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Öğe 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, FahriThrombus 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)Öğe Decreased circulatory erythropoietin in hyperacute phase of myocardial ischemia(Elsevier Ireland Ltd, 2011) Alioglu, Emin; Ercan, Ertugrul; Tamer, Gulden Sonmez; Duman, Can; Turk, Ugur; Tengiz, Istemihan; Tuzun, NurullahPurpose: Erythropoietin provides cellular protection by inhibiting apoptosis. Myocardial damage related to the cardiac ischemia is more prominent especially in the first 6 h. In the present study, circulatory erythropoietin levels in response to cardiac ischemia were evaluated. Materials and methods: Patients with stable angina who underwent balloon angioplasty (study group, n = 55) and hospitalized for coronary angiography (as control group, n = 23) were enrolled into the study. Serum erythropoietin levels were measured in both groups in baseline, 6 and 18 h after the procedure. Results: Coronary balloon inflation time was accepted as duration of myocardial ischemia. Study group showed significant erythropoietin reduction at sixth hour compared to control group. Erythropoietin reduction at sixth hour was significantly correlated with duration of myocardial ischemia. Conclusion: Decreased circulatory erythropoietin levels in the early phase of acute cardiac ischemia may accelerate the apoptotic activity. Recombinant erythropoietin replacement to prevent erythropoietin decrease following cardiac ischemia may have negative effect on myocyte loss. (C) 2008 Elsevier Ireland Ltd. All rights reserved.Öğe 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, ErtugrulBackground 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.Öğe 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, ErtugrulBackground 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.Öğe 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, EminObjectives: 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.Öğe N-Acetylcysteine in Preventing Contrast-Induced Nephropathy Assessed by Cystatin C(Wiley-Hindawi, 2013) Alioglu, Emin; Saygi, Serkan; Turk, Ugur; Kirilmaz, Bahadir; Tuzun, Nurullah; Duman, Can; Tengiz, IstemihanAims: Prophylactic oral N-acetylcysteine (NAC) has been widely used for prevention of contrast-induced nephropathy (CIN). However, clinical studies have not been demonstrating this effect consistently because of evidence that NAC can alter serum creatinine levels without affecting glomerular filtration rate (GFR). We investigated NAC for the prevention of CIN by monitoring creatinine and cystatin C. Methods: We enrolled 113 patients (49 patients in NAC group and 64 patients in control group) with normal to subnormal GFR who were scheduled for cardiovascular procedures. Patients in NAC group receive acetylcysteine 600 mg twice a day, on the day before and on the day of cardiovascular procedure. All patients received a periprocedural intravenous infusion (volume expansion) of 1 ml/kg/h with 0.45% saline for 24 h (12 h before and 12 h after exposure to contrast medium). Serum cystatin C and creatinine levels were measured before and at 12, 24, and 48 h after procedure. Results: The incidence of cystatin C-based CIN was 28.5% (n = 14) in NAC and 23.4% (n = 15) in control group (p = 0.663) and serum creatinine-based CIN was 12.2% (n = 6) in NAC and 17.2% (n = 11) in control group (P= 0.468). In this study, oral NAC had no effect on the prevention of CIN in patients undergoing cardiovascular procedures. Conclusion: In this study, oral NAC administration does not reduce neither the incidence of cystatin C-based CIN nor serum creatinine-based CIN in patients undergoing cardiovascular procedures.Öğe Non ST-segment elevation myocardial infarction in patient with essential thrombocythemia(BMC, 2009) Alioglu, Emin; Tuzun, Nurullah; Sahin, Fahri; Kosova, Buket; Saygi, Serkan; Tengiz, Istemihan; Turk, UgurA 68-year-old woman presented with acute chest pain and a greatly increased platelet count. Cardiac catheterization revealed subtotal occlusion and a thrombus-like filling defect in the right coronary artery. The patient was successfully treated with intravenous tirofiban. Essential thrombocythemia was diagnosed based on bone marrow findings, clinical presentation and laboratory analysis. The relationship between intracoronary thrombus and essential thrombocythemia is discussed.Öğe Prediction of Head-Up Tilt Test Result: Is it Possible?(Wiley-Blackwell Publishing, Inc, 2010) Turk, Ugur; Alioglu, Emin; Kirilmaz, Bahadir; Duygu, Hamza; Tuzun, Nurullah; Tengiz, Istemihan; Zoghi, MehdiBackground: The determination of early, accurate, predictive criteria for a positive result would permit a reduction in the duration of the head-up tilt testing (HUTT). Previous studies propounded that existence of early sympathetic overreactivity (rapid and sustained increase in heart rate) during HUTT predicts positive result. However, the exact value of this variable is unknown. We analyzed the early heart rate (HR) responses to HUTT and evaluated their ability to predict HUTT result. Methods: Consecutive patients referred to the syncope unit of our center for recurrent unexplained syncope were studied. Results: We studied 189 consecutive patients and 67 (35%) patients had a negative HUTT; 122 (65%) patients had a positive HUTT. The early HR increase was defined as the maximum HR during the first 10 minutes of tilting minus the resting HR before tilting. The receiver-operator curves (ROCs) show the overall performance of the HR changes for predicting the HUTT result. For all variables, area under the ROC curve (AUC) was nearly equivalent to 0.50 and early HR increase was not a predictor of the negative result of HUTT (AUC = 0.546). Also there was no any significant correlation between the magnitude of early HR increase and patient age (r = -0.03, P = 0.76). Conclusions: The results suggest that the early increase in HR during the first 10 minutes of the HUTT may not be a useful parameter for predicting the test result. Many factors, such as late exaggeration in sympathetic activity during HUTT and age-dependent reduction in baroreflex sensitivity, may attenuate the predictive value of early HR increase. (PACE 2010; 33:153-158).Öğe 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, ErtugrulObjective: 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.Öğe Thrombotic occlusion of a left main coronary artery in a patient with prosthetic mitral valve(Turkish Soc Cardiology, 2010) Saygi, Serkan; Alioglu, Emin; Turk, Ugur; Tuzun, Nurullah; Kirilmaz, Bahadir; Tengiz, Istemihan; Ercan, Ertugrul[Anstract Not Available]
