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    3D STRESS ECHOCARDIOGRAPHY EASIER TO USE COMPARED TO CONVENTIONAL METHOD PROVIDES HIGH PREDICTION RATE OF CORONARY ARTERY DISEASE
    (Elsevier Ireland Ltd, 2010) Kirilmaz, Bahadir; Turk, Ugur Onsel; Saygi, Serkan; Dogan, Huseyin; Tengiz, Istemihan; Ercan, Ertugrul
    [Anstract Not Available]
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    A Floating Thrombus in Sinus of Valsalva Complicated with Cardiogenic Shock in a Patient with Plasminogen Activator Inhibitor 1 4G/5G Polymorphism
    (Wiley-Blackwell, 2011) Saygi, Serkan; Alioglu, Emin; Karabulut, Mehmet Nuri; Turk, Ugur Onsel; Kirilmaz, Bahadir; Tuzun, Nurullah; Sahin, Fahri
    Thrombus in sinus of Valsalva is unusual reason for acute myocardial infarction. We demonstrated a case with floating thrombus in sinus of Valsalva obstructing the right coronary ostium intermittently, and causing cardiogenic shock. The patient was diagnosed with multiplane transesophageal echocardiography and treated successfully with surgical removal of mass. A homozygote polymorphism of plasminogen activator inhibitor (PAI) 1 4G/5G was found. This is the first report demonstrating a patient with PAI 1 polymorphism and thrombus of Valsalva complicated with cardiogenic shock. (Echocardiography 2011;28:E64-E167)
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    A Wandering Intravascular Scalpel Fragment After Lumbar Discectomy: A Case Report
    (Turkish Neurosurgical Soc, 2014) Aras, Adem Bozkurt; Ozkan, Omer Faruk; Alar, Timucin; Ozkan, Adile; Arik, M. Kasim; Kosar, Sule; Kirilmaz, Bahadir
    Vascular complications after lumbar discectomy are rarely seen. We present a unique and potentially life-threatening postoperative complication from this procedure. A 27-year-old man was admitted to our emergency vascular unit 1 day after a lumbar discectomy, during which a scalpel blade fragmented and a part was lost. Radiological images of the patient were performed and a broken scalpel blade was located anterior to the sacrum. An anterior laparotomy was performed which identified a mass within the left iliac vein that migrated suddenly to the inferior vena cava. An emergency angiography was performed, by which time the scalpel blade had ascended to the right-sided inferior pulmonary artery. It was subsequently removed via a right lateral thoracotomy.
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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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    Association Between Inherited Thrombophilia and Impaired Right Ventricular Function in Deep Vein Thrombosis Without Symptomatic Pulmonary Embolism
    (Sage Publications Inc, 2014) Asgun, Halil Fatih; Kirilmaz, Bahadir; Saygi, Serkan; Ozturk, Okan; Silan, Fatma; Karatag, Ozan; Kosar, Sule
    The aim was to evaluate the right ventricular function in patients with inherited thrombophilia and deep vein thrombosis (DVT) without pulmonary embolism. A total of 38 patients with DVT without symptomatic pulmonary embolism and 30 patients with varicose veins were enrolled. Clinical data, echocardiography, and 2 thrombophilic mutations were analyzed. Factor V Leiden (FVL) polymorphism was significantly frequent in the study group (P = .007). The difference in prothrombin G20210A polymorphism between the study and control groups was at a near-significant level (P = .058). There was statistically significant decrease in tricuspid annular plane systolic excursion values in patients with FVL and prothrombin G20210A polymorphism. Combined FVL and prothrombin G20210A polymorphisms were more closely related to the decrease in this value (P = .006). Deep vein thrombosis had no additional adverse effects on right ventricle. Impaired right ventricular systolic function occurs in FVL and prothrombin G20210A polymorphisms.
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    Association Between Resistin Level and Renal Function in Patients Undergoing Coronary Artery Bypass Graft Surgery
    (Bmj Publishing Group, 2012) Gungor, Hasan; Kirilmaz, Bahadir; Zorlu, Ali; Oguz, Emrah; Ayik, Mehmet Fatih; Kumak, Ferhat; Zoghi, Mehdi
    Aim: The purpose of this study was to evaluate the association between resistin levels and renal function in patients undergoing coronary artery bypass graft (CABG) surgery. Methods: Thirty-seven consecutive patients (mean +/- SD, age 60 +/- 10 years, 29 (78%) male) undergoing CABG surgery at our department were enrolled into our study. Blood samples were taken to examine quantities of resistin level and other blood parameters the day before surgery. The patients were categorized into 2 groups: lower resistin level (group 1) or higher resistin level (group 2) according to the median value of 9 ng/mL. Results: Mean + SD resistin level, glomerular filtration rate (GFR), and urea and creatinine levels were 9.5 +/- 4.2 ng/mL, 78 +/- 25 mL/min per 1.73 m(2), 42 +/- 14 mg/dL, and 1.08 +/- 0.2 mg/dL, respectively. Resistin showed significant correlation with serum levels of urea (r = 0.448l P = 0.005), creatinine (r = 0.367; P = 0.026), inverse correlation with GFR (r = -0.398; P = 0.015), statin usage (r = -0.393; P = 0.016), and A-blocker usage (r = -0.365; P = 0.026). In the multivariate logistic regression model, only GFR (odds ratio, 0.960; 95 confidence interval, 0.928-0.993; P = 0.018) remained independently associated with higher resistin levels after adjustment of other potential confounders in patients undergoing CABG surgery. According to the receiver operating characteristics curve analysis, the optimal cutoff value of GFR to predict higher resistin levels was found as 91 mL/min or less per 1.73 m(2), with 100% sensitivity and 61.1% specificity. Conclusion: The present study demonstrated that a lower glomerular filtration rate was associated with higher circulating resistin levels, independent of coronary heart disease risk factors in patients undergoing CABG surgery.
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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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    Comparison of Effects of Alpha Receptor Blockers on Endothelial Functions and Coagulation Parameters in Patients with Benign Prostatic Hyperplasia
    (Elsevier Science Inc, 2011) Alan, Cabir; Kirilmaz, Bahadir; Kocoglu, Hasan; Ersay, Ahmet Resit; Ertung, Yunus; Eren, Ali Erhan
    OBJECTIVE To investigate the effects of alpha receptor blockers used in the treatment of benign prostatic hyperplasia (BPH) on endothelial functions, coagulation parameters, and arterial blood pressure. MATERIALS AND METHODS One-hundred fifteen patients admitted to the treatment protocol because of symptomatic BPH were included in this prospective study. Patients were given the following treatments: doxazosin 4 mg/d (n = 25), terazosin 5 mg/d (n = 26), alfuzosin 10 mg/d (n = 26), tamsulosin 0.4 mg/d (n = 21), and observation (n = 17). All cases were evaluated before treatment and in the 12th week of treatment, according to biochemical parameters, endothelial functions, and arterial blood pressure. Biochemical parameters were bleeding time, coagulation time, prothrombin time, activated partial thromboplastin time, total prostate-specific antigen (PSA), and free PSA. Endothelial functions were evaluated with ultrasonography of the brachial artery. RESULTS When coagulation tests were evaluated, there were significant increases in bleeding and coagulation times in the groups using doxazosin and terazosin. Doxazosin and terazosin lowered arterial blood pressure significantly compared with other treatments. With regard to effects on endothelial function, there were significant differences in flow-mediated dilation rates of the brachial artery at 60 and 90 seconds before and during treatment in the alfuzosin and terazosin groups. CONCLUSIONS Alpha receptor blockers can decrease the risk of cardiovascular complications by both reducing platelet aggregation and protecting endothelial functions in patients with prostatic hyperplasia. The only drug with a favorable effect in all 4 areas of interest, including BPH symptoms, blood pressure, platelet aggregation, and endothelial functions, was terazosin. UROLOGY 77: 1439-1443, 2011. (C) 2011 Elsevier Inc.
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    Compartment Syndrome of the Vein Donor Leg Following an Uneventful Coronary Artery Bypass Surgery
    (Wiley, 2013) Asgun, Halil Fatih; Kirilmaz, Bahadir
    Compartment syndrome (CS) is a very rare complication of coronary artery bypass surgery (CABG) due to elevated intra-compartmental pressure induced by ischemia-reperfusion injury. We report a patient with CS following an uneventful CABG and discuss its management.
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    Detection of fetal keratin with high molecular weight cytokeratin immunostaining in lung biopsy material from a patient with amniotic fluid embolism
    (2013) Hacivelioglu, Servet; Oguzalp, Huseyin; Muratli, Asli; Asgun, Fatih; Kirilmaz, Bahadir; Omur, Dilek
    Amniotic fluid embolism (AFE) is a rare and fatal disorder in which the diagnosis can be challenging for clinicians and pathologists. A healthy 36-year-old woman (gravida 4, para 2) was admitted for delivery in the 40th week of gestation. At the fifth minute following birth, during expulsion of the placenta, the patient suddenly collapsed with bradycardia, shallow respiration, and loss of consciousness. After evaluation, an emergent pulmonary embolectomy for acute thrombo-embolism was performed, however the patient could not be weaned from cardiopulmonary bypass, and died of severe right ventricular dysfunction following the operation. Microscopic examination of the biopsy material detected clearly visible fetal epithelial squames inside pulmonary vessels, both with routine hematoxylin-eosin (HE) staining and immunostaining for high molecular weight cytokeratin (HMW-CK). The diagnosis of amniotic fluid embolism (AFE) was made, which was confirmed as the cause of death. We show that HMW-CK staining can be a useful means of detecting amniotic fluid-derived fetal keratin within alveolar tissue. We suggest that this technique, used in addition to HE staining and in combination with sudden-onset clinical findings, may increase the accuracy of diagnosis in AFE.
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    Digoxin intoxication: An old enemy in modern era
    (Science Press, 2012) Kirilmaz, Bahadir; Saygi, Serkan; Gungor, Hasan; Turk, Ugur Onsel; Alioglu, Emin; Akyuz, Serdar; Asgun, Fatih
    Objectives Although development of new treatment modalities limited digoxin usage, digoxin intoxication is still an important issue which could be easily overlooked. In this report, we analyzed a case series definitively diagnosed as digoxin intoxication in the modern era. Methods We analyzed 71 patients hospitalized with digoxin intoxication confirmed by history, complaints, clinical and electrocardiograph (ECG) findings, and serum digoxin levels > 2.0 ng/mL, during a five year period. The demographic and clinical data, indications for digoxin use, digoxin dosage, concurrent medications, laboratory data, hospital monitoring, and ECG findings were obtained from all patients. Results Thirty-eight of 71 patients (53.5%) had symptoms of heart failure during admission or later. Sixty-four percent of patients were older than 75 years. The percentage of females was 67%. Atrial fibrillation, hypertension and gastrointestinal complaints were more frequent in the females (64% in females, 30% in males, P = 0.007; 81% in female, 52% in males, P = 0.01; 50% in female, 17.3% in males, P = 0.008, respectively). The mortality rate during the hospital course was 7%. Conclusions This report demonstrated the reduced mortality rates in patients with digoxin intoxication over the study period. Gastrointestinal complaints are the most common symptoms in this population.
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    High Inflammatory Activity Related to the Number of Metabolic Syndrome Components
    (Wiley, 2010) Kirilmaz, Bahadir; Asgun, Fatih; Alioglu, Emin; Ercan, Ertugrul; Tengiz, Istemihan; Turk, Ugur; Saygi, Serkan
    It has been known that each component of the metabolic syndrome (MS) has an atherogenic potential and increases the risk of cardiovascular events. Therefore, patients who have MS are candidates for the development of atherosclerosis and accompanying complications. In this study, the authors assessed the levels of acute phase reactants as an indicator of inflammation in patients with MS. Twenty-five patients with recently diagnosed MS and not treated before who had at least 3 of 5 diagnostic criteria of MS listed in the Third Report of the Adult Treatment Panel National Cholesterol Education Program (NCEP-ATP III) guidelines were included in the study. Twenty healthy patients constituted the control group. Inflammatory parameters were compared between the groups. There was no significant difference between the MS and control group with regard to age and sex. White blood cell count (/mm(3)), high-sensitivity C-reactive protein (hs-CRP), uric acid, interleukin (IL) 6, and fibrinogen levels were found to be significantly higher in the MS group. Number of MS components was strongly correlated with serum levels of hs-CRP (r=0.688, P=.0001), IL-6 (r=0.546, P=.0001), fibrinogen (r=0.551, P=.0001), uric acid (r=0.517, P=.0001), and leucocyte count (/mmr3) (r=0.456, P=.002). Inflammation plays an important role in atherosclerotic complications, which is activated in MS. Increased number of MS components are strongly associated with elevated inflammatory and metabolic markers. Measurement of serum inflammatory parameters in patients with MS may be beneficial in detection and management of cardiovascular events and in the assessment of efficacy of treatment. J Clin Hypertens (Greenwich). 2010;12:136-144. (C)2009 Wiley Periodicals, Inc.
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    Left Atrial Appendage Function in Mitral Stenosis: Is It Determined by Cardiac Rhythm?
    (I C R Publishers, 2011) Saygi, Serkan; Turk, Ugur Onsel; Alioglu, Emin; Kirilmaz, Bahadir; Tengiz, Istemihan; Tuzun, Nurullah; Ercan, Ertugrul
    Background and aim of the study: The left atrial appendage (LAA) is a common source of cardiac thrombus formation associated with systemic embolism in patients with mitral stenosis (MS). Low flow velocities in the LAA are important factors in the development of thrombosis. Whilst oral anticoagulant therapy is used routinely in MS with atrial fibrillation (AF), the characteristics of LAA contractile functions and the protective role of oral anticoagulant treatment in patients with MS in sinus rhythm (SR) are unclear. The study aim was to compare LAA contractile functions in patients with MS who were either in SR or had AF. Methods: The study population comprised 51 patients with MS, who had undergone both standard transthoracic and transesophageal echocardiography. The patients were allocated to two groups, according to the presence of AF or SR. Ten healthy, gender-matched subjects were included in the study as a control group. Results: Except for age, the characteristics of the groups were similar. In patients with SR and AF, the LAA contractile functions were significantly lower than in controls. While the LAA contractile functions of the SR group were significantly lower than the AF group (LAA emptying/filling velocity: 26 +/- 7/24 +/- 8 versus 19 +/- 5/17 +/- 5 cm/s; p = 0.002 and p = 0.001, respectively, LAA maximum/minimum area: 5.4 +/- 1.2/3.2 +/- 0.9 versus 6.2 +/- 1.1/3.7 +/- 0.8 cm(2), p = 0.02 and p =0.02, respectively), no statistically significant differences were observed between patients in SR with mitral valve area (MVA) <= 1.5 cm(2) and patients in AF. Four SR patients (13%) and six AF patients (27%) had LAA thrombus. A strong correlation was observed between the MVA and LAA peak emptying/filling velocity in patients with MS in SR (r = 0.739, p = 0.0001 and r = 0.728, p = 0.0001, respectively). Conclusion: The study results showed that LAA contractile function is diminished in patients with moderate-severe MS in SR, and to a similar degree as patients in AF. It was concluded that patients with moderate-severe MS in SR have a higher risk for thromboembolic events than MS patients in AF.
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    Left atrial appendage function in mitral stenosis: Is it determined by cardiac rhythm?
    (2011) Saygi, Serkan; Turk, Ugur Onsel; Alioglu, Emin; Kirilmaz, Bahadir; Tengiz, Istemihan; Tuzun, Nurullah; Ercan, Ertugrul
    Background and aim of the study: The left atrial appendage (LAA) is a common source of cardiac thrombus formation associated with systemic embolism in patients with mitral stenosis (MS). Low flow velocities in the LAA are important factors in the development of thrombosis. Whilst oral anticoagulant therapy is used routinely in MS with atrial fibrillation (AF), the characteristics of LAA contractile functions and the protective role of oral anticoagulant treatment in patients with MS in sinus rhythm (SR) are unclear. The study aim was to compare LAA contractile functions in patients with MS who were either in SR or had AF. Methods: The study population comprised 51 patients with MS, who had undergone both standard transthoracic and transesophageal echocardiography. The patients were allocated to two groups, according to the presence of AF or SR. Ten healthy, gendermatched subjects were included in the study as a control group. Results: Except for age, the characteristics of the groups were similar. In patients with SR and AF, the LAA contractile functions were significantly lower than in controls. While the LAA contractile functions of the SR group were significantly lower than the AF group (LAA emptying/filling velocity: 26 ± 7/24 ± 8 versus 19 ± 5/17 ± 5 cm/s; p = 0.002 and p = 0.001, respectively, LAA maximum/minimum area: 5.4 ± 1.2/3.2 ± 0.9 versus 6.2 ± 1.1/3.7 ± 0.8 cm2, p = 0.02 and p =0.02, respectively), no statistically significant differences were observed between patients in SR with mitral valve area (MVA) ?1.5 cm 2 and patients in AF. Four SR patients (13%) and six AF patients (27%) had LAA thrombus. A strong correlation was observed between the MVA and LAA peak emptying/filling velocity in patients with MS in SR (r = 0.739, p = 0.0001 and r = 0.728, p = 0.0001, respectively). Conclusion: The study results showed that LAA contractile function is diminished in patients with mod-erate- severe MS in SR, and to a similar degree as patients in AF. It was concluded that patients with moderate-severe MS in SR have a higher risk for thromboembolic events than MS patients in AF. © Copyright by ICR Publishers 2011.
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    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, Emine
    PurposeCoronary 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.
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    Lipoprotein(a): A New Intensive Care Unit Admission Predictor in Coronavirus Disease 2019 Patients
    (Aves, 2023) Kucuk, Ugur; Kirilmaz, Bahadir; Sener, Alper; Alkan, Sevil; Vurucu, Servan; Aksit, Ercan
    OBJECTIVE: Endothelium-related events in patients with coronavirus disease 2019 are linked to a poor prognosis. Lipoprotein(a) plays a role in vascular endothelial cell dysfunction. This research aims to investigate whether baseline serum lipoprotein(a) levels could be a predictor for intensive care unit admission and related clinical parameters in coronavirus disease 2019 patients. MATERIAL AND METHODS: The research covers 126 patients who were hospitalized in intensive care unit or the non-intensive care unit in our hospital. This prospective cohort study was conducted from January 2021 to June 2021. The patients who were positive for severe acute respiratory syndrome coronavirus 2 according to real-time polymerase chain reaction test results were included in the study. Two groups were created according to the status of intensive care unit admission. Lipoprotein(a) was studied from blood samples taken at the time of hospital admission. RESULTS: According to the results of the first clinical evaluation, 46 patients were admitted to the intensive care unit and 80 patients were admitted to non-intensive care unit in the hospital. Patients with intensive care unit admission had significantly higher serum lipoprotein(a) levels than patients without intensive care unit admission (40.9 ng/mL and 17.4 ng/mL, P < .001, respectively). The regres-sion analysis revealed that serum lipoprotein(a) levels were independently related to intensive care unit admission (odds ratio 1.242, 95% CI 1.109-1.391, P < .001). In receiver operating characteristic curve analysis, lipoprotein(a) level & GE;31.42 ng/mL had 82.6% sensitivity and 72.5% specificity in predicting intensive care unit admission. The risk of intensive care unit admission was seen to be 12.522-fold higher in cases with lipoprotein(a) level & GE;31.42. CONCLUSION: Lipoprotein(a) could be used as a useful biomarker for the triage of coronavirus disease 2019 patients. Baseline serum lipoprotein(a) levels may serve as a useful prognostic biomarker in patients hospitalized for coronavirus disease 2019.
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    Long pentraxin-3 measured at late phase associated with GRACE risk scores in patients with non-ST elevation acute coronary syndrome and coronary stenting
    (Aves, 2012) Saygi, Serkan; Kirilmaz, Bahadir; Tengiz, Istemihan; Turk, Ugur Onsel; Yildiz, Hicran; Tuzun, Nurullah; Alioglu, Emin
    Objectives: We analyzed pentraxin 3 (PTX3) levels and the relation of PTX3 levels with GRACE risk scores in 39 patients with non-ST elevation acute coronary syndrome (ACS) and stabile angina after stenting. Study design: Seventeen patients with ACS and 22 patients with stabile angina who underwent coronary stenting were included in the study. PTX3 levels were measured serially at admission, at the 8th hour and at the 24th hour after stenting. Results: While diabetes and hypertension were more frequent in the stabile angina group, leukocyte counts were significantly higher in the ACS group. PTX3 levels measured at the 8th hour were significantly higher in the ACS group compared to the stabile angina group (p=0.003). Strong correlations were observed between 24th hour PTX3 levels and GRACE scores calculated for risk of death and death/MI at admission (in-hospital/to 6 months), and for risk of death/MI at discharge to 6 months (R=0.571, p=0.01, R=0.564, p=0.01; R=0.558, p=0.02, R=0.512, p=0.03; R=0.653, p=0.004, respectively). Conclusion: The serum PTX3 levels may provide important information for the early risk stratification of patients with ACS who underwent coronary stenting.
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    Long-term Prognostic Significance of Pentraxin-3 in Patients with Non-ST Elevation Myocardial Infarction and Coronary Stenting
    (Galenos Publ House, 2022) Kucuk, Ugur; Kirilmaz, Bahadir; Ercan, Ertugrul
    Aim: We aimed to investigate the relationship of serially measured pentraxin-3 (PTX3) levels with Gensini risk score and cardiovascular mortality in long-term follow-up in patients who underwent percutaneous coronary intervention (PCI) with the diagnosis of non -ST elevation myocardial infarction (NSTEMI) and stable angina pectoris (SAP). Materials and Methods: Our study was planned retrospectively, and the long-term cardiovascular mortality results of patients with NSTEMI and SAP, who underwent PCI, were evaluated. Our study consisted of two groups, including the study and the control groups. Eighteen patients with NSTEMI who underwent PCI were included in the study group, and 37 patients with a diagnosis of SAP were included in the control group. Blood samples were taken from all patients for PTX3 measurements at the time of admission, at the 8th and 24th hours. Gensini scores were calculated before PCI. Results: PTX3 levels measured at the eighth hour were found to be numerically and statistically significant in NSTEMI patients compared to SAP patients [13.37 (5.47-27.75) and 5 (3.83-12.42), p=0.006]. PTX3 values measured at the time of admission were found to be associated with Gensini score (r=0.299, p=0.026). PTX3 values measured at the eighth hour were found to be independent predictors of long-term cardiovascular mortality (Hazard ratio: 1.294, 95% confidence interval: 1024-1.653, p=0.039). Conclusion: PTX3 may be helpful in identifying individuals at high risk for cardiovascular mortality in the long term in NSTEMI patients.