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Öğe 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, EObjectives 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.Öğe Acute pericarditis as a complication of percutaneous mitral balloon valvulotomy(I C R Publishers, 2006) Turhan, H; Basar, N; Yasar, AS; Erbay, AR; Atak, RDuring the past two decades, percutaneous mitral balloon valvulotomy (PMBV) has been frequently used, with high success and low complication rates, in the treatment of patients with moderate to severe rheumatic mitral stenosis. The case is reported of a patient with severe rheumatic mitral stenosis who developed acute pericarditis two days after successful PMBV. To the best of the authors' knowledge, this is the first such case to be reported.Öğe Changes in plasma levels of adhesion molecules after percutaneous mitral balloon valvuloplasty(Elsevier Science Inc, 2004) Yetkin, E; Erbay, AR; Turhan, H; Balci, M; Yetkin, F; Yetkin, G; Ileri, MBackground: Adhesion molecules are expressed on vascular endothelium and on immune and inflammatory cells. Recently increased levels of adhesion molecules have been shown in patients with rheumatic mitral stenosis. This study examined the serum levels of the adhesion molecules intercellular adhesion molecule I (ICAM-1), vascular cell adhesion molecule I (VCAM-1), and E-selectin in patients with rheumatic mitral stenosis and the effects of percutaneous mitral balloon valvuloplasty (PMBV) on these adhesion molecules. Materials and methods: Thirty five patients (3 men, 32 women, mean age 39 5 years) with severe rheumatic mitral stenosis who underwent percutaneous balloon mitral valvuloplasty, and 35 age and sex matched healthy control subjects were included in the study. Serum levels of ICAM-1, VCAM-I, and E-selectin were measured in all patients who underwent PMBV and in all control subjects. Blood samples were taken for measurement of adhesion molecules immediately before and 24 h after the mitral balloon valvuloplasty. Results: The plasma levels of soluble adhesion molecules E-selectin, ICAM-I and VCAM-I were significantly elevated in patients with mitral stenosis compared to control subjects: E-selectin, 97 +/- 59 vs. 45 +/- 24 ng/ml (P=.001), sICAM-1, 874 +/- 301 ng/ml vs. 238 82 ng/ml (P<.0001); sVCAM-1, 3056 +/- 763 ng/ml vs. 985 +/- 298 ng/ml (P<.0001). Plasma levels of VCAM-1 significantly increased 24 h after the valvuloplasty procedure (3056 +/- 763 ng/ml vs. 3570 +/- 1225 ng/ml P=.013). Plasma levels of E-selectin showed a significant decrease after PMBV (97 +/- 59 vs. 70 +/- 58 ng/ml, P=.043) and plasma levels of ICAM-I did not show any change after PMBV (874 +/- 301 vs. 944 +/- 3 77 ng/ml, P=.356). Conclusion: Cellular adhesion molecules, sICAM-1, E-selectin, sVCAM-1 have shown changes in different directions in response to PMBV These results necessitate further studies to clarify the mechanism underlying the association between adhesion molecules and PMBV as well as rheumatic mitral stenosis. (C) 2004 Elsevier Inc. All rights reserved.Öğe Comparison of C-reactive protein levels inpatients with coronary artery ectasia versus patients with obstructive coronary artery disease(Excerpta Medica Inc-Elsevier Science Inc, 2004) Turhan, H; Erbay, AR; Yasar, AS; Balci, M; Bicer, A; Yetkin, EThis study evaluated plasma C-reactive protein (CRP) levels, a specific marker of inflammation, in 32 patients with isolated coronary artery ectasia (CAE) and compared the results with those of 32 patients with obstrucfive coronary artery disease without coronary artery ectasia and 30 subjects with angiographically normal coronary arteries. CRP levels were found to be significandy higher in patients with isolated CAE (p < 0.001), suggesting that more severe inflammation may be involved in the pathogenesis of CAE. (C) 2004 by Excerpta Medica, Inc.Öğe Correlation between infarct-related coronary artery patency and predischarge electrocardiographic patterns in patients with first anterior myocardial infarction who received thrombolytic therapy(Springer-Verlag, 2004) Atak, R; Ileri, M; Senen, K; Turhan, H; Erbay, AR; Basar, N; Yetkin, EThe aim of this study was to investigate the correlation between the ST-segment and T-wave patterns in pre-discharge electrocardiogram and patency of left anterior descending coronary artery in patients with a first anterior myocardial infarction (AMI). One hundred and fifty-six of 175 consecutive patients who were admitted to our clinic between January 2000 and September 2002 due to a first episode of transmural AMI and who received thrombolytic therapy were enrolled. Coronary angiography was performed by the Judkins method on the 6th-10th day after the acute infarction. The corrected TIMI frame count (CTFC) was estimated according to the previously described method. According to the combination of the ST-segment and T-wave morphology on the day (6-10) of cardiac catheterization, patients were classified into four groups: group A, ST elevation <0.1 mV and negative T waves; group B, ST elevation ?0.1 mV and negative T waves; group C, ST elevation <0.1 mV and positive T waves; and group D, ST elevation greater than or equal to0.1 mV and positive T waves. Of the 99 patients with negative T waves, 47 (48%) had CTFCless than or equal to27,32 (32%) CTFC between 27 and 40,15 (15%) CTFCgreater than or equal to40-100, and 5 (5%) CTFC>100. Of the 57 patients with positive T waves, CTFC was less than or equal to27 in 14 (25%), between 27 and 40 in 17 (30%), greater than or equal to40-100 in 11 (19%), and >100 in 15 (26%) (P<0.001). From the 76 patients with an isoelectric ST segment, 38 (50%) had CTFC?27, 29 (38%) CTFC between 27 and 40, 8 (11%) CTFC?40-100, and 1 (1%) CTFC >100. Of the 80 patients with an elevated ST segment, 23 (29%) had CTFCless than or equal to27, 20 (25%) CTFC between 27 and 40,18 (23%) CTFCgreater than or equal to40-100, and 19 (23%) CTFC>100(P<0.001). Use of the combination of two electrocardiographic parameters (ST segment and T waves) also indicated that there were significant differences between groups A and D, and groups B and D (P<0.001 and P<0.05, respectively). Development of an isoelectric ST segment with negative T waves may indicate a better degree of reperfusion after AML In contrast, patients in whom ST-segment elevation and positive T waves remain at discharge from the coronary care unit have a higher probability of a nonpatent left anterior descending artery.Öğe Decreased platelet activation and endothelial dysfunction after percutaneous mitral balloon valvuloplasty(Elsevier Ireland Ltd, 2003) Yetkin, E; Erbay, AR; Turhan, H; Ileri, M; Ayaz, S; Atak, R; Senen, KObjective: This study was conducted to assess the changes in platelet activation and endothelial dysfunction in patients with mitral stenosis (MS) and sinus rhythm (SR) following percutaneous mitral balloon valvuloplasty (PMBV). Background: Systemic thromboembolism is a serious complication in patients with valvular heart disease, and its incidence is highest in those with mitral stenosis. A hypercoagulable state has also been reported in patients with mitral stenosis and sinus rhythm. A recent study has shown that patients with previous PMBV had a lower incidence of thromboembolism. Methods and results: The study was conducted in 21 patients (two men, 19 women, mean age=34+/-6 years) with mitral stenosis and sinus rhythm (SR) who underwent percutaneous mitral balloon valvuloplasty and 17 healthy control subjects (two men, 15 women, mean age=33+/-6 years). Biochemical markers of platelet activity (beta thromboglobulin, BTG, and soluble P-selectin, sPsel) and endothelial dysfunction (von Willebrand Factor, vWF) were measured in both control subjects' and patients' serum samples taken immediately before PMBV and 24 h after PMBV procedure. All patients underwent successful PMBV Significant improvement of mitral valve area, pulmonary artery pressure, mean mitral gradients, and left atrial diameter were achieved in all patients after PMBV Compared with control subjects, patients with MS had higher plasma levels of BTG (66+/-26 ng/ml vs. 14+/-6 ng/ml, P<0.001), vWF (177+/-67 units/dl vs. 99+/-37 units/dl, P<0.0001), sPsel (226+/-74 ng/ml vs. 155+/-66 ng/ml, P<0.001). There was a significant reduction of plasma levels of BTG (66 +/- 26 ng/ml vs. 48 +/- 20 ng/ml, P=0.002), vWF (177 +/- 67 units/dl vs. 134 +/- 60 units/dl, P=0.001) and P-selectin (226 +/- 74 ng/ml vs. 173 +/- 71 ng/ml, P=0.008,) 24 h after PMBV Conclusion: We have shown that patients with severe MS and SR have increased platelet activation and endothelial dysfunction compared with control subjects and PMBV results in decreased platelet activity and improvement of endothelial injury. (c) 2003 Elsevier Ireland Ltd. All rights reserved.Öğe Documentation of slow coronary flow by the thrombolysis in myocardial infarction frame count in habitual smokers with angiographically normal coronary arteries(Springer, 2004) Erbay, AR; Turhan, H; Senen, K; Yetkin, O; Yasar, AS; Sezgin, AT; Atak, RThe thrombolysis in myocardial infarction (TIMI) frame count is a simple clinical tool for assessing quantitative indexes of coronary blood flow. In this study we aimed to evaluate the effects of long-term cigarette smoking on the TIMI frame count in patients with angiographically proven normal coronary arteries. Between May 2001 and January 2002, 41 habitual smokers and 41 sex-matched nonsmokers with angiographically proven normal coronary arteries were included in the study. The TIMI frame count was determined for each major coronary artery in each patient. The TIMI frame count of the smoking group was significantly higher than that of nonsmokers for all three coronary arteries: left anterior descending ( corrected), 39 +/- 13 vs 22 +/- 8; right coronary artery, 35 +/- 13 vs 24 +/- 11; and left circumflex artery, 37 +/- 13 vs 25 +/- 8 ( P < 0.001 for all). The smokers tended to be younger than nonsmokers ( 46 +/- 7 vs 49 +/- 9 years; P = 0.07). We have found that smokers with angiographically normal coronary arteries have a higher TIMI frame count than nonsmokers with angiographically normal coronary arteries. An increased TIMI frame count can be regarded as an index of the harmful effects of smoking on coronary circulation regardless of the underlying mechanism.Öğe Double left anterior descending coronary artery arising from the left and right coronary arteries: a rare congenital coronary artery anomaly(Springer, 2004) Turhan, H; Atak, R; Erbay, AR; Senen, K; Yetkin, EDouble left anterior descending coronary artery arising from the left and right coronary arteries is a very rare congenital coronary artery anomaly. In this report, we describe a patient with double left anterior descending coronary artery originating from the left and right coronary arteries. To the best of our knowledge, dual connection of the left anterior descending coronary artery to the left and right coronary arteries has been described in only five patients.Öğe Effect of coronary angioplasty on Helicobacter pylori IgG antibody(Elsevier Ireland Ltd, 2005) Yetkin, G; Ozerol, IH; Erbay, AR; Durmaz, R[Abstract Not Available]Öğe Effects of long-term beta-blocker therapy on P-wave duration and dispersion in patients with rheumatic mitral stenosis(Elsevier Ireland Ltd, 2005) Erbay, AR; Turhan, H; Yasar, AS; Bicer, A; Senen, K; Sasmaz, H; Sabah, IBackground: P-wave dispersion (PWD), has been defined as the difference between maximum and minimum P-wave duration. Prolonged P-wave duration and increased PWD have been reported to be related with increased risk for atrial fibrillation (AF). AF is the most common sustained arrhythmia encountered in patients with rheumatic mitral stenosis (MS). Beta-blockers are the mainstay of therapy in patients with rheumatic MS to control ventricular rate both during sinus rhythm and AF. In the present study, we aimed to evaluate the effect of long-term beta-blocker therapy on P-wave duration and PWD in patients with rheumatic MS. Method: Study population includes 46 patients (group I, 8 men, 38 women, mean age=34 +/- 8 years) with newly diagnosed moderate-to-severe rheumatic MS who have not taken any medication before and prescribed oral beta-blocker therapy and 46 healthy control subjects without any cardiovascular disease (group II, 8 men, 38 women, mean age=35 +/- 7 years). Mitral valve area, maximum and mean diastolic mitral gradients, left atrial diameter, and systolic pulmonary artery pressure were evaluated by transthoracic echocardiography before initiation of beta blocker therapy and repeated at the end of the first month. Baseline maximum and minimum P-wave duration and PWD were determined on 12-lead electrocardiogram recorded for each patient and control subject and repeated at the end of the first month after initiation of beta-blocker therapy in patient group. Results: Maximum P-wave duration and PWD were found to be significantly higher in patients with MS than those in control subjects (Maximum P-wave duration: 128 +/- 7 ms vs. 104 +/- 4 ms and PWD: 52 +/- 6 ms vs. 27 +/- 3 ms, p < 0.001 for both). Both groups had comparable minimum P-wave duration (75 +/- 4 ms vs. 76 +/- 4 ms, p=0.093). Maximum P-wave duration and PWD were found to be significantly decreased by long-term beta blocker therapy (Maximum P-wave duration; 128 +/- 7 ms vs. 122 +/- 6 ms, p < 0.001, PWD; 52 +/- 6 ms vs. 47 5 ms, p < 0.001). However, there was no significant difference between the values of minimum P wave duration measured before and at the end of the first month of beta-blocker therapy (75 +/- 4 ms vs. 75 +/- 3 ms, p=0.678). Statistically significant decrease were detected on maximum and mean mitral gradient and systolic pulmonary artery pressure and resting heart rate at the end of the first month of beta-blocker therapy. However, only the change in resting heart rate was found to be significantly correlated with the decrease in maximum P-wave duration and PWD (Maximum P-wave duration: r=0.327, p=0.026, PWD: r=0.378, p=0.01). Conclusion: We have shown for the first time that long-term beta-blocker therapy causes a significant decrease in maximum P-wave duration and PWD in patients with rheumatic MS. (c) 2004 Elsevier Ireland Ltd. All rights resrved.Öğe Elevated level of plasma homocysteine in patients with slow coronary flow(Elsevier Ireland Ltd, 2005) Erbay, AR; Turhan, H; Yasar, AS; Ayaz, S; Sahin, O; Senen, K; Sasmaz, HBack-ground: Elevated plasma levels of homocysteine are currently considered a major, independent risk factor for cardiovascular diseases. Recently, several investigators have Suggested that even mild elevation in plasma homocysteine level can severely disturb vascular endothelial function and subsequently impair coronary blood flow. Accordingly, we investigated plasma homocysteine level in patients with slow coronary flow. Method: Study population included 53 patients with angiographically proven normal coronary arteries and slow coronary flow in all three coronary vessels (group I, 21 females, 32 males, mean age=48 +/- 9 years), and 50 subjects with angiographically proven normal coronary arteries without associated slow coronary flow (group II, 22 females, 28 males, 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 deviations above those of control subjects (group II) and, therefore, were accepted as exhibiting slow coronary flow. The mean TIMI frame Count for each patient and control subject was calculated by adding the TIMI frame counts for each major epicardial coronary artery and then dividing the obtained value into 3. Plasma homocysteine level was measured in all patients and control subjects using commercially available homocysteine kits. Results: There was no statistically significant difference between two groups in respect to age, gender, hypertension, diabetes mellitus, hyperlipidemia and cigarette smoking (p > 0.05). Plasma homocysteine level of patients with slow coronary flow were found to be significantly higher than those of control subjects (15.5 +/- 5.7 vs. 8.7 +/- 4.2 mu M/l, respectively, p < 0.001). Moreover, we found a significant positive correlation between plasma homocysteine level and mean TIMI frame count (r=0.660, p < 0.001). Conclusion: We have shown that patients with slow coronary flow have raised level of plasma homocysteme compared to control subjects with normal coronary flow. This data suggests that elevated level of plasma homocysteine may play a role in the pathogenesis of slow coronary flow. (c) 2004 Elsevier Ireland Ltd. All rights reserved.Öğe Free-floating left atrial ball thrombus developed in an 11-year-old child with restrictive cardiomyopathy during sinus rhythm: Manifested as a major thromboembolic event(Elsevier Ireland Ltd, 2005) Turhan, H; Ocal, A; Erbay, AR; Yasar, AS; Cicekcioglu, F; Yetkin, EFree-floating left atrial ball thrombus is an extremely rare and serious disorder that usually occurs in the setting of a large, dilated left atrium with stagnant flow, commonly the result of severe rheumatic mitral stenosis and accompanying atrial fibrillation. In the present case, we report a free-floating left atrial ball thrombus developed in an 11-year-old child with idiopathic restrictive cardiomyopathy during sinus rhythm and manifested as peripheral arterial embolic event. To our knowledge, this is the first case of free-floating left atrial ball thrombus developed in a patient with restrictive cardiomyopathy. Furthermore, this also is the first case of free-floating left atrial ball thrombus developed in a patient during sinus rhythm. (c) 2005 Elsevier Ireland Ltd. All rights reserved.Öğe High prevalence of metabolic syndrome among young women with premature coronary artery disease(Lippincott Williams & Wilkins, 2005) Turhan, H; Yasar, AS; Basar, N; Bicer, A; Erbay, AR; Yetkin, EBackground The metabolic syndrome is more prevalent with the use of the recently defined National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria and is associated with a greater risk of atherosclerotic cardiovascular disease than any of its individual components. This study evaluated the prevalence of metabolic syndrome in female and male patients with newly diagnosed premature coronary artery disease. Method The study population included 582 consecutive patients (496 men, 86 women) with newly diagnosed premature coronary artery disease (aged less than or equal to 45 years). Besides classic major coronary risk factors, all patients were evaluated for the presence of metabolic syndrome based on the NCEP ATP III criteria. Results The majority of patients were male (85% versus 15%). The overall prevalence of metabolic syndrome was 37%. Women with premature coronary artery disease were found to have a higher prevalence of metabolic syndrome than men (73% versus 31% respectively, p < 0.001). Furthermore, the mean number of components of metabolic syndrome was significantly higher in women compared to men (2.81 +/- 1.09 versus 1.85 +/- 1.08 respectively, p < 0.001). In addition, metabolic syndrome was detected to be the most frequent coronary risk factor in women (73%). Besides, cigarette smoking was found to be significantly higher in males compared to females (70% versus 36% respectively, p < 0.001) and it was the most prevalent coronary risk factor in men with premature coronary artery disease. Conclusion We have shown for the first time a higher prevalence of metabolic syndrome in young females compared with young males with premature coronary artery disease. This data may be useful in directing primary and secondary preventive measures. (C) 2005 Lippincott Williams Wilkins.Öğe Impaired coronary blood flow in patients with metabolic syndrome: Documented by Thrombolysis in Myocardial Infarction (TIMI) frame count method(Mosby-Elsevier, 2004) Turhan, H; Erbay, AR; Yasar, AS; Bicer, A; Sasmaz, H; Yetkin, EBackground Endothelium plays an important role in regulating coronary vascular tone. In addition, several of cardiovascular risk factors that are associated metabolic syndrome have been reported to be associated with endothelial dysfunction. In the present study we aimed to evaluate the coronary blood flow in patients with metabolic syndrome by means of the Thrombolysis in Myocardial Infarction (TIMI) frame count. Method Forty-two patients with metabolic syndrome (group 1) and 42 control subjects without metabolic syndrome (group II) were included in the study. All subjects had angiographically proven normal coronary arteries. Diagnosis of metabolic syndrome was based on the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines published in 2001. Coronary flow rates of all subjects were documented by TIMI frame count method. Results TIMI frame counts for each of the major epicardial coronary arteries were found to be significantly higher in patients with metabolic syndrome compared with control subjects (corrected TIMI frame count for left anterior descending coronary artery: 35 +/- 7 vs 25 +/- 7, respectively; left circumflex coronary artery: 32 9 vs 25 7, respectively; right coronary artery: 31 +/- 9 vs 24 +/- 5, respectively; P <.001 for all). Statistically significant independent relationships were found between TIMI frame count and body mass index (R-2 = 0.480, P =.009), waist circumference (R-2 = 0.551, P = .001), and triglyceride level (R-2 = 0.434, P =.036). Conclusion We have shown for the first time that patients with metabolic syndrome and angiographically normal coronary arteries have higher TIMI frame counts for all 3 coronary vessels, indicating impaired coronary blood flow, compared to control subjects without metabolic syndrome.Öğe Impaired coronary collateral vessel development in patients with metabolic syndrome(Lippincott Williams & Wilkins, 2005) Turhan, H; Yasar, AS; Erbay, AR; Yetkin, E; Sasmaz, H; Sabah, IBackground The development of coronary collateral vessels is the physiological response of myocardial tissue to hypoxia or ischemia, which results in an increase in blood supply to the tissue. However, a lack of collateral vessels or the presence of poor collateralization in some patients despite the presence of significant coronary stenosis or obstruction and evidence of myocardial ischemia suggest that some other factors may affect the development of collateral circulation. In the present study we aimed to evaluate coronary collateral circulation in patients with metabolic syndrome with advanced coronary artery disease and compare the results with those of patients without metabolic syndrome. Method The study population comprised 102 patients with metabolic syndrome and advanced coronary artery disease (-90% diameter stenosis in at least one major epicardial coronary artery) and 102 control participants without metabolic syndrome who also had >= 90% diameter stenosis in at least one major epicardial coronary artery. The diagnosis of metabolic syndrome was based on the National Cholesterol Education Program Adult Treatment Panel III clinical definition. Coronary collateral vessels were analysed according to the Cohen and Rentrop grading system. Both groups were also divided into two additional groups according to the Rentrop collateral score as patients with poor collateral circulation (Rentrop score 0-1) and good collateral circulation (Rentrop score 2-3). Results The mean Rentrop collateral score for patients with metabolic syndrome was significantly lower than for those without metabolic syndrome (1.38 +/- 0.79 compared with 1.99 +/- 1.08, respectively, P < 0.001). When two groups were compared with respect to poor and good collateral circulation, poor collateral circulation was found to be significantly higher in the metabolic syndrome group (70% compared with 32%, respectively, P < 0.001). Moreover, multivariate logistic regression analysis revealed a significant relationship between poor collateral circulation and metabolic syndrome (odds ratio=4.29, 95% confidence interval = 1.73-10.69, P = 0.002). Conclusion We have shown for the first time that the development of coronary collateral vessels is poorer in patients with metabolic syndrome with advanced ischemic heart disease than in control participants without metabolic syndrome. Thus, it can be suggested that metabolic syndrome is one of the significant factors affecting the development of coronary collateral vessels adversely.Öğe Increased levels of soluble adhesion molecules in patients with isolated coronary artery ectasia(W B Saunders Co Ltd, 2003) Turhan, H; Yetkin, E; Erbay, AR; Atak, R; Senen, K; Sasmaz, H; Cehreli, S[Abstract Not Available]Öğe 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, NBackground: 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.Öğe Increased soluble adhesion molecules in patients with slow coronary flow(W B Saunders Co Ltd, 2003) Turhan, H; Yetkin, E; Erbay, AR; Atak, R; Senen, K; Sasmaz, H; Cehreli, S[Abstract Not Available]Öğe 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, KBackground: 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.Öğe Migraine headache induced recurrent atrial fibrillation: a case report(Acta Cardiologica, 2004) Turhan, H; Erbay, AR; Yetkin, EA variety of symptoms that accompany migraine are mediated by the autonomic nervous system. The autonomic nervous system has long been known to play a potentially important role in the occurrence of atrial fibrillation. Clinically significant effects on cardiac rhythm are uncommon during migraine attacks. In the present case, we report a man who experienced recurrent episodes of atrial fibrillation, which were likely secondary to the vomiting component of migraine.
