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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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    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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    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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    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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    The influence of ?-adducin gene polymorpism on response of blood pressure to exercise in patients with hypertension
    (Aves Yayincilik, 2010) Alioglu, Emin; Ercan, Ertugrul; Tengiz, Istemihan; Turk, Ugur Onsel; Ergun, Metin; Akgoz, Semra; Islegen, Cetin
    Objective: Clinical studies have indicated that an excessive response of blood pressure (BP) to exercise predicts risk of cardiovascular mortality. Although the mechanism responsible for the excessive BP response to exercise has not been revealed, there are some plausible mechanisms linking with underlying structural abnormalities in the cardiovascular system. Carriers of the Trp460 allele of the alpha-adducin Gly460Trp polymorphism have an increased risk of hypertension. The aim of the present study was to examine the influence of alpha-adducin gene polymorphism on response of BP to exercise in patients with hypertension. Methods: The cross-sectional observational study consisted of 49 hypertensive patients (29 women and 20 men; mean age, 53.1 +/- 8.8 years). All participants underwent a multistage exercise treadmill test according to the Bruce protocol. Arterial BPs were compared at rest, peak exercise and end of the recovery phase. Patients were classified according to their alpha-adducin gene polymorphisms; Gly460Gly homozygotes - Group 1 (n=28) and Trp460Trp homozygotes and Gly460Trp heterozygotes - Group 2 (n=21). Statistical analysis was performed using Chi-square, unpaired t, Mann-Whitney U and ANCOVA tests. Results: Mean exercise duration and mean exercise capacity in metabolic equivalents were not different between Group 1 and 2. The major finding of the study was that systolic BP responses at peak exercise and recovery period (3. min) were significantly higher (p=0.036) in hypertensive patients carrying at least one Trp460 allele of the alpha-adducin gene. Conclusion: Our results suggest that genetic variants that alter renal function and/or vasoreactivity are logical candidates to explain some of the individual variability in the BP response to exercise. (Anadolu Kardiyol Derg 2010; 10: 400-4)
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    The relationship between adiponectin, NT-pro-BNP and left ventricular ejection fraction in non-cachectic patients with systolic heart failure: an observational study
    (Aves, 2013) Tengiz, Istemihan; Turk, Ugur Onsel; Alioglu, Emin; Kirilmaz, Bahadir; Tamer, Gulden S.; Tuzun, Nurullah; Ercan, Ertugrul
    Objective: NT-pro-brain natriuretic peptide (NT-proBNP) has been shown to be an accurate diagnostic marker in patients with heart failure (HF). Adiponectin (Adp) levels are increased in HF but its diagnostic value is still uncertain in these patients. The study was designed to investigate the possible association of these markers in non-cachectic patients with newly diagnosed systolic heart failure. Methods: Fifty-seven systolic HF patients and 20 matched controls were enrolled in an observational cross-sectional study. Physical and echocardiographic examinations were performed and serum Adp, NT-proBNP, tumor necrosis factor-alpha (TNF-alpha) levels were measured. Study variables were compared between the groups. Correlation analyses were done and the diagnostic validity of the markers was compared with ROC analysis. Results: Adp and NT-proBNP levels were significantly higher in HF group (20.19 +/- 12.9 vs. 7.65 +/- 4.6 mu g/mL; p<0.001 and 1051.74 +/- 606.2 vs. 222.53 +/- 65.6 pg/mL; p=0.002; respectively). TNF-alpha levels were similar between the groups (2.83 +/- 1.8 vs. 2.08 +/- 1.2 pg/mL; p=0.582). Correlation analysis showed significant association among Adp and NT-proBNP levels, (r=0.448; p<0.001), and left ventricular ejection fraction (LVEF) values (r=-0.466; p<0.001). The Adp and NT-proBNP showed comparable diagnostic performances with mean [95% confidence interval] areas under the curves of 0.857 (0.771-0.944) and 0.888 (0.815-0.960), respectively. Conclusion: There were significant correlation between Adp levels with NT-proBNP levels and LVEF values but no any association between Adp levels with body mass index values and TNF-alpha levels in patients with newly diagnosed systolic heart failure. The result may arouse suspicion about the hypothesis, which proposes that Adp levels simply reflects disease severity or cardiac cachexia in patients with HF.