with previous surgery for ventricular septal defect]. Turk Kardiyol Dern Ars 2011; 39:154-8. [PMID: 21430423 DOI: 10.5543/tkda.2011.01051] [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
Ventricular mural aneurysms especially in the left ventricle represent an increased risk for life-threatening arrhythmias. We present a case of ventricular tachycardia originating from an inferobasal left ventricular aneurysm. A 25-year-old male patient presented with complaints of palpitation, breathlessness, and dizziness of two-hour onset. The electrocardiogram showed wide-QRS tachycardia at which time his blood pressure was 80/40 mmHg. The patient suddenly developed collapse and ventricular tachycardia was diagnosed on the monitor, and he returned to sinus rhythm following successful cardioversion. He remained stable during hospitalization. The electrocardiogram was in sinus rhythm with right bundle branch block and small Q waves in inferior leads. He had an eight-year history of surgery for ventricular septal defect closure, during which a ventricular aneurysm was detected but left untreated. Echocardiographic examination showed a dyskinetic aneurysmal region extending from the inferobasal segment to the posterior wall of the left ventricle. Coronary arteries were normal on angiography, and ventriculography confirmed the aneurysm. Electrophysiologic study was recommended, but the patient refused any treatment. He remained asymptomatic during 18 months of follow-up.
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Affiliation(s)
- Osman Can Yontar
- Department of Cardiology, Medicine Faculty of Cumhuriyet University, Sivas, Turkey.
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Yontar OC. Case images: pseudo-infarct pattern on the electrocardiogram. Turk Kardiyol Dern Ars 2011; 39:178. [PMID: 21430429 DOI: 10.5543/tkda.2011.01287] [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
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Yontar OC, Yilmaz MB, Yalta K, Erdem A, Tandogan I. Acute effects of levosimendan and dobutamine on QRS duration in patients with heart failure. Arq Bras Cardiol 2010; 95:738-42. [PMID: 21109913 DOI: 10.1590/s0066-782x2010005000143] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 05/26/2010] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Levosimendan is a novel inotropic agent that enhances cardiac contractility without increasing cellular calcium intake, so that it is not supposed to cause intracellular calcium overload and related arrhythmias. In patients with heart failure, prolonged QRS duration is associated with increased risk of mortality and sudden cardiac death. Structural changes in the left ventricle may lead to asynchronous contraction, causing conduction delay and a prolonged QRS on the surface electrocardiogram. OBJECTIVE We aimed to compare the acute effects of levosimendan and dobutamine on QRS duration in patients with severe heart failure and sinus rhythm. METHODS Sixty consecutive patients with ischemic heart failure were enrolled for the study and randomized into two groups for levosimendan (n=37) or dobutamine (n=23) infusions. 67.2 % were male; mean age was 66.4 ± 9.2 years for all patients. Baseline QRS durations in levosimendan and dobutamine groups were, 120.44 ± 23.82 ms vs 116.59 ± 13.80 ms respectively. Baseline ejection fractions were both depressed (23.15 ± 8.3% vs 24.56 ± 7.5%). RESULTS In the levosimendan group, QRS duration shortened from baseline value to 116.47 ± 24.56 msec (p=0.006), whereas dobutamine group showed no significant change (p=0.605). Both drugs caused an increase in ejection fraction, but only the levosimendan group showed significance (27.95 ± 8.9% p=0.003 vs 26.67 ± 7.6%, p=0.315). CONCLUSION We suggest that the administration of levosimendan, not dobutamine, shortens QRS duration on the surface ECG, possibly by means of providing collective contraction in the left ventricle muscle fibers. The molecular basis of this effect remains to be clarified.
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Affiliation(s)
- Osman Can Yontar
- Cumhuriyet University, Faculty of Medicine, Department of Cardiology, Sivas - Turkey.
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Yılmaz MB, Erdem A, Yontar OC, Sarıkaya S, Yılmaz A, Madak N, Karadaş F, Tandoğan I. Relationship between HbA₁c and coronary flow rate in patients with type 2 diabetes mellitus and angiographically normal coronary arteries. Turk Kardiyol Dern Ars 2010; 38:405-410. [PMID: 21200119] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
OBJECTIVES We examined the relationship between glycosylated hemoglobin (HbA1c) level and coronary flow rate in patients with type 2 diabetes mellitus (DM) and angiographically normal coronary arteries. STUDY DESIGN The study included 54 consecutive patients (36 males, 18 females; age range 37 to 72 years) with type 2 DM, whose coronary arteries were found normal on coronary angiography. All patients underwent echocardiography and plasma HbA1c levels were measured before coronary angiography. To determine slow coronary flow (SCF), coronary flow rates of the left anterior descending (LAD), circumflex (Cx), and right coronary (RCA) arteries were assessed using the TIMI frame count (TFC) method. RESULTS None of the patients had echocardiographic abnormalities. The mean HbA1c level was 7.4±2.0%, and the mean TFCs were 34.3±6.5, 22.4±3.5, and 20.4±2.2 for the LAD, Cx, and RCA, respectively. HbA1c levels were <7% in 26 patients, and ≥7% in 28 patients. Thirty-eight patients (70.4%) were found to have SCF in at least one coronary artery. TIMI frame counts of all three coronary arteries were significantly greater in patients in whom HbA1c was ≥7% (p<0.001). TIMI frame counts showed significant correlations with the HbA1c level (LAD: r=0.782; Cx: r=0.707; RCA: r=0.515; p<0.001 for all). The mean HbA1c level was significantly higher in patients with SCF compared to patients without SCF (7.8±1.9% vs. 5.6±0.9%; p<0.001). The incidence of SCF was significantly greater in patients with HbA1c ≥7.0% than those with HbA1c <7.0% (96.4% vs. 61.5%; p=0.004). Increased HbA1c (≥7%) significantly increased the risk for SCF in at least one coronary artery (OR=16.875; 95% CI 1.972-144.38). CONCLUSION Our findings suggest that there is a strong correlation between the HbA1c level and coronary flow rate.
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Affiliation(s)
- Mehmet Birhan Yılmaz
- Department of Cardiology, Medicine Faculty of Cumhuriyet University, Sivas, Turkey
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Yontar OC, Yilmaz MB, Yalta K, Tandoğan I. Efficacy of levosimendan in patients with chronic heart failure: Does rhythm matter? Anadolu Kardiyol Derg 2010; 10:310-316. [PMID: 20693125 DOI: 10.5152/akd.2010.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Levosimendan is a relatively new inotropic agent. Unlike other inotropic agents, Levosimendan does not increase cellular calcium intake, so that, does not cause intracellular calcium overload and related arrhythmias. Atrial fibrillation (AF) was shown to be an independent risk factor for mortality and morbidity in large heart failure (HF) trials. Heart failure induces AF, AF aggravates HF and therefore they generally coexist. We conducted a study to investigate if there is any differential effect of Levosimendan in HF patients with chronic AF and without AF. METHODS This is a prospective study. Consecutive patients, who were hospitalized because of acutely decompensated HF due to systolic dysfunction and decided Levosimendan administration, were enrolled. Patients were classified into two as those with AF (group A) and those with sinus rhythm (control group, group S). All patients had echocardiography before and after administration. Echocardiographic data were evaluated by ANOVA repeated measurements test. RESULTS Baseline left ventricle ejection fraction (LVEF) was poorer in group with AF (mean LVEF for group A: 20.9%, for group S: 26.4%, p=0.04). Baseline diastolic parameters were equally impaired. After infusion, diastolic parameters like velocity of propagation (Vp) and isovolumic relaxation time (IVRT) improved almost to same extent in both groups but deceleration time (DT) did not. IVRT values decreased (p=0.012) both in group S (from 108.6+/-23.2 msec to 100.4+/-28.4 msec) and group A (from 117.3+/-25.1 msec to 92.0+/-20.9 msec) without a significant difference between groups (p=0.180 for interaction). Another valuable diastolic parameter, Vp was also similarly improved (p=0.01) in both groups to similar extent (for group A, from 35.4+/-8.8 cm/sec to 41.1+/-7.7 cm/sec, for group S, from 33.7+/-7.5 cm/sec to 37.8+/-7.6 cm/sec; p=0.498 for interaction). CONCLUSION We have shown that in patients with chronic HF and AF, levosimendan improves left ventricular systolic and diastolic functions as good as those with HF and sinus rhythm. We suggest that a positive electrophysiological effect of levosimendan on failing myocardial tissue seems to fill the absence of atrial booster in patients with AF who are on beta-blocker therapy.
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Affiliation(s)
- Osman Can Yontar
- Department of Cardiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey.
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Yontar OC, Birhan Yilmaz M, Guray U. The relationship between the type of thrombus content and mean platelet volume in predicting reperfusion outcomes. Platelets 2010; 21:310-1. [PMID: 20433312 DOI: 10.3109/09537101003657768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Erdem A, Madak N, Yilmaz A, Yontar OC, Yucel H, Gul I, Tandogan I. Development of malignant ventricular arrhythmias in a young male with WPW pattern. Indian Pacing Electrophysiol J 2010; 10:195-200. [PMID: 20376188 PMCID: PMC2847871] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
In Wolff-Parkinson-White Syndrome (WPW), presence of accessory pathways causes various tachyarrhythmias that lead to different symptoms and clinical conditions in patients. Atrial fibrillation is observed in about 20-30% of this group of patients. Life threatening malignant ventricular arrhythmias and sudden cardiac deaths are observed in patients having rapid conduction in accessory pathways and short antegrade refractory periods (<250 msn). We present a WPW syndrome case that presented to the emergency service with narrow QRS tachycardia and later developed malignant ventricular arrhythmia.
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Affiliation(s)
- Alim Erdem
- Cardiology Department, Sivas Public Hospital, Kars, Turkey
| | - Nihat Madak
- Cardiology Department, School of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Ahmet Yilmaz
- Cardiology Department, School of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Osman Can Yontar
- Cardiology Department, School of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Hasan Yucel
- Cardiology Department, School of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Ibrahim Gul
- Cardiology Department, School of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Izzet Tandogan
- Cardiology Department, School of Medicine, Cumhuriyet University, Sivas, Turkey
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Yontar OC, Yilmaz MB, Güray U. [ST-segment elevation in patients with acute myocardial infarction during a mean platelet volume of applications after fibrinolytic treatment effect on TIMI frame number]. Turk Kardiyol Dern Ars 2010; 38:149-150. [PMID: 20473025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
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Yalta K, Yontar OC, Yilmaz MB, Erdem A, Turgut OO, Yilmaz A, Manduz S, Tandoğan I. Triple right coronary artery accompanied by an ectopic circumflex artery arising from right sinus of Valsalva. Anadolu Kardiyol Derg 2010; 10:E1. [PMID: 20149991 DOI: 10.5152/akd.2010.025] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Kenan Yalta
- Department of Cardiology Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
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Yontar OC, Yilmaz MB, Yalta K. Levosimendan in acute and chronic right ventricle failure. Acta Anaesthesiol Scand 2010; 54:118-9. [PMID: 19961440 DOI: 10.1111/j.1399-6576.2009.02057.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yontar OC, Yilmaz MB, Guray U. Mean platelet volume: A predictor of acute coronary occlusion. Scandinavian Journal of Clinical and Laboratory Investigation 2009; 70:6; author reply 7. [DOI: 10.3109/00365510903456921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Yontar OC, Yilmaz MB. Relationship between high-density lipoprotein and the progression of aortic valvular disease. J Card Surg 2009; 24:533. [PMID: 19740293 DOI: 10.1111/j.1540-8191.2009.00893.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Erdem A, Yontar OC, Yilmaz MB. Detecting posterior wall acute myocardial infarction by electrocardiogram. Am J Cardiol 2009; 103:1622. [PMID: 19463527 DOI: 10.1016/j.amjcard.2009.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 03/03/2009] [Accepted: 03/03/2009] [Indexed: 12/01/2022]
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Yontar OC, Yilmaz MB. Lipoprotein levels and the progression of aortic valvular disease. Heart 2009; 95:938-939. [PMID: 19443483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
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Yontar OC, Erdem A, Yilmaz MB. Sleep quality in patients with hypertension: additional negative effect of drug therapy. Sleep Med 2009; 10:1168; author reply 1168-9. [PMID: 19467925 DOI: 10.1016/j.sleep.2009.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2009] [Accepted: 04/16/2009] [Indexed: 10/20/2022]
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Yontar OC, Erdem A, Tandogan I. A giant coronary sinus mimicking descending aorta. Acta Cardiol 2008; 63:791-2. [PMID: 19157176 DOI: 10.2143/ac.63.6.2033398] [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: 11/18/2022]
Abstract
A 58-year-old male patient was admitted to the emergency service with dyspnoea.The patient underwent several laboratory and imaging tests including echocardiography and a diagnosis of descending aortic aneurysm was suspected.After computerised tomography scanning, a normal-size descending aorta was found so that echocardiography was done once more. Intravenous contrast examination revealed a giant coronary sinus in this patient.
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Affiliation(s)
- Osman Can Yontar
- Cumhuriyet University, Faculty of Medicine, Department of Cardiology, Sivas, Turkey.
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Abstract
Short QT syndrome (SQTS) is a gene-related arrhythmogenic syndrome harbouring a large spectrum of symptoms ranging from mild palpitations to sudden cardiac death.The mutation of genes (KCNH2, KCNQ1, and KCNJ2) encoding for cardiac potassium channels plays a central role in SQTS. Electrocardiography is the primary important step in the diagnosis (short QT interval along with T wave changes), but ECG findings may be easily ignored. Treatment of the syndrome is still controversial. Some specific antiarrhythmic drugs and an implantable converter/defibrillator (ICD) have been considered as main therapeutic strategies. ICD implantation may be a life-saving procedure due to the presence of sudden cardiac death risk in patients with SQTS, but ICD-related problems such as inappropriate shock deliveries due to oversensing of prominent T waves have made medical therapy an alternative option. Notwithstanding the scarcity of cases, clinicians should keep this syndrome in mind, and be familiar with its clinical findings particularly when evaluating patients with palpitation, syncope or a history of sudden cardiac death.We present a brief review of the literature concerning the aetiology, clinical findings and therapeutic approach to this rare entity.
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