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Activation of coagulation system in dilated cardiomyopathy: comparison of patients with and without left ventricular thrombus
(Lippincott Williams & Wilkins, 2004) Erbay, AR; Turhan, H; Aksoy, Y; Senen, K; Yetkin, E
Objectives We aimed to investigate plasma levels of molecular markers for platelet activity, thrombin activation and fibrinolytic status in patients with dilated cardiomyopathy (DCM) with and without left ventricular (LV) thrombus and to compare these markers between patients with DCM and control participants. Materials and methods The study population comprised 60 patients with DCM who met the inclusion criteria. Patients were divided into two groups: 22 patients with LV thrombus and 38 patients without LV thrombus. The age-matched control group consisted of 23 healthy participants (18 men and five women with a mean age of 49). Patients with DCM and healthy participants were compared with respect to platelet activity, thrombin activation and fibrinolytic status. These comparisons were also performed in patients with DCM with and without LV thrombus. Results Platelet factor 4 (28.2+/-4.4 ng/ml compared with 20+/-3.1 ng/ml, P<0.01) and beta-thromboglobulin (40+/-2 ng/ml compared with 17+/-3 ng/ml) levels, reflecting platelet activity, were significantly higher in patients with DCM than in control participants. Fibrinopeptide A (6.94+/-0.69 ng/ml compared with 1.96+/-0.1 ng/ml, P<0.001) and thrombin-antithrombin III complex (5.26+/-2.60 ng/ml compared with 3.17+/-1.23 ng/ml, P<0.001) levels, as markers of fibrin generation, were also higher in patients with DCM than in normal participants. Plasma levels of D-dimer (118+/-16 ng/ml compared with 85+/-3 ng/ml, P<0.001) and plasmin-alpha(2)-plasmin inhibitor complex (0.8+/-1.1 mug/ml compared with 0.6+/-1.7 mug/ml, P<0.001) in patients with DCM significantly exceeded those in the normal participants. There were no statistically significant differences between patients with and without LV thrombus in DCM with respect to platelet activity, thrombin activation and fibrinolytic status. Conclusion We have shown that platelet activation, thrombin activation and fibrinolytic activity are increased in patients with DCM compared to control participants. However, these markers reflecting coagulation activation in patients with LV thrombus are comparable to those in patients without LV thrombus. (C) 2004 Lippincott Williams Wilkins.
Aortic valve calcification: association with bone mineral density and cardiovascular risk factors
(Lippincott Williams & Wilkins, 2005) Aksoy, Y; Yagmur, C; Tekin, GO; Yagmur, J; Topal, E; Kekilli, E; Turhan, H
Background: Cardiovascular risk factors are reported to increase the incidence of aortic valve calcification. Among older women, low bone mineral density appears to be associated with increased prevalence of aortic calcification. We aimed to assess and compare cardiovascular risk factors and bone mineral density of patients with and without aortic valve calcification. Materials: and methods Cardiovascular risk factors and bone mineral density measurements have been assessed in 49 patients with aortic valve calcification and in 65 patients without aortic valve calcification. All patients were subsequently referred to the nuclear medicine department to measure bone mineral density after echocardiographic evaluation. Results: No statistically significant differences were observed between the two groups with respect to sex, body mass index, history of coronary artery disease, diabetes mellitus, hypercholesterolemia, and smoking status. Although height and weight of the patients with aortic valve calcification were significantly lower than those of patients without aortic valve calcification, they were not independent risk factors. Age and hypertension were found to be independent positive risk factors for aortic valve calcification, whereas T score was found to be negatively associated with aortic valve calcification. Conclusion: We have shown that aortic valve calcification is positively associated with age and hypertension, whereas bone mineral density is negatively associated with aortic valve calcification. The mechanism underlying the association between decreased bone mineral density and aortic valve calcification remains to be clarified in further studies.
Brain natriuretic peptide and its relationship to left ventricular hypertrophy in patients on peritoneal dialysis or hemodialysis less than 3 years
(Taylor & Francis Ltd, 2006) Taskapan, MC; Ulutas, O; Aksoy, Y; Senel, S; Sahin, I; Kosar, F; Taskapan, H
An increase of brain natriuretic peptide (BNP) levels is commonly observed in patients on dialysis. Increased circulating levels of BNP are related to future cardiac events and associated with shorter survival in patients on chronic hemodialysis (HD). During the first I or 2 years on dialysis, patients on peritoneal dialysis (PD) have been shown to have an improvement in left ventricular hypertrophy, blood pressure, and volume status. This study compares BNP levels and cardiac status of PD and HD patients without cardiovascular disease and on dialysis for less than 36 months. The correlation between plasma BNP concentration and findings of echocardiography before HD scans were examined and compared with findings of PD. Twenty-two HD patients (15 men, 7 women; mean age, 52.5 +/- 13.9 years) and 19 PD patients (10 men, 9 women; mean age, 47.6 +/- 11.3 years) were studied. There were no significant differences between HD and PD patients with regard to age, gender, duration of dialysis, left ventricular mass, left ventricular mass index (p > 0.05). Plasma BNP levels were markedly greater in HD patients (467.8 +/- 466.5 pg/ mL) than those of PD patients (143.1 +/- 165.2 pg/mL). Urine output was significantly higher in PD patients compared with HD patients (p < 0.05). A positive correlation between systolic blood pressure, diastolic blood pressure, and plasma BNP in HD patients (r: 0.653, p: 0.001; r: 0.493, p: 0.023, respectively) was detected. Additional studies are needed to investigate whether lower BNP level in PD patients is an advantage.
Changes in antibody titers against Chlamydia pneumoniae after coronary angioplasty
(Elsevier Ireland Ltd, 2004) Yetkin, G; Yetkin, E; Aksoy, Y; Gurbuz, OA; Mert, A
Objectives: The potential role of common infectious agents in the pathogenesis and progression of atherosclerosis has been studied increasingly over the last decade. The evidence for Chlamydia pneumoniae as a potential causative agent is strong and is based on the findings of numerous sero-epidemiological studies, examination of atheromatous plaque specimens, in vitro animal models. We performed a prospective study in percutaneous transluminal coronary angioplasty (PTCA) patients to investigate whether the angioplasty procedure influenced the specific humoral immune response reaction against C. pneumoniae antigens. Methods: We studied 76 patients who successfully underwent PTCA for de novo lesions. Blood samples were drawn immediately before PTCA and 1 month after PTCA. IgG and IgA antibodies against C. pneumoniae (strain CDC/CY&-029) were determined by an in-house developed enzyme inummoassay. Results: At the time of angioplasty 75% and 34% of the patients had seropositive antibodies to elementary bodies (EBs) of classes IgG and IgA, respectively. Mean titers of IgG antibodies before and I month after PTCA were 46 +/- 31 and 50 +/- 28 relative units (RU/ml) (P > 0.05). One month after PTCA, 97% and 34% of the patients had seropositive antibodies to EBs of classes IgG and IgA, respectively. We divided our patients into two groups on the basis of IgG seropositivity (group I: Chlamydia antibody IgG seronegative patients, group II: Chlamydia antibody IgG seropositive) before PTCA. Significant increase in the antibody titers of IgG (12 5 vs. 40 18, P < 0.001) and IgA (0.6 +/- 0.33 vs. 1.15 +/- 0.83, P = 0.007) was observed in group I patients 1 month after PTCA and 88% of them gained IgG seropositivity. There were no significant changes in IgG and IgA antibody levels in group II after PTCA. Conclusion: We have demonstrated a statistically significant rise in C. pneumoniae antibodies (especially IgG) induced by PTCA in patients previously seronegative. (C) 2003 Elsevier Ireland Ltd. All rights reserved.
Changes in antibody titers against chlamydia pneumoniae after percutaneous transluminal coronary angioplasty
(W B Saunders Co Ltd, 2002) Yetkin, G; Yetkin, E; Aksoy, Y; Ileri, M; Mert, A; Cehreli, S
[Abstract Not Available]
Decreased endothelium-dependent vasodilatation in patients with migraine: a new aspect to vascular pathophysiology of migraine
(Lippincott Williams & Wilkins, 2006) Yetkin, E; Ozisik, H; Ozcan, C; Aksoy, Y; Turhan, H
Background Migraine is a common neurovascular disorder characterized by attacks of severe headache, autonomic and neurological symptoms. We hypothesized that patients with migraine had abnormal endothelial function. The vascular theory of migraine assumes that the major pathophysiological events that initiate the migraine attack occur in the perivascular nerves of the major cerebral vessels. Accordingly, we aimed to measure endothelium-dependent vasoclilatation in migraineurs by means of flow-mediated dilatation, which reflects endothelium-dependent vasodilatation capacity. Materials and methods Forty-five patients who fulfilled the diagnostic criteria for migraine and 45 age and sex-matched healthy participants were enrolled in the study. Flow-mediated dilatation of the brachial artery was determined using a high-resolution B-mode ultrasonographic system. Flow-mediated vasodilatation was expressed as the change in post-stimulus diameter as a percentage of the baseline diameter. Results Mean ages of the patients were 33 +/- 10 years in migraineurs (range: 18-52 years, 36 female, 9 male) and 33 +/- 9 years in non-migraineurs (range: 17-50 years, 36 female and 9 male). Flow-mediated dilatation of patients with migraine is significantly lower than that of the controls (8.02 +/- 4.095% vs. 10.72 +/- 3.52%, respectively, P=0.001). Conclusion We have shown that migraineurs have decreased endothelium-dependent vasodilatation capacity compared with non-migraineurs. Migraine may be a local manifestation of systemic vascular vasomotion abnormalities.
Effect of ectasia size or the ectasia ratio on the thrombosis in myocardial infarction frame count in patients with isolated coronary artery ectasia
(Springer, 2005) Kosar, F; Acikgoz, N; Sahin, I; Topal, E; Aksoy, Y; Cehreli, S
Coronary blood flow was quantified using the thrombosis in myocardial infarction (TIMI) frame-count method. This measurement has been significantly correlated with flow velocity measured invasively by use of a Doppler flow wire. Coronary artery ectasia or aneurysm (CEA) is thought to be present in patients with a slow blood flow. In this study, we aimed to assess the relationship between the ectasia size or ectasia ratio and TIMI frame count in patients with CEA. The study population included 58 patients with isolated CEA of the right coronary artery. In patients with CEA, an ectasia ratio was calculated as diameter of the ectatic segment/diameter of the adjacent normal segment. According to the ectasia ratio, ectatic vessels were divided into two groups: ectasias with a 1.5- to 2.0-fold increase (group A) and more than 2.0-fold increase (group B) in normal vessel diameter. Patients with a significant stenotic lesion (> 50%) in the ectatic vessel were excluded. The control group was formed from a matched population of 35 patients with angiographically proven normal coronary arteries. Characteristics of the ectasia and control groups are similar. The TIMI frame counts for the right coronary artery (RCA) were significantly higher in the ectasia group as compared with the control group (43 +/- 12 vs 23 +/- 8, P < 0.001). The ectasia group had 38 patients in group A and 20 patients in group B. The TIMI frame counts were significantly higher in group B than in group A (43 +/- 10 vs 51 +/- 15, P < 0.05). The TIMI frame count of the RCA showed a significant correlation with the ectasia ratio and the maximum diameter of the ectatic segment (r = 0.578, P < 0.001 and r = 0.435, P < 0.001, respectively). Our data suggest that TIMI frame count measurement depends on the ectasia size or ectasia ratio, and an increased ectasia ratio is markedly associated with decreased TIMI frame counts in patients with CEA.
Effects of coronary revascularization and concomitant aneurysmectomy on QT interval duration and dispersion
(Churchill Livingstone Inc Medical Publishers, 2006) Kosar, F; Nisanoglu, V; Aksoy, Y; Colak, C; Erdil, N; Battaloglu, B
A reduction in QT dispersion (QTd) has been previously shown in patients receiving thrombolytics and undergoing coronary artery bypass grafting (CABG). The purpose of the present study was to investigate changes occurring in corrected QT intervals or QT dispersion after CABG and concomitant aneurysmectomy in the same session. The study population included 43 patients with coronary artery disease with left ventricular aneurysm (LVA). The control group included 32 patients with coronary artery disease without LVA. The study patients underwent CABG and aneurysmectomy in the same surgical session. Corrected maximum and minimum QT interval duration (QTcmax and QTcmm) and corrected QT dispersion (QTcd) were measured in the study patients before and after surgery. QTcmax and QTcd in the patients with LVA were significantly higher than in the patients without LVA (P < .001 and P < .001, respectively). QTcmax and QTcd in the patients with LVA were significantly shortened after surgery (P < .001 and P < .001, respectively). This study showed that QTcmax and QTcd values are significantly reduced after CABG and concomitant aneurysmectomy. We have suggested that coronary revascularization and left ventricular reconstruction in the same session have beneficial effects on QT interval duration and dispersion. (c) 2006 Elsevier Inc All rights reserved.
The effects of trimetazidine on heart rate variability in patients with slow coronary artery flow
(Churchill Livingstone Inc Medical Publishers, 2006) Topal, E; Ozdemir, R; Barutcu, I; Aksoy, Y; Sincer, I; Akturk, E; Çehreli, S
Objective: We sought to examine the effect of trimetazidine (TMZ) on heart rate variability (HRV), endothelin-1 (ET-1), NO, and anginal symptoms in patients with slow coronary artery flow (SCAF). Methods: The 48 patients with SCAF (29 women and 19 men; mean age, 52 +/- 9 years) were included in the study. Twenty milligrams TMZ 3 times a day or matched placebo were given randomly in a double-blinded fashion for 4 weeks. Patients were divided into 4 groups as follows: exercise-positive, TMZ-given group (group A, n = 12); exercise-positive, placebo-given group (group B, n = 12); exercise-negative, TMZ-given group (group C, n = 12); and exercise-negative, placebo-given group (group D, n = 12). Results: After TMZ treatment, HRV parameters, including SD of the all R-R intervals, SD of the averages of R-R intervals in all 5-minute segments of the entire recording, percentage of R-R intervals with more than 50-millisecond variation, and the square root of the mean of the sum of the squares of differences between adjacent R-R intervals, significantly improved both in exercise-positive and exercise-negative groups when compared with baseline. After TMZ treatment, ET-1 and NO levels significantly altered both in exercise-positive and exercise-negative groups when compared with baseline (17.7 +/- 2.7 vs 13.9 +/- 2.8 pg/mL [P = .01] and 18.1 +/- 3.8 vs 14.2 +/- 2.6 pg/mL [P = .01], respectively). After TMZ treatment, NO levels significantly increased in both exercise-positive and exercise-negative groups when compared with baseline (36.4 +/- 5.4 vs 43.3 +/- 6.8 pmol/L [P = .01] and 36.8 +/- 7.8 vs 43.3 +/- 4.8 mu mol/L [P = .01], respectively). However, in placebo group, neither HRV parameters nor ET-1 and NO levels altered when compared with baseline. Also, after treatment, a significant correlation was detected between HRV parameters, including SID of the averages of R-R intervals in all 5-minute segments of the entire recording, SID of the all R-R intervals, percentage of R-R. intervals with more than 50-millisecond variation, and the square root of the mean of the sum of the squares of differences between adjacent R-R intervals, and NO and ET-1 levels in TMZ group but not placebo. Conclusion: Short-term TMZ therapy improved HRV parameters and endothelial products such as ETLI and NO as well as anginal symptom in patients with SCAR Improvement in HRV parameters was correlated with ET-1 and NO levels. (c) 2006 Elsevier Inc. All rights reserved.
Elevated plasma homocysteine levels in patients with isolated coronary artery ectasia
(Lippincott Williams & Wilkins, 2006) Kosar, F; Sincer, I; Aksoy, Y; Ozerol, I
Objective Coronary artery ectasia is a variant of coronary atherosclerosis. Hyperhomocysteinemia has emerged as a major, independent risk factor for cardiovascular diseases. The purposes of this study were to determine plasma hyperhomocysteine levels in patients with coronary artery ectasia, and to compare patients with coronary artery ectasia, coronary artery disease, and controls with normal coronary angiogram. Method The study population included 37 patients with coronary artery ectasia and 36 patients with coronary artery disease. The control group consisted of 32 patients with angiographically proven normal coronary arteries. Plasma hyperhomocysteine levels were measured in all study patients with an enzyme-linked immunosorbent assay. Results Plasma homocysteine levels were significantly higher in patients with both coronary artery ectasia and coronary artery disease than in the controls (14.8 +/- 1.1 and 15.9 +/- 0.8 vs. 2.5 +/- 0.6 mu mol/l; P < 0.001 and P < 0.001, respectively). No significant differences in plasma homocysteine levels were found among CAE and CAD groups (P > 0.05). Conclusions We have demonstrated that patients with coronary artery ectasia and coronary artery disease have increased plasma hyperhomocysteine levels compared with the controls. These findings suggest that hyperhomocysteinemia may play an important role in the pathogenesis of coronary artery ectasia as in coronary artery disease.
Evaluation of right and left ventricular function using pulsed-wave tissue Doppler echocardiography in patients with subclinical hypothyroidism
(Springer, 2005) Kosar, F; Sahin, I; Turan, N; Topal, E; Aksoy, Y; Taskapan, C
Previous studies showed that subclinical hypothyroidism (SH) was associated with cardiovascular disorders, such as endothelial dysfunction, atherosclerosis and myocardial dysfunction. Only one study investigated left ventricular (LV) function using pulsed tissue Doppler echocardiography (TDE) in patients with SH. However, no study has used this technique in the identification of right ventricular (RV) function in these patients. We aimed to investigate the effect of SH on RV and LV function using TDE technique. The present study included 36 newly diagnosed SH patients and 28 healthy controls. For each subjects, serum free T-3 (FT3), free T-4 (FT4), total T-3 (TT3), total T-4 (TT4), TSH, peroxidase antibody (TPOab) and thyroglobulin antibody (TGab) levels were measured, and standard echocardiography and TDE were performed. In patients with SH, TSH levels were significantly higher, and TPOab and TGab levels were significantly higher when compared to healthy controls. TDE showed that the patients had significantly lower early diastolic mitral and tricuspid annular velocity (Ea) and early/late (Ea/Aa) diastolic mitral and tricuspid annular velocity ratio (p < 0.05, p < 0.05 and p < 0.001, p < 0.001, respectively), and significantly longer isovolumetric relaxation time (IRT) of left and right ventricles (p < 0.001 and p < 0.001, respectively). However, Aa, Sa, and isovolumetric contraction time (ICT) and ET (ejection time) of left and right ventricle did not significantly differ (p=ns for all). In addition, a negative correlation between TSH and TD-derived tricuspid Ea velocity and Ea/Aa ratio, and a positive correlation between TSH and IRT of right ventricle were observed. Our findings demonstrated that SH is associated with impaired RV diastolic function in addition to impaired LV diastolic function.
Homocysteine and coronary microcirculation: Is it a microvasculopathic agent?
(Elsevier Ireland Ltd, 2006) Turhan, H; Aksoy, Y; Yetkin, E
[Abstract Not Available]
Increased dilator response to nitrate in contrast to decreased flow mediated dilatation in migraineurs: An ultrasonographic evaluation of brachial artery
(Elsevier Science Inc, 2006) Yetkin, E; Ozisik, H; Ozcan, C; Aksoy, Y; Turhan, H
[Abstract Not Available]
Increased plasma soluble adhesion molecules; ICAM-1, VCAM-1, and E-selectin levels in patients with slow coronary flow
(Elsevier Ireland Ltd, 2006) Turhan, H; Saydam, GS; Erbay, AR; Ayaz, S; Yasar, AS; Aksoy, Y; Basar, N
Background: Inflammation has been reported to be a major contributing factor to many cardiovascular events. In the present study, we aimed to evaluate plasma soluble adhesion molecules; intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and E-selectin as possible indicators of endothelial activation or inflammation in patients with slow coronary flow. Method: Study population included 17 patients with angiographically proven normal coronary arteries and slow coronary flow in all three coronary vessels (group I, 11 male, 6 female, mean age=48 +/- 9 years), and 20 subjects with angiographically proven normal coronary arteries without associated slow coronary flow (group II, 11 male, 9 female, mean age=50 +/- 8 years). Coronary flow rates of all patients and control subjects were documented by Thrombolysis In Myocardial Infarction frame count (TIMI frame count). All patients in group I had TIMI frame counts greater than two standard deviation above those of control subjects (group 11) and, therefore, were accepted as exhibiting slow coronary flow. Serum levels of ICAM-1, VCAM-1, and E-selectin were measured in all patients and control subjects using commercially available ELISA kits. Results: Serum ICAM-1, VCAM-1, and E-selectin levels of patients with slow coronary flow were found to be significantly higher than those of control subjects with normal coronary flow (ICAM-1: 545 +/- 198 ng/ml vs. 242 +/- 113 ng/ml respectively, p < 0.001, VCAM-1: 2040 +/- 634 ng/ml vs. 918 +/- 336 ng/ml respectively, p < 0.001, E-selectin: 67 +/- 9 ng/ml vs. 52 +/- 8 ng/ml respectively, p < 0.001). Average TIMI frame count was detected to be significantly correlated with plasma soluble ICAM-1 (r=0.550, p < 0.001), VCAM-1 (r=0.569, p < 0.001) and E-selectin (r = 0.443, p = 0.006). Conclusion: Increased levels of soluble adhesion molecules in patients with slow coronary flow may be an indicator of endothelial activation and inflammation and are likely to be in the causal pathway leading to slow coronary flow. (c) 2005 Elsevier Ireland Ltd. All rights reserved.
Increased prevalence of varicocele in patients with coronary artery ectasia
(Lippincott Williams & Wilkins, 2005) Yetkin, E; Kilic, S; Acikgoz, N; Ergin, H; Aksoy, Y; Sincer, I; Aktürk, E
Background Coronary artery ectasia (CAE) is defined as localized or diffuse non-obstructive lesions of the epicardial coronary arteries with a luminal dilation exceeding the 1.5-fold of normal adjacent segment or vessel diameter. Varicocele is the dilatation of the pampiniform plexus. Recently increased prevalence of peripheral varicose veins has been shown in patients with CAE. In this study we aimed to assess the prevalence of varicocele, which is dilatation of another venous system, in patients with CAE. Materials and methods Thirty-five male consecutive patients with coronary artery ectasia in combination with or without coronary artery disease (CAD) and 63 male, age-matched patients with coronary artery disease were included in the study. All patients were evaluated for the presence of varicocele. Results Twenty-one patients with CAE were found to have varicocele (62% of group I patients). In patients with CAD, 24 patients (38%) were found to have varicocele. The difference between the two groups in respect to presence of varicocele was statistically significant (P=0.02; odds ratio=1.57; 95% confidence interval 1.05-2.3). Conclusion We have shown that patients with coronary artery ectasia have an increased prevalence of varicocele compared to those with coronary artery disease. The mechanism underlying coronary artery ectasia might further increase the prevalence of varicocele in susceptible patients.
Increased thrombolysis in myocardial infarction frame count in patients with myocardial infarction and normal coronary arteriogram: a possible link between slow coronary flow and myocardial infarction
(Elsevier Ireland Ltd, 2005) Yetkin, E; Turhan, H; Erbay, AR; Aksoy, Y; Senen, K
Background: Thrombolysis in myocardial infarction (TIMI) frame count is a simple clinical tool for assessing quantitative indexes of coronary blood flow. This technique counts the number of cineangiographic frames from initial contrast opacification of the proximal coronary artery to opacification of distal arterial landmarks. We hypothesized that patients with normal coronary artery (NCA) and myocardial infarction (MI) might have impaired coronary flow. Accordingly, we assessed the TIMI frame counts of patients with NCA and MI and compared to patients with NCA and without MI. Materials and method: This retrospective study included consecutive patients with MI and who were found to have normal coronary angiograms performed between 1999 and 2003. Fifty patients (group I) with NCA and MI were enrolled in the study. Fifty consecutive patients with NCA and without MI were also enrolled in the study as control group (group II). Mean time interval between MI and coronary angiography was 6 +/- 2 days. Results: There were statistically significant differences between groups I and II in respect to gender (11 females (22%) versus 22 females (44%),p = 0.003, respectively) and smoking status (62% (31/50) versus 38% (19/50),p = 0.02). Comparison of TIMI frame counts between two groups revealed that group I patients had significantly higher TIMI frame counts than group two patients for all three coronary arteries (LAD: 40 +/- 12 versus 23 +/- 7, Cx: 47 +/- 14 versus 27 +/- 7, RCA: 36 +/- 10 versus 26 +/- 10, respectively, p < 0.001 for all). Smokers were significantly younger when compared to non-smokers (44 +/- 5 years versus 51 +/- 9 years, p = 0.008, respectively). TIMI frame counts of smokers did not significantly differ from those of non-smokers in group I patients. There were statistically significant differences between smokers and nonsmokers in group II patients regarding TIMI frame counts for all three coronary arteries (LAD: 29 +/- 7 versus 18 +/- 3, LCX: 34 +/- 10 versus 22 +/- 4, RCA: 34 +/- 13 versus 20 +/- 4, respectively, p < 0.001 for all). Conclusion: We have shown that patients with MI and NCA have higher TIMI frame counts for all coronary arteries when compared to patients without MI and NCA. Absence of difference between smokers and non-smoker in the myocardial infarction group in respect to TIMI frame count, has suggested that smoking does not lead to further increase of TIMI frame counts. On the other hand, in patients without MI and with NCA, smokers have higher TIMI frame counts than non-smokers have. (c) 2005 Elsevier Ireland Ltd. All rights reserved.
Interval analysis in patients with acute biliary pancreatitis
(Lippincott Williams & Wilkins, 2005) Ates, F; Kosar, F; Aksoy, Y; Yildirim, B; Sahin, I; Hilmioglu, F
Background: It has been previously proposed that electrocardiographic abnormalities may be associated with acute pancreatitis. However, there is a lack of data on the QT interval and dispersion value in patients with acute pancreatitis, and no data are also available concerning QT interval and QT dispersion in acute biliary pancreatitis ( ABP). Aims: We aimed to investigate the QT parameters in patients with ABP, to compare them with those of healthy controls, and to analyze the relationship between QT parameters and Ranson score. Methods: The present study included 32 patients with acute biliary pancreatitis and 35 healthy controls. The severity of the pancreatitis was determined by Atlanta criteria: fewer than 3 Ranson criteria or fewer than 8 APACHE II ( the Acute Physiology and Chronic Health Evaluation) points indicated the mild disease ( group 1); 3 or more Ranson criteria or 8 or more APACHE II points or organ failure or systemic complications or local complications indicated the severe disease ( group 2). On admission, all patients underwent a standard 12-lead electrocardiogram, and corrected maximum QTc interval (QTc(max)), corrected minimum QT interval (QTc(min)), and corrected QTc dispersion (QTcd) values of the subjects were measured according to the Bazett formula in this study. Results: QTc(max) and QTcd were significantly longer in patients with ABP than in healthy controls ( 442 6 38 milliseconds versus 413 6 34 milliseconds, P< 0.05; and 67 +/- 21 milliseconds versus 42 +/- 18 milliseconds, P< 0.001, respectively). Similarly, QTc(max) and QTcd were significantly longer in group 2 than in group 1 ( 440 6 38 milliseconds versus 450 +/- 34 milliseconds, P< 0.01; and 66 +/- 9 milliseconds versus 71 +/- 11 milliseconds, P< 0.01, respectively). Correlation analysis showed that there is a significant positive relationship between Ranson scores of patients and QTcmax and QTcd ( P< 0.01 and P< 0.001, respectively). Conclusion: The effect of acute biliary pancreatitis on QT intervals and dispersion appears to be dependent not only on the disease but also on its severity, and these parameters may give additional prognostic information in ABP patients, even in the initial evaluation.
Myocardial viability in patients with chronic coronary artery disease and myocardial dysfuncton: Dobutamine stress echocardiography and echocardiography during glucose-insulin-potassium infusion
(Lippincott Williams & Wilkins, 2002) Turhan, H; Yetkin, E; Senen, K; Atak, R; Ileri, M; Aksoy, Y; Cehreli, S
[Abstract Not Available]
Pericardial hydatid cyst mimicking acute coronary syndrome
(Texas Heart Inst, 2005) Kosar, F; Aksoy, Y; Sahin, I; Erdil, N
Cardiac hydatid cysts are found mostly within myocardium. Only a few cases of pericardial location have been reported. Patients with hydatid cysts are usually asymptomatic. A 46-year-old man with clinical and electrocardiographic features mimicking acute myocardial ischemia was hospitalized for further evaluation. Detailed imaging and laboratory investigation revealed a pericardial hydatid cyst. The patient underwent operation for curative excision. After surgery the patient's symptoms resolved and his clinical status improved. We think that pericardial hydatid cyst should be considered in the differential diagnosis of patients with angina-like pain-especially in geographic areas where hydatid cysts are endemic.
Plasma soluble adhesion molecules; intercellular adhesion molecule-1, vascular cell adhesion molecule-1 and E-selectin levels in patients with isolated coronary artery ectasia
(Lippincott Williams & Wilkins, 2005) Turhan, H; Erbay, AR; Yasar, AS; Aksoy, Y; Bicer, A; Yetkin, G; Yetkin, E
Plasma soluble adhesion molecules, intercellular adhesion molecule-1 (ICAM)-1, vascular cell adhesion molecule-1 (VCAM-1) and E-selectin leves of patients with isolated coronary artery ectasia (CAE), patients with obstructive coronary artery disease without CAE and subjects with angiographically normal coronary arteries were evaluated. Patients with isolated CAE were detected to have significantly higher levels of plasma soluble ICAM-1, VCAM-1 and E-selectin in comparison with patients with obstructive coronary artery disease without CAE OCAM, 673 153 versus 381 +/- 106, respectively, P < 0.001; VCAM-1, 2366 +/- 925 versus 1136 +/- 208, respectively, P < 0.001; E-selectin, 74 +/- 21 versus 61 +/- 18, respectively, P = 0.01) and subjects with normal coronary arteries (ICAM-1, 673 +/- 153 versus 303 +/- 131, respectively, P < 0.001; VCAM-1, 2366 925 versus 729 231, respectively, P < 0.001; E-selectin, 74 +/- 21 versus 49 +/- 9, respectively, P < 0.001), suggesting the presence of a more severe and extensive chronic inflammation in the coronary circulation in patients with isolated CAE. \ Background The common coexistence of coronary artery ectasia (CAE) with coronary artery disease (CAD) suggests that it may be a variant of CAD. However, it is not clear why some patients with obstructive CAD develop CAE whereas most do not. inflammation has been reported to be a major contributing factor to both obstructive and aneurysmatic vascular disorders and therefore, in the present study, the plasma soluble adhesion molecules, intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and E-selectin levels in isolated CAE were investigated. Methods The study population consisted of three groups: the first consisted of 32 patients with isolated CAE without stenotic lesion; the second of 32 patients with obstructive CAD without CAE; and the third group of 30 control subjects with normal coronary arteries. Coronary diameters were measured as the maximum diameter of the ectasic segment by use of a computerized quantitative coronary angiography analysis system. According to the angiographic definition used in the Coronary Artery Surgery Study, a vessel is considered to be ectasic when its diameter is greater than or equal to 1.5 times that of the adjacent normal segment in segmental ectasia. Plasma soluble ICAM-1, VCAM-1 and E-selectin levels were measured in all patients and control subjects using commercially available enzyme-linked immunosorbent assay kits. Results Patients with isolated CAE were found to have significantly higher levels of plasma soluble ICAM-1, VCAM-1, and E-selectin in comparison with patients with obstructive CAD without CAE (ICAM, 673 +/- 153 versus 381 +/- 106, respectively; P < 0.001; VCAM-1, 2366 +/- 925 versus 1136 +/- 208, respectively; P < 0.001; E-selectin, 74 +/- 21 versus 61 +/- 18, respectively; P = 0.01) and control subjects with normal coronary arteries (ICAM-1, 673 +/- 153 versus 303 +/- 131, respectively;, P < 0.001; VCAM-1, 2366 +/- 925 versus 729 +/- 231, respectively; P < 0.001; E-selectin, 74 +/- 21 versus 49 +/- 9, respectively; P < 0.001). In addition, we detected statistically significant positive correlation between the total length of ectasic segments and the levels of plasma soluble ICAM-1 (r=0.625; P < 0.001), VCAM-1 (r= 0.548; P= 0.001) and E-selectin (r=0.390; P=0.027). Multivariate logistic regression analysis revealed a significant independent relation between isolated CAE and ICAM-1 [odds ratio (OR)= 1.023; 95% confidence interval (CI) = 1.0048-1.0414; P= 0.0129] and VCAM-1 (OR = 1.0057; 95% Cl = 1.0007-1.0106; P= 0.0240). Conclusions We have shown that patients with isolated CAE have raised levels of plasma soluble ICAM-1, VCAM-1 and E-selectin in comparison with patients with obstructive CAD without CAE and control subjects with normal coronary arteries, suggesting the presence of a more severe and extensive chronic inflammation in the coronary circulation in these patients. (C) 2005 Lippincott Williams Wilkins.

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