Introduction: Endovascular interventions have been increasingly used for the treatment of patient... more Introduction: Endovascular interventions have been increasingly used for the treatment of patients suffering from below-the-knee (BTK) ischemic lesions. Yet, there is a paucity of data regarding long-term adverse events in patients with critical limb ischemia (CLI) undergoing endovascular revascularization for BTK lesions. Recently introduced systemic immune-inflammation index (SII) is a reliable indicator of poor outcomes in various cardiovascular conditions. Herein, we aimed to investigate the prognostic role of the SII on mortality in patients with CLI undergoing endovascular revascularization for BTK lesions. Patients and Methods: The records of 112 patients with symptomatic CLI undergoing endovascular revascularization for BTK lesions between January 2015 and December 2019 were analyzed. Patients were divided into groups with low and high SII values based on an SII cut-off value derived from a ROC analysis. For each group, procedural details and follow-up outcomes were analyzed...
We aimed to investigate the effects of verapamil and adenosine in an adjunct to intravenous tirof... more We aimed to investigate the effects of verapamil and adenosine in an adjunct to intravenous tirofiban on management and prognosis of no-reflow phenomenon during primary percutaneous coronary intervention (PPCI) and to compare their efficacies on reversing of no-reflow phenomenon and short and midterm survival. We included 46 patients with acute ST-segment elevation myocardial infarction (STEMI) and occurrence of no-reflow phenomenon after PPCI. All patients received intravenous tirofiban and then randomized into one of the following 3 groups: intracoronary adenosine (N.=16), intracoronary verapamil (N.=15) or placebo (N.=15). Intracoronary verapamil therapy had significant effect in restoring impaired coronary blood flow by decreasing thrombolysis in myocardial infarction (TIMI) frame count from 73±44 to 52±48 (P=0.024). However, adenosine and serum physiologic administration were not found to be so effective in decreasing TIMI frame count (from 81±35 to 71±46, P=0.084; from 74±32 t...
finding related to pericardium (Figure 3). It was the severe TR itself and secondary right heart ... more finding related to pericardium (Figure 3). It was the severe TR itself and secondary right heart enlargement causing restraining effect on the intact pericardium. Operation for tricuspid valve was decided. The pericardium was normal and tricuspid annulus was severely dilated on surgical inspection. Tricuspid valve was replaced with a bioprosthetic valve. The patient did well just after the surgery with a rapid decrease in cardiac pressures. However she died due to respiratory failure on the postoperative 15th day. This was a case with right heart failure symptoms in which invasive hemodynamic findings were consistent with constrictive pericarditis and the noninvasive imaging modalities were not. This case illustrates that severe TR can mimic some hemodynamic findings of constrictive pericarditis due to restraining effect of the enlarged right heart on intact pericardium and on left ventricle [1]. Lack of significant respiratory changes in hemodynamic parameters which can safely be demonstrated in echocardiography and cardiac MRI, must suggest a normal pericardium.
Objective Critical limb ischemia (CLI) is a progressive form of peripheral artery disease (PAD). ... more Objective Critical limb ischemia (CLI) is a progressive form of peripheral artery disease (PAD). Patients with CLI have poor long-term prognosis. The aim of this study was to investigate the value of sarcopenia in terms of 1-year mortality in patients with below-the-knee lesions who underwent endovascular treatment for CLI. Methods A total of 190 patients with critical limb ischemia who underwent endovascular treatment (EVT) for below-the-knee (BTK) lesions were enrolled in this study. Sarcopenia was defined using the psoas muscle index (PMI). PMI was obtained by calculating the average psoas muscle area (APMA) of the left and right psoas muscles at the third lumbar vertebra level and dividing by the square of the height (cm2/m2). The primary endpoint of the study was 1-year mortality and the secondary endpoint was 1-year amputation. Patients were divided into 2 groups according to presence of sarcopenia. Results We detected sarcopenia in 64 patients. The mean age, height, and EF we...
We aimed to investigate the association between the neutrophil–lymphocyte ratio (NLR) and coronar... more We aimed to investigate the association between the neutrophil–lymphocyte ratio (NLR) and coronary artery ectasia (CAE). The study included 198 patients who had undergone coronary angiography for suspected coronary artery disease (CAD). The patients were divided into the following 4 groups: group 1, 44 patients with normal coronary arteries; group 2, 61 patients with CAD; group 3, 40 patients with isolated CAE; and group 4, 53 patients with CAE coexisting with CAD. Neutrophil–lymphocyte ratio was significantly lower in group 1 than the other groups and significantly higher in group 4. Patients in group 1 had significantly lower neutrophil counts and significantly higher lymphocyte counts than the patients in group 4. The isolated CAE and CAD groups were similar in terms of NLR, neutrophil count, and lymphocyte count. In addition, we found significant positive correlations between presence of ectasia, number of ectatic vessels, and NLR. Our findings provide additional evidence for th...
Romatizmal kalp kapağı hastalığı patofizyolojisinde kronik sistemik inflamatuar süreç önemli bir ... more Romatizmal kalp kapağı hastalığı patofizyolojisinde kronik sistemik inflamatuar süreç önemli bir rol oynar. Biz bu çalışmada perkütan translüminal mitral balon valvüloplastinin (PTMV) romatizmal mitral darlığı olan hastalarda kronik sistemik inflamatuar yanıt üzerinde etkisinin olup olmadığını araştırdık. Yöntemler: Biz bu çalışmada sistemik inflamatuar yanıtın derecesini değerlendirmek için kolay ulaşılan ve ucuz bir belirteç olan nötrofil lenfosit oranını (NLR) kullandık. Çalışmaya ciddi mitral darlığı olup başarılı PTMV yapılan toplam 41 hasta dahil edildi. Tüm hastaların NLR'si PTMV işlemi öncesinde ve sonrasında değerlendirildi. Bulgular: PTMV öncesinde ve sonrasında ortalama lenfosit sayısı, 2,1±0,6 x10 3 /µL; 1,9±0,6 x10 3 / µL (p=0,01), ve ortalama lökosit sayısı 4,8±1,4 x10 3 /µL; 4,4±1,3 x10 3 / µL (p=0.069) bulundu. Romatizmal mitral darlığı olan hastalarda PTMV sonrası NLR değerlerinde anlamlı düşüş saptandı. (2,7±1,0 ve 2,2± ,8, p = 0.001). Korelasyon analizinde mitral kapak alanı ve NLR arasında anlamlı negatif korelasyon (p= 0,004-r=0,440), ve sol atrial çap ile NLR arasında anlamlı pozitif korelasyon saptandı. (p=0,028 r=0,344). Sonuç: Bu çalışma romatizmal mitral darlığı olan hastalarda PTMV sonrası NLR değerlerinde anlamlı düşüş göstermiştir. Bu PTMV sonrası inflamasyonun azalması anlamına gelebilir. Bu sonuçların desteklenmesi için daha büyük çalışmalara ihtiyaç vardır. Anahtar kelimeler: Romatizmal mitral darlık, nötrofil lenfosit oranı, perkütan mitral valvüloplasti, inflamasyon.
High sensitive C-reactive protein (hs-CRP) levels are associated with short-and long-term mortali... more High sensitive C-reactive protein (hs-CRP) levels are associated with short-and long-term mortality in patients with acute coronary syndrome (ACS). We investigated whether baseline hs-CRP levels are associated with burden of coronary atherosclerosis assessed by SYNTAX score (SXScore). We enrolled 321 patients with ACS who underwent coronary angiography. The patients were divided into tertiles according to the SXScore: low SXScore (≤ 22), and intermediate-high SXScore (≥ 23). Subjects in the intermediate-high SXScore tertile had higher serum hs-CRP levels compare to low SXScore tertile patients (7.7 ± 3.4 mg/L versus 4.9 ± 2.5 mg/L, P < 0.001). The mean age of patients and prevalance of diabetes in the intermediate-high SXScore tertile were significantly higher than in the low SXScore tertile (63 ± 13 versus 58 ± 12 years P = 0.001 for age, P = 0.007 for diabetes). Multivariate logistic regression analysis showed that the strongest predictors of high SXScore were increased serum hs-CRP levels (OR: 1.14) together with multivessel disease (OR: 0.23), left ventricular ejection fraction (LVEF) (OR: 0.90), and troponin levels (OR: 1.12). Serum hs-CRP levels on admission in patients with ACS could predict the severity and complexity of coronary atherosclerosis together with multivessel disease, LVEF, and troponin levels. Thus, increased serum levels of hs-CRP were one of the strong predictors of high SXScore in ACS patients.
Journal of the American College of Cardiology, 2013
Results: NSE levels significantly increased after coronary angiography and intervention compared ... more Results: NSE levels significantly increased after coronary angiography and intervention compared to baseline levels (22.03AE27.70, 10.08AE3.15 consecutively). Baseline characteristics were similar between groups (Table-1). Left ventricular ejection fraction in the SNI+ group was significantly lower than SNI-group (43.71AE12.51%, 50.84AE9.34%, p¼0.002). Maximal CK-MB, Troponin-I, Syntax Score (SS), of SNI+ group were significantly higher than SNI-group (103.83AE99.22, 51.92AE78.33, p¼0.006; 50.04AE66.18, 19.18AE30.50, p¼0.002; 103.83AE99.22, 51.92AE78.33, p¼0.006 and 50.04AE66.18, 19.18AE30.50, p¼0.002 successively). SS and performing PCI were the independent predictors of SNI (p¼0.009, OR¼1.06, 95%CI¼1.014-1.107, p¼0.036, OR¼4.262, 95%CI¼1.097-16.56). Conclusions: PCI and coronary artery lesion complexity may increase the risk of SNI in patients with acute coronary syndrome.
Journal of the American College of Cardiology, 2013
The aim of this study was to retrospectively evaluate the morphologic and functional features of ... more The aim of this study was to retrospectively evaluate the morphologic and functional features of myocardial bridging (MB) with multi-detector computed tomography (MDCT) coronary angiography. Methods: The study population consisted of 191 consecutive patients who underwent coronary artery angiography with MDCT. Besides coronary lesions, morphologic features of the MB (depth, length and the distance of the tunneled artery from the left coronary ostium) were analysed. Results: MDCT detected and satisfactorily depicted MB on left anterior descending artery in 41 patients (21.5%). Statistically significant correlation was observed between the percentage of systolic compression and the depth of the tunneled segment (r¼0.538, p<0.01). Morphologic features of MB were not significantly related to the presence of CAD in proximal segments. Conclusıons: MDCT coronary angiography depicts the morphological and functional features of the MB in detail. With the rapid improvements in MDCT technology, MDCT coronary angiography steps forward and/or will be more prominent as the reference imaging modality in evaluation of the presence of coronary MB.
The nondipper pattern in hypertension is associated with worse cardiovascular outcomes. In this s... more The nondipper pattern in hypertension is associated with worse cardiovascular outcomes. In this study, we hypothesized that high copeptin levels could predict nondippers among hypertensive patients and investigated the associations between copeptin levels and nondipper pattern in newly diagnosed hypertensive patients. Ambulatory blood pressure measurements were obtained and the patients were divided into two groups according to ambulatory blood pressure measurement as nondippers and dippers. Serum copeptin levels were measured in addition to routine laboratory investigations. A total of 76 patients were included in the study. The clinical and laboratory characteristics of the two groups were similar. The mean copeptin values were found to be significantly higher in the nondipper hypertensive group [1.66 (1.19-4.01) and 1.35 (1.12-2.09) IU/ml, respectively, P=0.026]. In the correlation analysis, no correlation was found between copeptin levels and daytime diastolic blood pressure, but there were weak positive correlations with daytime systolic, 24 h systolic, and diastolic blood pressure values (r=0.335, P=0.034, r=0.350, P=0.027, r=0.372, P=0.018, respectively). However, there were significant positive correlations between serum copeptin levels and nocturnal systolic and diastolic blood pressure values (r=0.593, 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;lt;0.001, r=0.523, P=0.001, respectively). This study showed that high serum copeptin levels could predict the nondipper pattern in newly diagnosed hypertension.
Background: Serum alkaline phosphatase (ALP) level shown to be an prognostic factor in the myocar... more Background: Serum alkaline phosphatase (ALP) level shown to be an prognostic factor in the myocardial infarction and stroke by the promoting effect of vascular calcification. A few recent study also showed that elevated ALP levels was associated with mortality and unfavorable prognosis in the coronary artery disease. Herein, we aimed to investigate the correlation between serum ALP level and coronary collateral circulation (CCC) development which has not reported before. Materials-Methods: A total of 356 patients with stable angina pectoris were evaluated retrospectively. Upon admission ALP level was measured with automated analyzer and CCC was documented for each patients according to rentrop classification. Then, patients classified according to ALP level and CCC grade. Rentrop 0-1 flow defined as impaired CCC. Serum ALP>129 mg/dl in man and >104 mg/dl in women was defined as elevated ALP groups. All groups compared statistically according to clinical, laboratory and demographic features. Results: On the 53.7 % of the patients, impaired CCC was observed. Mean ALP level was 102.8AE57.9, range from 41-485 U/L with a 70.0/ 86.0/110.0 mg/dl percentile values and elevated ALP levels were obtained in the 19.4 % of the cases. There was significant correlation between ALP and CCC grade and, impaired CCC showed relatively higher ALP value (65.2% vs 50.9 %, p:0.03). Multivarite regression analysis also showed significant correlation between elevated ALP level and impaired CCC (OR: 1.85, with a 95 % CI 1.056 e 3.264; p:0.03). Conclusions: Serum ALP is a widely avaliable vasculopathic prognostic parameters in the coronary heart disease. Elevated ALP levels was associated with inadequate CCC which predict poor cardiac functions and major adverse cardiac events.
Background In patients with contraindication for beta-blockers who are also under long-term calci... more Background In patients with contraindication for beta-blockers who are also under long-term calcium channel-blocker therapy for any reason, ivabradine may be used as an alternative treatment to achieve the target heart rate. Purpose To assess whether single dose oral ivabradine in patients referred for coronary computed tomography angiography (CCTA) is safe and can significantly decrease heart rate compared to intravenous (i.v.) metoprolol in patients receiving long-term calcium channel-blocker therapy. Material and Methods One-hundred and twenty patients who were under calcium channel-blocker therapy referred for CCTA were randomized to premedication with single dose (15 mg) ivabradine ( n = 63) or i.v. metoprolol (5–10 mg) ( n = 62). Hearth rate (HR) was assessed at admission (HR1), prescan (HR2), and during CCTA scan (HR3) for all patients. Blood pressure (BP) was measured before medication (BP1) and immediately before CCTA scan (BP2). Results Although the HR averages of two grou...
than 18 were considered as moderate-high risk patients. All patients' blood samples were drawn to... more than 18 were considered as moderate-high risk patients. All patients' blood samples were drawn to measure RDW levels. Results: When the patient and control group were compared, mean RDW level was 13.85 (11.40-18.70) in the stent thrombosis group and 12 (10.70-14.00) in the control group (p<0.001). When the patient and control groups were combined to see the effect on Syntax scores on RDW levels, mean RDW was 12.9 (10.70-18.70) in patients with a low Syntax score þ control group and 13.6 (11.80-18.70) in patients with a moderate-high Syntax score þ control group (p¼0.009). A positive relation was determined between RDW levels and Syntax scores of combined patient þ control group (r¼0.204). RDW was 13.70 (11.40-18.70) in stent thrombosis patients with a low Syntax score and 14.15 (12.10-18.70) in stent thrombosis patients with a moderate-high Syntax score (p¼0.373). Conclusion: RDW levels were significantly higher in patients with stent thrombosis compared to control group (p<0.001) but this significant difference did not show a correlation with Syntax score increase (p¼0.373).
BACKGROUND Carotid artery stenting is a minimally invasive, durable alternative treatment option,... more BACKGROUND Carotid artery stenting is a minimally invasive, durable alternative treatment option, which is an alternative to the reference method, carotid endarterectomy, for patients with carotid artery stenosis; however, silent new ischemic cerebral lesions (SNICLs) after carotid artery stenting remain as a matter of concern. Hence, we aimed to assess the effect of complex vascular anatomy on silent new ischemic cerebral lesions in carotid artery stenting procedures. METHODS We prospectively evaluated 122 patients (mean age: 69.5 ± 7.1 years, male:83) who underwent carotid artery stenting for carotid artery revascularization. The patients having symptomatic transient ischemic attack or stroke after carotid artery stenting were excluded. The presence of a new hyperintense lesions on diffusion-weighted imaging without any neurological findings was considered as the SNICL. Patients were classified into two groups as DWI-positive and DWI-negative patients. RESULTS Among the study popu...
Introduction: Endovascular interventions have been increasingly used for the treatment of patient... more Introduction: Endovascular interventions have been increasingly used for the treatment of patients suffering from below-the-knee (BTK) ischemic lesions. Yet, there is a paucity of data regarding long-term adverse events in patients with critical limb ischemia (CLI) undergoing endovascular revascularization for BTK lesions. Recently introduced systemic immune-inflammation index (SII) is a reliable indicator of poor outcomes in various cardiovascular conditions. Herein, we aimed to investigate the prognostic role of the SII on mortality in patients with CLI undergoing endovascular revascularization for BTK lesions. Patients and Methods: The records of 112 patients with symptomatic CLI undergoing endovascular revascularization for BTK lesions between January 2015 and December 2019 were analyzed. Patients were divided into groups with low and high SII values based on an SII cut-off value derived from a ROC analysis. For each group, procedural details and follow-up outcomes were analyzed...
We aimed to investigate the effects of verapamil and adenosine in an adjunct to intravenous tirof... more We aimed to investigate the effects of verapamil and adenosine in an adjunct to intravenous tirofiban on management and prognosis of no-reflow phenomenon during primary percutaneous coronary intervention (PPCI) and to compare their efficacies on reversing of no-reflow phenomenon and short and midterm survival. We included 46 patients with acute ST-segment elevation myocardial infarction (STEMI) and occurrence of no-reflow phenomenon after PPCI. All patients received intravenous tirofiban and then randomized into one of the following 3 groups: intracoronary adenosine (N.=16), intracoronary verapamil (N.=15) or placebo (N.=15). Intracoronary verapamil therapy had significant effect in restoring impaired coronary blood flow by decreasing thrombolysis in myocardial infarction (TIMI) frame count from 73±44 to 52±48 (P=0.024). However, adenosine and serum physiologic administration were not found to be so effective in decreasing TIMI frame count (from 81±35 to 71±46, P=0.084; from 74±32 t...
finding related to pericardium (Figure 3). It was the severe TR itself and secondary right heart ... more finding related to pericardium (Figure 3). It was the severe TR itself and secondary right heart enlargement causing restraining effect on the intact pericardium. Operation for tricuspid valve was decided. The pericardium was normal and tricuspid annulus was severely dilated on surgical inspection. Tricuspid valve was replaced with a bioprosthetic valve. The patient did well just after the surgery with a rapid decrease in cardiac pressures. However she died due to respiratory failure on the postoperative 15th day. This was a case with right heart failure symptoms in which invasive hemodynamic findings were consistent with constrictive pericarditis and the noninvasive imaging modalities were not. This case illustrates that severe TR can mimic some hemodynamic findings of constrictive pericarditis due to restraining effect of the enlarged right heart on intact pericardium and on left ventricle [1]. Lack of significant respiratory changes in hemodynamic parameters which can safely be demonstrated in echocardiography and cardiac MRI, must suggest a normal pericardium.
Objective Critical limb ischemia (CLI) is a progressive form of peripheral artery disease (PAD). ... more Objective Critical limb ischemia (CLI) is a progressive form of peripheral artery disease (PAD). Patients with CLI have poor long-term prognosis. The aim of this study was to investigate the value of sarcopenia in terms of 1-year mortality in patients with below-the-knee lesions who underwent endovascular treatment for CLI. Methods A total of 190 patients with critical limb ischemia who underwent endovascular treatment (EVT) for below-the-knee (BTK) lesions were enrolled in this study. Sarcopenia was defined using the psoas muscle index (PMI). PMI was obtained by calculating the average psoas muscle area (APMA) of the left and right psoas muscles at the third lumbar vertebra level and dividing by the square of the height (cm2/m2). The primary endpoint of the study was 1-year mortality and the secondary endpoint was 1-year amputation. Patients were divided into 2 groups according to presence of sarcopenia. Results We detected sarcopenia in 64 patients. The mean age, height, and EF we...
We aimed to investigate the association between the neutrophil–lymphocyte ratio (NLR) and coronar... more We aimed to investigate the association between the neutrophil–lymphocyte ratio (NLR) and coronary artery ectasia (CAE). The study included 198 patients who had undergone coronary angiography for suspected coronary artery disease (CAD). The patients were divided into the following 4 groups: group 1, 44 patients with normal coronary arteries; group 2, 61 patients with CAD; group 3, 40 patients with isolated CAE; and group 4, 53 patients with CAE coexisting with CAD. Neutrophil–lymphocyte ratio was significantly lower in group 1 than the other groups and significantly higher in group 4. Patients in group 1 had significantly lower neutrophil counts and significantly higher lymphocyte counts than the patients in group 4. The isolated CAE and CAD groups were similar in terms of NLR, neutrophil count, and lymphocyte count. In addition, we found significant positive correlations between presence of ectasia, number of ectatic vessels, and NLR. Our findings provide additional evidence for th...
Romatizmal kalp kapağı hastalığı patofizyolojisinde kronik sistemik inflamatuar süreç önemli bir ... more Romatizmal kalp kapağı hastalığı patofizyolojisinde kronik sistemik inflamatuar süreç önemli bir rol oynar. Biz bu çalışmada perkütan translüminal mitral balon valvüloplastinin (PTMV) romatizmal mitral darlığı olan hastalarda kronik sistemik inflamatuar yanıt üzerinde etkisinin olup olmadığını araştırdık. Yöntemler: Biz bu çalışmada sistemik inflamatuar yanıtın derecesini değerlendirmek için kolay ulaşılan ve ucuz bir belirteç olan nötrofil lenfosit oranını (NLR) kullandık. Çalışmaya ciddi mitral darlığı olup başarılı PTMV yapılan toplam 41 hasta dahil edildi. Tüm hastaların NLR'si PTMV işlemi öncesinde ve sonrasında değerlendirildi. Bulgular: PTMV öncesinde ve sonrasında ortalama lenfosit sayısı, 2,1±0,6 x10 3 /µL; 1,9±0,6 x10 3 / µL (p=0,01), ve ortalama lökosit sayısı 4,8±1,4 x10 3 /µL; 4,4±1,3 x10 3 / µL (p=0.069) bulundu. Romatizmal mitral darlığı olan hastalarda PTMV sonrası NLR değerlerinde anlamlı düşüş saptandı. (2,7±1,0 ve 2,2± ,8, p = 0.001). Korelasyon analizinde mitral kapak alanı ve NLR arasında anlamlı negatif korelasyon (p= 0,004-r=0,440), ve sol atrial çap ile NLR arasında anlamlı pozitif korelasyon saptandı. (p=0,028 r=0,344). Sonuç: Bu çalışma romatizmal mitral darlığı olan hastalarda PTMV sonrası NLR değerlerinde anlamlı düşüş göstermiştir. Bu PTMV sonrası inflamasyonun azalması anlamına gelebilir. Bu sonuçların desteklenmesi için daha büyük çalışmalara ihtiyaç vardır. Anahtar kelimeler: Romatizmal mitral darlık, nötrofil lenfosit oranı, perkütan mitral valvüloplasti, inflamasyon.
High sensitive C-reactive protein (hs-CRP) levels are associated with short-and long-term mortali... more High sensitive C-reactive protein (hs-CRP) levels are associated with short-and long-term mortality in patients with acute coronary syndrome (ACS). We investigated whether baseline hs-CRP levels are associated with burden of coronary atherosclerosis assessed by SYNTAX score (SXScore). We enrolled 321 patients with ACS who underwent coronary angiography. The patients were divided into tertiles according to the SXScore: low SXScore (≤ 22), and intermediate-high SXScore (≥ 23). Subjects in the intermediate-high SXScore tertile had higher serum hs-CRP levels compare to low SXScore tertile patients (7.7 ± 3.4 mg/L versus 4.9 ± 2.5 mg/L, P < 0.001). The mean age of patients and prevalance of diabetes in the intermediate-high SXScore tertile were significantly higher than in the low SXScore tertile (63 ± 13 versus 58 ± 12 years P = 0.001 for age, P = 0.007 for diabetes). Multivariate logistic regression analysis showed that the strongest predictors of high SXScore were increased serum hs-CRP levels (OR: 1.14) together with multivessel disease (OR: 0.23), left ventricular ejection fraction (LVEF) (OR: 0.90), and troponin levels (OR: 1.12). Serum hs-CRP levels on admission in patients with ACS could predict the severity and complexity of coronary atherosclerosis together with multivessel disease, LVEF, and troponin levels. Thus, increased serum levels of hs-CRP were one of the strong predictors of high SXScore in ACS patients.
Journal of the American College of Cardiology, 2013
Results: NSE levels significantly increased after coronary angiography and intervention compared ... more Results: NSE levels significantly increased after coronary angiography and intervention compared to baseline levels (22.03AE27.70, 10.08AE3.15 consecutively). Baseline characteristics were similar between groups (Table-1). Left ventricular ejection fraction in the SNI+ group was significantly lower than SNI-group (43.71AE12.51%, 50.84AE9.34%, p¼0.002). Maximal CK-MB, Troponin-I, Syntax Score (SS), of SNI+ group were significantly higher than SNI-group (103.83AE99.22, 51.92AE78.33, p¼0.006; 50.04AE66.18, 19.18AE30.50, p¼0.002; 103.83AE99.22, 51.92AE78.33, p¼0.006 and 50.04AE66.18, 19.18AE30.50, p¼0.002 successively). SS and performing PCI were the independent predictors of SNI (p¼0.009, OR¼1.06, 95%CI¼1.014-1.107, p¼0.036, OR¼4.262, 95%CI¼1.097-16.56). Conclusions: PCI and coronary artery lesion complexity may increase the risk of SNI in patients with acute coronary syndrome.
Journal of the American College of Cardiology, 2013
The aim of this study was to retrospectively evaluate the morphologic and functional features of ... more The aim of this study was to retrospectively evaluate the morphologic and functional features of myocardial bridging (MB) with multi-detector computed tomography (MDCT) coronary angiography. Methods: The study population consisted of 191 consecutive patients who underwent coronary artery angiography with MDCT. Besides coronary lesions, morphologic features of the MB (depth, length and the distance of the tunneled artery from the left coronary ostium) were analysed. Results: MDCT detected and satisfactorily depicted MB on left anterior descending artery in 41 patients (21.5%). Statistically significant correlation was observed between the percentage of systolic compression and the depth of the tunneled segment (r¼0.538, p<0.01). Morphologic features of MB were not significantly related to the presence of CAD in proximal segments. Conclusıons: MDCT coronary angiography depicts the morphological and functional features of the MB in detail. With the rapid improvements in MDCT technology, MDCT coronary angiography steps forward and/or will be more prominent as the reference imaging modality in evaluation of the presence of coronary MB.
The nondipper pattern in hypertension is associated with worse cardiovascular outcomes. In this s... more The nondipper pattern in hypertension is associated with worse cardiovascular outcomes. In this study, we hypothesized that high copeptin levels could predict nondippers among hypertensive patients and investigated the associations between copeptin levels and nondipper pattern in newly diagnosed hypertensive patients. Ambulatory blood pressure measurements were obtained and the patients were divided into two groups according to ambulatory blood pressure measurement as nondippers and dippers. Serum copeptin levels were measured in addition to routine laboratory investigations. A total of 76 patients were included in the study. The clinical and laboratory characteristics of the two groups were similar. The mean copeptin values were found to be significantly higher in the nondipper hypertensive group [1.66 (1.19-4.01) and 1.35 (1.12-2.09) IU/ml, respectively, P=0.026]. In the correlation analysis, no correlation was found between copeptin levels and daytime diastolic blood pressure, but there were weak positive correlations with daytime systolic, 24 h systolic, and diastolic blood pressure values (r=0.335, P=0.034, r=0.350, P=0.027, r=0.372, P=0.018, respectively). However, there were significant positive correlations between serum copeptin levels and nocturnal systolic and diastolic blood pressure values (r=0.593, 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;lt;0.001, r=0.523, P=0.001, respectively). This study showed that high serum copeptin levels could predict the nondipper pattern in newly diagnosed hypertension.
Background: Serum alkaline phosphatase (ALP) level shown to be an prognostic factor in the myocar... more Background: Serum alkaline phosphatase (ALP) level shown to be an prognostic factor in the myocardial infarction and stroke by the promoting effect of vascular calcification. A few recent study also showed that elevated ALP levels was associated with mortality and unfavorable prognosis in the coronary artery disease. Herein, we aimed to investigate the correlation between serum ALP level and coronary collateral circulation (CCC) development which has not reported before. Materials-Methods: A total of 356 patients with stable angina pectoris were evaluated retrospectively. Upon admission ALP level was measured with automated analyzer and CCC was documented for each patients according to rentrop classification. Then, patients classified according to ALP level and CCC grade. Rentrop 0-1 flow defined as impaired CCC. Serum ALP>129 mg/dl in man and >104 mg/dl in women was defined as elevated ALP groups. All groups compared statistically according to clinical, laboratory and demographic features. Results: On the 53.7 % of the patients, impaired CCC was observed. Mean ALP level was 102.8AE57.9, range from 41-485 U/L with a 70.0/ 86.0/110.0 mg/dl percentile values and elevated ALP levels were obtained in the 19.4 % of the cases. There was significant correlation between ALP and CCC grade and, impaired CCC showed relatively higher ALP value (65.2% vs 50.9 %, p:0.03). Multivarite regression analysis also showed significant correlation between elevated ALP level and impaired CCC (OR: 1.85, with a 95 % CI 1.056 e 3.264; p:0.03). Conclusions: Serum ALP is a widely avaliable vasculopathic prognostic parameters in the coronary heart disease. Elevated ALP levels was associated with inadequate CCC which predict poor cardiac functions and major adverse cardiac events.
Background In patients with contraindication for beta-blockers who are also under long-term calci... more Background In patients with contraindication for beta-blockers who are also under long-term calcium channel-blocker therapy for any reason, ivabradine may be used as an alternative treatment to achieve the target heart rate. Purpose To assess whether single dose oral ivabradine in patients referred for coronary computed tomography angiography (CCTA) is safe and can significantly decrease heart rate compared to intravenous (i.v.) metoprolol in patients receiving long-term calcium channel-blocker therapy. Material and Methods One-hundred and twenty patients who were under calcium channel-blocker therapy referred for CCTA were randomized to premedication with single dose (15 mg) ivabradine ( n = 63) or i.v. metoprolol (5–10 mg) ( n = 62). Hearth rate (HR) was assessed at admission (HR1), prescan (HR2), and during CCTA scan (HR3) for all patients. Blood pressure (BP) was measured before medication (BP1) and immediately before CCTA scan (BP2). Results Although the HR averages of two grou...
than 18 were considered as moderate-high risk patients. All patients' blood samples were drawn to... more than 18 were considered as moderate-high risk patients. All patients' blood samples were drawn to measure RDW levels. Results: When the patient and control group were compared, mean RDW level was 13.85 (11.40-18.70) in the stent thrombosis group and 12 (10.70-14.00) in the control group (p<0.001). When the patient and control groups were combined to see the effect on Syntax scores on RDW levels, mean RDW was 12.9 (10.70-18.70) in patients with a low Syntax score þ control group and 13.6 (11.80-18.70) in patients with a moderate-high Syntax score þ control group (p¼0.009). A positive relation was determined between RDW levels and Syntax scores of combined patient þ control group (r¼0.204). RDW was 13.70 (11.40-18.70) in stent thrombosis patients with a low Syntax score and 14.15 (12.10-18.70) in stent thrombosis patients with a moderate-high Syntax score (p¼0.373). Conclusion: RDW levels were significantly higher in patients with stent thrombosis compared to control group (p<0.001) but this significant difference did not show a correlation with Syntax score increase (p¼0.373).
BACKGROUND Carotid artery stenting is a minimally invasive, durable alternative treatment option,... more BACKGROUND Carotid artery stenting is a minimally invasive, durable alternative treatment option, which is an alternative to the reference method, carotid endarterectomy, for patients with carotid artery stenosis; however, silent new ischemic cerebral lesions (SNICLs) after carotid artery stenting remain as a matter of concern. Hence, we aimed to assess the effect of complex vascular anatomy on silent new ischemic cerebral lesions in carotid artery stenting procedures. METHODS We prospectively evaluated 122 patients (mean age: 69.5 ± 7.1 years, male:83) who underwent carotid artery stenting for carotid artery revascularization. The patients having symptomatic transient ischemic attack or stroke after carotid artery stenting were excluded. The presence of a new hyperintense lesions on diffusion-weighted imaging without any neurological findings was considered as the SNICL. Patients were classified into two groups as DWI-positive and DWI-negative patients. RESULTS Among the study popu...
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