Doç. Dr. Abdurrahman Tasal - Academia.edu (original) (raw)

Papers by Doç. Dr. Abdurrahman Tasal

Research paper thumbnail of İleri Derecede Kalp Yetersizliğinde Tek Doz Ve Aralıklı Levosimendan Infüzyonu Alan Hastalarda Sol Ventrikül Performansı, Biyolojik Markerler Ve Nörohormonal Aktivasyon

TEZ6956Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2008.Kaynakça (s.73-80) var.ix, 81 s. : re... more TEZ6956Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2008.Kaynakça (s.73-80) var.ix, 81 s. : res. ; 29 cm.Amaç: Bu çalışmada ileri derece kalp yetersizliği nedeniyle tek doz ve aralıklı levosimendan infüzyonu yapılan hastalarda sol ventrikül performansı, biyolojik markerler ve nörohormonal aktivasyon incelendi. Gereç ve Yöntem: Akut dekompanse ileri derece kalp yetersizliği tanısıyla hastaneye yatırılan ve sol ventrikül ejeksiyon fraksiyonu % 35 veya altında olan 29 hasta (20 erkek, 9 kadın, yaş ortalaması: 60,2 ± 7,4 yıl) çalışmaya dahil edildi. Hastalar tek doz ve aralıklı (başlangıç, 1. ay ve 3. ay) olmak üzere iki ayrı grupta incelendi.On dakikada 6 ?g/kg yükleme ve ardından 0,1 ?g/kg/dk dozunda idame 24 saatlik levosimendan infüzyonu alan hastalar, levosimendan almadan önce, aldıktan sonra 3. gün ve 6. ayda klinik, ekokardiyografik ve laboratuar (B tipi natriüretik peptit, interlökin-1 beta, interlökin-2 , interlökin-6, tümör nekroz faktör alfa) olarak değerlendirildi.Aim: Th...

Research paper thumbnail of Psoriasis vulgarisli hastalarda epikardiyal yağ kalınlığı

Research paper thumbnail of Tribulus terrestris, Avena sativa ve Panax ginseng kombinasyonu(Clavis Panax) kullanımına bağlı ani INR yükselmesi

Summary– Warfarin sodium is an antithrombin agent used in patients with prosthetic valve and atri... more Summary– Warfarin sodium is an antithrombin agent used in patients with prosthetic valve and atrial fibrillation. However, there are many factors that can change the effectiveness of the drug. Today, herbal mixtures promoted through targeted print and visual media can lead to sudden activity changes in patients using warfarin. In this case report we will present two cases with a sudden rise in INR due to using combination of Tribulus terrestris, Avena sativa and Panax ginseng (Panax Clavis). Two patients who used warfarin due to a history of aortic valve replacement (case 1) and atrial fibrillation (case 2) were admitted to the hospital due very high levels of INR detected during routine follow-up. Both patients had used an herbal medicine called ‘’Panax’’ during the last month. The patients gave no indication regarding a change in diet or the use of another agent that might interact with warfarin. In cases where active bleeding could not be determinated, we terminated the use of th...

Research paper thumbnail of Is there any link between joint hypermobility and mitral valve prolapse in patients with fibromyalgia syndrome?

Clinical Rheumatology, 2015

The objective of the present study is to determine whether benign joint hypermobility syndrome (B... more The objective of the present study is to determine whether benign joint hypermobility syndrome (BJHS) modifies the risk of mitral valve prolapse (MVP) in patients with fibromyalgia (FM). Female patients fulfilling the 1990 American College of Rheumatology (ACR) diagnostic criteria for FM were included into the study. Joint hypermobility and BJHS were assessed using Beighton's scoring system and Brighton criteria, respectively. Echocardiograpic evaluation was performed in order to test the presence of MVP. Of the 75 female FM patients, 68.0 % (n = 51) and 20.0 % (n = 15) were diagnosed with BJHS and MVP, respectively. The frequencies of both MVP and BJHS seemed higher than the general population prevalence (p = 0.000 for both). The frequency of MVP was significantly higher in patients with BJHS than that in patients without BJHS (p = 0.028). In addition, BJHS was found to increase the risk of MVP approximately ninefold [odds ratio (OR) 8.7, 95 % confidence interval (CI) 1.1-70.7]. As a result, BJHS and MVP are both common in female patients with FM. Moreover, among the female patients with FM, those with BJHS are about nine times more prone to MVP than those without BJHS. Cardiologic assessment might be added to the routine follow-up strategies in FM patients with BJHS in order to exclude the cardiac pathologies, especially MVP.

Research paper thumbnail of E-page Original Images. Thrombotic lesion of saphenous vein graft resolved by antiaggregant therapy

Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology, 2008

PubMedID: 18400618[No abstract available

Research paper thumbnail of Serum gamma-glutamyl transferase levels and in-hospital mortality in patients with acute heart failure

Kardiologia Polska, 2014

Background: Acute heart failure (AHF) is a major cause of hospitalisation, morbidity and mortalit... more Background: Acute heart failure (AHF) is a major cause of hospitalisation, morbidity and mortality worldwide. Gamma-glutamyl transferase (GGT) is an enzyme responsible for the extracellular catabolism of antioxidant glutathione and a potential risk indicator of cardiac mortality. Limited data exists on the prognostic value of circulating levels of GGT in patients hospitalised due to AHF. Aim: To study the association between baseline GGT activity and in-hospital mortality in AHF patients. Methods: The study cohort consisted of 183 AHF patients with left ventricular ejection fraction (LVEF) < 50%. The primary endpoint was in-hospital mortality. Patients were divided into two groups according to in-hospital mortality. The relationship between GGT activity and in-hospital mortality was tested using logistic regression models, adjusting for clinical characteristics and echocardiographic findings. Results: After adjustment for possible confounders, GGT level was significantly related (OR 1.056, 95% CI 1.018-1.096, p = 0.04) to in-hospital mortality Conclusions: Elevated GGT activity is an independent predictor of short-term mortality in patients with AHF and reduced LVEF.

Research paper thumbnail of A New Parameter Predicting Chronic Total Occlusion of Coronary Arteries

Angiology, 2013

Platelet distribution width (PDW) measures the variability in platelet size and is a marker of pl... more Platelet distribution width (PDW) measures the variability in platelet size and is a marker of platelet activation. We investigated whether PDW is associated with the extent of coronary artery disease (CAD) and coronary total occlusions (CTOs). We studied 162 patients: 108 had a coronary lesion with a diameter stenosis of ≥50%, the CAD(+) group, and 54 patients had normal coronary anatomy, the CAD(−) group. The CAD(+) group was subdivided into CAD(+) CTO(+) and CAD(+) CTO(−) groups. Among patients with CAD, the CTO(+) group had a significantly greater PDW (%) than the CTO(−) group (16.9 ± 2.8, 15.4 ± 3.0, and 15.4 ± 1.9, respectively; P = .008). In a receiver–operating characteristic analysis, a PDW cut point of 15.7% was identified in patients with CTO(+) (area under curve = 0.64, 95% confidence interval 0.54-0.75). A PDW value of more than 15.7% demonstrated a sensitivity of 64% and a specificity of 66%. The PDW is a simple platelet index that may predict the presence of CTO.

Research paper thumbnail of Neutrophil-to-lymphocyte ratio and in-hospital mortality in patients with acute heart failure

Clinics, 2014

OBJECTIVES: Previous studies have demonstrated the role of inflammation in acute heart failure. T... more OBJECTIVES: Previous studies have demonstrated the role of inflammation in acute heart failure. The neutrophil-to-lymphocyte ratio was found to be a useful inflammatory marker for predicting adverse outcomes. We hypothesized that an elevated neutrophil-to-lymphocyte ratio would be associated with increased mortality in acute heart failure patients. METHODS: The study cohort consisted of 167 acute heart failure patients with an ejection fraction ,50%. The primary endpoint was in-hospital mortality, and the patients were divided into two groups according to inhospital mortality. RESULTS: In a multivariate regression analysis, including baseline demographic, clinical, and biochemical covariates, the neutrophil to lymphocyte ratio remained an independent predictor of mortality (OR 1.156, 95% CI 1.001-1.334, p = 0.048). CONCLUSION: In conclusion, an elevated neutrophil-to-lymphocyte ratio seems to be a predictor of short-term mortality in patients with acute heart failure and a reduced left ventricular ejection fraction.

Research paper thumbnail of Skuteczne leczenie przezskórne zamkniętej „tkanej” tętnicy wieńcowej –

Advances in Interventional Cardiology, 2012

Successful percutaneous management of occluded "woven" coronary artery: a case report Skuteczne l... more Successful percutaneous management of occluded "woven" coronary artery: a case report Skuteczne leczenie przezskórne zamkniętej "tkanej" tętnicy wieńcowej-opis przypadku A Ab bd du ur rr ra ah hm ma an n T Ta as sa al l 1 1 , , A Ah hm me et t B Ba ac ca ak ks si iz z 1 1 , , E Er rc ca an n E Er rd do og ga an n 1 1 , , Z Ze ek ke er ri iy ya a K Kü üç çü ük kd du ur rm ma az z 2 2

Research paper thumbnail of The Effect of the Phases of the Moon on Blood Pressure in Non-Hypertensive Individuals

Istanbul Medical Journal, 2014

The purpose of this study was to examine the influence of lunar phases on blood pressure in non-h... more The purpose of this study was to examine the influence of lunar phases on blood pressure in non-hypertensive individuals. Methods: A total of 158 non-hypertensive individuals were included in the study: 158 consecutive patients (72 males and 86 females, mean age 33.74±7.1). All patients underwent 24-hour ambulatory blood pressure monitoring (ABPM). The average, day, and night systolic and diastolic blood pressures were compared between groups. Results: Ambulatory blood pressure monitoring (ABPM) was performed during four phases of the moon in non-hypertensive individuals. (New moon "38 patients," first quarter "41 patients," full moon "42 patients," last quarter "37 patients," p=nonsignificant (NS)). However, there were no significant differences in average systolic and diastolic blood pressures between groups. Conclusion: We could not find any relationship between the phases of the moon and blood pressure.

Research paper thumbnail of A very rare case of coexistence of ventricular noncompaction cardiomyopathy, myocardial bridging and atherosclerosis

Advances in Interventional Cardiology, 2013

A very rare case of coexistence of ventricular noncompaction cardiomyopathy, myocardial bridging ... more A very rare case of coexistence of ventricular noncompaction cardiomyopathy, myocardial bridging and atherosclerosis E Er rc ca an n E Er rd do og ga an n, , M Me eh hm me et t A Ak kk ka ay ya a, , A Ah hm me et t B Ba ac ca ak ks si iz z, , A Ab bd du ur rr ra ah hm ma an n T Ta as sa al l, , E Em mr ra ah h S Se ev vg gi il li i

Research paper thumbnail of Case Report; A sudden rise in INR due to combination of Tribulus terrestis, Avena sativa, and Panax Ginseng (Panax Clavis)

Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology, 2012

Warfarin sodium is an antithrombin agent used in patients with prosthetic valve and atrial fibril... more Warfarin sodium is an antithrombin agent used in patients with prosthetic valve and atrial fibrillation. However, there are many factors that can change the effectiveness of the drug. Today, herbal mixtures promoted through targeted print and visual media can lead to sudden activity changes in patients using warfarin. In this case report we will present two cases with a sudden rise in INR due to using combination of Tribulus terrestris, Avena sativa and Panax ginseng (Panax Clavis). Two patients who used warfarin due to a history of aortic valve replacement (case 1) and atrial fibrillation (case 2) were admitted to the hospital due very high levels of INR detected during routine follow-up. Both patients had used an herbal medicine called ''Panax'' during the last month. The patients gave no indication regarding a change in diet or the use of another agent that might interact with warfarin. In cases where active bleeding could not be determinated, we terminated the use of the drug and re-evaluated dosage of warfarin before finally discharging the patient. Özet-Varfarin sodyum, protez kapak ve atriyal fibrilasyon hastalarında antitrombin ajan olarak kullanılmaktadır. Ancak ilacın etkinliğini değiştirebilen pek çok faktör bulunmaktadır. Günümüzde özellikle yazılı ve görsel medya tarafından kullanımı teşvik edilen bitkisel karışımlar bu ilacı kullanan hastalarda ani etkinlik değişimlerine yol açabilirler. Bu yazıda, Tribulus terrestris, Avena sativa ve Panax ginseng'in kombinasyonu (Clavis Panax) kullanımına bağlı ani INR yükselmesi olan iki olgu sunuldu. Aort kapak replasmanı (olgu 1) ve atriyal fibrilasyon (olgu 2) nedeniyle varfarin kullanan iki hasta rutin kontrollerinde INR değerlerinin çok yüksek olması üzerine hastaneye yatırıldı. Hastalardan son bir aydır "Panax" isimli bitkisel ilacı kullandıkları öğrenildi. Her iki hastada da etkileşime girecek başka bir ajan ya da diyet değişikliği saptanmadı. Aktif kanama izlenmeyen hastalar, söz konusu ilaç kesilip yeniden varfarin dozu ayarlandıktan sonra taburcu edildi.

Research paper thumbnail of Comparison of single-dose and repeated levosimendan infusion in patients with acute exacerbation of advanced heart failure

Medical Science Monitor, 2014

Departmental sources Background: Levosimendan (LS) is a novel inodilator that improves cardiac pe... more Departmental sources Background: Levosimendan (LS) is a novel inodilator that improves cardiac performance, central hemodynamics, and symptoms of patients with decompensated chronic heart failure. The aim of this study was to compare the effects of single and repeated LS infusion on left ventricular performance, biomarkers, and neurohormonal activation in patients with acute heart failure. Material/Methods: Twenty-nine consecutive patients with acute exacerbation of advanced heart failure were included in this study. LS was initiated as a bolus of 6 μg/kg followed by a continuous infusion of 0.1 μg/kg/min for 24 hours in both groups who received intravenous single and repeated (baseline and at 1 and 3 months) treatment. Physical examination, echocardiography, and biochemical tests (brain natriuretic peptide, tumour necrosis factor-a, interleukin-1b, 2, and 6) were performed before treatment and on 3 day of the treatment. The last evaluation was performed at 6 month after the baseline treatment. Results: Twenty male and 9 female patients with mean age of 60.2±7.4 years were included in this study. A significant improvement in New York Heart Association functional status and myocardial performance index was detected only in the repeated LS treated patients at 6 month compared to the pretreatment status (p=0.03 and p<0.001; respectively). In addition, a significant decrease in brain natriuretic peptide (p<0.01) and plasma interleukin-6 (p=0.05) levels were also achieved only in patients who were given repeated LS. Conclusions: Our study showed that repeated LS treatment is more effective compared to the single dose LS treatment in improving clinical status, hemodynamic and laboratory parameters in patients with acute exacerbation of advanced heart failure.

Research paper thumbnail of Implication of Serum Neutrophil Gelatinase-Associated Lipocalin Levels in Patients Who Underwent First-time Diagnostic Coronary Angiography

Journal of the American College of Cardiology, 2013

Aım: Aspirin is an inhibitor of platelet function and is one of the cornerstones of acute coronar... more Aım: Aspirin is an inhibitor of platelet function and is one of the cornerstones of acute coronary syndrome (ACS) treatment. However, the ideal dose and usage of aspirin in patients with ACS is not clear. The aim of this study is to investigate the antiplatelet effects of different aspirin doses and application ways in patients with ACS. Method: This study included 30 patients that were admitted to Cardiology Clinic of Ankara University Faculty of Medicine with a diagnosis of acute coronary syndrome. The patients included in the study were divided into three groups based on the dose of aspirin utilization (1x100 mg, 1x300 mg, and 3x100 mg). On 3rd day of acute coronary syndrome, thrombocyte aggregation levels, which were assesed by Ver-ifyNowÒ aspirin test, were compared at 2 hours (early) and 24 hours (late) after initial aspirin. Results: Ten of the patients (33%) were women and 20 were men (67%) and mean age was 61.2AE11.5 years. According to demographic and laboratory characteristics, no statistical difference was determined between the groups. Antiplatelet effect of aspirin at 2nd hour were as follows respectively; 402.4AE29.3 ARU in aspirin 300mg per day group, 440.4AE36.7 ARU in 100mg 3 times a day group and 418.2AE41 ARU in aspirin 100 mg per day group (p¼0.04). All groups' ARU values were increased at 24th hour compared with first 2nd hour measurements but this increase was minimum in 3x100 mg aspirin group. There were no difference in ARU values at 24th hour measurement between groups. No aspirin resistance observed in any of the patients. Conclusıon: Antiplatelet effect of both 100 mg and 300 mg aspirin doses decreased during the day but their efficacy still continued and no difference was detected between the doses. Despite the theoretical advantages of the use of aspirin in divided doses, our study did not support this.

Research paper thumbnail of Novel Fibroinflammatory Markers in Non-valvular Atrial Fibrillation: Galectin-3, Lcn2/NGAL, P3NP

Journal of the American College of Cardiology, 2013

p¼0.001 Mann-Whitney U test, 146AE88 pg/ml & 429AE302 pg/ml p<0.0001 Student-t test, and 1426AESt... more p¼0.001 Mann-Whitney U test, 146AE88 pg/ml & 429AE302 pg/ml p<0.0001 Student-t test, and 1426AEStudent-t test respectively). Hs1230 pg/ml & 6590AE4594 pg/ml p<0.0001-Crp and NLR level were also higher in NVAF (2.1AE1.0 & 2.7AE1.1 p¼0.02 Student-t test and 4.2AE1.9 mg/L & 6.0AE4.7 mg/L p¼0.04 Student-t test, respectively). In correlation analyses, NLR showed quite significant correlation with LAVi whereas Hs-CRP did not (p¼0.007 r¼0.247, pearson test & p¼0.808 r¼0.025, pearson test,respectively). Moreover, Galectin-3, MMP-9, and PIIINP had strong positive correlation with LAVi (p¼0.021 r¼640, spearman test & p¼0.004 r¼0.319 pearson test, & p¼0.004 r¼0.325 pearson test,respectively). Conclusion: As a result of this data we suggest that galectin-3 and PIIINP can be used as novel targets in AF patients in order to decrease degree of fibro-inflammation in the atria.

Research paper thumbnail of Short Term Effect of Percutaneous Recanalization of Chronic Total Occlusions on QT Dispersion and Heart Rate Variability Parameters

Journal of the American College of Cardiology, 2013

None Background: QT dispersion (QTd), which is a measure of inhomogeneity of myocardial repolariz... more None Background: QT dispersion (QTd), which is a measure of inhomogeneity of myocardial repolarization, increases following impaired myocardial perfusion. Its prolongation may provide a suitable substrate for life-threatening ventricular arrhythmias. We investigated the changes in QTd and heart rate variability (HRV) parameters after successful coronary artery revascularization in a patient with chronic total occlusions (CTO). Material/Methods: This study included 139 successfully revascularized CTO patients (118 men, 21 women, mean age 58.3±9.6 years). QTd was measured from a 12-lead electrocardiogram and was defined as the difference between maximum and minimum QT interval. HRV analyses of all subjects were obtained. Frequency domain (LF: HF) and time domain (SDNN, pNN50, and rMSSD) parameters were analyzed. QT intervals were also corrected for heart rate using Bazett's formula, and the corrected QT interval dispersion (QTcd) was then calculated. All measurements were made before and after percutaneous coronary intervention (PCI). Results: Both QTd and QTcd showed significant improvement following successful revascularization of CTO (55.83±14.79 to 38.87±11.69; p<0.001 and 61.02±16.28 to 42.92±13.41; p<0.001). The revascularization of LAD (n=38), Cx (n=28) and RCA (n=73) resulted in decrease in HRV indices, including SDDN, rMSSD, and pNN50, but none of the variables reached statistical significance. Conclusions: Successful revascularization of CTO may result in improvement in regional heterogeneity of myocardial repolarization, evidenced as decreased QTcd after the PCI. The revascularization in CTO lesions does not seem to have a significant impact on HRV.

Research paper thumbnail of Comparison of Single-dose and Intermittent Levosimendan Infusion in Patients With Acute Exacerbation of Advanced Heart Failure

Journal of the American College of Cardiology, 2013

The aim of the study was to investigate the effects of single and intermittent levosimendan infus... more The aim of the study was to investigate the effects of single and intermittent levosimendan infusion on left ventricular performance, biomarkers and neurohormonal activation in patients with acute exerbation of advanced heart failure. Methods: Twenty nine patients (20 male, 9 female, mean age 60.2AE7.4 years) with acute exerbation of advanced heart failure (ejection fraction 35%) were included in this study. Levosimendan was initiated as a bolus of 6 mg/kg followed by a continuous infusion of 0,1 mg/kg/min for 24 hours in both groups who were taken intravenous

Research paper thumbnail of Is Postdilatation with a Noncompliant Balloon Necessary after Coronary Stent Deployment during Primary Angioplasty?

Journal of Interventional Cardiology, 2013

Postdilatation (PD) with noncompliant balloon during elective percutaneous coronary intervention ... more Postdilatation (PD) with noncompliant balloon during elective percutaneous coronary intervention (PCI) is performed usually in clinical practice in order to optimize stent expansion. However, current knowledge about its use in patients undergoing primary PCI is controversial. This study aims to evaluate the angiographical and clinical results of PD in patients who underwent primary PCI with drug eluting stents (DESs). A total of 405 consecutive patients (mean age 56.9 ± 12.3 years; 302 male) with ST elevation myocardial infarction were evaluated retrospectively. Patients received DES with or without predilatation according to physician&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;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;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 discretion. Eligible patients were divided into 2 groups based on PD procedure. The clinical end-points were death, target vessel revascularization (TVR) and stent thrombosis at 6 months after PCI. The angiographic end-points were postprocedural correct Thrombolysis in Myocardial Infarction (TIMI) frame count (cTFC), final TIMI flow, and myocardial blush grade (MBG). PD was performed in 214 patients (52.8%). Angiographical parameters such as TIMI flow, cTFC, and MBG did not differ after PD (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;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;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;gt;0.05). During 6-month follow-up, TVR and stent thrombosis rates were lower in the PD group (6 vs. 16, P=0.03; and 3 vs. 10, P=0.04, respectively). PD and diabetes were detected as independent predictors of MACE (β=0.52, P=0.01, and β=-0.47, P=0.02; respectively). Our study revealed that PD does not yield adverse effects on final angiographic parameters when performed during primary PCI. Besides PD seems to decrease probability of stent thrombosis and TVR.

Research paper thumbnail of Utility of the neutrophil to lymphocyte ratio for predicting in-hospital mortality after levosimendan infusion in patients with acute decompensated heart failure

Journal of Cardiology, 2014

Background: The aim of this study was to investigate the effect of a levosimendan infusion on hem... more Background: The aim of this study was to investigate the effect of a levosimendan infusion on hematological variables in patients with acute decompensated heart failure (ADHF). The predictive value of these variables for in-hospital mortality was also evaluated. Methods: A total of 553 patients (368 males; mean age, 63.4 ± 14.9 years) with acute exacerbations of advanced heart failure (ejection fraction ≤35%) and treated with either dobutamine or levosimendan were included in this retrospective analysis. The patients that received levosimendan therapy were divided into two groups according to in-hospital mortality: group 1 (21%) included patients who died during hospitalization (n = 45), while group 2 (79%) included patients with a favorable outcome (n = 174) after levosimendan infusion. Changes in several hematological variables between admission and the third day after levosimendan infusion were evaluated. Results: The demographic characteristics and risk factors of the two groups were similar. A comparison of changes in laboratory variables after the infusion of levosimendan revealed significant improvement only in those patients who had not died (group 2) during hospitalization. The neutrophil to lymphocyte (N/L) ratio after levosimendan infusion was an independent predictor of in-hospital mortality (odds ratio: 1.310, 95% CI: 1.158-1.483, p < 0.001). In a receiver-operating characteristic curve analysis, a value of 5.542 for the N/L ratio after levosimendan administration was identified as an effective cutoff point for predicting in-hospital mortality (area under the curve = 0.737; 95% confidence interval = 1100-1301; p < 0.001). Conclusions: Levosimendan treatment was associated with significant changes in hematological variables in patients with ADHF. A sustained higher N/L ratio after levosimendan infusion is associated with an increased risk of in-hospital mortality in patients with ADHF.

Research paper thumbnail of Polycystic ovary syndrome is associated with P-wave prolongation and increased P-wave dispersion

Gynecological Endocrinology, 2013

The polycystic ovary syndrome (PCOS) is associated with various cardiac manifestations including ... more The polycystic ovary syndrome (PCOS) is associated with various cardiac manifestations including cardiac arrhythmias. P-wave dispersion (Pdis) is an appealing marker for predicting the risk of developing atrial arrhythmias. The purpose of this study was to evaluate P-wave durations and Pdis in patients with PCOS. Forty adult patients with PCOS and 46 age- and sex-matched healthy individuals were included in this study. P-wave maximum duration (Pmax) and P-wave minimum duration (Pmin) were calculated on the 12-lead electrocardiogram, and the difference between the Pmax and the Pmin was defined as Pdis. All individuals also underwent transthoracic echocardiographic evaluation. Pmax and Pdis were significantly higher in patients with PCOS compared with controls (p = 0.007, 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;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;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; 0.001, respectively). There was no difference in Pmin duration between both the groups (p = 0.2). Waist-to-hip ratio, insulin and homeostasis model assessment of insulin resistance (HOMA-IR) were higher in the PCOS group. Early mitral inflow deceleration time (DT) (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;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;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; 0.001) and isovolumetric relaxation time (p = 0.003) were longer in PCOS group. Waist-to-hip ratio, DT, E/A ratio and diastolic blood pressure correlated with Pdis. Patients with PCOS have prolonged Pmax and Pdis. The increase in those parameters may be an indicator for identification of patients at increased risk of atrial fibrillation.

Research paper thumbnail of İleri Derecede Kalp Yetersizliğinde Tek Doz Ve Aralıklı Levosimendan Infüzyonu Alan Hastalarda Sol Ventrikül Performansı, Biyolojik Markerler Ve Nörohormonal Aktivasyon

TEZ6956Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2008.Kaynakça (s.73-80) var.ix, 81 s. : re... more TEZ6956Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2008.Kaynakça (s.73-80) var.ix, 81 s. : res. ; 29 cm.Amaç: Bu çalışmada ileri derece kalp yetersizliği nedeniyle tek doz ve aralıklı levosimendan infüzyonu yapılan hastalarda sol ventrikül performansı, biyolojik markerler ve nörohormonal aktivasyon incelendi. Gereç ve Yöntem: Akut dekompanse ileri derece kalp yetersizliği tanısıyla hastaneye yatırılan ve sol ventrikül ejeksiyon fraksiyonu % 35 veya altında olan 29 hasta (20 erkek, 9 kadın, yaş ortalaması: 60,2 ± 7,4 yıl) çalışmaya dahil edildi. Hastalar tek doz ve aralıklı (başlangıç, 1. ay ve 3. ay) olmak üzere iki ayrı grupta incelendi.On dakikada 6 ?g/kg yükleme ve ardından 0,1 ?g/kg/dk dozunda idame 24 saatlik levosimendan infüzyonu alan hastalar, levosimendan almadan önce, aldıktan sonra 3. gün ve 6. ayda klinik, ekokardiyografik ve laboratuar (B tipi natriüretik peptit, interlökin-1 beta, interlökin-2 , interlökin-6, tümör nekroz faktör alfa) olarak değerlendirildi.Aim: Th...

Research paper thumbnail of Psoriasis vulgarisli hastalarda epikardiyal yağ kalınlığı

Research paper thumbnail of Tribulus terrestris, Avena sativa ve Panax ginseng kombinasyonu(Clavis Panax) kullanımına bağlı ani INR yükselmesi

Summary– Warfarin sodium is an antithrombin agent used in patients with prosthetic valve and atri... more Summary– Warfarin sodium is an antithrombin agent used in patients with prosthetic valve and atrial fibrillation. However, there are many factors that can change the effectiveness of the drug. Today, herbal mixtures promoted through targeted print and visual media can lead to sudden activity changes in patients using warfarin. In this case report we will present two cases with a sudden rise in INR due to using combination of Tribulus terrestris, Avena sativa and Panax ginseng (Panax Clavis). Two patients who used warfarin due to a history of aortic valve replacement (case 1) and atrial fibrillation (case 2) were admitted to the hospital due very high levels of INR detected during routine follow-up. Both patients had used an herbal medicine called ‘’Panax’’ during the last month. The patients gave no indication regarding a change in diet or the use of another agent that might interact with warfarin. In cases where active bleeding could not be determinated, we terminated the use of th...

Research paper thumbnail of Is there any link between joint hypermobility and mitral valve prolapse in patients with fibromyalgia syndrome?

Clinical Rheumatology, 2015

The objective of the present study is to determine whether benign joint hypermobility syndrome (B... more The objective of the present study is to determine whether benign joint hypermobility syndrome (BJHS) modifies the risk of mitral valve prolapse (MVP) in patients with fibromyalgia (FM). Female patients fulfilling the 1990 American College of Rheumatology (ACR) diagnostic criteria for FM were included into the study. Joint hypermobility and BJHS were assessed using Beighton&amp;amp;amp;amp;amp;amp;#39;s scoring system and Brighton criteria, respectively. Echocardiograpic evaluation was performed in order to test the presence of MVP. Of the 75 female FM patients, 68.0 % (n = 51) and 20.0 % (n = 15) were diagnosed with BJHS and MVP, respectively. The frequencies of both MVP and BJHS seemed higher than the general population prevalence (p = 0.000 for both). The frequency of MVP was significantly higher in patients with BJHS than that in patients without BJHS (p = 0.028). In addition, BJHS was found to increase the risk of MVP approximately ninefold [odds ratio (OR) 8.7, 95 % confidence interval (CI) 1.1-70.7]. As a result, BJHS and MVP are both common in female patients with FM. Moreover, among the female patients with FM, those with BJHS are about nine times more prone to MVP than those without BJHS. Cardiologic assessment might be added to the routine follow-up strategies in FM patients with BJHS in order to exclude the cardiac pathologies, especially MVP.

Research paper thumbnail of E-page Original Images. Thrombotic lesion of saphenous vein graft resolved by antiaggregant therapy

Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology, 2008

PubMedID: 18400618[No abstract available

Research paper thumbnail of Serum gamma-glutamyl transferase levels and in-hospital mortality in patients with acute heart failure

Kardiologia Polska, 2014

Background: Acute heart failure (AHF) is a major cause of hospitalisation, morbidity and mortalit... more Background: Acute heart failure (AHF) is a major cause of hospitalisation, morbidity and mortality worldwide. Gamma-glutamyl transferase (GGT) is an enzyme responsible for the extracellular catabolism of antioxidant glutathione and a potential risk indicator of cardiac mortality. Limited data exists on the prognostic value of circulating levels of GGT in patients hospitalised due to AHF. Aim: To study the association between baseline GGT activity and in-hospital mortality in AHF patients. Methods: The study cohort consisted of 183 AHF patients with left ventricular ejection fraction (LVEF) < 50%. The primary endpoint was in-hospital mortality. Patients were divided into two groups according to in-hospital mortality. The relationship between GGT activity and in-hospital mortality was tested using logistic regression models, adjusting for clinical characteristics and echocardiographic findings. Results: After adjustment for possible confounders, GGT level was significantly related (OR 1.056, 95% CI 1.018-1.096, p = 0.04) to in-hospital mortality Conclusions: Elevated GGT activity is an independent predictor of short-term mortality in patients with AHF and reduced LVEF.

Research paper thumbnail of A New Parameter Predicting Chronic Total Occlusion of Coronary Arteries

Angiology, 2013

Platelet distribution width (PDW) measures the variability in platelet size and is a marker of pl... more Platelet distribution width (PDW) measures the variability in platelet size and is a marker of platelet activation. We investigated whether PDW is associated with the extent of coronary artery disease (CAD) and coronary total occlusions (CTOs). We studied 162 patients: 108 had a coronary lesion with a diameter stenosis of ≥50%, the CAD(+) group, and 54 patients had normal coronary anatomy, the CAD(−) group. The CAD(+) group was subdivided into CAD(+) CTO(+) and CAD(+) CTO(−) groups. Among patients with CAD, the CTO(+) group had a significantly greater PDW (%) than the CTO(−) group (16.9 ± 2.8, 15.4 ± 3.0, and 15.4 ± 1.9, respectively; P = .008). In a receiver–operating characteristic analysis, a PDW cut point of 15.7% was identified in patients with CTO(+) (area under curve = 0.64, 95% confidence interval 0.54-0.75). A PDW value of more than 15.7% demonstrated a sensitivity of 64% and a specificity of 66%. The PDW is a simple platelet index that may predict the presence of CTO.

Research paper thumbnail of Neutrophil-to-lymphocyte ratio and in-hospital mortality in patients with acute heart failure

Clinics, 2014

OBJECTIVES: Previous studies have demonstrated the role of inflammation in acute heart failure. T... more OBJECTIVES: Previous studies have demonstrated the role of inflammation in acute heart failure. The neutrophil-to-lymphocyte ratio was found to be a useful inflammatory marker for predicting adverse outcomes. We hypothesized that an elevated neutrophil-to-lymphocyte ratio would be associated with increased mortality in acute heart failure patients. METHODS: The study cohort consisted of 167 acute heart failure patients with an ejection fraction ,50%. The primary endpoint was in-hospital mortality, and the patients were divided into two groups according to inhospital mortality. RESULTS: In a multivariate regression analysis, including baseline demographic, clinical, and biochemical covariates, the neutrophil to lymphocyte ratio remained an independent predictor of mortality (OR 1.156, 95% CI 1.001-1.334, p = 0.048). CONCLUSION: In conclusion, an elevated neutrophil-to-lymphocyte ratio seems to be a predictor of short-term mortality in patients with acute heart failure and a reduced left ventricular ejection fraction.

Research paper thumbnail of Skuteczne leczenie przezskórne zamkniętej „tkanej” tętnicy wieńcowej –

Advances in Interventional Cardiology, 2012

Successful percutaneous management of occluded "woven" coronary artery: a case report Skuteczne l... more Successful percutaneous management of occluded "woven" coronary artery: a case report Skuteczne leczenie przezskórne zamkniętej "tkanej" tętnicy wieńcowej-opis przypadku A Ab bd du ur rr ra ah hm ma an n T Ta as sa al l 1 1 , , A Ah hm me et t B Ba ac ca ak ks si iz z 1 1 , , E Er rc ca an n E Er rd do og ga an n 1 1 , , Z Ze ek ke er ri iy ya a K Kü üç çü ük kd du ur rm ma az z 2 2

Research paper thumbnail of The Effect of the Phases of the Moon on Blood Pressure in Non-Hypertensive Individuals

Istanbul Medical Journal, 2014

The purpose of this study was to examine the influence of lunar phases on blood pressure in non-h... more The purpose of this study was to examine the influence of lunar phases on blood pressure in non-hypertensive individuals. Methods: A total of 158 non-hypertensive individuals were included in the study: 158 consecutive patients (72 males and 86 females, mean age 33.74±7.1). All patients underwent 24-hour ambulatory blood pressure monitoring (ABPM). The average, day, and night systolic and diastolic blood pressures were compared between groups. Results: Ambulatory blood pressure monitoring (ABPM) was performed during four phases of the moon in non-hypertensive individuals. (New moon "38 patients," first quarter "41 patients," full moon "42 patients," last quarter "37 patients," p=nonsignificant (NS)). However, there were no significant differences in average systolic and diastolic blood pressures between groups. Conclusion: We could not find any relationship between the phases of the moon and blood pressure.

Research paper thumbnail of A very rare case of coexistence of ventricular noncompaction cardiomyopathy, myocardial bridging and atherosclerosis

Advances in Interventional Cardiology, 2013

A very rare case of coexistence of ventricular noncompaction cardiomyopathy, myocardial bridging ... more A very rare case of coexistence of ventricular noncompaction cardiomyopathy, myocardial bridging and atherosclerosis E Er rc ca an n E Er rd do og ga an n, , M Me eh hm me et t A Ak kk ka ay ya a, , A Ah hm me et t B Ba ac ca ak ks si iz z, , A Ab bd du ur rr ra ah hm ma an n T Ta as sa al l, , E Em mr ra ah h S Se ev vg gi il li i

Research paper thumbnail of Case Report; A sudden rise in INR due to combination of Tribulus terrestis, Avena sativa, and Panax Ginseng (Panax Clavis)

Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology, 2012

Warfarin sodium is an antithrombin agent used in patients with prosthetic valve and atrial fibril... more Warfarin sodium is an antithrombin agent used in patients with prosthetic valve and atrial fibrillation. However, there are many factors that can change the effectiveness of the drug. Today, herbal mixtures promoted through targeted print and visual media can lead to sudden activity changes in patients using warfarin. In this case report we will present two cases with a sudden rise in INR due to using combination of Tribulus terrestris, Avena sativa and Panax ginseng (Panax Clavis). Two patients who used warfarin due to a history of aortic valve replacement (case 1) and atrial fibrillation (case 2) were admitted to the hospital due very high levels of INR detected during routine follow-up. Both patients had used an herbal medicine called ''Panax'' during the last month. The patients gave no indication regarding a change in diet or the use of another agent that might interact with warfarin. In cases where active bleeding could not be determinated, we terminated the use of the drug and re-evaluated dosage of warfarin before finally discharging the patient. Özet-Varfarin sodyum, protez kapak ve atriyal fibrilasyon hastalarında antitrombin ajan olarak kullanılmaktadır. Ancak ilacın etkinliğini değiştirebilen pek çok faktör bulunmaktadır. Günümüzde özellikle yazılı ve görsel medya tarafından kullanımı teşvik edilen bitkisel karışımlar bu ilacı kullanan hastalarda ani etkinlik değişimlerine yol açabilirler. Bu yazıda, Tribulus terrestris, Avena sativa ve Panax ginseng'in kombinasyonu (Clavis Panax) kullanımına bağlı ani INR yükselmesi olan iki olgu sunuldu. Aort kapak replasmanı (olgu 1) ve atriyal fibrilasyon (olgu 2) nedeniyle varfarin kullanan iki hasta rutin kontrollerinde INR değerlerinin çok yüksek olması üzerine hastaneye yatırıldı. Hastalardan son bir aydır "Panax" isimli bitkisel ilacı kullandıkları öğrenildi. Her iki hastada da etkileşime girecek başka bir ajan ya da diyet değişikliği saptanmadı. Aktif kanama izlenmeyen hastalar, söz konusu ilaç kesilip yeniden varfarin dozu ayarlandıktan sonra taburcu edildi.

Research paper thumbnail of Comparison of single-dose and repeated levosimendan infusion in patients with acute exacerbation of advanced heart failure

Medical Science Monitor, 2014

Departmental sources Background: Levosimendan (LS) is a novel inodilator that improves cardiac pe... more Departmental sources Background: Levosimendan (LS) is a novel inodilator that improves cardiac performance, central hemodynamics, and symptoms of patients with decompensated chronic heart failure. The aim of this study was to compare the effects of single and repeated LS infusion on left ventricular performance, biomarkers, and neurohormonal activation in patients with acute heart failure. Material/Methods: Twenty-nine consecutive patients with acute exacerbation of advanced heart failure were included in this study. LS was initiated as a bolus of 6 μg/kg followed by a continuous infusion of 0.1 μg/kg/min for 24 hours in both groups who received intravenous single and repeated (baseline and at 1 and 3 months) treatment. Physical examination, echocardiography, and biochemical tests (brain natriuretic peptide, tumour necrosis factor-a, interleukin-1b, 2, and 6) were performed before treatment and on 3 day of the treatment. The last evaluation was performed at 6 month after the baseline treatment. Results: Twenty male and 9 female patients with mean age of 60.2±7.4 years were included in this study. A significant improvement in New York Heart Association functional status and myocardial performance index was detected only in the repeated LS treated patients at 6 month compared to the pretreatment status (p=0.03 and p<0.001; respectively). In addition, a significant decrease in brain natriuretic peptide (p<0.01) and plasma interleukin-6 (p=0.05) levels were also achieved only in patients who were given repeated LS. Conclusions: Our study showed that repeated LS treatment is more effective compared to the single dose LS treatment in improving clinical status, hemodynamic and laboratory parameters in patients with acute exacerbation of advanced heart failure.

Research paper thumbnail of Implication of Serum Neutrophil Gelatinase-Associated Lipocalin Levels in Patients Who Underwent First-time Diagnostic Coronary Angiography

Journal of the American College of Cardiology, 2013

Aım: Aspirin is an inhibitor of platelet function and is one of the cornerstones of acute coronar... more Aım: Aspirin is an inhibitor of platelet function and is one of the cornerstones of acute coronary syndrome (ACS) treatment. However, the ideal dose and usage of aspirin in patients with ACS is not clear. The aim of this study is to investigate the antiplatelet effects of different aspirin doses and application ways in patients with ACS. Method: This study included 30 patients that were admitted to Cardiology Clinic of Ankara University Faculty of Medicine with a diagnosis of acute coronary syndrome. The patients included in the study were divided into three groups based on the dose of aspirin utilization (1x100 mg, 1x300 mg, and 3x100 mg). On 3rd day of acute coronary syndrome, thrombocyte aggregation levels, which were assesed by Ver-ifyNowÒ aspirin test, were compared at 2 hours (early) and 24 hours (late) after initial aspirin. Results: Ten of the patients (33%) were women and 20 were men (67%) and mean age was 61.2AE11.5 years. According to demographic and laboratory characteristics, no statistical difference was determined between the groups. Antiplatelet effect of aspirin at 2nd hour were as follows respectively; 402.4AE29.3 ARU in aspirin 300mg per day group, 440.4AE36.7 ARU in 100mg 3 times a day group and 418.2AE41 ARU in aspirin 100 mg per day group (p¼0.04). All groups' ARU values were increased at 24th hour compared with first 2nd hour measurements but this increase was minimum in 3x100 mg aspirin group. There were no difference in ARU values at 24th hour measurement between groups. No aspirin resistance observed in any of the patients. Conclusıon: Antiplatelet effect of both 100 mg and 300 mg aspirin doses decreased during the day but their efficacy still continued and no difference was detected between the doses. Despite the theoretical advantages of the use of aspirin in divided doses, our study did not support this.

Research paper thumbnail of Novel Fibroinflammatory Markers in Non-valvular Atrial Fibrillation: Galectin-3, Lcn2/NGAL, P3NP

Journal of the American College of Cardiology, 2013

p¼0.001 Mann-Whitney U test, 146AE88 pg/ml & 429AE302 pg/ml p<0.0001 Student-t test, and 1426AESt... more p¼0.001 Mann-Whitney U test, 146AE88 pg/ml & 429AE302 pg/ml p<0.0001 Student-t test, and 1426AEStudent-t test respectively). Hs1230 pg/ml & 6590AE4594 pg/ml p<0.0001-Crp and NLR level were also higher in NVAF (2.1AE1.0 & 2.7AE1.1 p¼0.02 Student-t test and 4.2AE1.9 mg/L & 6.0AE4.7 mg/L p¼0.04 Student-t test, respectively). In correlation analyses, NLR showed quite significant correlation with LAVi whereas Hs-CRP did not (p¼0.007 r¼0.247, pearson test & p¼0.808 r¼0.025, pearson test,respectively). Moreover, Galectin-3, MMP-9, and PIIINP had strong positive correlation with LAVi (p¼0.021 r¼640, spearman test & p¼0.004 r¼0.319 pearson test, & p¼0.004 r¼0.325 pearson test,respectively). Conclusion: As a result of this data we suggest that galectin-3 and PIIINP can be used as novel targets in AF patients in order to decrease degree of fibro-inflammation in the atria.

Research paper thumbnail of Short Term Effect of Percutaneous Recanalization of Chronic Total Occlusions on QT Dispersion and Heart Rate Variability Parameters

Journal of the American College of Cardiology, 2013

None Background: QT dispersion (QTd), which is a measure of inhomogeneity of myocardial repolariz... more None Background: QT dispersion (QTd), which is a measure of inhomogeneity of myocardial repolarization, increases following impaired myocardial perfusion. Its prolongation may provide a suitable substrate for life-threatening ventricular arrhythmias. We investigated the changes in QTd and heart rate variability (HRV) parameters after successful coronary artery revascularization in a patient with chronic total occlusions (CTO). Material/Methods: This study included 139 successfully revascularized CTO patients (118 men, 21 women, mean age 58.3±9.6 years). QTd was measured from a 12-lead electrocardiogram and was defined as the difference between maximum and minimum QT interval. HRV analyses of all subjects were obtained. Frequency domain (LF: HF) and time domain (SDNN, pNN50, and rMSSD) parameters were analyzed. QT intervals were also corrected for heart rate using Bazett's formula, and the corrected QT interval dispersion (QTcd) was then calculated. All measurements were made before and after percutaneous coronary intervention (PCI). Results: Both QTd and QTcd showed significant improvement following successful revascularization of CTO (55.83±14.79 to 38.87±11.69; p<0.001 and 61.02±16.28 to 42.92±13.41; p<0.001). The revascularization of LAD (n=38), Cx (n=28) and RCA (n=73) resulted in decrease in HRV indices, including SDDN, rMSSD, and pNN50, but none of the variables reached statistical significance. Conclusions: Successful revascularization of CTO may result in improvement in regional heterogeneity of myocardial repolarization, evidenced as decreased QTcd after the PCI. The revascularization in CTO lesions does not seem to have a significant impact on HRV.

Research paper thumbnail of Comparison of Single-dose and Intermittent Levosimendan Infusion in Patients With Acute Exacerbation of Advanced Heart Failure

Journal of the American College of Cardiology, 2013

The aim of the study was to investigate the effects of single and intermittent levosimendan infus... more The aim of the study was to investigate the effects of single and intermittent levosimendan infusion on left ventricular performance, biomarkers and neurohormonal activation in patients with acute exerbation of advanced heart failure. Methods: Twenty nine patients (20 male, 9 female, mean age 60.2AE7.4 years) with acute exerbation of advanced heart failure (ejection fraction 35%) were included in this study. Levosimendan was initiated as a bolus of 6 mg/kg followed by a continuous infusion of 0,1 mg/kg/min for 24 hours in both groups who were taken intravenous

Research paper thumbnail of Is Postdilatation with a Noncompliant Balloon Necessary after Coronary Stent Deployment during Primary Angioplasty?

Journal of Interventional Cardiology, 2013

Postdilatation (PD) with noncompliant balloon during elective percutaneous coronary intervention ... more Postdilatation (PD) with noncompliant balloon during elective percutaneous coronary intervention (PCI) is performed usually in clinical practice in order to optimize stent expansion. However, current knowledge about its use in patients undergoing primary PCI is controversial. This study aims to evaluate the angiographical and clinical results of PD in patients who underwent primary PCI with drug eluting stents (DESs). A total of 405 consecutive patients (mean age 56.9 ± 12.3 years; 302 male) with ST elevation myocardial infarction were evaluated retrospectively. Patients received DES with or without predilatation according to physician&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;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;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 discretion. Eligible patients were divided into 2 groups based on PD procedure. The clinical end-points were death, target vessel revascularization (TVR) and stent thrombosis at 6 months after PCI. The angiographic end-points were postprocedural correct Thrombolysis in Myocardial Infarction (TIMI) frame count (cTFC), final TIMI flow, and myocardial blush grade (MBG). PD was performed in 214 patients (52.8%). Angiographical parameters such as TIMI flow, cTFC, and MBG did not differ after PD (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;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;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;gt;0.05). During 6-month follow-up, TVR and stent thrombosis rates were lower in the PD group (6 vs. 16, P=0.03; and 3 vs. 10, P=0.04, respectively). PD and diabetes were detected as independent predictors of MACE (β=0.52, P=0.01, and β=-0.47, P=0.02; respectively). Our study revealed that PD does not yield adverse effects on final angiographic parameters when performed during primary PCI. Besides PD seems to decrease probability of stent thrombosis and TVR.

Research paper thumbnail of Utility of the neutrophil to lymphocyte ratio for predicting in-hospital mortality after levosimendan infusion in patients with acute decompensated heart failure

Journal of Cardiology, 2014

Background: The aim of this study was to investigate the effect of a levosimendan infusion on hem... more Background: The aim of this study was to investigate the effect of a levosimendan infusion on hematological variables in patients with acute decompensated heart failure (ADHF). The predictive value of these variables for in-hospital mortality was also evaluated. Methods: A total of 553 patients (368 males; mean age, 63.4 ± 14.9 years) with acute exacerbations of advanced heart failure (ejection fraction ≤35%) and treated with either dobutamine or levosimendan were included in this retrospective analysis. The patients that received levosimendan therapy were divided into two groups according to in-hospital mortality: group 1 (21%) included patients who died during hospitalization (n = 45), while group 2 (79%) included patients with a favorable outcome (n = 174) after levosimendan infusion. Changes in several hematological variables between admission and the third day after levosimendan infusion were evaluated. Results: The demographic characteristics and risk factors of the two groups were similar. A comparison of changes in laboratory variables after the infusion of levosimendan revealed significant improvement only in those patients who had not died (group 2) during hospitalization. The neutrophil to lymphocyte (N/L) ratio after levosimendan infusion was an independent predictor of in-hospital mortality (odds ratio: 1.310, 95% CI: 1.158-1.483, p < 0.001). In a receiver-operating characteristic curve analysis, a value of 5.542 for the N/L ratio after levosimendan administration was identified as an effective cutoff point for predicting in-hospital mortality (area under the curve = 0.737; 95% confidence interval = 1100-1301; p < 0.001). Conclusions: Levosimendan treatment was associated with significant changes in hematological variables in patients with ADHF. A sustained higher N/L ratio after levosimendan infusion is associated with an increased risk of in-hospital mortality in patients with ADHF.

Research paper thumbnail of Polycystic ovary syndrome is associated with P-wave prolongation and increased P-wave dispersion

Gynecological Endocrinology, 2013

The polycystic ovary syndrome (PCOS) is associated with various cardiac manifestations including ... more The polycystic ovary syndrome (PCOS) is associated with various cardiac manifestations including cardiac arrhythmias. P-wave dispersion (Pdis) is an appealing marker for predicting the risk of developing atrial arrhythmias. The purpose of this study was to evaluate P-wave durations and Pdis in patients with PCOS. Forty adult patients with PCOS and 46 age- and sex-matched healthy individuals were included in this study. P-wave maximum duration (Pmax) and P-wave minimum duration (Pmin) were calculated on the 12-lead electrocardiogram, and the difference between the Pmax and the Pmin was defined as Pdis. All individuals also underwent transthoracic echocardiographic evaluation. Pmax and Pdis were significantly higher in patients with PCOS compared with controls (p = 0.007, 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;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;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; 0.001, respectively). There was no difference in Pmin duration between both the groups (p = 0.2). Waist-to-hip ratio, insulin and homeostasis model assessment of insulin resistance (HOMA-IR) were higher in the PCOS group. Early mitral inflow deceleration time (DT) (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;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;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; 0.001) and isovolumetric relaxation time (p = 0.003) were longer in PCOS group. Waist-to-hip ratio, DT, E/A ratio and diastolic blood pressure correlated with Pdis. Patients with PCOS have prolonged Pmax and Pdis. The increase in those parameters may be an indicator for identification of patients at increased risk of atrial fibrillation.