Fehmi Kacmaz | Üsküdar University, İstanbul, TURKEY (original) (raw)

Papers by Fehmi Kacmaz

Research paper thumbnail of OP-351 the Percutaneous Closure of Paravalvular Prosthetic Regurgitation: Our First Experiences

International Journal of Cardiology, 2012

results with compression of LMCA between aortic root and main pulmonary artery in patients with A... more results with compression of LMCA between aortic root and main pulmonary artery in patients with Anomalous LMCA. Determination of coronary artery anomalies is frequently difficult with conventional coronary angiography because of the lack of 3-dimensional information which relates the course of the anomalous LMCA to the great vessels. MDCT can provide higher spatial resolution and higher temporal resolution rather than coronary angiography.

Research paper thumbnail of Sinüs Valsalva yırtılması olan bir hastada perkütan kapama için geriye doğru yaklaşım

Türk kardiyoloji derneği arşivi, Dec 1, 2014

Research paper thumbnail of Detection of a coronary arteriovenous fistula between the circumflex artery and pulmonary vein by CT angiography

Archives of the Turkish Society of Cardiology, 2005

Research paper thumbnail of A very rare cause of continuous murmur and coronary ischemia: high-flow coronary-to-pulmonary artery fistula

Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2008

A 52-year-old woman presented with complaints of chest discomfort and angina radiating to the nec... more A 52-year-old woman presented with complaints of chest discomfort and angina radiating to the neck and left arm on exertion. She reported that the severity of angina was increasing after sublingual nitrate intake. Coronary angiography showed a high-flow fistula between the left main coronary artery and pulmonary artery. Left coronary arteries were normal, but there was a stenotic lesion in the right coronary artery. Coronary artery fistula was ligated successfully under bypass surgery. It was thought that the severity of myocardial ischemia caused by the high-flow fistula was aggravated by sublingual nitrate due to coronary steal phenomenon.

Research paper thumbnail of PP-117 Successful Retrograde Angioplasty Via Collateral Circulation in Patient with Chronic Total Ocluded Posterior Tibial Artery

The American Journal of Cardiology, 2016

Research paper thumbnail of at Pennsylvania State U

ow nloaded from Improvement in sympatho-vagal imbalance and heart rate variability in patients wi... more ow nloaded from Improvement in sympatho-vagal imbalance and heart rate variability in patients with mitral stenosis after percutaneous balloon commissurotomy

Research paper thumbnail of by guest on Septem

ow nloaded from Improvement in sympatho-vagal imbalance and heart rate variability in patients wi... more ow nloaded from Improvement in sympatho-vagal imbalance and heart rate variability in patients with mitral stenosis after percutaneous balloon commissurotomy

Research paper thumbnail of Retrograde approach for percutaneous closure in a patient with ruptured sinus of Valsalva

Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2014

In this report, we present a 37-year-old male with ruptured right sinus of Valsalva. He was treat... more In this report, we present a 37-year-old male with ruptured right sinus of Valsalva. He was treated by percutaneous closure of the rupture using the retrograde approach. The procedure was performed successfully within 26 minutes. We think this approach may be used in future instead of the antegrade approach.

Research paper thumbnail of The efficiency and safety of percutaneous closure of secundum atrial septal defects with the Occlutech Figulla device: initial clinical experience

Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2010

We evaluated the efficiency and safety of the Occlutech Figulla device in percutaneous closure of... more We evaluated the efficiency and safety of the Occlutech Figulla device in percutaneous closure of secundum atrial septal defects (ASD). The study included 28 patients (17 women, 11 men; mean age 43 years) who underwent percutaneous transcatheter closure using the Occlutech Figulla device for secundum ASDs causing a hemodynamically significant shunt. Defect size was estimated by transthoracic (TTE) and transesophageal (TEE) echocardiography, and also by balloon sizing in nine patients. The patients were followed-up for six months and were examined by TTE. The mean defect size was 20.3+/-2.1 mm on TTE, 22.1+/-1.9 mm on TEE, and 24.2+/-2.4 mm on balloon sizing. The mean device size was 26.8+/-3.6 mm (range 6 to 36 mm). The mean procedure time was 44.7+/-21.4 minutes. The device was placed successfully in all the patients. A small residual flow was seen immediately after device placement in three patients (10.7%), which disappeared in two patients at three months, and in one patient at ...

Research paper thumbnail of A new electrocardiographic marker of myocardial reperfusion in patients with acute ST-segment elevation myocardial infarction treated with primary percutaneous intervention: the value of QRS duration

EuroIntervention, 2012

Aims: Although ischaemia-induced QRS complex changes have been described previously, their relati... more Aims: Although ischaemia-induced QRS complex changes have been described previously, their relation with reperfusion status is not clear. We aimed to investigate the relation of QRS duration with reperfusion at tissue level compared to myocardial blush in patients with acute myocardial infarction who underwent successful primary percutaneous coronary angioplasty. Methods and results: One hundred and forty-eight patients were enrolled. Based on the post-angioplasty myocardial blush grade (MBG), patients were divided into reperfusion (grades 2 and 3) and impaired reperfusion (grades 0 and 1) groups. Although the two groups did not differ in terms of admission QRS duration (81±17 vs. 79±15 msec, p=0.473), the patients in the impaired reperfusion group had a significantly longer QRS duration both at immediate post-angioplasty (78±18 vs. 68±17 msec, p=0.001) and at the 60 th minute ECG (77±17 vs. 60±17 msec, p<0.001). Patients in the impaired reperfusion group revealed significantly less narrowing of QRS duration in the post-angioplasty 60 th minute ECG (6±5 vs. 20±5 msec, p<0.001) when compared to the patients in the reperfusion group. After adjusting all variables, QRS narrowing in the 60 th minute ECG was determined as an independent electrocardiographic predictor of reperfusion (OR:1.39, 95% CI: 1.25-1.54, p<0.001). Conclusions: We demonstrated that QRS duration is a strong indicator of myocardial reperfusion status.

Research paper thumbnail of High Levels of High Sensitivity C-Reactive Protein and Uric Acid can Predict Disease Severity in Patients with Mitral Regurgitation

Journal of the American College of Cardiology, 2013

ABSTRACT Background High sensitive C-Reactive Protein (hs-CRP) predicts morbidity and mortality i... more ABSTRACT Background High sensitive C-Reactive Protein (hs-CRP) predicts morbidity and mortality in various clinical conditions. The effect of hsCRP on progression of chronic rheumatic mitral stenosis (CRMS) has not been demonstrated. Methods and results A total of 132 patients with CRMS (95 female, 37 male) and 145 control (100 female, 45 male) were included in the study. Baseline clinical, echocardiographic, hematologic and hs-CRP measurements were collected prospectively. Mean mitral valve area (MVA) was 1.4±0.3 cm2, mean wilkins valve score value was 8.9±1.7, left atrial diameter was 5.0±0.7cm, left atrial area was 37.2±12.6 cm2, and systolic pulmonary arterial pressure (SPAP) was 44±11mmHg in patients with CRMS. The mean levels of hs-CRP value, fibrinogen, and mean platelet volume (MPV) were significantly higher in CRMS group compared to control group. The levels of hsCRP were found to be positively correlated with mean Wilkins valve score value, SPAP, presence of atrial fibrillation (AF), left atrial diameter, left atrial area, presence of LASEC(+), fibrinogen, and MPV and inversely correlated with MVA in patients with CRMS. Linear regression analysis revealed that the hsCRP level independently affects mean Wilkins valve score value, left atrial area (LAA), LASEC(+) and AF in the patients with CRMS. Conclusions These results suggest that increased hsCRP levels are associated with CRMS severity. These association may be important when treating patients with CRMS.

Research paper thumbnail of Systolic Total Narrowing of Left Anterior Descending Coronary Artery and Flow Interruption Secondary to Myocardial Bridge: A Rare Case Report and Review of Literature

Clinical Cardiology, 2008

A 33-y-old man was admitted to the emergency department with sudden onset of severe substernal ch... more A 33-y-old man was admitted to the emergency department with sudden onset of severe substernal chest pain radiating to the left arm and neck. No pathological signs were recorded upon physical examination. The admission electrocardiogram (ECG) recorded during chest pain showed a large anterior wall myocardial infarction. Intravenous (IV) infusion of 1.5 million units of streptokinase over 1 h was initiated. Coronary angiography revealed total narrowing and flow interruption in the midsegment of the left anterior descending (LAD) coronary artery secondary to a myocardial bridge during systole and disappearance with diastole. He was discharged on aspirin (300 mg/d), metoprolol (100 mg/d), enalapril (10 mg twice daily), and atorvastatin (40 mg/d) treatment at the follow-up period.

Research paper thumbnail of Hepatitis C Infection is Associated With Increased Coronary Artery Atherosclerosis Defined by Modified Reardon Severity Score System

Circulation Journal, 2008

Background The link between arteriosclerotic disease in the carotid or coronary artery and chroni... more Background The link between arteriosclerotic disease in the carotid or coronary artery and chronic hepatitis C virus (HCV) infection has been shown in some studies although other studies have produced contrary results. However, the effect of chronic HCV infection on the extension or severity of coronary artery disease (CAD) has not been determined so the aim of the present study was to determine the effect of HCV infection on the severity of CAD. Methods and Results The study group comprised 139 HCV seropositive and 225 HCV seronegative patients with angiographically documented CAD. A modified scoring system of Reardon et al was used. There were no significant differences between groups in terms of sex, age, hypertension, diabetes mellitus, smoking or family history. Levels of C-reactive protein and fibrinogen were significantly higher in the HCV seropositive group (p<0.001) and the Reardon severity score was higher (8.75±1.69 vs 6.01±1.80, p<0.001). After adjustment, HCV seropositivity still represented an independent predictor for severity of coronary atherosclerosis demonstrated by higher Reardon severity score with an odds ratio of 2.018 (95% confidence interval 1.575-2.579, p<0.001). Conclusion HCV infection is an independent predictor for increased coronary atherosclerosis, as demonstrated by higher Reardon severity score.

Research paper thumbnail of Effects of Cigarette Smoking on Heart Rate Variability and Plasma N-Terminal Pro-B-Type Natriuretic Peptide in Healthy Subjects: Is There the Relationship between Both Markers?

Annals of Noninvasive Electrocardiology, 2008

Background: Cigarette smoking increased the risk of acute cardiac events related with endothelial... more Background: Cigarette smoking increased the risk of acute cardiac events related with endothelial dysfunction and increased sympathetic activity. Impaired autonomic nervous activity is recognized as a considerable symptom of cardiac dysfunction and is strongly associated with increased risk overall mortality. Methods: A total of 75 healthy habitual smokers (40 female, 35 male, mean age 36.5 ± 8.5 years), and 73 non-smokers subjects (45 female, 28 male, mean age 34.6 ± 7.2 years) were studied. LF and LF/HF ratio were significantly higher in smokers than in non-smokers. On the contrary, SDNN, SDANN, RMSSD, and HF values were lower in smokers compared to those in non-smokers. Not the duration of smoking but the number of cigarettes smoked per day was correlated with the HRV parameters and NT-pro BNP. Furthermore, the average levels of NT-pro BNP were found to be positively correlated with LF, LF/HF and inversely correlated with SDNN, SDANN, RMSSD and HF. Results: As a result, smoking impaires sympathovagal balance and decreases the heart rate variability in healthy subjects. And even a one cigarette smoking leads to overt sympathetic excitation. Furthermore, smoking results in an increase in NT-proBNP levels and the changes in adrenergic nervous system and NT-proBNP levels are well correlated. Conclusion: These findings could contribute to the higher rate of cardiovascular events in smokers.

Research paper thumbnail of Relation of admission QRS duration with development of angiographic no-reflow in patients with acute ST-segment elevation myocardial infarction treated with primary percutaneous interventions

Journal of Electrocardiology, 2008

Research paper thumbnail of Endovascular stent graft repair of abdominal and thoracic aortic aneurysms

Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology, 2012

Preoperatif antiagregan kullanımı koroner baypas cerrahisi süresince gelişebilecek atriyal fibril... more Preoperatif antiagregan kullanımı koroner baypas cerrahisi süresince gelişebilecek atriyal fibrilasyon oranını azaltabilir Atrial fibrillation (AF) is one of the most common postoperative arrhythmias in patients who undergo coronary artery bypass grafting (1). This complication leads to increases in mortality and morbidity rate in coronary bypass surgery and in hospital stay caused by excess usage of medications (2). Diverse experimental and clinical trials are conducted to reduce post-operative AF development rate and associated complications; however, AF rate still remains to be up to 40% during bypass surgery. The etiology of postoperative AF is not well defined, although recent studies suggest a multi-factorial mechanism, which includes oxidative stress, inflammation, atrial fibrosis, and excessive production of catecholamines, changes in autonomic tone and in the expression of connexins (3, 4). By evaluating retrospectively our coronary bypass surgery results, we observed that we did not discontinue preoperatively used anti-aggregants since a long time and that postoperative AF rate was lower than found in coronary literature. At Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital coronary artery bypass surgeries that are performed by the same clinic between January 2009 and December 2009 were reviewed retrospectively. Statistical analysis is made by SPSS 15. Stopping anti-aggregants therapy before coronary bypass surgery is a classical literature knowledge; therefore control group parameters are taken from the literature ratios. Atrial fibrillation development rate was retrospectively evaluated in 250 coronary bypass patients who used anti-aggregants and also not discontinued before the operation. There was no significant difference between selected patients in terms of clinical and laboratory examinations. There was no atrial fibrillation history in all patients. There was no significant difference in duration of operation and number of used graft. LIMA and saphenous vein were used as graft in all patients. Atrial diameter of patients was similar and they had no atrial dilatation. Atrial fibrillation was developed in 9 patients (3%). According to literature information (3, 4), atrial fibrillation rate was assessed very low. In the controls after two months; there was no statistically significant increase in AF ratio. There was no significant increase in postoperative administration of blood or blood derivative considered as side effects despite to continuation of anti-aggregant usage. Revision and tamponade rate due to bleeding was conforming to literature. Continuing to preoperative anti-aggregant in patients without AF development risk factors significantly reduces AF development rate and we conclude that this may be considered as our coronary experience of a wide serial.

Research paper thumbnail of Complete atrioventricular block and syncope during acute pulmonary thromboembolism

Archives of the Turkish Society of Cardiology, 2007

The most common electrocardiographic (ECG) findings in acute pulmonary thromboembolism (PTE) are ... more The most common electrocardiographic (ECG) findings in acute pulmonary thromboembolism (PTE) are right bundle branch block, T wave, and ST-segment changes. Complete atrioventricular (AV) block has hitherto been reported in only one patient with PTE. A 63-year-old female patient presented with recurrent syncope and sudden-onset dyspnea. There was complete AV block in the admission ECG. She never had similar complaints before and an ECG taken three months before was completely normal. A temporary pacemaker was placed through the femoral vein. Physical and laboratory findings were suggestive of acute pulmonary embolism. Pulmonary artery angiography demonstrated nearly total occlusion of the proximal right pulmonary artery. Her coronary arteries were normal. Thrombolytic therapy with streptokinase infusion followed by standard heparin infusion resulted in clinical improvement and resolution of complete AV block. The patient was discharged on the 15th day with oral warfarin treatment. Akut pulmoner tromboembolizmde sag dal bloku, T

Research paper thumbnail of Classification of patients with ventricular tachycardia according to etiological, demographic and clinical features

Archives of the Turkish Society of Cardiology, 2005

Results: The most common etiological cause was chronic ischemia (45.9%), followed by acute ischem... more Results: The most common etiological cause was chronic ischemia (45.9%), followed by acute ischemia (18.6%) and dilated cardiomyopathy (14.3%), whereas no etiologic cause was found in 60 patients (15.3%). Ventricular tachycardia was accompanied by ventricular fibrillation (VF) and syncope in 109 (27.8%) and 196 (50%) patients, respectively. Of the patient group, 147 patients (37.5%) had three-vessel, 68 patients (17.4%) had two-vessel, and 35 patients (8.9%) had one-vessel disease. Ninety-two patients (23.5%) died during hospitalization. In-hospital mortality was significantly higher in patients with diabetes mellitus (p=0.002), acute myocardial infarction (p=0.004), syncope (p<0.001), and VF (p<0.001), whereas it was significantly lower in patients with idiopathic VT (p=0.01), and in those with an implanted cardioverter defibrillator (p=0.005). Logistic regression analysis revealed that syncope (p<0.001) and VF (p<0.001) were independent factors affecting mortality.

Research paper thumbnail of Acute Myocardial Infarction Due to Coronary Artery Dissection in a Premenopausal Woman, Possible Contribution of Aortic Coarctation and Review of Literature

British journal of medicine and medical research, 2014

It is well -known that coronary artery disease (CAD) is the most cause of death in all over the w... more It is well -known that coronary artery disease (CAD) is the most cause of death in all over the world and generally been considered as a disease of elderly people and occasionally middle-aged men. Emerging data displays an important sex -based difference in CAD. Therefore CAD in the female population especially in premenopausal women is still identified less often and is treated less aggressively compared to that in the male population. The incidence of CAD in wo men older than 65 years is similar to that in men. However It is generally acknowledged that the risk for CAD is very low in premenopausal women by the reason of protective effect of woman hormones. Herein we report acute myocardial infarction due to coron ary artery dissection in a premenopausal women, and conceivablecontribution of aortic coarctation .

Research paper thumbnail of Simultaneous ST-segment elevation in the precordial and inferior leads in acute myocardial infarction

Standart 12 derivasyonlu yüzey elektrokardiyografi (EKG) akut miyokard infarktüsü (AM ) tanısında... more Standart 12 derivasyonlu yüzey elektrokardiyografi (EKG) akut miyokard infarktüsü (AM ) tanısında de erli bilgiler veren, basit kullanı lı, noninvaziv bir yöntem olmasının yanında, infarktüsten sorumlu arter ile ST-segment yükselmesi arasında yakın ili ki gösterir. Akut miyokard infarktüslü hastalarda en yaygın EKG bulgusu ya prekordiyal derivasyonlarda ya da inferior derivasyonlarda ST-segment yükselmesidir. Ancak, aynı anda her ikisinde ST-segment yükselmesi nadir görülen bir durumdur. Anterior AM sırasında inferior derivasyonlardaki ST-segment yüksekli inin, sol ventrikülün inferior bölgesini besleyen ve apeksi dolanan sol ön inen (SÖ ) koroner arterin tıkanması ya da ana koroner arterin akut tıkanması sonucu olu tu u dü ünülmektedir. Bu yazıda, anterior AM sırasında EKG’de hem prekordiyal hem de inferior derivasyonlarda ST-segment yükselmesi görülen bir olgu sunuldu.

Research paper thumbnail of OP-351 the Percutaneous Closure of Paravalvular Prosthetic Regurgitation: Our First Experiences

International Journal of Cardiology, 2012

results with compression of LMCA between aortic root and main pulmonary artery in patients with A... more results with compression of LMCA between aortic root and main pulmonary artery in patients with Anomalous LMCA. Determination of coronary artery anomalies is frequently difficult with conventional coronary angiography because of the lack of 3-dimensional information which relates the course of the anomalous LMCA to the great vessels. MDCT can provide higher spatial resolution and higher temporal resolution rather than coronary angiography.

Research paper thumbnail of Sinüs Valsalva yırtılması olan bir hastada perkütan kapama için geriye doğru yaklaşım

Türk kardiyoloji derneği arşivi, Dec 1, 2014

Research paper thumbnail of Detection of a coronary arteriovenous fistula between the circumflex artery and pulmonary vein by CT angiography

Archives of the Turkish Society of Cardiology, 2005

Research paper thumbnail of A very rare cause of continuous murmur and coronary ischemia: high-flow coronary-to-pulmonary artery fistula

Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2008

A 52-year-old woman presented with complaints of chest discomfort and angina radiating to the nec... more A 52-year-old woman presented with complaints of chest discomfort and angina radiating to the neck and left arm on exertion. She reported that the severity of angina was increasing after sublingual nitrate intake. Coronary angiography showed a high-flow fistula between the left main coronary artery and pulmonary artery. Left coronary arteries were normal, but there was a stenotic lesion in the right coronary artery. Coronary artery fistula was ligated successfully under bypass surgery. It was thought that the severity of myocardial ischemia caused by the high-flow fistula was aggravated by sublingual nitrate due to coronary steal phenomenon.

Research paper thumbnail of PP-117 Successful Retrograde Angioplasty Via Collateral Circulation in Patient with Chronic Total Ocluded Posterior Tibial Artery

The American Journal of Cardiology, 2016

Research paper thumbnail of at Pennsylvania State U

ow nloaded from Improvement in sympatho-vagal imbalance and heart rate variability in patients wi... more ow nloaded from Improvement in sympatho-vagal imbalance and heart rate variability in patients with mitral stenosis after percutaneous balloon commissurotomy

Research paper thumbnail of by guest on Septem

ow nloaded from Improvement in sympatho-vagal imbalance and heart rate variability in patients wi... more ow nloaded from Improvement in sympatho-vagal imbalance and heart rate variability in patients with mitral stenosis after percutaneous balloon commissurotomy

Research paper thumbnail of Retrograde approach for percutaneous closure in a patient with ruptured sinus of Valsalva

Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2014

In this report, we present a 37-year-old male with ruptured right sinus of Valsalva. He was treat... more In this report, we present a 37-year-old male with ruptured right sinus of Valsalva. He was treated by percutaneous closure of the rupture using the retrograde approach. The procedure was performed successfully within 26 minutes. We think this approach may be used in future instead of the antegrade approach.

Research paper thumbnail of The efficiency and safety of percutaneous closure of secundum atrial septal defects with the Occlutech Figulla device: initial clinical experience

Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2010

We evaluated the efficiency and safety of the Occlutech Figulla device in percutaneous closure of... more We evaluated the efficiency and safety of the Occlutech Figulla device in percutaneous closure of secundum atrial septal defects (ASD). The study included 28 patients (17 women, 11 men; mean age 43 years) who underwent percutaneous transcatheter closure using the Occlutech Figulla device for secundum ASDs causing a hemodynamically significant shunt. Defect size was estimated by transthoracic (TTE) and transesophageal (TEE) echocardiography, and also by balloon sizing in nine patients. The patients were followed-up for six months and were examined by TTE. The mean defect size was 20.3+/-2.1 mm on TTE, 22.1+/-1.9 mm on TEE, and 24.2+/-2.4 mm on balloon sizing. The mean device size was 26.8+/-3.6 mm (range 6 to 36 mm). The mean procedure time was 44.7+/-21.4 minutes. The device was placed successfully in all the patients. A small residual flow was seen immediately after device placement in three patients (10.7%), which disappeared in two patients at three months, and in one patient at ...

Research paper thumbnail of A new electrocardiographic marker of myocardial reperfusion in patients with acute ST-segment elevation myocardial infarction treated with primary percutaneous intervention: the value of QRS duration

EuroIntervention, 2012

Aims: Although ischaemia-induced QRS complex changes have been described previously, their relati... more Aims: Although ischaemia-induced QRS complex changes have been described previously, their relation with reperfusion status is not clear. We aimed to investigate the relation of QRS duration with reperfusion at tissue level compared to myocardial blush in patients with acute myocardial infarction who underwent successful primary percutaneous coronary angioplasty. Methods and results: One hundred and forty-eight patients were enrolled. Based on the post-angioplasty myocardial blush grade (MBG), patients were divided into reperfusion (grades 2 and 3) and impaired reperfusion (grades 0 and 1) groups. Although the two groups did not differ in terms of admission QRS duration (81±17 vs. 79±15 msec, p=0.473), the patients in the impaired reperfusion group had a significantly longer QRS duration both at immediate post-angioplasty (78±18 vs. 68±17 msec, p=0.001) and at the 60 th minute ECG (77±17 vs. 60±17 msec, p<0.001). Patients in the impaired reperfusion group revealed significantly less narrowing of QRS duration in the post-angioplasty 60 th minute ECG (6±5 vs. 20±5 msec, p<0.001) when compared to the patients in the reperfusion group. After adjusting all variables, QRS narrowing in the 60 th minute ECG was determined as an independent electrocardiographic predictor of reperfusion (OR:1.39, 95% CI: 1.25-1.54, p<0.001). Conclusions: We demonstrated that QRS duration is a strong indicator of myocardial reperfusion status.

Research paper thumbnail of High Levels of High Sensitivity C-Reactive Protein and Uric Acid can Predict Disease Severity in Patients with Mitral Regurgitation

Journal of the American College of Cardiology, 2013

ABSTRACT Background High sensitive C-Reactive Protein (hs-CRP) predicts morbidity and mortality i... more ABSTRACT Background High sensitive C-Reactive Protein (hs-CRP) predicts morbidity and mortality in various clinical conditions. The effect of hsCRP on progression of chronic rheumatic mitral stenosis (CRMS) has not been demonstrated. Methods and results A total of 132 patients with CRMS (95 female, 37 male) and 145 control (100 female, 45 male) were included in the study. Baseline clinical, echocardiographic, hematologic and hs-CRP measurements were collected prospectively. Mean mitral valve area (MVA) was 1.4±0.3 cm2, mean wilkins valve score value was 8.9±1.7, left atrial diameter was 5.0±0.7cm, left atrial area was 37.2±12.6 cm2, and systolic pulmonary arterial pressure (SPAP) was 44±11mmHg in patients with CRMS. The mean levels of hs-CRP value, fibrinogen, and mean platelet volume (MPV) were significantly higher in CRMS group compared to control group. The levels of hsCRP were found to be positively correlated with mean Wilkins valve score value, SPAP, presence of atrial fibrillation (AF), left atrial diameter, left atrial area, presence of LASEC(+), fibrinogen, and MPV and inversely correlated with MVA in patients with CRMS. Linear regression analysis revealed that the hsCRP level independently affects mean Wilkins valve score value, left atrial area (LAA), LASEC(+) and AF in the patients with CRMS. Conclusions These results suggest that increased hsCRP levels are associated with CRMS severity. These association may be important when treating patients with CRMS.

Research paper thumbnail of Systolic Total Narrowing of Left Anterior Descending Coronary Artery and Flow Interruption Secondary to Myocardial Bridge: A Rare Case Report and Review of Literature

Clinical Cardiology, 2008

A 33-y-old man was admitted to the emergency department with sudden onset of severe substernal ch... more A 33-y-old man was admitted to the emergency department with sudden onset of severe substernal chest pain radiating to the left arm and neck. No pathological signs were recorded upon physical examination. The admission electrocardiogram (ECG) recorded during chest pain showed a large anterior wall myocardial infarction. Intravenous (IV) infusion of 1.5 million units of streptokinase over 1 h was initiated. Coronary angiography revealed total narrowing and flow interruption in the midsegment of the left anterior descending (LAD) coronary artery secondary to a myocardial bridge during systole and disappearance with diastole. He was discharged on aspirin (300 mg/d), metoprolol (100 mg/d), enalapril (10 mg twice daily), and atorvastatin (40 mg/d) treatment at the follow-up period.

Research paper thumbnail of Hepatitis C Infection is Associated With Increased Coronary Artery Atherosclerosis Defined by Modified Reardon Severity Score System

Circulation Journal, 2008

Background The link between arteriosclerotic disease in the carotid or coronary artery and chroni... more Background The link between arteriosclerotic disease in the carotid or coronary artery and chronic hepatitis C virus (HCV) infection has been shown in some studies although other studies have produced contrary results. However, the effect of chronic HCV infection on the extension or severity of coronary artery disease (CAD) has not been determined so the aim of the present study was to determine the effect of HCV infection on the severity of CAD. Methods and Results The study group comprised 139 HCV seropositive and 225 HCV seronegative patients with angiographically documented CAD. A modified scoring system of Reardon et al was used. There were no significant differences between groups in terms of sex, age, hypertension, diabetes mellitus, smoking or family history. Levels of C-reactive protein and fibrinogen were significantly higher in the HCV seropositive group (p<0.001) and the Reardon severity score was higher (8.75±1.69 vs 6.01±1.80, p<0.001). After adjustment, HCV seropositivity still represented an independent predictor for severity of coronary atherosclerosis demonstrated by higher Reardon severity score with an odds ratio of 2.018 (95% confidence interval 1.575-2.579, p<0.001). Conclusion HCV infection is an independent predictor for increased coronary atherosclerosis, as demonstrated by higher Reardon severity score.

Research paper thumbnail of Effects of Cigarette Smoking on Heart Rate Variability and Plasma N-Terminal Pro-B-Type Natriuretic Peptide in Healthy Subjects: Is There the Relationship between Both Markers?

Annals of Noninvasive Electrocardiology, 2008

Background: Cigarette smoking increased the risk of acute cardiac events related with endothelial... more Background: Cigarette smoking increased the risk of acute cardiac events related with endothelial dysfunction and increased sympathetic activity. Impaired autonomic nervous activity is recognized as a considerable symptom of cardiac dysfunction and is strongly associated with increased risk overall mortality. Methods: A total of 75 healthy habitual smokers (40 female, 35 male, mean age 36.5 ± 8.5 years), and 73 non-smokers subjects (45 female, 28 male, mean age 34.6 ± 7.2 years) were studied. LF and LF/HF ratio were significantly higher in smokers than in non-smokers. On the contrary, SDNN, SDANN, RMSSD, and HF values were lower in smokers compared to those in non-smokers. Not the duration of smoking but the number of cigarettes smoked per day was correlated with the HRV parameters and NT-pro BNP. Furthermore, the average levels of NT-pro BNP were found to be positively correlated with LF, LF/HF and inversely correlated with SDNN, SDANN, RMSSD and HF. Results: As a result, smoking impaires sympathovagal balance and decreases the heart rate variability in healthy subjects. And even a one cigarette smoking leads to overt sympathetic excitation. Furthermore, smoking results in an increase in NT-proBNP levels and the changes in adrenergic nervous system and NT-proBNP levels are well correlated. Conclusion: These findings could contribute to the higher rate of cardiovascular events in smokers.

Research paper thumbnail of Relation of admission QRS duration with development of angiographic no-reflow in patients with acute ST-segment elevation myocardial infarction treated with primary percutaneous interventions

Journal of Electrocardiology, 2008

Research paper thumbnail of Endovascular stent graft repair of abdominal and thoracic aortic aneurysms

Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology, 2012

Preoperatif antiagregan kullanımı koroner baypas cerrahisi süresince gelişebilecek atriyal fibril... more Preoperatif antiagregan kullanımı koroner baypas cerrahisi süresince gelişebilecek atriyal fibrilasyon oranını azaltabilir Atrial fibrillation (AF) is one of the most common postoperative arrhythmias in patients who undergo coronary artery bypass grafting (1). This complication leads to increases in mortality and morbidity rate in coronary bypass surgery and in hospital stay caused by excess usage of medications (2). Diverse experimental and clinical trials are conducted to reduce post-operative AF development rate and associated complications; however, AF rate still remains to be up to 40% during bypass surgery. The etiology of postoperative AF is not well defined, although recent studies suggest a multi-factorial mechanism, which includes oxidative stress, inflammation, atrial fibrosis, and excessive production of catecholamines, changes in autonomic tone and in the expression of connexins (3, 4). By evaluating retrospectively our coronary bypass surgery results, we observed that we did not discontinue preoperatively used anti-aggregants since a long time and that postoperative AF rate was lower than found in coronary literature. At Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital coronary artery bypass surgeries that are performed by the same clinic between January 2009 and December 2009 were reviewed retrospectively. Statistical analysis is made by SPSS 15. Stopping anti-aggregants therapy before coronary bypass surgery is a classical literature knowledge; therefore control group parameters are taken from the literature ratios. Atrial fibrillation development rate was retrospectively evaluated in 250 coronary bypass patients who used anti-aggregants and also not discontinued before the operation. There was no significant difference between selected patients in terms of clinical and laboratory examinations. There was no atrial fibrillation history in all patients. There was no significant difference in duration of operation and number of used graft. LIMA and saphenous vein were used as graft in all patients. Atrial diameter of patients was similar and they had no atrial dilatation. Atrial fibrillation was developed in 9 patients (3%). According to literature information (3, 4), atrial fibrillation rate was assessed very low. In the controls after two months; there was no statistically significant increase in AF ratio. There was no significant increase in postoperative administration of blood or blood derivative considered as side effects despite to continuation of anti-aggregant usage. Revision and tamponade rate due to bleeding was conforming to literature. Continuing to preoperative anti-aggregant in patients without AF development risk factors significantly reduces AF development rate and we conclude that this may be considered as our coronary experience of a wide serial.

Research paper thumbnail of Complete atrioventricular block and syncope during acute pulmonary thromboembolism

Archives of the Turkish Society of Cardiology, 2007

The most common electrocardiographic (ECG) findings in acute pulmonary thromboembolism (PTE) are ... more The most common electrocardiographic (ECG) findings in acute pulmonary thromboembolism (PTE) are right bundle branch block, T wave, and ST-segment changes. Complete atrioventricular (AV) block has hitherto been reported in only one patient with PTE. A 63-year-old female patient presented with recurrent syncope and sudden-onset dyspnea. There was complete AV block in the admission ECG. She never had similar complaints before and an ECG taken three months before was completely normal. A temporary pacemaker was placed through the femoral vein. Physical and laboratory findings were suggestive of acute pulmonary embolism. Pulmonary artery angiography demonstrated nearly total occlusion of the proximal right pulmonary artery. Her coronary arteries were normal. Thrombolytic therapy with streptokinase infusion followed by standard heparin infusion resulted in clinical improvement and resolution of complete AV block. The patient was discharged on the 15th day with oral warfarin treatment. Akut pulmoner tromboembolizmde sag dal bloku, T

Research paper thumbnail of Classification of patients with ventricular tachycardia according to etiological, demographic and clinical features

Archives of the Turkish Society of Cardiology, 2005

Results: The most common etiological cause was chronic ischemia (45.9%), followed by acute ischem... more Results: The most common etiological cause was chronic ischemia (45.9%), followed by acute ischemia (18.6%) and dilated cardiomyopathy (14.3%), whereas no etiologic cause was found in 60 patients (15.3%). Ventricular tachycardia was accompanied by ventricular fibrillation (VF) and syncope in 109 (27.8%) and 196 (50%) patients, respectively. Of the patient group, 147 patients (37.5%) had three-vessel, 68 patients (17.4%) had two-vessel, and 35 patients (8.9%) had one-vessel disease. Ninety-two patients (23.5%) died during hospitalization. In-hospital mortality was significantly higher in patients with diabetes mellitus (p=0.002), acute myocardial infarction (p=0.004), syncope (p<0.001), and VF (p<0.001), whereas it was significantly lower in patients with idiopathic VT (p=0.01), and in those with an implanted cardioverter defibrillator (p=0.005). Logistic regression analysis revealed that syncope (p<0.001) and VF (p<0.001) were independent factors affecting mortality.

Research paper thumbnail of Acute Myocardial Infarction Due to Coronary Artery Dissection in a Premenopausal Woman, Possible Contribution of Aortic Coarctation and Review of Literature

British journal of medicine and medical research, 2014

It is well -known that coronary artery disease (CAD) is the most cause of death in all over the w... more It is well -known that coronary artery disease (CAD) is the most cause of death in all over the world and generally been considered as a disease of elderly people and occasionally middle-aged men. Emerging data displays an important sex -based difference in CAD. Therefore CAD in the female population especially in premenopausal women is still identified less often and is treated less aggressively compared to that in the male population. The incidence of CAD in wo men older than 65 years is similar to that in men. However It is generally acknowledged that the risk for CAD is very low in premenopausal women by the reason of protective effect of woman hormones. Herein we report acute myocardial infarction due to coron ary artery dissection in a premenopausal women, and conceivablecontribution of aortic coarctation .

Research paper thumbnail of Simultaneous ST-segment elevation in the precordial and inferior leads in acute myocardial infarction

Standart 12 derivasyonlu yüzey elektrokardiyografi (EKG) akut miyokard infarktüsü (AM ) tanısında... more Standart 12 derivasyonlu yüzey elektrokardiyografi (EKG) akut miyokard infarktüsü (AM ) tanısında de erli bilgiler veren, basit kullanı lı, noninvaziv bir yöntem olmasının yanında, infarktüsten sorumlu arter ile ST-segment yükselmesi arasında yakın ili ki gösterir. Akut miyokard infarktüslü hastalarda en yaygın EKG bulgusu ya prekordiyal derivasyonlarda ya da inferior derivasyonlarda ST-segment yükselmesidir. Ancak, aynı anda her ikisinde ST-segment yükselmesi nadir görülen bir durumdur. Anterior AM sırasında inferior derivasyonlardaki ST-segment yüksekli inin, sol ventrikülün inferior bölgesini besleyen ve apeksi dolanan sol ön inen (SÖ ) koroner arterin tıkanması ya da ana koroner arterin akut tıkanması sonucu olu tu u dü ünülmektedir. Bu yazıda, anterior AM sırasında EKG’de hem prekordiyal hem de inferior derivasyonlarda ST-segment yükselmesi görülen bir olgu sunuldu.