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Öğe Contradictory Effect of Coronary Collateral Circulation on Regional Myocardial Perfusion That Assessed by Quantitative Myocardial Perfusion Scintigraphy(Elmer Press, 2021) Özdemir, Semra; Barutçu, Ahmet; Akşit, Ercan; Duygu, Ali; Koç Öztürk, FulyaBackground: Previous studies showed conflicting results about the contribution of coronary collateral circulation (CCC) to myocardial perfusion and function. The aim of this study was to investigate these contradictory problems by gated myocardial perfusion scintigraphy (gated MPS) for the first time. Methods: The current cohort was retrospectively selected among patients who underwent gated MPS and coronary angiography within 2 months. Two different groups including 96 patients were assessed by gated MPS to detect the understanding of the miscellaneous effect of CCC on myocardial perfusion. Group 1 consisted of those who had collateral arteries that were not-well-developed (Rentrop grade 0 - 1) (n = 58), while group 2 consisted of those who had collateral arteries that were well-developed (Rentrop grade 2 - 3) (n = 38). Results: There was no statistically significant difference between groups 1 and 2 in terms of perfusion and functional parameters obtained from gated MPS. Furthermore, no statistically significant difference was found in the phase analysis parameters which is a novel technique to evaluate left ventricular synchronization. On the other hand the left ventricular mass index values were high and quite close to the statistically significant value (P = 0.059) in group 2. Conclusions: The current results that obtained by using the gated MPS technique for the first time in the evaluation of CCC showed that the well-developed collateral circulation has a positive effect on myocardial perfusion and function, but this effect was not statistically significant. Results need to be supported by large scale of patients' size.Öğe Diffuse coronary artery aneursym due to acute coronary syndrome(2013) Bekler, Adem; Özeren, Ali; Altun, Burak; Gazi, Emine; Temiz, Ahmet; Barutçu, Ahmet; Özkan, Muhammed Turgut AlperA 53-years old male patient admitted to our hospital with typical chest pain. There are no risk factors for coronary artery diseases (CAD) and no systemic disease in his medical history. Electrocardiographic and echocardiographic findings were normally. Serum troponin I level was significantly high and therefore he was hospitalized with a diagnosis of non-ST elevated myocardial infarction. The coronary angiography showed diffuse coronary artery aneursym without significant stenosis. We present here a patient with diffuse coronary artery aneursym due to acute coronary syndrome without risk factors of CAD and systemic disease in his medical history.Öğe Evaluation of surface ECG changes in pregnant women with gestational diabetes mellitus(Acta Medica Mediterranea, 2014) Gencer, Meryem; Gazi, Emine; Temiz, Ahmet; Hacivelio?lu, Servet; Güngör, Ayşe çakir; Barutçu, Ahmet; Altun, BurakObjective: Gestational diabetes mellitus (GDM) has an increased risk of maternal and fetal complications. Increased maternal cardiac risk is one of the most important complications. QT dispersion and Tp-e duration are findings of surface electrocardiogram (ECG) and they are used an index of inhomogeneity in ventricular electrical activity, and prolongation of QT dispersion is related to increased incidence of ventricular arrhythmias. In this study, we aimed to investigate QT dispersion, Tp-e interval and Tp-e/QT ratio in pregnant women with GDM and emphasize the increased cardiac risk and the importance of GDM screening Methods: Thirty pregnant women with GDM (mean age 27.3±6.1 years) and 23 normal pregnant women (30.2±5.4 years) were included in the study. A 12-lead surface electrocardiogram was used to evaluate QT and Tp-e durations for all participants. All QT intervals were corrected for heart rate using *1*?ş q L"2K, NBazett's formula. QT dispersion was defined as the difference between the maximum corrected QT and minimum corrected QT duration. Student's t test or Mann-Whitney U was used to compare groups. The results were evaluated at the p<0.05 significance level. Results: Mean age, body mass index, blood pressure, heart rate and gestational week of pregnancy were similar between the two groups. QT dispersion (54±13 msc vs. 44±12 msc, p=0.006), Tp-e (81±7 msc vs. 76±8msc, p=0.013) and corrected Tp-e (102.4±9.7msc vs. 96.5±8.2msc, p=0.038) were significantly longer in pregnant women with GDM. The Tp-e/QT corrected ratio was found to be higher in GDM patients (0.19±0.01 vs. 0.18±0.02, p=0.040). Conclusion: Our results suggest that QT dispersion, Tp-e interval and Tp-e/QTc ratio are increased in pregnant women with GDM compared to non-diabetic pregnant women. For this reason we suggest GDM screening for all healthy pregnant women and evaluation the long-term cardiac risks.Öğe İntrakoroner yoğun trombüsü olan akut ST yükselmesiz miyokard İnfarktüsü geçiren genç olguda, invaziv girişime alternatif olarak başarılı tirofiban uygulaması(Çanakkale Onsekiz Mart Üniversitesi, 2014) Bekler, Adem; Barutçu, Ahmet; Temiz, Ahmet; Altun, Burak; Gazi, Emine; Güngör, ÖmerTipik göğüs ağrısı şikayetiyle başvuran 32 yaşındaki erkek hasta, kardiak enzimlerin yüksek olması üzerine ST elavasyonu olmayan miyokard infarktüsü tanısıyla koroner yoğun bakım ünitesine yatırıldı. Yapılan koroner anjiografide LAD'de yoğun trombüslü lezyon saptandı. Hastanın ağrısının ve EKG'de dinamik değişiklik olmaması üzerine invaziv girişim düşünülmedi. Asetilsalisilik asit, klopidogrel, heparin ve tirofiban içeren yoğun antiagregan tedaviye başlandı. 48 saat sonra yapılan kontrol anjiografide LAD'deki trombüsün tamamen eridiği izlendi.Öğe Koroner Yavaş Akım Hastalarında Klinik Özelliklerin Değerlendirilmesi: İnfl amasyon ve Aterosklerozun Belirteçleri(2013) Gazi, Emine; Temiz, Ahmet; Barutçu, Ahmet; Altun, Burak; Çölkesen, YücelGiriş: Koroner yavaş akım, koroner arterlerde darlık olmaksızın akım hızının yavaşlaması ile tanımlanan bir patolojidir ve etiyolojisi tam olarak aydınlatılamamıştır. Bu çalışmada koroner yavaş şakım için risk faktörlerini araştırmak amaçlanmıştır.Hastalar ve Yöntem:Ocak 2011-Haziran 2012 tarihleri arasında yapılan koroner anjiyografi lerde koroner yavaş akım saptanan 38 (ortalama yaş 55 ± 10) hasta ile kontrol grubu olarak normal lkoroner arter akımı saptanan 51 (ortalama yaş 54 ± 11) hasta çalışmaya alındı. Koroner kan akı-mının değerlendirilmesinde TIMI kare sayısı yöntemi kullanıldı. Hastaların demografi k özellikleri, kardiyovasküler hastalık için risk faktörleri, laboratuvar değerleri, rutin ekokardiyografi k ölçümleri i ve epikardiyal yağ dokusu ölçümleri ayrıntılı olarak kaydedildi. Grupların karşılaştırılmasındaa sürekli değişkenler için student-t veya Mann-Whitney U testi ve kategorik değişkenler için ki-kare etesti kullanıldı. Koroner yavaş akım için bağımsız prediktörlerin değerlendirmesi lineer regresyonn analiziyle yapıldı. p< 0.05 değeri anlamlı olarak kabul edildi.Bulgular:Gruplar arasında, erkek cinsiyet değişkeni dışında (%60.5 ve %31.4, p= 0.006) demografi k özellikler bakımından fark yoktu. Serum ürik asit düzeyi koroner yavaş akım hastala-rında daha yüksek bulundu (5.7 ± 1.1 mg/dL ve 4.8 ± 0.8 mg/dL; p= 0.001). Koroner yavaş akım hastalarında sol ventrikül sistol sonu çapı (ortanca 28 mm vs. 31 mm, p= 0.011) daha fazla ve e ejeksiyon fraksiyonu (ortanca %59 ve %64, p= 0.001) daha düşük bulundu. Koroner yavaş akım hastalarının epikardiyal yağ dokusu kalınlığı [8.2 mm ve 6.2 mm , p= 0.001] ve aort tkökü genişliği anlamlı olarak daha fazla saptandı [30 mm ve 26 mm , p= 0.001].Ürik asit düzeyi (p= 0.025; ?= 2.14), epikardiyal yağ dokusu (p= 0.015; ?= 1.49) ve aort kökü ü genişliği (p= 0.001; ?= 1.38) koroner yavaş akım için bağımsız öngördürücüler olarak bulundu.Sonuç: Bu çalışma infl amasyon ve ateroskleroz ile ilişkili olduğu bilinen ürik asit düzeyi, epikardiyal yağ dokusu ve aort kökü genişliğinin koroner yavaş akım için risk faktörleri arasındaa olabileceğini göstermiştir.Öğe Massively aneurysmatic right coronary artery detected by coronary angiography which is performed due to suspicion of acute coronary syndrome(2014) Temiz, Ahmet; Bekler, Adem; Gazi, Emine; Altun, Burak; Barutçu, Ahmet; Özkan, Muhammet Turgut Alper56 years old male patient with previous diagnosis of hypertension was admitted to emergency unit with complaint of low blood pressure. His electrocardiogram yielded right budle branch block and ST elevation in inferior leads. But the patient had no chest pain. We performed coronary angiography and demonstrated a huge anurysmatic right coronary artery with trombus at the distal part. Medical treatment including aspirine, statin, clopidogrel, heparine and tirofiban was applied to the patient. Cardiac troponins remained normal in serial samples during the hospital stay and patient was discharged with oral vitamine K antagonist.Öğe Percutaneous Closure of the Atrial Septal Defect in a Patient with Dextrocardia and Situs Inversus Totalis(2021) Gazi, Emine; Barutçu, Ahmet; Aksit, Ercan; Volina, Emir; Demir, CengizSitus inversus totalis with dextrocardia and atrial septal defect is extremely rare. Different position and inversion types are required different closure techniques. We present a dextrocardia patient whose atrial septal defect was closed percutaneously. A 47-year-old female patient was referred for cardiological evaluation due to the diagnosis of situs inversus totalis and dextrocardia while preparing for gall bladder surgery. The patient’s heart was located on the right side, right heart chambers were dilated and a secundum-type atrial septal defect of 15 mm in width was detected. A 20 mm atrial septal defect closure device (Occlutech, GmbH) was placed and the defect was completely covered. In this case report, we defined technical differences and issues that should be considered when planning interventions in dextrocardia patients.Öğe ST ELEVASYONLU MİYOKARD ENFARKTÜSÜ İLE PERSİSTAN THEBESİAN SİNUSOİDLERİ BİRLİKTELİĞİ(2014) Bekler, Adem; Gazi, Emine; Temiz, Ahmet; Altun, Burak; Barutçu, AhmetEpikardiyal koroner arterler ile ventriküller arasında direkt bağlantı sağlayan koroner arter fistülleri çoğunlukla herhangi bir nedenle yapılan koroner anjiyografi sırasında tespit edilmekte ve koroner çalma sendromuna neden olarak iskemiye yol açabilmektedir. Biz burada, akut inferior miyokard enfarktüsü ile başvuran ve yapılan primer perkütan koroner girişim için yapılan koroner anjiografide sirkumflex ve sol ön inen arterden sol ventriküle fistüle neden olan kalıcı Thebesian sinusoidleri tespit edilen 65 yaşındaki bayan bir vakayı sunmayı amaçladıkÖğe The association between cardiac mr feature tracking strain and myocardial late gadolinium enhancement in patients with hypertrophic cardiomyopathy(Limited Liability Company KlinMed Consulting, 2023) Özden, Özge; Ünlü, Serkan; Kılıç, Doğu İsmail; Sherif, Sara Abu; Opan, Selçuk; Kemal, Hatice S.; Barutçu, AhmetAim Hypertrophic cardiomyopathy (HCM) is a relatively common, heritable cardiomyopathy, and cardiac magnetic resonance (CMR) studies have been performed previously to evaluate different aspects of the disease. However, a comprehensive study, including all four cardiac chambers and analysis of left atrial (LA) function, is missing in the literature. The aim of this retrospective study was to analyze CMR-feature tracking (CMR-FT) strain parameters and atrial function of HCM patients and to investigate the association of these parameters with the amount of myocardial late gadolinium enhancement (LGE). Material and Methods In this retrospective, cross-sectional study, we analyzed the CMR images (CMRI) of 58 consecutive patients, who from February 2020 to September 2022 were diagnosed with HCM at our tertiary cardiovascular center. Patients who were younger than 18 yrs or who had moderate or severe valvular heart disease, significant coronary artery disease, previous myocardial infarction, suboptimal image quality, or with contraindication to CMR were excluded. CMRI was performed at 1.5 T with a scanner, and all scans were assessed by an experienced cardiologist and then re-assessed by an experienced radiologist. SSFP 2-, 3-and 4-chamber, short axis views were obtained and left ventricular (LV) end -diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), and mass were measured. LGE images were obtained using a PSIR sequence. Native T1 and T2 mapping and post-contrast T1 map sequences were performed and each patient's myocardial extracellular volume (ECV) was calculated. LA volume index (LAVI), LA ejection fraction (LAEF), LA coupling index (LACI) were calculated. The complete CMR analysis of each patient was performed with CVI 42 software (Circle CVi, Calgary, Canada), off-line. Results The patients were divided into two groups, HCM with LGE (n=37, 64 %) and HCM without LGE (n=21, 36 %). The average patient age in the HCM patients with LGE was 50.8 & PLUSMN;14 yrs and 47 & PLUSMN;12.9 yrs in the HCM patients without LGE. Maximum LV wall thickness and basal antero-septum thickness were significantly higher in the HCM with LGE group compared to the HCM without LGE group (14.8 & PLUSMN;3.5 mm vs 20.3 & PLUSMN;6.5 mm (p<0.001), 14.2 & PLUSMN;3.2 mm vs 17.3 & PLUSMN;6.1 mm (p=0.015), respectively). LGE was 21.9 & PLUSMN;31.7 g and 15.7 & PLUSMN;13.4 % in the HCM with LGE group. LA area (22.2 & PLUSMN;6.1 vs 28.8 & PLUSMN;11.2 cm2; p=0.015) and LAVI (28.9 & PLUSMN;10.2 vs 45.6 & PLUSMN;23.1; p-0.004) were significantly higher in the HCM with LGE group. LACI was doubled in the HCM with LGE group (0.2 & PLUSMN;0.1 vs 0.4 & PLUSMN;0.2; p<0.001). LA strain (30.4 & PLUSMN;13.2 vs 21.3 & PLUSMN;16.2; p-0.04) and LV strain (15.2 & PLUSMN;3 vs 12.2 & PLUSMN;4.5; p=0.012) were significantly decreased in the HCM with LGE group. Conclusion This study sheds light on the CMR-FT differences between HCM with and without LGE. We found a greater burden of LA volume but significantly lower LA and LV strain in the LGE patients. These findings highlight further the LA and LV remodeling in HCM. Impaired LA function appears to have physiological significance, being associated with greater LGE. While our CMR-FT findings support the progressive nature of HCM, beginning with sarcomere dysfunction to eventual fibrosis, further studies are needed to validate these results in larger cohorts and to evaluate their clinical relevance.
