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Papers by Mustafa Akin

International Journal of Cardiology, 2010

Objective: Acute myocardial infarction (AMI) during the early postpartum period is rare but may b... more Objective: Acute myocardial infarction (AMI) during the early postpartum period is rare but may be associated with poor maternal outcome. We report an inferior AMI in 30-year-old woman with mitral valve replacement (MVR) during early postpartum period successfully treated with tirofiban. Case: A 30-year-old woman with MVR was admitted to our emergency department because of sudden onset chest pain on the third day after delivery. She did not have dyspnea, syncope, haemoptysis, or fever. She gave no history of cardiovascular risk factors. Her medical history included an operation of MVR approximately ten months ago. She had used warfarin for four months then began to take enoxaparine (2*1 SC) during pregnancy. Electrocardiography showed ST-segment elevation of 2 mm in leads DII, DIII, aVF and reciprocal ST depression in DI, aVL, V1-3. Echocardiography revealed hypokinesis of the inferior wall, with an overall ejection fraction estimated at 45%. Emergency coronary angiography demonstrated extensive thrombus load in the left circumflex coronary artery (LCx) and first obtus margin brunch (OM1). Because of significant amount of thrombus load and TIMI III flow in LCx and OM1, angioplasty did not performed. Additionally thrombolytic therapy was not administrated due to presence of vaginal hemorrhage. She was treated with aspirin, clopidogrel, metoprolol, enapril, rosuvastatin, nitroglycerin, unfractionated heparin and tirofiban infusion. Four hours after starting the therapy ST-segment normalization in inferior and V1-3 lead on electrocardiography was observed. The patient received tirofiban infusion for 48 hours. Total resolution of thrombus in LCx and OM1 was observed in control coronary angiography three days after medical therapy. Patient did not have any problems during follow-up period and she was discharged ten days after the admission. Discussion/Conclusion: AMI due to extensive intracoronary thrombus load without evidence of atherosclerotic disease in early postpartum period is a rare condition. For a patient that has got AMI due to massive thrombus and that is not suitable for percutaneous coronary intervention and has got contraindication to thrombolytic therapy, tirofiban infusion must be kept in mind. However, further studies are required to determine the efficacy and safety of tirofiban therapy (alone or adjunctive) use for AMI.

International Journal of Cardiology, 2008

Background: Levosimendan is a novel positive inotropic calcium sensitizer agent used in acute hea... more Background: Levosimendan is a novel positive inotropic calcium sensitizer agent used in acute heart failure. In acute heart failure, it improves hemodynamic parameters more favorably than the conventional positive inotropes. In this study, the effect levosimendan on E/E′ ratio as a noninvasive indicator of LV filling pressure was evaluated compared to dobutamine in a prospective, randomized, patient-blind manner. Methods: Patients with an LVEF b 40% admitting with acute heart failure attack with ischemic origin were included to this study. Patients were randomized to levosimendan (n = 30, mean age: 64 ± 10 years, 63% male) or dobutamine (n = 32, mean age: 66 ± 8 years, 54% male) groups. The ratio of the peak E wave velocity taken from mitral inflow with PW Doppler to the peak E′ wave velocity taken from mitral lateral annulus with tissue Doppler was determined. Pre-treatment and 24-hour after the treatment E/E′ ratios were calculated and then compared in both groups. Results: Age, gender, concomitant medications were similar in both groups (p N 0.05). There was no difference for pre-treatment baseline E/E′ ratios between levosimendan and dobutamine groups (15.7 ± 4.0 vs 15.2 ± 7.5 respectively, p = 0.1). There were significant reductions in posttreatment E/E′ ratios in levosimendan (15.7 ± 4.0 vs 9.3 ± 2.8, p = 0.01) and dobutamine groups (15.2 ± 7.5 vs 12.9 ± 5.6, p = 0.04). However, the reduction in levosimendan group was greater compared to dobutamine group (p = 0.01). Conclusions: Levosimendan causes a greater reduction of E/E′ ratio compared to dobutamine in acute systolic left heart failure. This may explain the more favorable hemodynamic effects of levosimendan when compared to conventional positive inotropics in patients with systolic left heart failure.

International Journal of Cardiovascular Imaging, 2008

Purpose In this study, demographic, clinic, electrocardiographic and angiographic properties of p... more Purpose In this study, demographic, clinic, electrocardiographic and angiographic properties of patients, on whom coronary angiography was performed with the pre-diagnosis of coronary artery disease (CAD) and whose ventriculography demonstrated typical apical hypertrophic cardiomyopathy (AHCM), were investigated. Methods Seventeen patients (mean age 58 ± 10 years, 10 male) with CAD pre-diagnosis, on whom coronary angiography was performed and had typical spade-like appearance on left ventriculography, were included in the study between January 2000 and May 2005. Results As risk factor for CAD, 8 (47%) patients had hypertension, 8 (47%) patients had dyslipidaemia, 2 (11%) patients had type 2 diabetes mellitus, 13 (77%) patients had a history of smoking, and 2 (11%) patients had family history. Seven (42%) patients presented unstable angina pectoris, 8 (47%) patients presented stable angina pectoris and 2 (11%) patients were asymptomatic. On coronary angiography, it was determined that 10 (58%) patients had normal coronary arteries, 3 (17%) patients had non-significant stenosis and 4 (25%) patients had myocardial bridging. Five (30%) patients revealed mid-ventricular obstruction and intraventricular gradient was 25 ± 5 mmHg by the catheterization. All patients showed ‘‘giant’’ negative (≥ 10 mm) T waves in the precordial leads, whereas 2 patients had atrial fibrillation. Maximum wall thickness was measured as 18 ± 4 mm in the apical region by transthoracic echocardiography. One patient (5%) who had mid-ventricular obstruction developed atrial fibrillation during 2 years follow-up, though any other events did not occur during hospitalization or follow-up period. Conclusions Physicians caring for patients with chest pain should consider AHCM in their differential diagnosis in case of a patient with chest pain and electrocardiographic changes suggestive of CAD.

International Journal of Cardiology, 2002

Left ventricular hypertrophy (LVH) increases the risk of ventricular arrhythmias and sudden death... more Left ventricular hypertrophy (LVH) increases the risk of ventricular arrhythmias and sudden death and has a significant effect on total cardiovascular mortality. QT dispersion (QTd) is a measure of inhomogeneous repolarization and is used as an indicator of arrhythmogenicity. In this study we detected QTd in patients with different etiologies of left ventricular hypertrophy and the effect of LVH in QTd on endurance athletes. The study group consisted of 147 white male subjects with 3 different etiologies of LVH and 30 healthy male individuals. The underlying etiologies of LVH were essential hypertension, valvular aortic stenosis and long-term training (athletic heart). QTd was measured by surface electrocardiogram and Bazett's formula was used to correct QTd for heart rate (QTcd). Left ventricular mass was determined by transthoracic echocardiography and left ventricular mass index was calculated in relation to body surface area. The QTcd was significantly higher in patients with pathological LVH (due to hypertension and aortic stenosis) than in the athletes' group (physiological LVH) and healthy subjects (P<0.05). The magnitude of QTcd was similar between athletes and the control group (P=0.6). The difference of QTcd between the groups with pathological LVH was not statistically significant (P=0.1). In conclusion; the increasing of QT dispersion is associated with only pathological conditions of LVH. The left ventricular hypertrophy has not a negative effect in QT dispersion on endurance athletes. The measurement of QT dispersion may be a non-invasive useful method for screening additional pathological conditions in endurance athletes.

International Journal of Cardiology, 2008

Background: Inflammation is one of the key mechanism in the development and progression of corona... more Background: Inflammation is one of the key mechanism in the development and progression of coronary artery disease. Myocardial bridging (MB) increases the tendency for development of atherosclerosis. The role of inflammation on the development of atherosclerosis in the MB is not clear. In this study, we investigated the existence of inflammation in the patients who have atherosclerotic plaque in the bridged segment. Methods: This study included 40 patients (group I) presented with stable angina pectoris and detected MB in LAD on coronary angiography and 30 control subjects (group II) with normal coronary angiogram. Patients in group I were divided into two subgroups based on the findings on intravascular ultrasound (IVUS): group IA included 25 patients without atherosclerotic lesion in any coronary artery and group IB included 15 patients with atherosclerotic lesion in addition to MB in bridged segment of LAD. High-sensitivity C-reactive protein (hs-CRP) levels were compared between group I and II and group IA and IB. Results: IVUS showed an atherosclerotic involvement with the proximal segment of MB in 15 patients (= group IB). No plaques were seen in other coronary arteries, in distal of MB or in the bridged segment. With regards to the level of hs-CRP, while no difference was established between group I and group II (1.7 ± 0.4 mg/L vs 1.9 ± 0.6 mg/L, p N 0.05), hs-CRP was significantly higher in group IB than in group IA (3.2 ± 0.3 mg/L vs 1.5 ± 0.2 mg/L, p = 0.001) and control group (3.2 ± 0.3 mg/L vs 1.9 ± 0.6 mg/L, p = 0.03). A significant positive correlation was detected between the hs-CRP and the percentage of atherosclerotic stenosis on IVUS in group IB (R = 0.639, p = 0.01). Conclusions: These results indicate the presence of a low grade inflammation in patients with atherosclerotic lesion in bridged segment.

Clinical Research in Cardiology, 2008

Objective The lack of nocturnal decline in blood pressure (BP) is associated with an increase in ... more Objective The lack of nocturnal decline in blood pressure (BP) is associated with an increase in cardiovascular events. Soluble CD40 ligand (sCD40L) is involved in the pathogenesis of risk factor-related vascular damage. The purpose of this study was to examine the relationship between vascular endothelial functions, carotid intima-media thickness (cIMT), plasma sCD40L levels and circadian BP profile in patients with essential hypertension. Material and methods The study population consisted of 81 essential hypertensive out-patients. BP dipping was defined as a night-to-day systolic and diastolic decrease ≥10%. Forty-seven dipper and 34 nondipper patients were compared. High sensitivity C-reactive protein (hs-CRP), sCD40L and urinary albumin were measured. Brachial artery flow-mediated dilatation (FMD) and cIMT was compared between the groups. Results sCD40L level (3.28 ± 2.08 and 2.30 ± 1.99 ng/ml, respectively, P = 0.036) and urinary albumin concentration (36.7 ± 20.1 and 23 ± 29.7 mg/l, respectively, P < 0.0001) were higher in nondippers than in dippers. Serum hs-CRP levels were not significantly different. FMD was found higher in dippers than nondippers (11.8 ± 3.9% and 6.6 ± 2.2%, respectively, P < 0.0001). The average cIMT was significantly higher in nondippers than dippers (0.928 ± 0.060 Vs. 0.734 ± 0.134 mm; P < 0.0001). Conclusions Nondipper patern has an additional negative effect on endothelial functions in hypertensive patients. Nondippers have enhanced sCD40L levels, which may contribute to their increased susceptibility to develop vascular damage.

Heart and Vessels, 1996

A 34-year-old man presenting with angina both at rest and on exertion was investigated. He develo... more A 34-year-old man presenting with angina both at rest and on exertion was investigated. He developed severe ST segment elevation and a brief period of ventricular tachycardia during an exercise tolerance test. On coronary angiography, 60% fixed luminal narrowing was observed in the proximal left anterior descending coronary artery and a severe spasm developed at this site, leading to temporary total occlusion of the vessel. Successful coronary angioplasty (PTCA) was performed on this lesion, with a residual 15% narrowing. However, the patient had a recurrence of angina 3 weeks later, despite being administered high doses of nitrate and calcium antagonist. During control angiography, the lesion severity was unchanged, but spasm developed again following contrast injection. At this time, a Palmaz-Schatz stent was implanted. Calcium antagonist, nitrate, Ticlopidine and low molecular weight heparin therapy was started. There was no recurrence of symptoms during a 3-month follow-up. The exercise tolerance test, and myocardial perfusion scintigraphy findings were normal and the stent was patent without restenosis at the end of the 3-month follow-up. Intracoronary stent implantation for persistent coronary spasm refractory to conventional medical therapy can be considered a feasible and attractive treatment modality for the control of symptoms.

Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques, 2006

Objective: The relationship between myocardial bridging (MB) and ischemic heart disease is still ... more Objective: The relationship between myocardial bridging (MB) and ischemic heart disease is still controversial. In this study, we aimed to evaluate the existing atherosclerosis and noninvasive endothelial function of brachial artery in patients with MB. Methods: The present study included 50 patients (group I) who had MB in left anterior descending (LAD) on coronary angiography. All of the coronary artery segments were evaluated by intravascular ultrasound (IVUS). Endothelial function was assessed with measurement of flow-mediated dilatation (FMD) and nitrate-dependent dilatation in the brachial artery. The study also included 30 healthy control subjects (group II). Patients in the group I were further subdivided into two subgroups based on the findings on IVUS: group IA included 20 patients without atherosclerotic lesions and group IB included 30 patients with atherosclerotic coronary artery disease in addition to MB. Results: FMD values were found to be significantly lower in the patients with MB (group I) than in the control (6.4 ± 3% vs 11 ± 4%, P <0.001). In regard to FMD values in subgroups, FMD was 7 ± 2% in the group IA and 5.8 ± 1% in the group IB (P = 0.023). On IVUS, atherosclerotic plaque was found proximal to the bridge in the same coronary artery segment in addition to MB in 75% of the patients in group I (group IB). No atherosclerotic plaque was found in within or distal segments of MB. Conclusion: Endothelial function is impaired in patients with MB and there is an increased tendency for atherosclerosis proximal to the bridge in the patients with MB. Endothelial dysfunction is more severe in the patients with atherosclerosis proximal to the bridge.

Journal of The Renin-angiotensin-aldosterone System, 2005

We demonstrated that increased premature CHD risk is associated with higher frequencies of the AC... more We demonstrated that increased premature CHD risk is associated with higher frequencies of the ACE DD and AGT MM genotypes. These findings indicate a synergistic contribution of ACE DD and AGT MM polymorphisms to the development of premature CHD. Also, our results suggest that family history, smoking, diabetes, hypertension, obesity and ACE DD genotype were independent risk factors for premature CHD.

Cardiology in The Young, 2007

International Journal of Cardiology, 2000

We present a case of ruptured aneurysm of sinus of valsalva (ASV) along with subaortic ventricula... more We present a case of ruptured aneurysm of sinus of valsalva (ASV) along with subaortic ventricular septal defect (VSD). Transesophageal echocardiographic examination in addition to transthoracic echocardiography provides more powerful information about ASVs and coexistent cardiac malformations. This may be additional value for the cardiac surgeon planning resection of the lesion.

Catheterization and Cardiovascular Diagnosis, 1992

Balloon mitral valvuloplasty with Inoue technique was performed in two group of patients. In grou... more Balloon mitral valvuloplasty with Inoue technique was performed in two group of patients. In group I (n = 40) valvuloplasty was performed under fluoroscopy without using echocardiography, whereas in group II (n = 13) valvuloplasty was performed under the guidance of transesophageal echocardiography alone, without using fluoroscopy. Patients in two groups were comparable with regard to clinical variables and hemodynamic parameters. Two female patients in group II were pregnant.Transmitral pressure gradient decrease did not differ significantly between two groups (pressure gradient: 17 ± 5 to 4 ± 1 in group I and 15 ± 4 to 3 ± 1 mm Hg in group II). Mitral valvular area increase was also not different in two groups (1.09 ± 0.2 cm2 to 2.3 ± 0.5 cm2 in group I and 0.9 ± 0.2 to 2 ± 0.3 cm2 in group II). In 14 cases from group I and 2 cases from group II mitral regurgitation increased after valvuloplasty (p < .05). Left atrial perforation occurred in one patient from group I and 2 patients from group II.In conclusion, mitral balloon valvuloplasty under transesophageal echocardiographic guidance alone is a safe and effective procedure in the treatment of mitral stenosis.

International Journal of Cardiology, 1996

Takayasu arteritis is a non-spesific inflamatory process of unknown etiology affecting the aorta ... more Takayasu arteritis is a non-spesific inflamatory process of unknown etiology affecting the aorta and its branches. A retrospective study was done in 14 patients diagnosed as Takayasu arteritis. Eleven patients were female and three were male. Ages ranged from 12 to 30 years. Seven patients had type I arteritis, three patients type II arteritis, and four patients type III Takayasu arteritis. Successful angioplasty was performed in five cases.

Pace-pacing and Clinical Electrophysiology, 2008

Background: Recurrent vasovagal syncope (VVS) can be a severely disabling disorder that may lead ... more Background: Recurrent vasovagal syncope (VVS) can be a severely disabling disorder that may lead to an important deterioration of quality of life because of the severity and recurrence of episodes. This study sought to investigate the effectiveness of repeated orthostatic self-training in preventing syncope in patients with recurrent VVS.Methods: Eighty-two consecutive patients (mean age 41 ± 4 years, 37 males) with recurrent VVS episodes and positive head-up tilt testing (HUT) were enrolled in this study. The patients were then randomized (1:1) to conventional therapy or conventional therapy plus additional tilt training sessions. The patients were followed for spontaneous syncope for one year. Primary end-points were the recurrence of syncope, the number of episodes, and the interval of time to the first recurrence.Results: There were no significant differences of baseline clinical characteristics and parameters of HUT between the tilt training and control groups. The patients had 4 ± 2/year syncopal episodes prior to the HUT. The mean follow-up after randomization was 12 ± 2 months. Spontaneous syncope recurrence during follow-up was 56% (23 patients) versus 37% (15 patients) in the control and tilt training groups, respectively (P = 0.1). Time to first recurrence was also similar in both groups (70 ± 20 days vs 50 ± 15 days, P = 0.09). The frequency of recurrent syncopes was similar in all types of VVSs while the rate of episodes was significantly higher in control group in patients with vasodepressor type during follow-up period (32% vs 10%, P = 0.04). The mean number of recurrent syncope episodes was also similar in both groups (3 ± 1 vs 2 ± 1, P = 0.4).Conclusions: Tilt training was unable to influence the spontaneous syncope recurrence for recurrent VVS except for vasodepressor type.

Journal of Cardiac Surgery, 2004

Percutaneous transbrachial insertion of two complex coils into the intercostal branch of the left... more Percutaneous transbrachial insertion of two complex coils into the intercostal branch of the left internal mammary artery resulted in the relief of severe angina in a 45-year-old man who had coronary artery bypass surgery 2 years before. The diagnosis of coronary artery steal was made clinically. This case illustrates the importance of recognizing coronary steal in patients who redevelop angina after coronary artery surgery with the use of an incompletely prepared left internal mammary artery as a conduit. Brachial or radial artery should be preferred to reach left internal mammary artery (LIMA) for cannulation easily. The preoperative angiographic imaging of LIMA is important to detect the side branches and their sizes. The patient was treated without the need for further surgery

Primary spontaneous coronary artery dissection is one of the rare causes of acute myocardial infa... more Primary spontaneous coronary artery dissection is one of the rare causes of acute myocardial infarction. Previous studies reports that it is mostly seen in middle aged women in the last trimester of pregnancy and early postpartum period. Clinical presentation of the disease is variable in pattern and severity related to extent and development rate of dissection. In the last 2 years, nine non-pregnant primary spontaneous coronary artery dissection cases were found in coronary angiography among 3750 patients prediagnosed as coronary artery disease. The cases were presented and discussed with review of the pertinent literature. q

Journal of The American Society of Echocardiography, 2007

In this study, we investigated the sensitivities of dobutamine stress echocardiography (DSE) and ... more In this study, we investigated the sensitivities of dobutamine stress echocardiography (DSE) and integrated backscatter (IBS) in detecting ischemia in patients with symptomatic myocardial bridging (MB). Fourteen patients given the diagnosis of MB in the left anterior descending coronary artery as shown by coronary angiography were enrolled. All patients underwent DSE and stress IBS. The cyclic variation of IBS (CVIBS) was taken from the midanteroseptal, midinferior, and midposterolateral areas of the parasternal short-axis images at rest, low dose, peak dose, and recovery. The low-dose, peak-dose, and recovery CVIBS data were compared with baseline values. At peak dose, hypokinesia was observed in the left anterior descending coronary artery region in two patients (14%). A significant reduction in CVIBS was detected only when compared with the baseline at peak dose in the anteroseptal wall (8.4 +/- 1.3 vs 5.9 +/- 0.8, P = .003). A significant negative correlation was found between the CVIBS and the systolic narrowing percentage (R = -0.856, P = .001) and the length of MB (R = -0.576, P = .01) in the anteroseptal wall at peak dose. Whereas DSE is not sufficiently sensitive in the detection of ischemia in patients with symptomatic MB, the reduction in CVIBS during DSE may be an objective sign of ischemia.

International Journal of Cardiology, 1996

Takayasu arteritis is a non-spesific inflamatory process of unknown etiology affecting the aorta ... more Takayasu arteritis is a non-spesific inflamatory process of unknown etiology affecting the aorta and its branches. A retrospective study was done in 14 patients diagnosed as Takayasu arteritis. Eleven patients were female and three were male. Ages ranged from 12 to 30 years. Seven patients had type I arteritis, three patients type II arteritis, and four patients type III Takayasu arteritis. Successful angioplasty was performed in five cases.

European Journal of Cardio-thoracic Surgery, 2001

Primary spontaneous coronary artery dissection is one of the rare causes of acute myocardial infa... more Primary spontaneous coronary artery dissection is one of the rare causes of acute myocardial infarction. Previous studies reports that it is mostly seen in middle aged women in the last trimester of pregnancy and early postpartum period. Clinical presentation of the disease is variable in pattern and severity related to extent and development rate of dissection. In the last 2 years, nine non-pregnant primary spontaneous coronary artery dissection cases were found in coronary angiography among 3750 patients prediagnosed as coronary artery disease. The cases were presented and discussed with review of the pertinent literature. q

Thrombosis Research, 2005

Keywords: eNOS coronary heart disease single nucleotide polymorphism meta-analysis Introduction: ... more Keywords: eNOS coronary heart disease single nucleotide polymorphism meta-analysis Introduction: Growing studies have revealed the underlying association between eNOS 894 G/T (rs1799983) polymorphism and coronary heart disease (CHD) among Asia population. Results from these studies remained conflicting. We conducted this meta-analysis to estimate the overall CHD risk of eNOS 894 G/T polymorphism regarding Asia population. Materials and methods: Up to October 2011, databases including PubMed, Embase and CNKI (China National Knowledge Infrastructure) were searched to access the relevant genetic association studies. Summary odds ratios and corresponding 95% confidence intervals (CIs) for eNOS 894 G/T polymorphism and CHD risk were estimated using fixed or random-effects models when appropriate. Results: 18 case-control studies with 2,994 cases and 3,130 controls were available for this study, including 13 studies of East-Asia descendents, 5 studies of Non East-Asian descendents. The mean T allele frequency was 0.111 in the East-Asia population and 0.147 in the Non East-Asia population, respectively. The summary OR for CHD associated with the T allele was 1.52 (95% confidence intervals (95%CI), 1.37-1.69) by random effects model. Similarly, significantly increased risks were observed in the East-Asia population (OR = 1.54; 95%CI = 1.35-1.76) and in the Non East-Asia population (OR = 1.48; 95%CI = 1.24-1.77), respectively. Conclusions: This meta-analysis indicated that eNOS 894 G/T polymorphism may play an important role in CHD development among Asia population.

International Journal of Cardiology, 2010

Objective: Acute myocardial infarction (AMI) during the early postpartum period is rare but may b... more Objective: Acute myocardial infarction (AMI) during the early postpartum period is rare but may be associated with poor maternal outcome. We report an inferior AMI in 30-year-old woman with mitral valve replacement (MVR) during early postpartum period successfully treated with tirofiban. Case: A 30-year-old woman with MVR was admitted to our emergency department because of sudden onset chest pain on the third day after delivery. She did not have dyspnea, syncope, haemoptysis, or fever. She gave no history of cardiovascular risk factors. Her medical history included an operation of MVR approximately ten months ago. She had used warfarin for four months then began to take enoxaparine (2*1 SC) during pregnancy. Electrocardiography showed ST-segment elevation of 2 mm in leads DII, DIII, aVF and reciprocal ST depression in DI, aVL, V1-3. Echocardiography revealed hypokinesis of the inferior wall, with an overall ejection fraction estimated at 45%. Emergency coronary angiography demonstrated extensive thrombus load in the left circumflex coronary artery (LCx) and first obtus margin brunch (OM1). Because of significant amount of thrombus load and TIMI III flow in LCx and OM1, angioplasty did not performed. Additionally thrombolytic therapy was not administrated due to presence of vaginal hemorrhage. She was treated with aspirin, clopidogrel, metoprolol, enapril, rosuvastatin, nitroglycerin, unfractionated heparin and tirofiban infusion. Four hours after starting the therapy ST-segment normalization in inferior and V1-3 lead on electrocardiography was observed. The patient received tirofiban infusion for 48 hours. Total resolution of thrombus in LCx and OM1 was observed in control coronary angiography three days after medical therapy. Patient did not have any problems during follow-up period and she was discharged ten days after the admission. Discussion/Conclusion: AMI due to extensive intracoronary thrombus load without evidence of atherosclerotic disease in early postpartum period is a rare condition. For a patient that has got AMI due to massive thrombus and that is not suitable for percutaneous coronary intervention and has got contraindication to thrombolytic therapy, tirofiban infusion must be kept in mind. However, further studies are required to determine the efficacy and safety of tirofiban therapy (alone or adjunctive) use for AMI.

International Journal of Cardiology, 2008

Background: Levosimendan is a novel positive inotropic calcium sensitizer agent used in acute hea... more Background: Levosimendan is a novel positive inotropic calcium sensitizer agent used in acute heart failure. In acute heart failure, it improves hemodynamic parameters more favorably than the conventional positive inotropes. In this study, the effect levosimendan on E/E′ ratio as a noninvasive indicator of LV filling pressure was evaluated compared to dobutamine in a prospective, randomized, patient-blind manner. Methods: Patients with an LVEF b 40% admitting with acute heart failure attack with ischemic origin were included to this study. Patients were randomized to levosimendan (n = 30, mean age: 64 ± 10 years, 63% male) or dobutamine (n = 32, mean age: 66 ± 8 years, 54% male) groups. The ratio of the peak E wave velocity taken from mitral inflow with PW Doppler to the peak E′ wave velocity taken from mitral lateral annulus with tissue Doppler was determined. Pre-treatment and 24-hour after the treatment E/E′ ratios were calculated and then compared in both groups. Results: Age, gender, concomitant medications were similar in both groups (p N 0.05). There was no difference for pre-treatment baseline E/E′ ratios between levosimendan and dobutamine groups (15.7 ± 4.0 vs 15.2 ± 7.5 respectively, p = 0.1). There were significant reductions in posttreatment E/E′ ratios in levosimendan (15.7 ± 4.0 vs 9.3 ± 2.8, p = 0.01) and dobutamine groups (15.2 ± 7.5 vs 12.9 ± 5.6, p = 0.04). However, the reduction in levosimendan group was greater compared to dobutamine group (p = 0.01). Conclusions: Levosimendan causes a greater reduction of E/E′ ratio compared to dobutamine in acute systolic left heart failure. This may explain the more favorable hemodynamic effects of levosimendan when compared to conventional positive inotropics in patients with systolic left heart failure.

International Journal of Cardiovascular Imaging, 2008

Purpose In this study, demographic, clinic, electrocardiographic and angiographic properties of p... more Purpose In this study, demographic, clinic, electrocardiographic and angiographic properties of patients, on whom coronary angiography was performed with the pre-diagnosis of coronary artery disease (CAD) and whose ventriculography demonstrated typical apical hypertrophic cardiomyopathy (AHCM), were investigated. Methods Seventeen patients (mean age 58 ± 10 years, 10 male) with CAD pre-diagnosis, on whom coronary angiography was performed and had typical spade-like appearance on left ventriculography, were included in the study between January 2000 and May 2005. Results As risk factor for CAD, 8 (47%) patients had hypertension, 8 (47%) patients had dyslipidaemia, 2 (11%) patients had type 2 diabetes mellitus, 13 (77%) patients had a history of smoking, and 2 (11%) patients had family history. Seven (42%) patients presented unstable angina pectoris, 8 (47%) patients presented stable angina pectoris and 2 (11%) patients were asymptomatic. On coronary angiography, it was determined that 10 (58%) patients had normal coronary arteries, 3 (17%) patients had non-significant stenosis and 4 (25%) patients had myocardial bridging. Five (30%) patients revealed mid-ventricular obstruction and intraventricular gradient was 25 ± 5 mmHg by the catheterization. All patients showed ‘‘giant’’ negative (≥ 10 mm) T waves in the precordial leads, whereas 2 patients had atrial fibrillation. Maximum wall thickness was measured as 18 ± 4 mm in the apical region by transthoracic echocardiography. One patient (5%) who had mid-ventricular obstruction developed atrial fibrillation during 2 years follow-up, though any other events did not occur during hospitalization or follow-up period. Conclusions Physicians caring for patients with chest pain should consider AHCM in their differential diagnosis in case of a patient with chest pain and electrocardiographic changes suggestive of CAD.

International Journal of Cardiology, 2002

Left ventricular hypertrophy (LVH) increases the risk of ventricular arrhythmias and sudden death... more Left ventricular hypertrophy (LVH) increases the risk of ventricular arrhythmias and sudden death and has a significant effect on total cardiovascular mortality. QT dispersion (QTd) is a measure of inhomogeneous repolarization and is used as an indicator of arrhythmogenicity. In this study we detected QTd in patients with different etiologies of left ventricular hypertrophy and the effect of LVH in QTd on endurance athletes. The study group consisted of 147 white male subjects with 3 different etiologies of LVH and 30 healthy male individuals. The underlying etiologies of LVH were essential hypertension, valvular aortic stenosis and long-term training (athletic heart). QTd was measured by surface electrocardiogram and Bazett&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s formula was used to correct QTd for heart rate (QTcd). Left ventricular mass was determined by transthoracic echocardiography and left ventricular mass index was calculated in relation to body surface area. The QTcd was significantly higher in patients with pathological LVH (due to hypertension and aortic stenosis) than in the athletes&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; group (physiological LVH) and healthy subjects (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). The magnitude of QTcd was similar between athletes and the control group (P=0.6). The difference of QTcd between the groups with pathological LVH was not statistically significant (P=0.1). In conclusion; the increasing of QT dispersion is associated with only pathological conditions of LVH. The left ventricular hypertrophy has not a negative effect in QT dispersion on endurance athletes. The measurement of QT dispersion may be a non-invasive useful method for screening additional pathological conditions in endurance athletes.

International Journal of Cardiology, 2008

Background: Inflammation is one of the key mechanism in the development and progression of corona... more Background: Inflammation is one of the key mechanism in the development and progression of coronary artery disease. Myocardial bridging (MB) increases the tendency for development of atherosclerosis. The role of inflammation on the development of atherosclerosis in the MB is not clear. In this study, we investigated the existence of inflammation in the patients who have atherosclerotic plaque in the bridged segment. Methods: This study included 40 patients (group I) presented with stable angina pectoris and detected MB in LAD on coronary angiography and 30 control subjects (group II) with normal coronary angiogram. Patients in group I were divided into two subgroups based on the findings on intravascular ultrasound (IVUS): group IA included 25 patients without atherosclerotic lesion in any coronary artery and group IB included 15 patients with atherosclerotic lesion in addition to MB in bridged segment of LAD. High-sensitivity C-reactive protein (hs-CRP) levels were compared between group I and II and group IA and IB. Results: IVUS showed an atherosclerotic involvement with the proximal segment of MB in 15 patients (= group IB). No plaques were seen in other coronary arteries, in distal of MB or in the bridged segment. With regards to the level of hs-CRP, while no difference was established between group I and group II (1.7 ± 0.4 mg/L vs 1.9 ± 0.6 mg/L, p N 0.05), hs-CRP was significantly higher in group IB than in group IA (3.2 ± 0.3 mg/L vs 1.5 ± 0.2 mg/L, p = 0.001) and control group (3.2 ± 0.3 mg/L vs 1.9 ± 0.6 mg/L, p = 0.03). A significant positive correlation was detected between the hs-CRP and the percentage of atherosclerotic stenosis on IVUS in group IB (R = 0.639, p = 0.01). Conclusions: These results indicate the presence of a low grade inflammation in patients with atherosclerotic lesion in bridged segment.

Clinical Research in Cardiology, 2008

Objective The lack of nocturnal decline in blood pressure (BP) is associated with an increase in ... more Objective The lack of nocturnal decline in blood pressure (BP) is associated with an increase in cardiovascular events. Soluble CD40 ligand (sCD40L) is involved in the pathogenesis of risk factor-related vascular damage. The purpose of this study was to examine the relationship between vascular endothelial functions, carotid intima-media thickness (cIMT), plasma sCD40L levels and circadian BP profile in patients with essential hypertension. Material and methods The study population consisted of 81 essential hypertensive out-patients. BP dipping was defined as a night-to-day systolic and diastolic decrease ≥10%. Forty-seven dipper and 34 nondipper patients were compared. High sensitivity C-reactive protein (hs-CRP), sCD40L and urinary albumin were measured. Brachial artery flow-mediated dilatation (FMD) and cIMT was compared between the groups. Results sCD40L level (3.28 ± 2.08 and 2.30 ± 1.99 ng/ml, respectively, P = 0.036) and urinary albumin concentration (36.7 ± 20.1 and 23 ± 29.7 mg/l, respectively, P < 0.0001) were higher in nondippers than in dippers. Serum hs-CRP levels were not significantly different. FMD was found higher in dippers than nondippers (11.8 ± 3.9% and 6.6 ± 2.2%, respectively, P < 0.0001). The average cIMT was significantly higher in nondippers than dippers (0.928 ± 0.060 Vs. 0.734 ± 0.134 mm; P < 0.0001). Conclusions Nondipper patern has an additional negative effect on endothelial functions in hypertensive patients. Nondippers have enhanced sCD40L levels, which may contribute to their increased susceptibility to develop vascular damage.

Heart and Vessels, 1996

A 34-year-old man presenting with angina both at rest and on exertion was investigated. He develo... more A 34-year-old man presenting with angina both at rest and on exertion was investigated. He developed severe ST segment elevation and a brief period of ventricular tachycardia during an exercise tolerance test. On coronary angiography, 60% fixed luminal narrowing was observed in the proximal left anterior descending coronary artery and a severe spasm developed at this site, leading to temporary total occlusion of the vessel. Successful coronary angioplasty (PTCA) was performed on this lesion, with a residual 15% narrowing. However, the patient had a recurrence of angina 3 weeks later, despite being administered high doses of nitrate and calcium antagonist. During control angiography, the lesion severity was unchanged, but spasm developed again following contrast injection. At this time, a Palmaz-Schatz stent was implanted. Calcium antagonist, nitrate, Ticlopidine and low molecular weight heparin therapy was started. There was no recurrence of symptoms during a 3-month follow-up. The exercise tolerance test, and myocardial perfusion scintigraphy findings were normal and the stent was patent without restenosis at the end of the 3-month follow-up. Intracoronary stent implantation for persistent coronary spasm refractory to conventional medical therapy can be considered a feasible and attractive treatment modality for the control of symptoms.

Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques, 2006

Objective: The relationship between myocardial bridging (MB) and ischemic heart disease is still ... more Objective: The relationship between myocardial bridging (MB) and ischemic heart disease is still controversial. In this study, we aimed to evaluate the existing atherosclerosis and noninvasive endothelial function of brachial artery in patients with MB. Methods: The present study included 50 patients (group I) who had MB in left anterior descending (LAD) on coronary angiography. All of the coronary artery segments were evaluated by intravascular ultrasound (IVUS). Endothelial function was assessed with measurement of flow-mediated dilatation (FMD) and nitrate-dependent dilatation in the brachial artery. The study also included 30 healthy control subjects (group II). Patients in the group I were further subdivided into two subgroups based on the findings on IVUS: group IA included 20 patients without atherosclerotic lesions and group IB included 30 patients with atherosclerotic coronary artery disease in addition to MB. Results: FMD values were found to be significantly lower in the patients with MB (group I) than in the control (6.4 ± 3% vs 11 ± 4%, P <0.001). In regard to FMD values in subgroups, FMD was 7 ± 2% in the group IA and 5.8 ± 1% in the group IB (P = 0.023). On IVUS, atherosclerotic plaque was found proximal to the bridge in the same coronary artery segment in addition to MB in 75% of the patients in group I (group IB). No atherosclerotic plaque was found in within or distal segments of MB. Conclusion: Endothelial function is impaired in patients with MB and there is an increased tendency for atherosclerosis proximal to the bridge in the patients with MB. Endothelial dysfunction is more severe in the patients with atherosclerosis proximal to the bridge.

Journal of The Renin-angiotensin-aldosterone System, 2005

We demonstrated that increased premature CHD risk is associated with higher frequencies of the AC... more We demonstrated that increased premature CHD risk is associated with higher frequencies of the ACE DD and AGT MM genotypes. These findings indicate a synergistic contribution of ACE DD and AGT MM polymorphisms to the development of premature CHD. Also, our results suggest that family history, smoking, diabetes, hypertension, obesity and ACE DD genotype were independent risk factors for premature CHD.

Cardiology in The Young, 2007

International Journal of Cardiology, 2000

We present a case of ruptured aneurysm of sinus of valsalva (ASV) along with subaortic ventricula... more We present a case of ruptured aneurysm of sinus of valsalva (ASV) along with subaortic ventricular septal defect (VSD). Transesophageal echocardiographic examination in addition to transthoracic echocardiography provides more powerful information about ASVs and coexistent cardiac malformations. This may be additional value for the cardiac surgeon planning resection of the lesion.

Catheterization and Cardiovascular Diagnosis, 1992

Balloon mitral valvuloplasty with Inoue technique was performed in two group of patients. In grou... more Balloon mitral valvuloplasty with Inoue technique was performed in two group of patients. In group I (n = 40) valvuloplasty was performed under fluoroscopy without using echocardiography, whereas in group II (n = 13) valvuloplasty was performed under the guidance of transesophageal echocardiography alone, without using fluoroscopy. Patients in two groups were comparable with regard to clinical variables and hemodynamic parameters. Two female patients in group II were pregnant.Transmitral pressure gradient decrease did not differ significantly between two groups (pressure gradient: 17 ± 5 to 4 ± 1 in group I and 15 ± 4 to 3 ± 1 mm Hg in group II). Mitral valvular area increase was also not different in two groups (1.09 ± 0.2 cm2 to 2.3 ± 0.5 cm2 in group I and 0.9 ± 0.2 to 2 ± 0.3 cm2 in group II). In 14 cases from group I and 2 cases from group II mitral regurgitation increased after valvuloplasty (p < .05). Left atrial perforation occurred in one patient from group I and 2 patients from group II.In conclusion, mitral balloon valvuloplasty under transesophageal echocardiographic guidance alone is a safe and effective procedure in the treatment of mitral stenosis.

International Journal of Cardiology, 1996

Takayasu arteritis is a non-spesific inflamatory process of unknown etiology affecting the aorta ... more Takayasu arteritis is a non-spesific inflamatory process of unknown etiology affecting the aorta and its branches. A retrospective study was done in 14 patients diagnosed as Takayasu arteritis. Eleven patients were female and three were male. Ages ranged from 12 to 30 years. Seven patients had type I arteritis, three patients type II arteritis, and four patients type III Takayasu arteritis. Successful angioplasty was performed in five cases.

Pace-pacing and Clinical Electrophysiology, 2008

Background: Recurrent vasovagal syncope (VVS) can be a severely disabling disorder that may lead ... more Background: Recurrent vasovagal syncope (VVS) can be a severely disabling disorder that may lead to an important deterioration of quality of life because of the severity and recurrence of episodes. This study sought to investigate the effectiveness of repeated orthostatic self-training in preventing syncope in patients with recurrent VVS.Methods: Eighty-two consecutive patients (mean age 41 ± 4 years, 37 males) with recurrent VVS episodes and positive head-up tilt testing (HUT) were enrolled in this study. The patients were then randomized (1:1) to conventional therapy or conventional therapy plus additional tilt training sessions. The patients were followed for spontaneous syncope for one year. Primary end-points were the recurrence of syncope, the number of episodes, and the interval of time to the first recurrence.Results: There were no significant differences of baseline clinical characteristics and parameters of HUT between the tilt training and control groups. The patients had 4 ± 2/year syncopal episodes prior to the HUT. The mean follow-up after randomization was 12 ± 2 months. Spontaneous syncope recurrence during follow-up was 56% (23 patients) versus 37% (15 patients) in the control and tilt training groups, respectively (P = 0.1). Time to first recurrence was also similar in both groups (70 ± 20 days vs 50 ± 15 days, P = 0.09). The frequency of recurrent syncopes was similar in all types of VVSs while the rate of episodes was significantly higher in control group in patients with vasodepressor type during follow-up period (32% vs 10%, P = 0.04). The mean number of recurrent syncope episodes was also similar in both groups (3 ± 1 vs 2 ± 1, P = 0.4).Conclusions: Tilt training was unable to influence the spontaneous syncope recurrence for recurrent VVS except for vasodepressor type.

Journal of Cardiac Surgery, 2004

Percutaneous transbrachial insertion of two complex coils into the intercostal branch of the left... more Percutaneous transbrachial insertion of two complex coils into the intercostal branch of the left internal mammary artery resulted in the relief of severe angina in a 45-year-old man who had coronary artery bypass surgery 2 years before. The diagnosis of coronary artery steal was made clinically. This case illustrates the importance of recognizing coronary steal in patients who redevelop angina after coronary artery surgery with the use of an incompletely prepared left internal mammary artery as a conduit. Brachial or radial artery should be preferred to reach left internal mammary artery (LIMA) for cannulation easily. The preoperative angiographic imaging of LIMA is important to detect the side branches and their sizes. The patient was treated without the need for further surgery

Primary spontaneous coronary artery dissection is one of the rare causes of acute myocardial infa... more Primary spontaneous coronary artery dissection is one of the rare causes of acute myocardial infarction. Previous studies reports that it is mostly seen in middle aged women in the last trimester of pregnancy and early postpartum period. Clinical presentation of the disease is variable in pattern and severity related to extent and development rate of dissection. In the last 2 years, nine non-pregnant primary spontaneous coronary artery dissection cases were found in coronary angiography among 3750 patients prediagnosed as coronary artery disease. The cases were presented and discussed with review of the pertinent literature. q

Journal of The American Society of Echocardiography, 2007

In this study, we investigated the sensitivities of dobutamine stress echocardiography (DSE) and ... more In this study, we investigated the sensitivities of dobutamine stress echocardiography (DSE) and integrated backscatter (IBS) in detecting ischemia in patients with symptomatic myocardial bridging (MB). Fourteen patients given the diagnosis of MB in the left anterior descending coronary artery as shown by coronary angiography were enrolled. All patients underwent DSE and stress IBS. The cyclic variation of IBS (CVIBS) was taken from the midanteroseptal, midinferior, and midposterolateral areas of the parasternal short-axis images at rest, low dose, peak dose, and recovery. The low-dose, peak-dose, and recovery CVIBS data were compared with baseline values. At peak dose, hypokinesia was observed in the left anterior descending coronary artery region in two patients (14%). A significant reduction in CVIBS was detected only when compared with the baseline at peak dose in the anteroseptal wall (8.4 +/- 1.3 vs 5.9 +/- 0.8, P = .003). A significant negative correlation was found between the CVIBS and the systolic narrowing percentage (R = -0.856, P = .001) and the length of MB (R = -0.576, P = .01) in the anteroseptal wall at peak dose. Whereas DSE is not sufficiently sensitive in the detection of ischemia in patients with symptomatic MB, the reduction in CVIBS during DSE may be an objective sign of ischemia.

International Journal of Cardiology, 1996

Takayasu arteritis is a non-spesific inflamatory process of unknown etiology affecting the aorta ... more Takayasu arteritis is a non-spesific inflamatory process of unknown etiology affecting the aorta and its branches. A retrospective study was done in 14 patients diagnosed as Takayasu arteritis. Eleven patients were female and three were male. Ages ranged from 12 to 30 years. Seven patients had type I arteritis, three patients type II arteritis, and four patients type III Takayasu arteritis. Successful angioplasty was performed in five cases.

European Journal of Cardio-thoracic Surgery, 2001

Primary spontaneous coronary artery dissection is one of the rare causes of acute myocardial infa... more Primary spontaneous coronary artery dissection is one of the rare causes of acute myocardial infarction. Previous studies reports that it is mostly seen in middle aged women in the last trimester of pregnancy and early postpartum period. Clinical presentation of the disease is variable in pattern and severity related to extent and development rate of dissection. In the last 2 years, nine non-pregnant primary spontaneous coronary artery dissection cases were found in coronary angiography among 3750 patients prediagnosed as coronary artery disease. The cases were presented and discussed with review of the pertinent literature. q

Thrombosis Research, 2005

Keywords: eNOS coronary heart disease single nucleotide polymorphism meta-analysis Introduction: ... more Keywords: eNOS coronary heart disease single nucleotide polymorphism meta-analysis Introduction: Growing studies have revealed the underlying association between eNOS 894 G/T (rs1799983) polymorphism and coronary heart disease (CHD) among Asia population. Results from these studies remained conflicting. We conducted this meta-analysis to estimate the overall CHD risk of eNOS 894 G/T polymorphism regarding Asia population. Materials and methods: Up to October 2011, databases including PubMed, Embase and CNKI (China National Knowledge Infrastructure) were searched to access the relevant genetic association studies. Summary odds ratios and corresponding 95% confidence intervals (CIs) for eNOS 894 G/T polymorphism and CHD risk were estimated using fixed or random-effects models when appropriate. Results: 18 case-control studies with 2,994 cases and 3,130 controls were available for this study, including 13 studies of East-Asia descendents, 5 studies of Non East-Asian descendents. The mean T allele frequency was 0.111 in the East-Asia population and 0.147 in the Non East-Asia population, respectively. The summary OR for CHD associated with the T allele was 1.52 (95% confidence intervals (95%CI), 1.37-1.69) by random effects model. Similarly, significantly increased risks were observed in the East-Asia population (OR = 1.54; 95%CI = 1.35-1.76) and in the Non East-Asia population (OR = 1.48; 95%CI = 1.24-1.77), respectively. Conclusions: This meta-analysis indicated that eNOS 894 G/T polymorphism may play an important role in CHD development among Asia population.