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    Adjunctive Hyperbaric Oxygen Therapy or Alone Antibiotherapy? Methicillin Resistant Staphylococcus aureus Mediastinitis in a Rat Model
    (Soc Brasil Cirurgia Cardiovasc, 2015) Kurt, Tolga; Vural, Ahmet; Temiz, Ahmet; Ozbudak, Ersan; Yener, Ali Umit; Sacar, Suzan; Sacar, Mustafa
    Objective: In the post-sternotomy mediastinitis patients, Staphylococcus aureus is the pathogenic microorganism encountered most often. In our study, we aimed to determine the efficacy of antibiotic treatment with vancomycin and tigecycline, alone or in combination with hyperbaric oxygen treatment, on bacterial elimination in experimental S. aureus mediastinitis. Methods: Forty-nine adult female Wistar rats were used. They were randomly divided into seven groups, as follows: non-contaminated, contaminated control, vancomycin, tigecycline, hyperbaric oxygen, hyperbaric oxygen + vancomycin and hyperbaric oxygen + tigecycline. The vancomycin rat group received 10 mg/kg/day of vancomycin twice a day through intramuscular injection. The tigecycline group rats received 7 mg/kg/day of tigecycline twice a day through intraperitoneal injection. The hyperbaric oxygen group underwent 90 min sessions of 100% oxygen at 2.5 atm pressure. Treatment continued for 7 days. Twelve hours after the end of treatment, tissue samples were obtained from the upper part of the sternum for bacterial count assessment. Results: When the quantitative bacterial counts of the untreated contaminated group were compared with those of the treated groups, a significant decrease was observed. However, comparing the antibiotic groups with the same antibiotic combined with hyperbaric oxygen, there was a significant reduction in microorganisms identified (P<0.05). Comparing hyperbaric oxygen used alone with the vancomycin and tigecycline groups, it was seen that the effect was not significant (P<0.05). Conclusion: We believe that the combination of hyperbaric oxygen with antibiotics had a significant effect on mediastinitis resulting from methicillin-resistant Staphylococcus aureus. Methicillin-resistant Staphylococcus aureus mediastinitis can be treated without requiring a multidrug combination, thereby reducing the medication dose and concomitantly decreasing the side effects.
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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 serum hepcidin levels in patients with non-ST elevation myocardial infarction
    (Turkish Soc Cardiology, 2014) Altun, Burak; Altun, Mehzat; Acar, Gurkan; Kilinc, Metin; Tasolar, Hakan; Kucuk, Ahmet; Temiz, Ahmet
    Objective: Hepcidin is an acute-phase reactant produced in the liver displaying intrinsic antimicrobial activity. There are few studies about hepcidin considered to be acute and chronic inflammatory marker in acute coronary syndromes patients. We investigated in our study whether the level of hepcidin has increased in the acute phase of non-ST elevation myocardial infarction patients (NSTEMI) known as acute inflammatory aggravation of chronic atherosclerotic process. Methods: Seventy patients with NSTEMI and twenty healthy people were recruited as controls in this observational cross-sectional study. Serum hepcidin levels were determined by ELISA, and troponin levels were measured by standard laboratory methods. Levels of hepcidin and troponin were measured at admission and 6 hours later. Mean values of continuous variables were compared between groups using the Student t-test or Mann-Whitney U test, according to whether normally distributed or not, as tested by the Kolmogorov-Smirnov test. Serum troponin and hepcidin levels measured at admission and after 6th hours were compared using paired t-test. Results: Hepcidin level was similar between NSTEMI and controls at admission (24.55 +/- 32.13, 23.67 +/- 33.62 ng/mL, p>0.05, respectively). Also, serum hepcidin levels did not change significantly from baseline in blood samples taken after 6 hour from admission in NSTEMI patients (24.55 +/- 32.13 ng/mL, 29.75 +/- 31.48 ng/mL, p=0.62, respectively). However, serum troponin levels were increased significantly compared to baseline (0.29 +/- 3.56, 2.92 +/- 7.2 ng/mL, p<0.01). Conclusion: Our findings suggest that hepcidin could not be use as a marker of myocardial necrosis in acute phase such as troponin in patients with NSTEMI.
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    Assessment of serum hepcidin levels in patients with non-ST elevationmyocardial infarction
    (2014) Altun, Burak; Altun, Mehzat; Acar, Gürkan; Kılınç, Metin; Taşolar, Mehmet Hakan; Küçük, Ahmet; Temiz, Ahmet
    Objective: Hepcidin is an acute-phase reactant produced in the liver displaying intrinsic antimicrobial activity. There are few studies abouthepcidin considered to be acute and chronic inflammatory marker in acute coronary syndromes patients. We investigated in our study wheth-er the level of hepcidin has increased in the acute phase of non-ST elevation myocardial infarction patients (NSTEMI) known as acute inflam-matory aggravation of chronic atherosclerotic process.Methods: Seventy patients with NSTEMI and twenty healthy people were recruited as controls in this observational cross-sectional study.Serum hepcidin levels were determined by ELISA, and troponin levels were measured by standard laboratory methods. Levels of hepcidin andtroponin were measured at admission and 6 hours later. Mean values of continuous variables were compared between groups using theStudent t-test or Mann-Whitney U test, according to whether normally distributed or not, as tested by the Kolmogorov-Smirnov test. Serumtroponin and hepcidin levels measured at admission and after 6th hours were compared using paired t-test.Results: Hepcidin level was similar between NSTEMI and controls at admission (24.55±32.13, 23.67±33.62 ng/mL, p>0.05, respectively). Also, serum hepcidinlevels did not change significantly from baseline in blood samples taken after 6 hour from admission in NSTEMI patients (24.55±32.13 ng/mL, 29.75±31.48ng/mL, p=0.62, respectively). However, serum troponin levels were increased significantly compared to baseline (0.29±3.56, 2.92±7.2 ng/mL, p<0.01).Conclusion: Our findings suggest that hepcidin could not be use as a marker of myocardial necrosis in acute phase such as troponin in patientswith NSTEMI.
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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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    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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    Can the ankle brachial pressure index (ABPI) and carotis intima media thickness (CIMT) be new early stage markers of subclinical atherosclerosis in patients with rheumatoid arthritis?
    (Springer Wien, 2015) Kurt, Tolga; Temiz, Ahmet; Gokmen, Ferhat; Adam, Gurhan; Ozcan, Sedat; Ozbudak, Ersan; Sacar, Mustafa
    It takes years for atherosclerosis to manifest symptoms. However, it needs to be identified earlier because of the premature cardiovascular risk factors in patients with rheumatoid arthritis (RA). In this study, we aimed to investigate the effect of atherosclerosis on the ankle brachial pressure index (ABPI) and carotis intima media thickness (CIMT) in patients with RA. RA patients attending the rheumatology clinic were examined retrospectively; then we called them for the measurements of ABPI and CIMT prospectively. Subjects were divided into four groups, as follows (Table 1): group 1 comprised RA patients with an ABPI less than 0.9; group 2 included RA patients with an ABPI between 0.9 and 1.2; group 3 was made up of RA patients with an ABPI greater than 1.2; and group 4 included patients without RA with an ABPI between 0.9 and 1.2 as a control group. Patients' demographic data were recorded. Hypertension (HT), diabetes mellitus, ABPI and CIMT measurements were taken by specialists. Duration of RA and disease scores (disease activity score-28, health assessment questionnaire score and visual assessment score) were recorded. The prevalence of peripheral vascular disease in patients with RA was twice as high as that in the normal population of equivalent age. Patients in group 2, with RA and normal ABPI, exhibited a significant higher mean in CIMT (mm) compared with the control group (p < 0.01), despite having normal ABPI. This confirms that these patients have a higher risk of stroke compared with the control group. Group 1's newly diagnosed HT (p < 0.01) and systolic blood pressure (SBP) values (p < 0.01) were higher and statistically significant when compared with the group 4 (control group); in addition, significant plaque levels were observed in the carotid arteries (p < 0.01). Group 3 patients had a similar history of HT and increased SBP compared with patients in group 4 (p < 0.01), and had similar characteristics to with group 1. No statistically significant differences were found between the groups in terms of inflammatory markers such as C-reactive protein and rheumatoid factor, anti-cyclic citrullinated peptide and white blood cell counts. Based on the present findings, patients with RA need to be evaluated in the early stage of the disease for subclinical peripheral artery disease using the ABPI, as well as CIMT, which is also a non-invasive technique, in terms of cerebrovascular events. Inflammatory markers exhibited no statistically significant difference. We think that the atherosclerotic process stems not only from the inflammatory effects of RA, but also perhaps from its immunological nature.
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    Comparison of fragmented QRS and myocardial perfusion-gated SPECT findings
    (Lippincott Williams & Wilkins, 2013) Ozdemir, Semra; Tan, Yusuf Ziya; Colkesen, Yuecel; Temiz, Ahmet; Turker, Fatmanur; Akgoz, Semra
    AimFragmented QRS (fQRS) complex is an ECG parameter that has recently been introduced and investigated. It is assumed that fQRS occurs because of disruptions in ventricular conduction due to ventricular infarction and ischemia. Therefore, in this article, we aimed to investigate the relationship between the detection of infarction and ischemia on myocardial perfusion-gated single-photon emission computed tomography images and appearance of fQRS on ECG.Materials and methodsWe retrospectively reviewed the records of patients with a diagnosis of coronary artery disease who were referred to our institution for myocardial perfusion scintigraphy. In total, 261 patients (122 women and 139 men, with a mean age of 6110.33 years) with and without fQRS (136 and 125, respectively) were included in the present study. The myocardial perfusion scintigraphy results were evaluated for the presence or absence of myocardial ischemia and infarction by visual and quantitative (summed stress score, summed rest, summed difference score, summed motion score, and summed thickening score) assessments. Statistical analysis was performed to determine the relationship between the presence of fQRS and myocardial ischemia and/or infarction. Student's t-test and the Mann-Whitney U-test were used for comparing the results. Pearson's (2)-test and Fisher's exact tests were also used to compare the distribution of variables between the two groups.ResultsThe prevalence of ischemia and infarction were found to be, respectively, 4.38-fold and 5.95-fold higher in patients with fQRS compared with the control group. Moreover, the prevalence of both ischemia and infarction was found to be 10.54-fold higher in patients with fQRS compared with the control group.ConclusionThere is a highly statistically significant possibility of detecting ischemia and infarction in perfusion myocardial scintigrams of patients whose ECGs have fQRS. (C) 2013 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.
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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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    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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    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 Alper
    A 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.
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    Dispne nedeniyle başvuran hastada saptanan rüptüre olmamış dev asendan aort
    (Çanakkale Onsekiz Mart Üniversitesi, 2013-06) Temiz, Ahmet; Çetin, Mustafa; Erdoğan, Turan; Bostan, Mehmet; Altun, Burak
    [No Abstract Available]
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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; Sılan, Fatma; Colkesen, Yucel; Özdemir, Öztürk
    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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    Epicardial Adipose Tissue Thickness in Hemodialysis Patients
    (Wiley, 2014) Altun, Burak; Tasolar, Hakan; Eren, Necmi; Binnetoglu, Emine; Altun, Mehzat; Temiz, Ahmet; Gazi, Emine
    Aim: Hemodialysis (HD) patients had higher cardiovascular mortality and it is related to atherosclerosis. Epicardial adipose tissue (EAT) thickness is a marker of atherosclerosis and independent predictor of coronary artery disease. The aim of our study was to evaluate the relationship between EAT and carotid intima-media thickness (CIMT) predictors of early atherosclerosis in HD patients. Methods: The study included 62 HD patients and 40 healthy controls. EAT thickness and CIMT were measured by echocardiography in all subjects. Results: Epicardial adipose tissue thickness and CIMT were higher (6.98 +/- 1.67 vs. 3.84 +/- 0.73 mm, P < 0.001, 0.94 +/- 0.17 vs. 0.63 +/- 0.11 mm, P < 0.001, respectively) in HD patients than in control subjects. EAT thickness were correlated with CIMT, HD duration, age, and calcium. In addition, HD duration, CIMT, and age were independent predictors of EAT thickness on HD patients in regression analysis. Conclusion: Epicardial adipose tissue thickness may be a useful indicator of early atherosclerosis in HD patients.
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    EVALUATION OF EPICARDIAL FAT TISSUE THICKNESS AND CAROTID INTIMA MEDIA THICKNESS IN PATIENTS WITH PRIMARY HYPERPARATHYROIDISM AFTER PARATHYROIDECTOMY
    (Carbone Editore, 2017) Eroglu, Mustafa; Ozkul, Faruk; Erbag, Gokhan; Temiz, Ahmet; Altun, Burak; Arik, Kasim; Sen, Hacer
    Introduction: It has been shown that epicardial fat tissue (EFT) thickness in primary hyperparathyroidism (PHPT) is increased and that this is closely associated with cardiovascular disease and atherosclerosis. However, EFT thickness in patients with hyperparathyroidism who were treated with parathyroidectomy has not yet been studied. In this study we aimed to examine whether carotid intima-media thickness (CIMT) and EFT thickness would be affected after treatment of PHPT by parathyroidectomy. Materials and methods: 27 patients with PHPT who were diagnosed with a parathyroidectomy indication and 39 healthy volunteers were included in the study. For all patients with PHPT, anthropometric measurements were made before and 12 months after parathyroidectomy, and EFT thickness, CIMT, serum parathormone (PTH), calcium and lipid levels were measured. Results: It was observed that preoperative CIMT and EFT thickness in patients with PHPT were significantly higher than the control group (for both p<0.001). Although hyperparathyroidism and hypercalcemia of the patients improved after parathyroidectomy, no significant change in the thickness of CIMT or EFT was determined. Conclusions: CIMT and EFT thickness seem to be good cardiovascular indicators for diagnosis of patients with PHPT. Nevertheless, this study raises the question of the reliability of a decrease in these parameters in patient follow-up. It is therefore necessary to be more careful in evaluating these parameters after treatment of patients with PHPT.