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Öğe 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, AhmetBackground: 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.Öğe 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, UgurBackgroundVentricular 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.Öğe 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, UgurVentricular 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.Öğe 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, SemraObjective: 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.Öğe 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, AhmetBackground: 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.Öğe 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 AlperObjective: 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.Öğe 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, TezcanObjective: 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.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 Eosinophil count is related with coronary thrombus in non ST-elevated acute coronary syndrome(Palacky Univ, Medical Fac, 2015) Tenekecioglu, Erhan; Yilmaz, Mustafa; Bekler, Adem; Demir, SerafettinBackground. White blood cells are reported as important not only in plaque vulnerability but also in thrombus formation and thrombus growth in acute coronary syndromes. Eosinophils contain granules that promote thrombus formation and thrombus growth in some heart diseases. In this study we aimed to investigate the relation of eosinophil count with coronary thrombus formation in patients with non ST-elevated acute coronary syndrome (NST-ACS). Method. A total of 251 consecutive patients were hospitalized in our hospital with a diagnosis of NST-ACS. Venous blood is collected for measurement of hematologic indices in all patients undergoing the coronary angiography. Coronary angiographies were performed in our clinic using the standard Judkins technique and angiographic assessment of the presence of thrombus was made. Results. During coronary angiography, coronary thrombus was not detected in 82 patients (Group 1). In the coronary angiography of 169 patients, coronary thrombus was detected at various grades (Group 2). While the neutrophil count (6.84 +/- 1.94 vs. 5.53 +/- 1.37; P<0.001) and eosinophil count (0.257 +/- 0.125 vs. 0.163 +/- 0.114; P<0.005) was significnatly increased in the group with coronary thrombus, the lymphocyte count (1.87 +/- 0.66 vs. 2.00 +/- 0.70; P<0.001) was significantly decreased in the group with coronary thrombus as compared to the patient group without coronary thrombus. In the correlation analyzes; presence of coronary thrombus is correlated with total cholesterol, LDL-C, total CK, CK-MB, troponin, total number of diseased coronary, platelet count, neutrophil count, lymphocyte count and eosinophil count. On multivariate linear regression analysis, total leukocyte count, neutrophil count, lymphocyte count, eosinophil count, troponin and total cholesterol was found to be independent predictor of coronary thrombus in patients with NST-ACS. Conclusion. Beside the increased neutrophil count, increased eosinophil count in CBC should alert the clinician about coronary thrombus development in patients with NST-ACS in order to make early medical interventions at acute phase of the disease.Öğe Fragmented QRS and prediction of paroxysmal atrial fibrillation episodes(Professional Medical Publications, 2014) Temiz, Ahmet; Gazi, Emine; Gungor, Omer; Altun, Burak; Barutcu, Ahmet; Bekler, Adem; Tan, Yusuf ZiyaObjective: Prior studies have demonstrated the relationship between cardiovascular diseases and fragmented QRS (fQRS). fQRS was also associated with ventricular arrhythmias. Our objective was to find out the relationship between fQRS and paroxysmal atrial fibrillation (PAF). Method: A total of 301 patients without overt structural heart disease were prospectively included in the study. Patients were divided in to 2 groups according to presence of fQRS. Multivariate logistic regression analysis was used to assess the predictive value of fQRS for predicting PAF. Results: One hundred and three patients had fQRS. Patients with fQRS were older (53 +/- 16.8 vs 45.3 +/- 17.2, p < 0.001), with larger left atrium (LA) (33.2 +/- 5.9 vs 30.1 +/- 5.9 mm, p=0.001), with thicker interventricular septum (IVS) (10.2 +/- 1.9 vs 9.5 +/- 2.3 mm, p=0.032), more diabetic (19.8 vs 10.6%, p= 0.029) and have more PAF episodes (22.3 vs 4.1%, p < 0.001) in comparison with patients without fQRS. fQRS was an independent predictor of detecting PAF episode (odds ratio, 9.69; 95% confidence interval, 2.46-38.15, p= 0.001). Hypertension and diabetes mellitus were also predictive. Conclusion: The presence of fQRS independently predicted PAF episodes in holter monitoring (HM). Further studies are needed to clarify the clinical implications of this finding.Öğe Fragmented QRS is associated with frequency of premature ventricular contractions in patients without overt cardiac disease(Turkish Soc Cardiology, 2015) Temiz, Ahmet; Gazi, Emine; Altun, Burak; Gungor, Omer; Barutcu, Ahmet; Bekler, Adem; Tan, Yusuf ZiyaObjective: In this study, we aimed to demonstrate whether the presence of fragmented QRS (fQRS) is associated with the frequency of premature ventricular contractions (PVCs). Methods: We retrospectively analyzed 282 cases by 24-hour Holter monitorings (HMs) between August 2012 and February 2013. Firstly, the patients were divided into 2 groups with respect to presence of fQRS and then divided into 3 groups with respect to frequency of PVCs as Group 1: seldom PVC (<120 PVCs/day), Group 2: moderate-frequency PVC (120-720 PVCs/day), and Group 3: frequent PVC (>720 PVCs/day). We investigated the predictors of frequent PVCs by using multinomial logistic regression analysis. Results: Ninety-eight patients had fQRS. There was no difference between the 2 groups with respect to body mass index, gender, hypertension, and diabetes mellitus. Patients with fQRS were older (54.9 +/- 15.6 vs. 47.0 +/- 16.3, p<0.001) and had more family history of coronary artery disease (25% vs. 13%, p=0.012). Patients with fQRS was more likely to be on aspirin therapy (28.6% vs. 10.4%, p<0.001) and have a larger left atrium diameter (33.5 +/- 5.7 vs. 30.4 +/- 5.8, p=0.001). Presence of fQRS was significantly associated with the frequency of PVCs (for frequent PVC 27.7% vs. 7.6%, p<0.001; for moderate-frequency PVC 18.4% vs. 11.4%, p=0.012); 26.2% of Group 1 (n=202) had fQRS, 46.2% of Group 2 (n=39) had fQRS, and 65.9% of Group 3 (n=41) had fQRS. In the multinomial regression analysis, only age (odds ratio: 4.24, 95% confidence interval 2.08-8.64, p=0.001) and fQRS (odds ratio: 2.11, 95% confidence interval 1.00-4.45, p=0.05) were predictors of frequent PVCs. Conclusion: This study demonstrated that the presence of fQRS is associated with frequent PVCs in patients without overt structural heart disease.Öğe Increased Platelet Distribution Width Is Associated With Severity of Coronary Artery Disease in Patients With Acute Coronary Syndrome(Sage Publications Inc, 2015) Bekler, Adem; Ozkan, Muhammed Turgut Alper; Tenekecioglu, Erhan; Gazi, Emine; Yener, Ali Umit; Temiz, Ahmet; Altun, BurakPlatelet activation plays a pivotal role in acute coronary syndrome (ACS). We investigated the relationship between platelet distribution width (PDW) and severity of coronary artery disease (CAD) in patients with ACS. A total of 502 patients with ACS were enrolled. High (n = 151) and low PDW (n = 351) groups were defined as patients having values in the third tertile (>17%) and lower 2 tertiles (17%). There were significantly higher Gensini score (44 [10-168] vs 36 [2-132], P < .001), and neutrophil-lymphocyte ratio (3.1 [0.8-12.4] vs 2.5 [0.3-13], P = .012) and baseline platelet counts were significantly lower (220 [61-623] vs 233 [79-644] 10(3)/mm(3), P = .022) in the high PDW group. The variables PDW >17%, diabetes mellitus, and myocardial infarction were found to be associated with high Gensini score (odds ratio [OR]: 1.91, 95% confidence interval [CI]: 1.27-2.88, P = .002; OR: 2.85, 95%CI: 1.91-4.25, P < .001; OR: 2.67, 95% CI:1.74-4.1, P < .001, respectively). An increased PDW (>17%) is associated with severity of CAD in patients with ACS.Öğe Intercellular Adhesion Molecule-1 K469E and Angiotensinogen T207M Polymorphisms in Coronary Slow Flow(Karger, 2014) Gazi, Emine; Barutcu, Ahmet; Altun, Burak; Temiz, Ahmet; Bekler, Adem; Urfali, Mine; Sılan, FatmaObjective: To investigate intercellular adhesion molecule-1 (ICAM1) and angiotensinogen (AGT) gene polymorphisms, as related to atherosclerosis and endothelial dysfunction, in coronary slow flow (CSF). Subjects and Methods: The participants in this study were 48 patients with CSF and 67 patients with normal coronary flow as controls. The K469E polymorphism of ICAM1 (rs5498) and the T207M polymorphism of AGT (rs4762) were determined using the polymerase chain reaction amplification method. Results: Baseline demographic parameters were similar in both groups. The mean thrombolysis in myocardial infarction frame count was significantly higher in patients with CSF (23.8 +/- 5.1) compared to the controls (13.3 +/- 2.6, p < 0.001). A significant association was found between the ICAM1 K allele and CSF (OR: 1.96, 95% CI: 1.15-3.35, p = 0.013). There was no difference in the frequency of AGT T207M genotypes in the patients with CSF and the control subjects. Conclusion: This study showed that K469E polymorphisms of ICAM1 that play a role in atherosclerotic pathogenesis are related to CSF. (C) 2014 S. Karger AG, BaselÖğe 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 Is cardiopulmonary bypass simulator efficient for perfusion training?(Anatolian Journal of Clinical Investigation, 2015) Özkan, M. Turgut Alper; Yener, Ali Ümit; Özcan, Sedat; Bekler, Adem; Toman, Hüseyin; Saçar, MustafaHeart-lung machine, used in open heart surgeries performed in cardiovascular surgery department, has been managed by professional groups defined as perfusionists. The preparation for the operation of the heart-lung machine used during open heart surgery, running the machine during operation, monitoring, maintenance, crisis management and use of the machine in a harmony with the team during cardiac surgery require a certain knowledge and experience. We aimed to evaluate the contribution of theoretical and practical training with the support of a heart-lung machine simulator to skills of the students during the associate degree program. First term perfusion undergraduate students who took the same curriculum and took same number of total practical lessons in different years were included in the study. Between 2012-2013, 18 students following 1st term curriculum who had taken practical training in the operating room (Group 1) and between 2013-2014, 18 students following 1st term curriculum who had taken practical training in the simulation laboratory (Group 2), were tested in 50 parameters through knowledge (17), skills (17) and attitude (16). Group 1 was successful in 40.72 ± 3.58 parameters of the 50 parameters, and Group 2 was successful in 42.17 ± 3.55 parameters of the 50 parameters. There was no statistically significant difference between the two groups (p> 0.05). In our study, we evaluated the effect of simulation training with the system we created , and we observed no significant difference between two groups. © 2015, Anatolian Journal of Clinical Investigation. All rights reserved.Öğe Left Ventricular Twist Mechanics Are Impaired in Patients with Coronary Slow Flow(Wiley, 2015) Barutcu, Ahmet; Bekler, Adem; Temiz, Ahmet; Kirilmaz, Bahadir; Yener, Ali UEmit; Tan, Yusuf Ziya; Gazi, EminePurposeCoronary slow flow (CSF) is a rare condition described as the delayed angiographic passage of a contrast agent in the absence of stenosis in epicardial coronary arteries. Left ventricular (LV) systolic and diastolic dysfunctions have been described in the presence of CSF. However, the effect of CSF on LV twist functions has not been assessed. We aimed to evaluate the effects of CSF on LV twist mechanics using speckle tracking echocardiography (STE). MethodsTwenty CSF patients (24-60years) were enrolled according to the exclusion criteria. Twenty subjects with similar demographic characteristics and normal coronary arteries were the controls. Participants were evaluated with conventional echocardiography and STE. ResultsThe general characteristics of the two groups were similar. LV twist, LV torsion, and apical rotation were impaired in the CSF group (P=0.015, P=0.012, and P<0.001, respectively). Time to peak twist (TPT) and time to peak untwisting (TPU) were prolonged in CSF patients (P<0.001 and P<0.001, respectively). In the CSF group, rotation-deformation delay was shortened (P<0.001) and global longitudinal strain (GLS) was lower (P<0.001). The thrombolysis in myocardial infarction (TIMI) frame count was negatively correlated with LV twist, LV torsion and apical rotation (P=0.002, r=-0.624; P=0.002, r=-0.624; and P=0.002, r=-0.632, respectively). ConclusionsWe demonstrated that LV twist mechanics are impaired in CSF patients. Worse LV twist parameters were associated with greater TIMI frame count.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 Platelet/lymphocyte ratio and risk of in-hospital mortality in patients with ST-elevated myocardial infarction(Int Scientific Information, Inc, 2014) Temiz, Ahmet; Gazi, Emine; Gungor, Omer; Barutcu, Ahmet; Altun, Burak; Bekler, Adem; Binnetoglu, EmineBackground: Platelet-to-lymphocyte ratio (PLR) is a new prognostic marker in coronary artery disease. We aimed to evaluate the relationship between PLR and in-hospital mortality in patients with ST-elevated acute myocardial infarction (AMI). Material/Methods: The present study included 636 patients with ST-elevated AMI. The study population was divided into tertiles based on their admission PLR. Patients having values in the third tertile was defined as the high PLR group (n=212) and those having values in the lower 2 tertiles were defined as the low PLR group (n=424). Results: Risk factors of coronary artery disease and treatments administered during the in-hospital period were similar between the groups. Male patient ratio was found to be lower in the high PLR group (73% vs. 82.8%, p=0.004). In-hospital mortality was increased in the high PLR group when compared to the low PLR group (12.7% vs. 5.9%, p=0.004). The PLR > 144 was found to be an independent predictor of in-hospital cardiovascular mortality (HR: 2.16, 95% CI: 1.16-4.0, p=0.014). Conclusions: This study showed that PLR is an independent predictor of cardiovascular mortality in patients with ST-elevated AMI.Öğe Predictive value of elevated neutrophil-lymphocyte ratio for left ventricular systolic dysfunction in patients with non ST-elevated acute coronary syndrome(Professional Medical Publications, 2015) Bekler, Adem; Erbag, Gokhan; Sen, Hacer; Gazi, Emine; Ozcan, SedatObjective: We aimed to study the predictive value of the neutrophil-lymphocyte ratio (NLR) for left ventricular systolic dysfunction (LVSD) in patients with non ST-elevated acute coronary syndrome (NST-ACS). Methods: A total of 405 patients (mean age 62 years and 75% male) with NST-ACS were included in the study. The study population was divided into tertiles based on admission NLR values. The low, medium and high tertiles defined as NLR <= 1.81 (n=135), 1.81<=.3.2 (n=135) and NLR>3.2 (n=135), respectively. Results: The patients in the high NLR group were older (p<0.001), have higher rate of diabetes mellitus (p=0.028) and non-ST elevated myocardial infarction (NSTEMI) (p<0.001) and have lower left ventricular ejection fraction (LVEF) (p<0.001). Baseline WBC (p=0.02) and neutrophil (p<0.001) levels and NLR (p<0.001) were significantly higher, baseline hemoglobin (p=0.044), hematocrit (p=0.019) and lymphocyte (p<0.001) levels were significantly lower in the high NLR group. NLR was negatively correlated with LVEF in correlation analysis. An NLR >3.2 and age >= 70 were found to be an independent predictor of systolic dysfunction in multivariate analyses. Conclusion: An NLR >3.2 is a useful predictor for LVSD in patients with NST-ACS. The practice of using an NLR count on admission may be useful for identifying high-risk patients and their associated treatment methods.Öğe Predictors of coronary collaterals in patients with non ST-ellevated acute coronary syndrome: the paradox of the leukocytes(Termedia Publishing House Ltd, 2014) Tenekecioglu, Erhan; Yilmaz, Mustafa; Karaagac, Kemal; Bekler, Adem; Aslan, Burhan; Demir, Serafettin; Kuzeytemiz, MustafaAim of the study: Atherosclerosis represents active inflammation in which leukocytes play significant role. Coronary collateral development is a response to myocardial ischaemia. In this study we aimed to investigate the association of the leukocytes with coronary collateral development in patients with non ST-elevated acute coronary syndromes (NST-ACS). Material and methods: A total of 251 consecutive patients were hospitalized in our hospital with a diagnosis of NST-ACS. The blood samples were collected 1-hour after admission to the hospital and peripheral leukocytes (neutrophils, monocytes and lymphocytes) were examined. All patients underwent coronary angiography. The coronary collateral vessels (CCV) are graded according to the Rentrop scoring system. Results: Group 1 consisted of 146 patients with Rentrop 0 and Group 2 consisted of 105 patients with Rentrop I, 2 and 3. The presence of CCV was significantly associated with neutrophil count, lymphocyte count, monocyte count and neutrophil-lymphocyte ratio (NLR). In subgroup analyses, higher NLR was significantly associated with good CCV development in patients with NST-ACS. Conclusions: Higher neutrophil count, monocyte count and NLR and lower lymphocyte count on admission, were associated with the presence of CCV in patients with NST-ACS. High NLR may predict good collateral development in patients with NST-ACS.
