Ercan Erdoğan - Academia.edu (original) (raw)
Papers by Ercan Erdoğan
International Urology and Nephrology, 2012
P-wave parameters including P-wave dispersion (P d) have been examined in general population to p... more P-wave parameters including P-wave dispersion (P d) have been examined in general population to predict development of atrial fibrillation (AF). But data on end-stage renal disease (ESRD) population are limited. P index (Pi) and interatrial block (IAB) as novel parameters may more accurately predict AF and have not been previously investigated in ESRD patients. We aimed to evaluate these novel ECG parameters in ESRD patients. Eighty-six HD, 47 CAPD, and 43 age- and gender-matched control subjects were enrolled in the study. P-wave duration was measured in all 12-leads of the surface ECG. The standard deviation of the P-wave duration across the 12 ECG leads was accepted as a Pi. P-wave duration above and equal to 110 ms was defined as IAB. All P-wave parameters were evaluated digitally by two observers. Pi was found to be significantly different among the groups in ANOVA. In post hoc analysis, P i was increased in HD group compared with the control group (p = 0.01). Also, P i tended to increase in CAPD group compared with controls (p = 0.06). The effect of ESRD on P i was independent of age, gender, and systolic blood pressure in univariate covariant analysis. The prevalence of IAB was 61, 55, and 32 % in patients with HD, CAPD, and controls, respectively (p = 0.001). P d was significantly higher in HD group compared with healthy controls. However, Pd values of CAPD patients did not show significant difference compared with controls. The present study demonstrated that IAB frequency and Pi were increased in patients with ESRD.
The Turkish Journal of Gastroenterology, 2013
ABSTRACT To the Editor, Achalasia is a rare disease that is characterized by the deterioration in... more ABSTRACT To the Editor, Achalasia is a rare disease that is characterized by the deterioration in esophageal peristalsis and a poorly relaxing lower esophageal sphincter (LES) due to increased LES pressure, with an incidence of 1/100.000 (1). The main symptoms are dysphagia to solids and liquids, regurgitation and chest pain. Heartburn occurs in 27-42% of achalasia patients. In the literature, achalasia and the coexistence of some cardiovascular diseases has been reported. The coexistence of achalasia with cardiac pre-excitation, pneumopericardium and esophagopericardial fistula presenting as pericarditis, left atrial thrombus, takotsubo cardiomyopathy, and mitral stenosis was previously reported (2-6). One of the remarkable previous reports is about achalasia as a rare cause of congestive heart failure via severe compression of the left atrium (7). Moreover, there were also reports about cardiac arrhythmia during pneumatic dilatation of achalasia or fatal heart block following treatment with botulinum toxin (8,9). However, in the literature, to the best of our knowledge, the coexistence of hypertrophic cardiomyopathy (HCM) and achalasia has not been reported before. Hypertrophic cardiomyopathy, a disease with a prevalence of 1:500, is characterized by left ventricle (LV) hypertrophy, without dilatation, usually asymmetrical and mainly septal, in the absence of any other cardiac or systemic diseases that can lead to a LV hypertrophy (10). Heartburn and chest pain are frequent symptoms. The coexistence of HCM and achalasia in the same patient is very unusual. We had the experience of managing a 38-year-old male patient with HCM and achalasia. He had complaints of retrosternal pain, heartburn and exercise intolerance. He had been treated previously by his family physician with proton pump inhibitors for one month but symptoms did not resolve. Finally, he was referred to a cardiologist for further evaluation after electrocardiogram (ECG) was obtained because of deep negative T waves in the precordial and lateral leads and LV hypertrophy with a strain pattern. The transthoracic echocardiographic study showed an asymmetric type of LV hypertrophy (anterior ventricular septum: 30 mm, posterior wall 11 mm) (Figure 1). The diagnosis of HCM was made. There was a moderate LV outflow gradient (mean gradient: 30 mmHg). Myocardial perfusion scintigraphy (SPECT) was planned on the suspicion of coronary ischemia, but no signs of ischemia or perfusion defects were detected. He was treated with 100 mg metoprolol and 100 mg acetylsalicylic acid once a day; however, on the 20th day of the treatment, he returned with a deteriorating heartburn and progressive dysphagia. He was referred to a gastroenterologist. The upper gastrointestinal endoscopy was normal. However, barium esophagogram revealed the diagnosis of achalasia with anarrowed ending of the esophagus, resembling a bird's beak, and a dilated esophagus with delayed emptying of the barium into the stomach (Figure 2). With the diagnosis of achalasia, pneumatic balloon dilatation was performed. His medication was changed to verapamil 120 mg once a day and metoprolol was stopped due to its possible augmentative effects on LES contractility. In this particular patient, we think that the initial metoprolol therapy after the diagnosis of HCM may have accelerated the symptoms of achalasia due to its augmentative effects on LES contractility. The coexistence of these diseases also drew our attention to some interesting common physiopathological pathways. Vasoactive intestinal polypeptide (VIP) and the VIP receptor 1 gene, which is highly polymorphic, were suggested to play a role in late-onset idiopathic achalasia (11). Increased degradation of VIP in the heart with fibrosis was also demonstrated previously (12). Furthermore, there are some reports suggesting that the impaired neuronal nitric oxide (NO) synthesis of the myenteric plexus may be a contributing factor in the pathogenesis of achalasia (13). There is also a growing body of evidence about NO playing an important role in the physiopathology of HCM. Decreased expression of myocardial endothelial NO synthase among dogs with HCM was previously described by Piech et al. (14). Moreover, different protein kinase C (PKC) isozymes were shown to mediate LES tone and phasic contraction of esophageal circular smooth muscle (15); PKC-αwas shown to induce cardiomyocyte hypertrophy by an increase in protein synthesis, protein-DNA ratio, and cell surface area (16). The crucial roles of the VIP signaling system, NO and PKC in the physiopathology of both diseases may require further investigation. We believe it is important for the clinician to be aware of the presence of this entity. HCM patients with deteriorating chest pain or new-onset dysphagia during the follow-up, especially while under therapy with beta-blockers, should undergo further examination in consideration of achalasia, which should necessitate a gastroenterology…
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2012
Shone's syndrome is a very rare cardiac malformation composed of four obstructive congenital ... more Shone's syndrome is a very rare cardiac malformation composed of four obstructive congenital lesions, which include the parachute mitral valve (PMV), supravalvular ring, subaortic stenosis, and coarctation of aorta. Diagnosis requires a comprehensive examination including a carefully performed echocardiography. It is extremely unusual for a patient to remain undiagnosed during adulthood. Here we report a 26-year-old male patient with Shone's syndrome and patent ductus arteriosus (PDA). The patient reported that he had been suffering from exercise intolerance and aggravating dyspnea. Two years ago, he was operated on in another hospital based on the wrong diagnosis of mitral valve prolapse and subaortic membrane. Transthoracic echocardiography revealed the existence of a PMV, which led to severe mitral stenosis through a previously implanted mitral annular ring. Other components of Shone's syndrome, subaortic membrane and aortic coarctation, together with PDA, were also o...
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2011
![Research paper thumbnail of [Isolated pulmonary supravalvular stenosis accompanied by pulmonary artery aneurysm]](https://attachments.academia-assets.com/85091351/thumbnails/1.jpg)
](Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2011
We present a 19-year-old asymptomatic female patient in whom isolated pulmonary supravalvular ste... more We present a 19-year-old asymptomatic female patient in whom isolated pulmonary supravalvular stenosis and pulmonary artery aneurysm were incidentally detected. On cardiologic examination, a systolic murmur was heard over the lungs, right axis deviation was seen on the electrocardiogram, and marked appearance of the pulmonary artery was noted on the chest X-ray. On transthoracic echocardiography, the pulmonary artery trunk was found to be wider than normal, and there were mild pulmonary and tricuspid regurgitation. Color Doppler examination showed a turbulent flow 2 cm distal to the pulmonary valve. Transesophageal echocardiography showed a supravalvular membranous structure and a proximal pulmonary artery aneurysm. The pulmonary artery trunk was measured as 40 mm at the widest part. Thoracic computed tomography revealed that the proximal pulmonary artery aneurysm was localized to the pulmonary artery trunk and measured 41 mm. As the patient was asymptomatic and there were no signs ...
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2010
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2010
We evaluated the effects of endothelial dysfunction and inflammation on slow coronary flow (SCF).... more We evaluated the effects of endothelial dysfunction and inflammation on slow coronary flow (SCF). The study included 26 patients (group 1; 13 females, 13 males; mean age 58.8 years) who had normal coronary arteries but SCF in three coronary vessels and 25 subjects (group 2, 14 females, 11 males; mean age 62.7 years) with normal coronary arteries and normal flow. Coronary flow was quantified according to the TIMI (Thrombolysis In Myocardial Infarction) frame count method for the left anterior descending (LAD), circumflex (Cx), and right coronary (RCA) arteries. Endothelial function was assessed by plasma asymmetric dimethylarginine (ADMA) levels, brachial artery endothelium-dependent flow-mediated dilatation (FMD), and nitroglycerin-mediated dilatation (NMD). Inflammation was assessed by high-sensitivity C-reactive protein (hs-CRP) levels. TIMI frame count was significantly higher in group 1 compared to group 2 for each artery (p<0.001). In group 1, the mean FMD was significantly ...
Kardiologia polska, Jan 3, 2015
Psoriasis vulgaris is one of the most common chronic inflammatory skin disorders. Patients with p... more Psoriasis vulgaris is one of the most common chronic inflammatory skin disorders. Patients with psoriasis are at risk of developing atrial fibrillation (AF). The electromechanical delay (EMD) is the time interval from the onset of the P wave on surface electrocardiography (ECG) to the beginning of the A wave. Prolonged atrial EMD is an independent risk factor for the development of AF. This study investigated the intra- and interatrial EMD in patients with psoriasis. This study included 85 adults with psoriasis vulgaris (group 1) and 46 age- and sex-matched healthy individuals (group 2). ECGs were obtained from all subjects, and atrial EMD variables were calculated. Results are reported as means ± standard deviations and percentages. Continuous variables were analyzed using Student's t- test. A p-value < 0.05 was considered statistically significant. Interatrial electromechanical delay (IA-EMD) and intra- left atrial electromechanical delay (ILA-EMD) were significantly longer...
BMC Cardiovascular Disorders, 2014
Blood Pressure, 2014
Abstract Objectives. Autonomic dysfunction (AD) is frequent in sarcoidosis and considered a resul... more Abstract Objectives. Autonomic dysfunction (AD) is frequent in sarcoidosis and considered a result of small fiber neuropathy. A non-dipper blood pressure (BP) pattern, which is also linked to AD, is associated with increased risk of cardiovascular and renal diseases. The aim of the present study was to evaluate the non-dipping BP pattern in normotensive patients with pulmonary sarcoidosis (PS). Methods. Sixty-three normotensive patients with PS (group 1) and 49 healthy subjects (group 2) were prospectively enrolled. Ambulatory BP monitoring was performed in all participants over a 24-h period. Results. The non-dipping BP pattern was significantly more frequent in patients with PS compared with the control group (80% vs 53%, respectively, p = 0.002). More advanced PS (grade 2) was an independent predictor of non-dipper BP pattern (odds ratio = 10.4, 95% confidence interval 1.1-95.4, p = 0.03). Masked hypertension and body mass index were also found to be other predictors of non-dipping BP pattern. Conclusions. The present study showed that non-dipping BP pattern is frequently observed in normotensive patients with PS. The probable mechanism underlying the non-dipping BP in PS is autonomic nervous system dysfunction. PS represents an independent risk factor for non-dipping BP and these patients have increased cardiovascular risk.
Clinics, 2013
Successful revascularization of chronic total occlusions has been associated with improved left v... more Successful revascularization of chronic total occlusions has been associated with improved left ventricular systolic function, reduced anginal symptoms, increased exercise capacity, and increased survival. This study was conducted to determine the impact of revascularization in chronic total occlusion on left ventricular function using novel echocardiographic techniques. METHODS: A total of 129 patients with chronic total occlusion who underwent revascularization between April 2011 and November 2012 were included in this study. Echocardiographic assessments with two-dimensional speckle tracking echocardiography and real-time three-dimensional echocardiography were performed before the procedure and one month after the procedure. The left ventricular ejection fraction, left ventricular volumes, and three-dimensional systolic dyssynchrony index were quantified. RESULTS: An immediate procedural success was obtained in 118 patients (91.5%). There were no acute or subacute stent thromboses during follow-up. The mean left ventricular ejection fraction significantly increased (p,0.001), while the left ventricular end-diastolic and end-systolic volumes significantly decreased (p = 0.001 and p,0.001, respectively). The three-dimensional systolic dyssynchrony index also decreased significantly (p,0.001). The global longitudinal strain showed a significant increase after successful revascularization (p,0.001). An increase in the global longitudinal strain was correlated with an increase in the left ventricular ejection fraction (r = 0.27, p = 0.02). The patients with a left ventricular ejection fraction $50% displayed a greater improvement in the global longitudinal strain, and the patients with diabetes showed less improvement. CONCLUSIONS: Using novel echocardiographic techniques, our results showed that restoring the coronary blood flow in chronic total occlusion patients reduces the left ventricular volumes and improves the left ventricular ejection fraction and the global longitudinal strain of hibernating myocardium.
Advances in Interventional Cardiology, 2013
Critical hand ischemia caused by chronic occlusive arterial disease is an uncommon condition. Dia... more Critical hand ischemia caused by chronic occlusive arterial disease is an uncommon condition. Diabetes mellitus and chronic renal insufficiency are the concomitant conditions in most of these patients. A 59-year-old woman with diabetic nephropathy being treated with hemodialysis was referred to the Cardiology Department for a non-healing necrotic lesion in the distal part of the fourth finger. We performed balloon angioplasty for diffuse and severe calcified total occlusion of the radial artery using long and high pressure resistant balloons. After successful angioplasty the symptoms were relieved immediately and the finger was almost healed within 2 months of follow-up. K Ke ey y w wo or rd ds s: : limb ischemia, radial artery occlusion, angioplasty.
European Geriatric Medicine, 2013
Istanbul Medical Journal, 2014
Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology, 2012
Wiener klinische Wochenschrift, 2012
Scandinavian Cardiovascular Journal, 2012
Red cell distribution width (RDW) has been associated with poor outcomes in patients with cardiov... more Red cell distribution width (RDW) has been associated with poor outcomes in patients with cardiovascular diseases. However, little is known about the role of RDW in prediction of new-onset atrial fibrillation (AF) after coronary artery bypass grafting (CABG). We aimed to investigate the relation between the RDW and postoperative AF in patients undergoing CABG. A total of 132 patients undergoing nonemergency CABG were included in the study. Patients with previous atrial arrhythmia or requiring concomitant valve surgery were excluded. We retrospectively analyzed 132 consecutive patients (mean age, 60.55 ± 9.5 years; 99 male and 33 female). The RDW level was determined preoperatively and on postoperative Day 1. Preoperative RDW levels were significantly higher in patients who developed AF than in those who did not (13.9 ± 1.4 vs. 13.3 ± 1.2, p = 0.03). There was not any correlation between postoperative RDW levels and AF. Using a cutpoint of 13.45, the preoperative level correlated with the incidence of AF with a sensitivity of 61% and specificity of 60%. Preoperative RDW level predicts new-onset AF after CABG in patients without histories of AF.
Nutrition, Metabolism and Cardiovascular Diseases, 2014
Metabolic syndrome (MS) is associated with cardiovascular mortality and morbidity in patients wit... more Metabolic syndrome (MS) is associated with cardiovascular mortality and morbidity in patients with acute coronary syndrome. The purpose of this study was to evaluate the impact of MS on long-term clinical outcomes in patients with pure non-ST segment myocardial infarction (NSTEMI) or unstable angina pectoris (USAP). We prospectively enrolled 310 consecutive NSTEMI/USAP patients (74 females; mean age, 59.3 ± 11.9 years). The study population was divided into two groups: MS(+) and MS(-). The clinical outcomes of the patients were followed for up to 3 years. Increased 3-year cardiovascular mortality and reinfarction were observed in the MS(+) group, as compared to the MS(-) group (15 vs. 3.4%, p = 0.001, and 22.2 vs. 8.3%, p = 0.001, respectively). Hospitalization rates for heart failure and stroke were not significantly different between the two groups on follow-up. By a Cox multivariate analysis, a significant association was noted between MS and the adjusted risk of 3-year cardiovascular mortality (odds ratio 3.4, 95% confidence interval, 1.24-9.1, p = 0.02). These results suggest that MS is associated with an increased risk of 3-year cardiovascular mortality and reinfarction in patients with NSTEMI/USAP.
Journal of the Neurological Sciences, 2013
Neutrophil/lymphocyte ratio (NLR) has been associated with poor outcomes in patients with cardiov... more Neutrophil/lymphocyte ratio (NLR) has been associated with poor outcomes in patients with cardiovascular diseases. However, little is known about the role of NLR in patients with thromboembolic stroke due to atrial fibrillation (AF). We aimed to compare the NLR ratios between non-valvular AF patients with or without thromboembolic stroke. A total of 126 non-valvular AF patients with or without stroke were included in the study; 126 consecutive patients (52 males and 74 females), mean age, 70 ± 10.2 years old. No patient had a recent history of an acute infection or an inflammatory disease. Baseline NLR was measured by dividing neutrophil count to lymphocyte count. WBC count&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;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;12.000 cells per μL or &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;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;4.000 cells per μL and high body temperature&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;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;38 º are excluded from the study. Mean NLR was significantly higher among persons with stroke compared to individuals without a stroke (5.6 ± 3.4 vs. 3.1 ± 2.1, p=0.001). There were no significant differences in RDW levels between the two groups (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;gt;0.05). HAS-BLED and CHADS(2) scores were significantly higher in the stroke group. Higher NLR, an emerging marker of inflammation, is associated with thromboembolic stroke in non-valvular AF patients.
International Urology and Nephrology, 2012
P-wave parameters including P-wave dispersion (P d) have been examined in general population to p... more P-wave parameters including P-wave dispersion (P d) have been examined in general population to predict development of atrial fibrillation (AF). But data on end-stage renal disease (ESRD) population are limited. P index (Pi) and interatrial block (IAB) as novel parameters may more accurately predict AF and have not been previously investigated in ESRD patients. We aimed to evaluate these novel ECG parameters in ESRD patients. Eighty-six HD, 47 CAPD, and 43 age- and gender-matched control subjects were enrolled in the study. P-wave duration was measured in all 12-leads of the surface ECG. The standard deviation of the P-wave duration across the 12 ECG leads was accepted as a Pi. P-wave duration above and equal to 110 ms was defined as IAB. All P-wave parameters were evaluated digitally by two observers. Pi was found to be significantly different among the groups in ANOVA. In post hoc analysis, P i was increased in HD group compared with the control group (p = 0.01). Also, P i tended to increase in CAPD group compared with controls (p = 0.06). The effect of ESRD on P i was independent of age, gender, and systolic blood pressure in univariate covariant analysis. The prevalence of IAB was 61, 55, and 32 % in patients with HD, CAPD, and controls, respectively (p = 0.001). P d was significantly higher in HD group compared with healthy controls. However, Pd values of CAPD patients did not show significant difference compared with controls. The present study demonstrated that IAB frequency and Pi were increased in patients with ESRD.
The Turkish Journal of Gastroenterology, 2013
ABSTRACT To the Editor, Achalasia is a rare disease that is characterized by the deterioration in... more ABSTRACT To the Editor, Achalasia is a rare disease that is characterized by the deterioration in esophageal peristalsis and a poorly relaxing lower esophageal sphincter (LES) due to increased LES pressure, with an incidence of 1/100.000 (1). The main symptoms are dysphagia to solids and liquids, regurgitation and chest pain. Heartburn occurs in 27-42% of achalasia patients. In the literature, achalasia and the coexistence of some cardiovascular diseases has been reported. The coexistence of achalasia with cardiac pre-excitation, pneumopericardium and esophagopericardial fistula presenting as pericarditis, left atrial thrombus, takotsubo cardiomyopathy, and mitral stenosis was previously reported (2-6). One of the remarkable previous reports is about achalasia as a rare cause of congestive heart failure via severe compression of the left atrium (7). Moreover, there were also reports about cardiac arrhythmia during pneumatic dilatation of achalasia or fatal heart block following treatment with botulinum toxin (8,9). However, in the literature, to the best of our knowledge, the coexistence of hypertrophic cardiomyopathy (HCM) and achalasia has not been reported before. Hypertrophic cardiomyopathy, a disease with a prevalence of 1:500, is characterized by left ventricle (LV) hypertrophy, without dilatation, usually asymmetrical and mainly septal, in the absence of any other cardiac or systemic diseases that can lead to a LV hypertrophy (10). Heartburn and chest pain are frequent symptoms. The coexistence of HCM and achalasia in the same patient is very unusual. We had the experience of managing a 38-year-old male patient with HCM and achalasia. He had complaints of retrosternal pain, heartburn and exercise intolerance. He had been treated previously by his family physician with proton pump inhibitors for one month but symptoms did not resolve. Finally, he was referred to a cardiologist for further evaluation after electrocardiogram (ECG) was obtained because of deep negative T waves in the precordial and lateral leads and LV hypertrophy with a strain pattern. The transthoracic echocardiographic study showed an asymmetric type of LV hypertrophy (anterior ventricular septum: 30 mm, posterior wall 11 mm) (Figure 1). The diagnosis of HCM was made. There was a moderate LV outflow gradient (mean gradient: 30 mmHg). Myocardial perfusion scintigraphy (SPECT) was planned on the suspicion of coronary ischemia, but no signs of ischemia or perfusion defects were detected. He was treated with 100 mg metoprolol and 100 mg acetylsalicylic acid once a day; however, on the 20th day of the treatment, he returned with a deteriorating heartburn and progressive dysphagia. He was referred to a gastroenterologist. The upper gastrointestinal endoscopy was normal. However, barium esophagogram revealed the diagnosis of achalasia with anarrowed ending of the esophagus, resembling a bird's beak, and a dilated esophagus with delayed emptying of the barium into the stomach (Figure 2). With the diagnosis of achalasia, pneumatic balloon dilatation was performed. His medication was changed to verapamil 120 mg once a day and metoprolol was stopped due to its possible augmentative effects on LES contractility. In this particular patient, we think that the initial metoprolol therapy after the diagnosis of HCM may have accelerated the symptoms of achalasia due to its augmentative effects on LES contractility. The coexistence of these diseases also drew our attention to some interesting common physiopathological pathways. Vasoactive intestinal polypeptide (VIP) and the VIP receptor 1 gene, which is highly polymorphic, were suggested to play a role in late-onset idiopathic achalasia (11). Increased degradation of VIP in the heart with fibrosis was also demonstrated previously (12). Furthermore, there are some reports suggesting that the impaired neuronal nitric oxide (NO) synthesis of the myenteric plexus may be a contributing factor in the pathogenesis of achalasia (13). There is also a growing body of evidence about NO playing an important role in the physiopathology of HCM. Decreased expression of myocardial endothelial NO synthase among dogs with HCM was previously described by Piech et al. (14). Moreover, different protein kinase C (PKC) isozymes were shown to mediate LES tone and phasic contraction of esophageal circular smooth muscle (15); PKC-αwas shown to induce cardiomyocyte hypertrophy by an increase in protein synthesis, protein-DNA ratio, and cell surface area (16). The crucial roles of the VIP signaling system, NO and PKC in the physiopathology of both diseases may require further investigation. We believe it is important for the clinician to be aware of the presence of this entity. HCM patients with deteriorating chest pain or new-onset dysphagia during the follow-up, especially while under therapy with beta-blockers, should undergo further examination in consideration of achalasia, which should necessitate a gastroenterology…
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2012
Shone's syndrome is a very rare cardiac malformation composed of four obstructive congenital ... more Shone's syndrome is a very rare cardiac malformation composed of four obstructive congenital lesions, which include the parachute mitral valve (PMV), supravalvular ring, subaortic stenosis, and coarctation of aorta. Diagnosis requires a comprehensive examination including a carefully performed echocardiography. It is extremely unusual for a patient to remain undiagnosed during adulthood. Here we report a 26-year-old male patient with Shone's syndrome and patent ductus arteriosus (PDA). The patient reported that he had been suffering from exercise intolerance and aggravating dyspnea. Two years ago, he was operated on in another hospital based on the wrong diagnosis of mitral valve prolapse and subaortic membrane. Transthoracic echocardiography revealed the existence of a PMV, which led to severe mitral stenosis through a previously implanted mitral annular ring. Other components of Shone's syndrome, subaortic membrane and aortic coarctation, together with PDA, were also o...
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2011
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2011
We present a 19-year-old asymptomatic female patient in whom isolated pulmonary supravalvular ste... more We present a 19-year-old asymptomatic female patient in whom isolated pulmonary supravalvular stenosis and pulmonary artery aneurysm were incidentally detected. On cardiologic examination, a systolic murmur was heard over the lungs, right axis deviation was seen on the electrocardiogram, and marked appearance of the pulmonary artery was noted on the chest X-ray. On transthoracic echocardiography, the pulmonary artery trunk was found to be wider than normal, and there were mild pulmonary and tricuspid regurgitation. Color Doppler examination showed a turbulent flow 2 cm distal to the pulmonary valve. Transesophageal echocardiography showed a supravalvular membranous structure and a proximal pulmonary artery aneurysm. The pulmonary artery trunk was measured as 40 mm at the widest part. Thoracic computed tomography revealed that the proximal pulmonary artery aneurysm was localized to the pulmonary artery trunk and measured 41 mm. As the patient was asymptomatic and there were no signs ...
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2010
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2010
We evaluated the effects of endothelial dysfunction and inflammation on slow coronary flow (SCF).... more We evaluated the effects of endothelial dysfunction and inflammation on slow coronary flow (SCF). The study included 26 patients (group 1; 13 females, 13 males; mean age 58.8 years) who had normal coronary arteries but SCF in three coronary vessels and 25 subjects (group 2, 14 females, 11 males; mean age 62.7 years) with normal coronary arteries and normal flow. Coronary flow was quantified according to the TIMI (Thrombolysis In Myocardial Infarction) frame count method for the left anterior descending (LAD), circumflex (Cx), and right coronary (RCA) arteries. Endothelial function was assessed by plasma asymmetric dimethylarginine (ADMA) levels, brachial artery endothelium-dependent flow-mediated dilatation (FMD), and nitroglycerin-mediated dilatation (NMD). Inflammation was assessed by high-sensitivity C-reactive protein (hs-CRP) levels. TIMI frame count was significantly higher in group 1 compared to group 2 for each artery (p<0.001). In group 1, the mean FMD was significantly ...
Kardiologia polska, Jan 3, 2015
Psoriasis vulgaris is one of the most common chronic inflammatory skin disorders. Patients with p... more Psoriasis vulgaris is one of the most common chronic inflammatory skin disorders. Patients with psoriasis are at risk of developing atrial fibrillation (AF). The electromechanical delay (EMD) is the time interval from the onset of the P wave on surface electrocardiography (ECG) to the beginning of the A wave. Prolonged atrial EMD is an independent risk factor for the development of AF. This study investigated the intra- and interatrial EMD in patients with psoriasis. This study included 85 adults with psoriasis vulgaris (group 1) and 46 age- and sex-matched healthy individuals (group 2). ECGs were obtained from all subjects, and atrial EMD variables were calculated. Results are reported as means ± standard deviations and percentages. Continuous variables were analyzed using Student's t- test. A p-value < 0.05 was considered statistically significant. Interatrial electromechanical delay (IA-EMD) and intra- left atrial electromechanical delay (ILA-EMD) were significantly longer...
BMC Cardiovascular Disorders, 2014
Blood Pressure, 2014
Abstract Objectives. Autonomic dysfunction (AD) is frequent in sarcoidosis and considered a resul... more Abstract Objectives. Autonomic dysfunction (AD) is frequent in sarcoidosis and considered a result of small fiber neuropathy. A non-dipper blood pressure (BP) pattern, which is also linked to AD, is associated with increased risk of cardiovascular and renal diseases. The aim of the present study was to evaluate the non-dipping BP pattern in normotensive patients with pulmonary sarcoidosis (PS). Methods. Sixty-three normotensive patients with PS (group 1) and 49 healthy subjects (group 2) were prospectively enrolled. Ambulatory BP monitoring was performed in all participants over a 24-h period. Results. The non-dipping BP pattern was significantly more frequent in patients with PS compared with the control group (80% vs 53%, respectively, p = 0.002). More advanced PS (grade 2) was an independent predictor of non-dipper BP pattern (odds ratio = 10.4, 95% confidence interval 1.1-95.4, p = 0.03). Masked hypertension and body mass index were also found to be other predictors of non-dipping BP pattern. Conclusions. The present study showed that non-dipping BP pattern is frequently observed in normotensive patients with PS. The probable mechanism underlying the non-dipping BP in PS is autonomic nervous system dysfunction. PS represents an independent risk factor for non-dipping BP and these patients have increased cardiovascular risk.
Clinics, 2013
Successful revascularization of chronic total occlusions has been associated with improved left v... more Successful revascularization of chronic total occlusions has been associated with improved left ventricular systolic function, reduced anginal symptoms, increased exercise capacity, and increased survival. This study was conducted to determine the impact of revascularization in chronic total occlusion on left ventricular function using novel echocardiographic techniques. METHODS: A total of 129 patients with chronic total occlusion who underwent revascularization between April 2011 and November 2012 were included in this study. Echocardiographic assessments with two-dimensional speckle tracking echocardiography and real-time three-dimensional echocardiography were performed before the procedure and one month after the procedure. The left ventricular ejection fraction, left ventricular volumes, and three-dimensional systolic dyssynchrony index were quantified. RESULTS: An immediate procedural success was obtained in 118 patients (91.5%). There were no acute or subacute stent thromboses during follow-up. The mean left ventricular ejection fraction significantly increased (p,0.001), while the left ventricular end-diastolic and end-systolic volumes significantly decreased (p = 0.001 and p,0.001, respectively). The three-dimensional systolic dyssynchrony index also decreased significantly (p,0.001). The global longitudinal strain showed a significant increase after successful revascularization (p,0.001). An increase in the global longitudinal strain was correlated with an increase in the left ventricular ejection fraction (r = 0.27, p = 0.02). The patients with a left ventricular ejection fraction $50% displayed a greater improvement in the global longitudinal strain, and the patients with diabetes showed less improvement. CONCLUSIONS: Using novel echocardiographic techniques, our results showed that restoring the coronary blood flow in chronic total occlusion patients reduces the left ventricular volumes and improves the left ventricular ejection fraction and the global longitudinal strain of hibernating myocardium.
Advances in Interventional Cardiology, 2013
Critical hand ischemia caused by chronic occlusive arterial disease is an uncommon condition. Dia... more Critical hand ischemia caused by chronic occlusive arterial disease is an uncommon condition. Diabetes mellitus and chronic renal insufficiency are the concomitant conditions in most of these patients. A 59-year-old woman with diabetic nephropathy being treated with hemodialysis was referred to the Cardiology Department for a non-healing necrotic lesion in the distal part of the fourth finger. We performed balloon angioplasty for diffuse and severe calcified total occlusion of the radial artery using long and high pressure resistant balloons. After successful angioplasty the symptoms were relieved immediately and the finger was almost healed within 2 months of follow-up. K Ke ey y w wo or rd ds s: : limb ischemia, radial artery occlusion, angioplasty.
European Geriatric Medicine, 2013
Istanbul Medical Journal, 2014
Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology, 2012
Wiener klinische Wochenschrift, 2012
Scandinavian Cardiovascular Journal, 2012
Red cell distribution width (RDW) has been associated with poor outcomes in patients with cardiov... more Red cell distribution width (RDW) has been associated with poor outcomes in patients with cardiovascular diseases. However, little is known about the role of RDW in prediction of new-onset atrial fibrillation (AF) after coronary artery bypass grafting (CABG). We aimed to investigate the relation between the RDW and postoperative AF in patients undergoing CABG. A total of 132 patients undergoing nonemergency CABG were included in the study. Patients with previous atrial arrhythmia or requiring concomitant valve surgery were excluded. We retrospectively analyzed 132 consecutive patients (mean age, 60.55 ± 9.5 years; 99 male and 33 female). The RDW level was determined preoperatively and on postoperative Day 1. Preoperative RDW levels were significantly higher in patients who developed AF than in those who did not (13.9 ± 1.4 vs. 13.3 ± 1.2, p = 0.03). There was not any correlation between postoperative RDW levels and AF. Using a cutpoint of 13.45, the preoperative level correlated with the incidence of AF with a sensitivity of 61% and specificity of 60%. Preoperative RDW level predicts new-onset AF after CABG in patients without histories of AF.
Nutrition, Metabolism and Cardiovascular Diseases, 2014
Metabolic syndrome (MS) is associated with cardiovascular mortality and morbidity in patients wit... more Metabolic syndrome (MS) is associated with cardiovascular mortality and morbidity in patients with acute coronary syndrome. The purpose of this study was to evaluate the impact of MS on long-term clinical outcomes in patients with pure non-ST segment myocardial infarction (NSTEMI) or unstable angina pectoris (USAP). We prospectively enrolled 310 consecutive NSTEMI/USAP patients (74 females; mean age, 59.3 ± 11.9 years). The study population was divided into two groups: MS(+) and MS(-). The clinical outcomes of the patients were followed for up to 3 years. Increased 3-year cardiovascular mortality and reinfarction were observed in the MS(+) group, as compared to the MS(-) group (15 vs. 3.4%, p = 0.001, and 22.2 vs. 8.3%, p = 0.001, respectively). Hospitalization rates for heart failure and stroke were not significantly different between the two groups on follow-up. By a Cox multivariate analysis, a significant association was noted between MS and the adjusted risk of 3-year cardiovascular mortality (odds ratio 3.4, 95% confidence interval, 1.24-9.1, p = 0.02). These results suggest that MS is associated with an increased risk of 3-year cardiovascular mortality and reinfarction in patients with NSTEMI/USAP.
Journal of the Neurological Sciences, 2013
Neutrophil/lymphocyte ratio (NLR) has been associated with poor outcomes in patients with cardiov... more Neutrophil/lymphocyte ratio (NLR) has been associated with poor outcomes in patients with cardiovascular diseases. However, little is known about the role of NLR in patients with thromboembolic stroke due to atrial fibrillation (AF). We aimed to compare the NLR ratios between non-valvular AF patients with or without thromboembolic stroke. A total of 126 non-valvular AF patients with or without stroke were included in the study; 126 consecutive patients (52 males and 74 females), mean age, 70 ± 10.2 years old. No patient had a recent history of an acute infection or an inflammatory disease. Baseline NLR was measured by dividing neutrophil count to lymphocyte count. WBC count&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;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;12.000 cells per μL or &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;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;4.000 cells per μL and high body temperature&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;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;38 º are excluded from the study. Mean NLR was significantly higher among persons with stroke compared to individuals without a stroke (5.6 ± 3.4 vs. 3.1 ± 2.1, p=0.001). There were no significant differences in RDW levels between the two groups (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;gt;0.05). HAS-BLED and CHADS(2) scores were significantly higher in the stroke group. Higher NLR, an emerging marker of inflammation, is associated with thromboembolic stroke in non-valvular AF patients.