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    A Fatal Case of Culture-Negative Late Prosthetic Mitral Valve Endocarditis
    (Emergency Medicine Physicians Assoc Turkey, 2022) Kucuk, Ugur; Alkan, Sevil; Barutcu, Ahmet
    Prosthesis valve dehiscence is one of the most serious complications of prosthetic valves. Despite the improvements in medical and surgical treatments, prosthesis valve dehiscence has high mortality. Due to fatality rates, the early diagnosis and treatment of these patients is required. In this case report, we presented a patient with severe mitral deficiency and acute heart failure following mechanical mitral prosthesis valve dehiscence secondary to culture-negative endocarditis.
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    An anchoring technique by looping with the tip of a super-stiff wire: May be a solution in patients with anomaly of the aortic arch and tortuous carotid artery disease?
    (2013) Barutcu, Ahmet; Gazi, Emine; Aksu, Feyza; Tatli, Ersan
    Vascular anatomy is one of the most important factors for the successful carotid artery interventions, either angioplasty or stenting. We report a new technique for advancing a guiding catheter into the common carotid artery when there is an unfavourable aortic arch anatomy and tortuosity of the carotid artery. Copyright 2013 BMJ Publishing Group. All rights reserved.
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    Are patients, who were previously diagnosed with coronary artery disease by coronary angiography, on optimal medical treatment?
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2015) Temiz, Ahmet; Yener, Ali Umit; Barutcu, Ahmet; Gazi, Emine; Altun, Burak; Bekler, Adem; Vural, Ahmet
    Background: This study aims to detect the drug usage rate of patients who had coronary artery disease (CAD) diagnosis by coronary angiogram (CAG). Methods: Reports of 1,549 patients (993 males, 556 females; mean age 62.9 +/- 10.9 years; range 20 to 87 years) (184 normal CAG, 1,365 CAD) who were performed CAG between October 2009 and February 2012 were retrospectively analyzed. Medication data were collected between August 2013 and November 2013 from patients' pharmacy refill data. Usage of aspirin, tienopiridine, statin, angiotensin converting enzyme inhibitor, beta blocker (BB), warfarin, angiotensinogen receptor blocker, nitrate, trimetazidine, calcium channel blocker, and diuretic were recorded. Results: Usage rates of angiotensinogen receptor blocker, trimetazidine, calcium channel blocker, warfarin, diuretic, and fibrate were not statistically different between patients with CAD and normal CAG. Rates of using aspirin (50.3% vs. 39.1%, p=0.005), tienopiridine (25.6% vs. 9.8%, p<0.001), angiotensin converting enzyme inhibitor (38.0% vs. 21.7%, p<0.001), statin (48.5% vs. 30.6%, p<0.001), BB (56.8% vs. 40.2%, p<0.001) and nitrate (15.1% vs. 6.0%, p<0.001) were higher in patients with CAD. Rate of patients using all four drugs, antiplatelet agent, statin, angiotensin converting enzyme inhibitor, and BB was only 13.1% in CAD group. Only 25.8% of patients with CAD used all three of antiplatelet agent, statin, and BB. Conclusion: Patients with CAD are not on optimal medical treatment. These patients should be questioned in every visit in terms of the status of their treatment to administer the optimum medications to reduce cardiovascular mortality and morbidity.
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    Arrhythmia Risk Assessment Using Heart Rate Variability Parameters in Patients with Frequent Ventricular Ectopic Beats without Structural Heart Disease
    (Wiley, 2014) Barutcu, Ahmet; Temiz, Ahmet; Bekler, Adem; Altun, Burak; Kirilmaz, Bahadir; Aksu, Feyza Ulusoy; Kucuk, Ugur
    BackgroundVentricular ectopic beats (VEBs) are usually considered a benign condition that can be managed with conservative measures. Heart rate variability (HRV), which is one of the most important methods for assessing autonomic activity, is a noninvasive, quantitative method of analyzing autonomic effects on the heart. We aimed to investigate the risk of arrhythmia in patients with VEBs and without cardiovascular disease by using HRV parameters. MethodsPatients with frequent VEBs (more than 30 times in 1 hour, according to the Lown classification) were identified. Identified patients were evaluated by 24-hour ECG recording. Our study included 43 patients with frequent VEBs and 43 controls. ResultsGeneral characteristics of the study population were similar. The LF (low frequency)/HF (high frequency) ratio was significantly higher in the frequent VEBs group than in the control group (P < 0.001). The rate of paroxysmal atrial fibrillation (PAF) was higher in the frequent VEB group than in the control group (P = 0.003). The number of VEBs was correlated with LF/HF ratio and PAF (r = 0.339, P = 0.001 and r = 0.294, P = 0.006, respectively). ConclusionsOur study showed that the sympathetic nervous system is dominant in young patients with VEBs and without significant comorbidities. There is a higher risk of atrial fibrillation in patients with VEBs and they should be monitored closely for atrial fibrillation.
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    Assessment of left-atrial strain parameters in patients with frequent ventricular ectopic beats without structural heart disease
    (Springer, 2014) Barutcu, Ahmet; Gazi, Emine; Temiz, Ahmet; Bekler, Adem; Altun, Burak; Kirilmaz, Bahadir; Kucuk, Ugur
    Ventricular ectopic beats (VEBs) are often encountered in daily clinical practice. Clinical significance of VEBs seen in patients without structural cardiovascular diseases is controversial. We aimed to investigate the effects of VEBs on left atrium (LA) function using speckle tracking echocardiography with LA strain parameters. Patients with frequent VEBs (more than 30 times in 1 h, according to the Lown classification) were identified. Identified patients were evaluated by speckle tracking methods. There were 40 patients with frequent VEBs and 40 controls in our study. The general characteristics were similar of the study population. The LA global longitudinal strain parameters were significantly different. Global Peak atrial longitudinal strain (PALS) (38.39 +/- A 7.93 vs. 44.15 +/- A 6.71, p = 0.001) and peak atrial contraction strain (PACS) (16.37 +/- A 4.58 vs. 20.49 +/- A 3.65, p = 0.000) were revealed significantly lower in the VEBs group. Time to peak longitudinal strain (TPLS) was found significantly longer in the VEBs group [485.5 (352-641) vs. 435 (339-516.5) p = 0.000]. Number of VEBS was correlated with TPLS (r = 0.499, p = 0.000). PALS and PACS were negatively correlated with number of VEBs (r = -0.348, p = 0.002 and r = -0.444, p = 0.000, respectively). We described that in this study, The LA functions are affected by VEBs adversely. This deterioration is increasing as the number of VEBs.
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    Assessment of the effects of frequent ventricular extrasystoles on the left ventricle using speckle tracking echocardiography in apparently normal hearts
    (Turkish Soc Cardiology, 2016) Barutcu, Ahmet; Bekler, Adem; Temiz, Ahmet; Kirilmaz, Bahadir; Gazi, Emine; Altun, Burak; Ozdemir, Semra
    Objective: Impairment in left ventricular (LV) function due to excessive ventricular extrasystoles (VESs) occurs during long-time follow-up. Speckle tracking echocardiography (STE) has been shown to be superior to conventional methods for evaluating cardiac functions. We aimed to use STE for early detection of LV dysfunction in patients with apparently normal hearts who have frequent VESs. Methods: Fifty-five patients with frequent VESs were identified according to the Lown classification (Grade 2; unifocal more than 30 times in 1 h). Subjects aged 22-60 years with frequent VESs that had been detected for at least 1 year were included in the study according to the inclusion criteria. Forty-five subjects with similar demographic characteristics, but without VESs, were included as the control group. All participants were evaluated by STE. Results: Fifty-five patients with frequent VESs (mean age 47 years, range 22-60 years; 42.2% male) and 45 control subjects (mean age 46 years, range 22-60 years; 37.8% male) were enrolled in the study. Global LV longitudinal strain (GLS) was decreased in patients with frequent VESs (-18.41 +/- 3.37 and -21.82 +/- 2.43; p<0.001). In addition, global LV circumferential strain was decreased in patients with frequent VESs (-16.83 +/- 6.06, -20.51 +/- 6.02; p<0.001). The frequency and exposure time of VESs were negatively correlated with GLS (r=-0.398, p<0.001; r=-0.191, p=0.001, respectively). Conclusion: STE revealed that LV functions were decreased in patients with VESs. This deterioration increased with the frequency and exposure time of VESs. Impairment of LV function due to excessive VESs occurs during long-time follow-up. STE may be used for early detection of LV dysfunction.
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    Assessment of the relationship between red cell distribution width and fragmented QRS in patients with non-ST elevated acute coronary syndrome
    (Int Scientific Literature, Inc, 2014) Bekler, Adem; Gazi, Emine; Tenekecioglu, Erhan; Karaagac, Kemal; Altun, Burak; Temiz, Ahmet; Barutcu, Ahmet
    Background: Red cell distribution width (RDW) and fragmented QRS (fQRS) complexes have also been reported to be predictors of cardiac events and all-cause mortality in coronary artery disease (CAD). We aimed to investigate the association of serum red cell distribution width (RDW) levels and fQRS in patients with non-ST elevated acute coronary syndrome (NST-ACS). Material/Methods: We retrospectively evaluated a total of 251 patients (191 men and 60 women) with NST-ACS. The NST-ACS consisted of unstable angina (UA) and non-ST elevated myocardial infarction (NSTEMI). The fQRS pattern was defined as the presence of an additional R' or crochetage wave, notching in the nadir of the S wave or fragmentation of the RS or QS complexes in 2 contiguous leads corresponding to a major coronary artery territory. The relationships between the RDW and fQRS were assessed. Results: The patients in the fQRS group were older, left ventricular ejection fraction (LVEF) levels were significantly lower, and baseline RDW and troponin levels were significantly higher than in the group without fQRS. There were positive correlations between age, number of coronary arteries narrowed, and RDW, and negative correlations between triglyceride, LVEF, and RDW in study patients. There were positive correlations between number of fQRS leads, age, and RDW, and negative correlations between triglyceride, LVEF, and RDW in NSTEMI patients. Conclusions: Our results indicate that an elevated RDW values is associated with fQRS in NST-ACS. Elevated RDW values and fQRS together may be useful for identifying NSTEMI patients in NST-ACS.
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    Association of abnormal coronary sinus reflux with coronary slow flow and importance of the Thebesian valve
    (Elsevier Ireland Ltd, 2020) Aksit, Ercan; Barutcu, Ahmet; Sehitoglu, Muserref Hilal; Kirilmaz, Bahadir; Arslan, Mehmet; Gazi, Emine; Tok, Ozge Ozden
    Background: The relationship between coronary slow flow (CSF) and coronary sinus (CS) reflux has not been previously studied. This study aimed to investigate the relationship between CSF and CS reflux and Thebesian valve presence as well as the relationship between CS reflux and serum annexin-V and ICAM-1 levels. Methods: In this case-control study, patients were divided into two groups: CSF (n = 13) and control (n = 7) groups. CS flow parameters and Thebesian valve presence were evaluated by cardiac magnetic resonance (CMR). Moreover, serum ICAM-1 and annexin-V levels were measured. Results: Regurgitation volume and regurgitation fraction, indicators of reflux flow in CS, were higher in the CSF group than in the control group (p = 0.039 and p = 0.019). Fewer Thebesian valves were observed in the CSF group than in the control group (p = 0.022). Furthermore, a positive correlation was found between regurgitation volume and regurgitation fraction and serum annexin-V and ICAM-1 levels (r = 0.813, p < 0.001 and r = 0.996, p < 0.001; r = 0.817, p < 0.001 and r = 0.993, p < 0.001, respectively). Conclusions: This study revealed the significant relationship between CSF and reflux flow in CS. The fact that the patients in the CSF group have fewer Thebesian valves suggests the importance of the valve in preventing backward flow from the coronary vein. A positive correlation between serum ICAM-1 and annexin-V levels with regurgitation volume and regurgitation fraction indicates that after a certain threshold, CS reflux should be considered an abnormal condition. (C) 2020 Elsevier B.V. All rights reserved.
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    Atrial conduction time, and left atrial mechanical and electromechanical functions in patients with polycystic ovary syndrome: interatrial conduction delay
    (Clinics Cardive Publ Pty Ltd, 2015) Gazi, Emine; Gencer, Meryem; Hanci, Volkan; Temiz, Ahmet; Altun, Burak; Barutcu, Ahmet; Gungor, Ayse Nur
    Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders of women during the reproductive period. Cardiovascular risk factors are more frequent in patients with PCOS. We aimed to investigate the P-wave dispersion (Pd), inter-and intra-atrial conduction time and mechanical functions of the left atrium (LA) in patients with PCOS. Methods: Forty-eight patients with PCOS and 38 normal healthy women were enrolled in this study. A 12-lead surface electrocardiogram was used to evaluate Pd. Left ventricular (LV) functions were measured using conventional and tissue Doppler imaging (TDI) methods. Inter-and intra-atrial conduction times were measured by TDI. LA volumes were measured echocardiographically with the biplane area-length method from the apical four-chamber view. Results: Heart rate (82.02 +/- 13.15 vs 74.24 +/- 11.02 bpm, p = 0.014) and Pd were significantly increased in the PCOS patients [ 27 +/- 5 vs 24 +/- 6 ms, p = 0.035]. Transmitral E/A ratio was significantly lower in the PCOS patients than in the controls (1.5 +/- 0.3 vs 1.7 +/- 0.4 m/s, p = 0.023). Passive emptying volume (12.54 +/- 4.39 vs 15.28 +/- 3.85 ml/m(2), p = 0.004) and passive emptying fraction [54.4 (21-69) vs 59.1% (28-74), p = 0.008] were significantly decreased in PCOS patients. Total emptying volume was significantly decreased (17.9 +/- 5.49 vs 20.67 +/- 4.29 ml/m(2), p = 0.018) in PCOS patients. Interatrial (19 +/- 7.4 vs 15 +/- 6.4 ms, p = 0.035) and intra-atrial [8.5 (1-19) vs 5 ms (1-20), p = 0.026] electromechanical delays were found to be significantly higher in PCOS patients. Conclusion: This study showed that patients with PCOS had increased inter-and intra-atrial conduction delays, and decreased LA passive emptying volumes and fractions.
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    Atrial electromechanical coupling intervals in pregnant subjects
    (Clinics Cardive Publ Pty Ltd, 2014) Altun, Burak; Tasolar, Hakan; Gazi, Emine; Gungor, Aysenur Cakir; Uysal, Ahmet; Temiz, Ahmet; Barutcu, Ahmet
    Objective: The aim of this study was to evaluate atrial conduction abnormalities obtained by tissue Doppler imaging (TDI) and electrocardiogram analysis in pregnant subjects. Methods: A total of 30 pregnant subjects (28 +/- 4 years) and 30 controls (28 +/- 3 years) were included. Systolic and diastolic left ventricular (LV) function was measured using conventional echocardiography and TDI. Inter-atrial, intra-atrial and intra-left atrial electromechanical coupling (PA) intervals were measured with TDI. P-wave dispersion (PD) was calculated from a 12-lead electrocardiogram. Results: Atrial electromechanical coupling at the septal and left lateral mitral annulus (PA septal, PA lateral) was significantly prolonged in pregnant subjects (62.1 +/- 2.7 vs 55.3 +/- 3.2 ms, p < 0.001; 45.7 +/- 2.5 vs 43.1 +/- 2.7 ms, p < 0.001, respectively). Inter-atrial (PA lateral - PA tricuspid), intra-atrial (PA septum - PA tricuspid) and intra-left atrial (PA lateral - PA septum) electromechanical coupling intervals, maximum P-wave (P-max) duration and PD were significantly longer in the pregnant subjects (26.4 +/- 4.0 vs 20.2 +/- 3.6 ms, p < 0.001; 10.0 +/- 2.0 vs 8.0 +/- 2.6 ms, p = 0.002; 16.4 +/- 3.3 vs 12.2 +/- 3.0 ms, p < 0.001; 103.1 +/- 5.4 vs 96.8 +/- 7.4 ms, p < 0.001; 50.7 +/- 6.8 vs 41.6 +/- 5.5 ms, p < 0.001, respectively). We found a significant positive correlation between inter-atrial and intra-left atrial electromechanical coupling intervals and P-max (r = 0.282, p = 0.029, r = 0.378, p = 0.003, respectively). Conclusion: This study showed that atrial electromechanical coupling intervals and PD, which are predictors of AF, were longer in pregnant subjects and this may cause an increased risk of AF in pregnancy.
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    Cardiac Magnetic Resonance Speckle Tracking Analysis of Right Ventricle Function in Myocarditis with Preserved Right Ventricular Ejection Fraction
    (Mdpi, 2024) Ozden, Ozge; Unlu, Serkan; Sahin, Ahmet Anil; Barutcu, Ahmet; Govdeli, Elif Ayduk; Sherif, Sara Abou; Papadopoulos, Konstantinos
    Background and Objectives: Diagnosis of myocarditis remains a challenge in clinical practice; however, magnetic resonance imaging (CMRI) can ease the diagnostic approach by providing various parameters. The prevalence of right ventricular involvement in acute myocarditis is suggested to be more frequent than previously hypothesized. In this study, we sought to investigate subclinical RV involvement in patients with acute myocarditis and preserved RV ejection fraction (EF), using CMRI RV speckle-tracking imaging. Materials and Methods: CMRI of 27 patients with acute myocarditis (nine females, age 35.1 +/- 12.2 y) was retrospectively analyzed. A control group consisting of CMRI images of 27 healthy individuals was included. Results: No significant differences were found regarding left ventricle (LV) and atrium dimensions. LV ejection fraction was significantly different between groups (56.6 +/- 10.6 vs. 62.1 +/- 2.6, p < 0.05). No significant differences were present between parameters used for conventional assessment of RV. However, RV strain absolute values were significantly lower in the acute myocarditis group in comparison with that of the control group (18.4 +/- 5.4 vs. 21.8 +/- 2.8, p = 0.018). Conclusions: Subclinical RV dysfunction detected by CMR-derived strain may be present in patients with acute myocarditis even with preserved RVEF.
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    Comparison of effects of sugammadex and neostigmine on QTc prolongation in rabbits under general anesthesia
    (Acta Cirurgica Brasileira, 2014) Erbas, Mesut; Toman, Huseyin; Sahin, Hasan; Kiraz, Hasan Ali; Barutcu, Ahmet; Simsek, Tuncer; Yener, Ali Umit
    PURPOSE: To compare the effects of sugammadex and neostigmine, used to antagonize the effects of rocuronium, on the QT(c) interval. METHODS: This study used 10 adult New Zealand white rabbits of 2.5-3.5 kg randomly divided into two groups: sugammadex group (Group S, n: 5) and neostigmine group (Group N, n: 5). For general anesthesia administering 2 mg/kg iv propofol and 1 mcg/kg iv fentanyl, 0.6 mg/kg iv rocuronium was given. Later to provide reliable airway for all experimental animals V-Gel Rabbit was inserted. The rabbits were manually ventilated by the same anesthetist. After the V-Gel Rabbit was inserted at 2, 5, 10, 20, 25, 27, 30 and 40 minutes measurements were repeated and recorded. At 25 minutes after induction Group N rabbits were given 0.05 mg/kg iv neostigmine + 0.01 mg/kg iv atropine. Group S were administered 2 mg/kg iv sugammadex. RESULTS: Comparing the QT(c) interval in the rabbits in Group S and Group N, in the 25th, 27th and 30th minute after muscle relaxant antagonist was administered the QT(c) interval in the neostigmine group rabbits was significantly increased (p < 0.05). CONCLUSION: While sugammadex, administered to antagonize the effect of rocuronium, did not significantly affect the QTc interval, neostigmine+atropine proloned the QT(c) interval.
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    Comparison of the GRACE risk score and the TIMI risk index in predicting the extent and severity of coronary artery disease in patients with acute coronary syndrome
    (Kare Publ, 2015) Bekler, Adem; Altun, Burak; Gazi, Emine; Temiz, Ahmet; Barutcu, Ahmet; Gungor, Omer; Ozkan, Muhammed Turgut Alper
    Objective: The prognostic value of the Global Registry of Acute Coronary Events (GRACE) risk score (GRS) and the Thrombolysis In Myocardial Infarction (TIMI) risk index (TRI) has been reported in coronary artery disease (CAD) patients. We aimed to evaluate the relationship between the GRS, TRI, and severity of CAD evaluated by SYNTAX score (SS) in patients with acute coronary syndrome (ACS). Methods: Patients with ACS who were admitted to the coronary care unit of our institution were retrospectively evaluated in this study. A total of 287 patients with ACS [154 non-ST elevated ACS (NSTE-ACS), 133 ST elevated myocardial infarction (STEMI)] were included in the study. The GRS and TRI were calculated on admission using specified variables. The severity of CAD was evaluated using the SS. The patients were divided into low (GRS<109)-, intermediate (GRS 109-140)-, and high (GRS>140)-risk groups and group 1 (TRI<17), group 2 (TRI 17-26), and group 3 (TRI>26) according to GRS and TRI scores. A Pearson correlation analysis was used for the relation between GRS, TRI, and SS. Results: Patients with a history of coronary artery bypass surgery, those who had missing data for calculating the GRS and TRI, and those whose systolic blood pressure (SBP) was more than 180 mm Hg or whose diastolic blood pressure (DBP) was more than 110 mm Hg were excluded from the study. Were excluded from the study. There were significant differences in mean age (p<0.001), heart rate (p<0.001), SS (p<0.001), TRI (p<0.001), rate of NSTE-ACS (p<0.001), and STEMI (p<0.001) in all patients between the risk groups. There was a positive significant correlation between the GRS and the SS (r=0.427, p<0.001), but there were no significant correlation between the TRI and SS (r=0.121, p=0.135). The area under the ROC curve value for GRS was 0.65 (95% CI: 0.56-0.74, p=0.001) in the prediction of severity of CAD. Conclusion: The GRS is more associated with SS than TRI in predicting the severity of CAD in patients with ACS.
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    Comprehensive Assessment of Heart Failure with Preserved Ejection Fraction Using Cardiac MRI
    (Elsevier Inc., 2021) Vega-Adauy, Julian; Tok, Özge Özden; Çelik, Ahmet; Barutcu, Ahmet; Vannan, Mani A.
    Heart failure with preserved ejection fraction (HFpEF) burden is increasing. Its diagnostic process is challenging and imprecise due to absence of a single diagnostic marker, and the multiparametric echocardiography evaluation needed. Left ventricular (LV) ejection fraction (LVEF) is a limited marker of LV function; thus, allocating HF phenotypes based on LVEF can be misleading. HFpEF encompasses a broad spectrum of causes, and its diagnostic criteria give a central role to echocardiography, a first-line technique with inherent limitations related to ultrasound capabilities. Conversely, cardiac magnetic resonance provides superior anatomic and functional assessment, enabling tissue characterization, offering unprecedented diagnostic precision.
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    Could elevated platelet-lymphocyte ratio predict left ventricular systolic dysfunction in patients with non-ST elevated acute coronary syndrome?
    (Turkish Soc Cardiology, 2015) Bekler, Adem; Gazi, Emine; Yilmaz, Mustafa; Temiz, Ahmet; Altun, Burak; Barutcu, Ahmet; Peker, Tezcan
    Objective: The prognostic value of a high platelet-lymphocyte ratio (PLR) has been reported in patients with non-ST elevated myocardial infarction (NSTEMI) and different oncologic disorders. We aimed to evaluate the predictive value of the PLR for left ventricular systolic dysfunction (LVSD) in patients with non-ST elevated acute coronary syndrome (NST-ACS). Methods: A total of 220 patients with NST-ACS were included in the study. The study population was divided into tertiles based on admission PLR values. High (n=73) and low PLR (n=147) groups were defined as patients having values in the third tertile (>135.6) and lower 2 tertiles (<= 135.6), respectively. Left ventricular dysfunction was defined as ejection fraction <= 40%, and related variables were evaluated by backward conditional binary logistic regression analysis. Results: The patients in the high PLR group were older (p<0.001) and had a higher rate of previous myocardial infarction and NSTEMI (p=0.046, p=0.013, respectively). There were significantly more coronary arteries narrowed (p=0.001) and lower left ventricular ejection fraction (p<0.001) in the high PLR group. Baseline platelet levels were significantly higher (p<0.001) and triglyceride and lymphocyte levels were significantly lower (p=0.009 and p<0.001, respectively) in the high PLR group. PLR >135.6 was found to be an independent predictor of systolic dysfunction in the multivariate analyses (beta: 0.306, 95% confidence interval: 0.151-0.619; p=0.001). Conclusion: A high PLR is a strong and independent predictor for LVSD in patients with NST-ACS.
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    Could Epicardial Adipose Tissue Thickness by Echocardiography Be Correlated with Acute Coronary Syndrome Risk Scores
    (Wiley, 2013) Altun, Burak; Colkesen, Yucel; Gazi, Emine; Tasolar, Hakan; Temiz, Ahmet; Simsek, Hicran Yildiz; Barutcu, Ahmet
    AimThe aim of our study was, echocardiographic epicardial adipose tissue (EAT) thickness could show the severity and the prognosis of acute coronary syndromes (ACS). Methods and ResultsSixty-five ACS patients (mean age 57.412.2years) who underwent coronary angiography were studied. EAT thickness on the free wall of right ventricle was measured at end-diastole from the parasternal long-axis views of 3 cardiac cycles. SYNTAX and Global Registry of Acute Coronary Events (GRACE) scoring considered for severity and the prognosis of ACS. The mean value of the EAT thickness were 5.5 +/- 0.5mm (range 1-12mm). EAT thickness had a positive correlation with high sensitive troponin T (r=0.712, P<0.001) and body mass index (r=0.522, P<0.001.) EAT thickness was significantly correlated patients with high SYNTAX score (r=0.690, P<0.001), but not correlated with GRACE score (r=0.224, P=0.072). ConclusionEpicardial adipose tissue thickness was correlated with angiographic severity of ACS, but not correlated with clinical prognosis risk score.
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    Covered stents may provide extra protection during carotid artery stenting in high risk patients with an excessive thrombus burden
    (2013) Tatli, Ersan; Barutcu, Ahmet; Gazi, Emine; Gunduz, Yasemin
    Carotid artery disease is an important cause of mortality and morbidity related to atherosclerosis. Recently, percutaneous intervention procedures have been widely used to treat atherosclerotic carotid artery disease. We report the case of a 57-year-old male patient with a history of acute amaurosis fugax. Carotid angiography was performed as blood pressure differed between his left and right arms and there was a pan-systolic murmur on the left common carotid artery. Total occlusion of the proximal right brachiocephalic artery and a thrombus occluding 90-99% of the left internal carotid artery were detected by carotid angiogram. A self-expanding graft-covered stent was successfully implanted and there were no complications. This case shows that graft-covered stents may be a good alternative technique in special situations. Copyright 2013 BMJ Publishing Group. All rights reserved.
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    Deep neural network ensemble for on-the-fly quality control-driven segmentation of cardiac MRI T1 mapping
    (Elsevier, 2021) Hann, Evan; Popescu, Iulia A.; Zhang, Qiang; Gonzales, Ricardo A.; Barutcu, Ahmet; Neubauer, Stefan; Ferreira, Vanessa M.
    Recent developments in artificial intelligence have generated increasing interest to deploy automated image analysis for diagnostic imaging and large-scale clinical applications. However, inaccuracy from automated methods could lead to incorrect conclusions, diagnoses or even harm to patients. Manual inspection for potential inaccuracies is labor-intensive and time-consuming, hampering progress towards fast and accurate clinical reporting in high volumes. To promote reliable fully-automated image analysis, we propose a quality control-driven (QCD) segmentation framework. It is an ensemble of neural networks that integrate image analysis and quality control. The novelty of this framework is the selection of the most optimal segmentation based on predicted segmentation accuracy, on-the-fly. Additionally, this framework visualizes segmentation agreement to provide traceability of the quality control process. In this work, we demonstrated the utility of the framework in cardiovascular magnetic resonance T1mapping - a quantitative technique for myocardial tissue characterization. The framework achieved nearperfect agreement with expert image analysts in estimating myocardial T1 value ( r = 0 . 987 , p < . 0 0 05 ; mean absolute error (MAE) = 11.3ms), with accurate segmentation quality prediction (Dice coefficient prediction MAE = 0.0339) and classification (accuracy = 0.99), and a fast average processing time of 0.39 second/image. In summary, the QCD framework can generate high-throughput automated image analysis with speed and accuracy that is highly desirable for large-scale clinical applications. (c) 2021 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )
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    Endothelial function and germ-line ACE I/D, eNOS and PAI-1 gene profiles in patients with coronary slow flow in the Canakkale population: multiple thrombophilic gene profiles in coronary slow flow
    (Clinics Cardive Publ Pty Ltd, 2014) Gazi, Emine; Temiz, Ahmet; Altun, Burak; Barutcu, Ahmet; Silan, Fatma; Colkesen, Yucel; Ozdemir, Ozturk
    Background: We examined the effects of ACE, PAI-1 and eNOS gene polymorphisms on endothelial function. The genes are related to atherosclerosis and endothelial dysfunction in coronary slow flow (CSF). Methods: Thirty-three patients with angiographically proven CSF and 48 subjects with normal coronary flow were enrolled in this study. Coronary flow patterns were determined by the thrombolysis in myocardial infarction (TIMI) frame count method. Endothelial function was assessed in the brachial artery by endothelium-dependent flow-mediated dilatation (FMD). PAI-1 4G/5G, eNOS T-786C and ACE I/D polymorphisms were determined by polymerase chain reaction (PCR) amplification. Results: No difference was found between the groups regarding age, heart rate and blood pressure. Males were more prevalent among patients with CSF than control subjects (58.8 vs 29.8%, p = 0.009). Mean TIMI frame counts were significantly higher in CSF patients (24.2 +/- 4.0 vs 13.1 +/- 2.5 fpm, p = 0.001). FMD was significantly lower in CSF patients than in the controls (4.9 +/- 6.6 vs 7.9 +/- 5.6%, p = 0.029). TIMI frame count and FMD were found to be negatively correlated in a correlation analysis (r = -0.269, p = 0.015). PAI-1 4G/5G, eNOS T-786C and ACE I/D polymorphisms were similar in the two groups. Conclusions: This study showed that endothelial function was impaired in patients with CSF. PAI-1, ACE and eNOS polymorphisms were not related to CSF in our study population.
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    Evaluation of the effect of coronary slow flow phenomenon on cardiac functions
    (Bayrakol Medical Publisher, 2022) Barutcu, Ahmet; Aksit, Ercan; Arslan, Mehmet; Tok, Oezge Oezden; Kuecuek, Ugur
    Aim: Although coronary slow flow phenomenon (CSFP) is seen in 2% of patients undergoing coronary angiography, its clinical significance and impact on ventricular function remain controversial. Cardiac magnetic resonance imaging (CMR) is the gold standard for evaluating ventricular function and volumes. In this study, we aimed to assess the impact of CSF on ventricular function using CMR-based deformation imaging.Material and Methods: This is a cross-sectional study. Twenty-two people were included in the study. Patients with structural heart disease and secondary coronary slow flow were excluded. Twelve subjects with CSFP and 10 subjects with normal flow and normal cardiac function were compared by CMR and CMR strain.Results: Left ventricle (LV) and right ventricle (RV) functions and volumes were similar. There was no difference between CMR strains in both groups. Furthermore, there was no correlation between age and heart function in patients with CSF.Discussion: CSF has no or limited impact on cardiac functions. Further long-term prospective studies should be carried out to establish the impact and significance of CSF in patients with CSF.