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Akut koroner sendrom hastalarının tedavisinde yeni nesil oral antitrombotik ajanlar: Kılavuzlara güncel bakış
(MN Kardiyoloji, 2015) Taşolar, Hakan; Pekdemir, Hasan
Öz: Geçmişten günümüze akut koroner sendromların (AKS) tanısı, tedavisi ve önlemi konusunda belirgin ilerlemeler kaydedilmiş olmasına karşın, miyokard enfarktüsü, ölüm, sakatlık, kötü yaşam kalitesi ve önlenebilir sağlık harcamaları açısından ciddi bir sorun teşkil etmeye devam etmektedir. AKS nin patofizyolojisinde plak rüptürüne bağlı gelişen trombüsün lümeni tıkamasıyla, miyokard iskemisinden nekroza doğru giden bir süreç rol almaktadır. AKS tedavisinin merkezinde antitrombosit tedavisinin olmasının en önemli patofizyolojik açıklaması da burada yatmaktadır. Yayınlanan güncel kılavuzlarda, AKS tanısı konulduktan sonra, iskemik komplikasyonları azaltmak ve tekrarlayan aterotrombozu engellemek için, mümkün olan en kısa zamanda antitrombosit tedavi başlanması önerilmektedir. Biz de son yayınlanan kılavuzlar ışığında klopidogrel tedavisine alternatif olarak sunulan yeni P2Y12 blokeri preperatları olan prasugrel ve tikagreloru yakından incelemeyi ve AKS hastalarında uygulanan antitrombotik tedavideki güncel gelişmeleri değerlendirmeyi amaçladık.
Antithrombotic treatment patterns and stroke prevention in patients with atrial fibrillation in Turkey: Inferences from GARFIELD-AF registry
(2019) Yetiş Sayın, Begüm; Okutucu, Sercan; Yılmaz, Mehmet Birhan; Özdemir, Kurtuluş; Aydınlar, Ali; Şahin, Durmuş Yıldıray; Altun, Armağan; Açıkel, Sadık; Okuyan, Ertuğrul; Sucu, Murat; Öngen, Zeki; Ersanlı, Kazım; Yılmaz, Özcan; Demir, Mesut; Pekdemir, Hasan; Topsakal, Ramazan; Şahiner, Mehmet Levent; Aras, Dursun; Oto, Ali
Abstract: Objective: The corner stone of atrial fibrillation therapy includes the prevention of stroke with less adverse effects. The Global AnticoagulantRegistry in the FIELD–Atrial Fibrillation (GARFIELD-AF) study provided data to compare treatment strategies in Turkey with other populations andevery-day practice of stroke prevention management with complications.Methods: GARFIELD-AF is a large-scale registry that enrolled 52,014 patients in five sequential cohorts at >1.000 centers in 35 countries. Thisstudy was initiated to track the evolution of global anticoagulation practice, and to study the impact of NOAC therapy in AF. A total of 756 patientsfrom 17 enrolling sites in Turkey were in cohort 4 and 5. Treatment strategies at diagnosis initiated by CHA2DS2-VASc score, baseline characteristics of patients, treatment according to stroke and bleeding risk profiles, and INR values were analyzed in cohorts. Additionally, event ratesduring the first year follow up were evaluated.Results: AF patients in Turkey were mostly seen in young women. Stroke risk according to the CHADS2 score and CHA2DS2-VASc score compared with world data. The mean of risk score values, including HAS-BLED score were lower in Turkey than in the world data. The percentageof patients receiving FXa inhibitor with or without an antiplatelet usage was more than the other drug groups. All-cause mortality was higher inTurkey. Different form world data when HAS-BLED score was above 3, the therapy was mostly changed to antiplatelet drugs in Turkey.Conclusion: In addition to deficiencies in available treatment options, patient care and clinical outcomes of patients with AF, the data of GARFIELD-AF provide data from Turkey about therapeutic strategies and best practices. (Anatol J Cardiol 2019; 21: 272-80)
Antrasiklin grubu antibiyotiklerin sol ventrikül fonksiyonları, ventriküler De-repolarizasyon parametreleri ve dispersiyonları üzerine etkileri
(Türk Hematoloji Onkoloji Dergisi, 1998) Tuncer, Cemal; Büyükberber, Süleyman; Aydoğdu, İsmet; Özdemir, Ramazan; Güven, Aytekin; Pekdemir, Hasan; Seçkin, Yüksel; Sezgin, Alpay; Komsuoğlu, Baki
Öz: Antrasiklin grubu antibiyotiklerin kümülattf dozu 400 mg/m2'nin altında olduğu zaman semptomatik kardiyotoksisite gelişmesi nadirdir. Bununla birlikte subklinik kardiyak hasar gelişmesi son derece sık-tır. Buna rağmen literatürde antrasiklin kemoterapisinin ventriküler de-repolarizasyon intervallerine ve dispersiyonlan üzerine etkisi ve bu parametrelerin geç kardiyotoksisiteyi kestirebilmelerine dair çalışma-lara rastlanmamıştır. Çalışmamızda antrasiklin grubu değişik ilaçlar alan maligniteli 13 erkek ve 7 ka-dın toplam 20 hastada, başlangıçtaki, intermediate kümülatif dozdaki ve total kümülatif dozdaki EKG parametreleri ve ekokardiyografi parametreleri birlikte değerlendirilmiştir. Ejeksiy on fraksiyonu (EF) to-tal doz alanlarda (%42.86+11.52), başlangıç (%54.5+-12.12) ve intermediate doz alanlara göre (%52.89±14.72) anlamlı olarak azaldı (p<0.05). Fraksiyonel kısalma (FS) ise total doz alanlarda (%21.86+10.06) sadece başlangıçtaki değere göre (%32.5±6.56) anlamlı olarak azaldı. Total doz alan-lardaki E velosite değeri (54.71±13-9 cm/sn), başlangıçtaki (69.5+17.3 cm/sn) ve intermediate doz alanlardaki (71.22+20.47 cm/sn) değerlere göre anlamlı olarak azaldı (p<0.05). A velosite değeri hem intermediate doz alanlarda (70.67+1833 cm/sn) hem de total doz alanlarda (62.14+13.11 cm/sn), başlangıçtaki (43.7+12.8 cm/sn) değere göre arttı (p<0.05). E/A oranı ise başlangıca (1.54+0.58) göre, intermediate (1.05+0.32) ve total (0.88+0.28) doz alanlarda anlamlı olarak azaldı (p<0.05). Ayrıca to-tal doz alanlardaki E/A oranı, intermediate doz alanlara göre de anlamlı olarak daha az bulundu (p<0.05). EKG parametreleri ile ilgili tüm değerler arasında istatistiksel bîr fark bulunamadı (p>0.05). Sonuç olarak ucuz ve tekrarlanabilir bir metod olan EKG'nin oluşabilecek malign ventriküler aritmiler ve geç kardiyak toksisite için erken birprediktör olamayacağı düşünüldü.
Aort kapak alanı hesaplanmasında transözefajial ekokardiyografi ile transtorasik ekokardiyografinin karşılaştırılması
(1998) Özdemir, Ramazan; Tuncer, Cemal; Güven, Aytekin; Pekdemir, Hasan; Sezgin, Alpay Turan; Müderrisoğlu, Haldun
Kalp kapaklarının değerlendirilmesinde transözefajial ekokardiyografinin (TEE) transtorasik ekokardiyografiye (TTE) üstünlüğü bilinmektedir. Bu çalışmada aort kapak alanı hesaplanmasında duyarlılık açısından TEE ile TTE arasında fark olup olmadığı tespit edilmek istendi. Çalışmaya TTE ile kalsifik aort darlığı saptanan 3 kadın (yaş ört: 55±8 yıl), 12 erkek (yaş ort:58±7 yıl) olmak üzere toplam 15 hasta alındı. Hastaların aort kapak alanları TTE ile hesaplandı. Daha sonra premedikasyonun ardından TEE ile sol ventrikül çıkış traktüsü ölçüldü. Ardından süreklilik denklemi kullanılarak aort kapak alanı tekrardan değerlendirildi. TTE'de ortalama gradient 32 mmHg ölçüldü. TTE ile sol ventrikül çıkış traktüsü (LVOT) 1.8 cm ölçülürken, TEE'de 2.2 cm olarak değerlendirildi (p<0.05). Ölçülen LVOT değerlerine göre hesaplanan aort kapak alanı TTE'de l cm2 bulunurken TEE'de l A cm2 olarak bulundu (p<0.01). TEE ile LVOT ölçümü gerçek değere tfaha yakın olarak tespit edilebildiğinden dolayı aort kapak alanının noninvaziv değerlendirilmesinde daha doğru bir yaklaşım olacağı kanısındayız.
Assesment of Left Atrial Volume in Patients with Mitral Annular Calcification With Real-Time Three-Dimensional Echocardiography
(Elsevier Science Inc, 2013) Bayramoglu, Adil; Otlu, Yilmaz Omur; Hidayet, Siho; Tasolar, Hakan; Kurt, Fuat; Pekdemir, Hasan
[Abstract Not Available]
Assessment of atrial conduction time by tissue Doppler echocardiography and P-wave dispersion in patients with mitral annulus calcification
(Churchill Livingstone Inc Medical Publishers, 2010) Pekdemir, Hasan; Cansel, Mehmet; Yagmur, Julide; Acikgoz, Nusret; Ermis, Necip; Kurtoglu, Ertugrul; Tasolar, Hakan
The aim of our study was to investigate atrial conduction time in patients with mitral annulus calcification (MAC) using P-wave dispersion (PWD) and electromechanical coupling measured with the surface electrocardiogram and the tissue Doppler echocardiography. Fifty-nine patients with MAC and 43 control subjects underwent resting the surface electrocardiogram and tissue Doppler echocardiography. The difference between the maximum (Pmax) and minimum P-wave durations was calculated and defined as PWD. Interatrial and intraatrial electromechanical delays were measured with tissue Doppler echocardiography. Both Pmax and PWD were higher in patients with MAC compared with controls (111.4 +/- 15.8 vs 97.3 +/- 18.8 milliseconds; P < .0001 and 46.4 +/- 14.6 vs 31.4 +/- 13.1 milliseconds; P < .0001, respectively). Both interatial and intraatrial conduction time were also delayed in patients with MAC compared with controls (29.8 +/- 13.3 vs 17.6 +/- 12.5 milliseconds; P < .0001; 9.4 +/- 5.1 vs 6.8 +/- 4.0 milliseconds; P < .008, respectively). Left atrial (LA) diameter was significantly higher in patients with MAC compared with controls (35.4 +/- 5.0 mm vs 32.3 +/- 4.2 mm; P < .001). The LA diameter correlated significantly with both interatrial conduction times and PWD (r = 0.56; P < .0001 and r = 0.47; P < .0001, respectively). There is a delay in both intraatrial and interatrial electromechanical coupling intervals in patients with MAC. (C) 2010 Elsevier Inc. All rights reserved.
Assessment of left atrial volume and mechanical functions using real- time three-dimensional echocardiography in patients with mitral annular calcification
(The Anatolian Journal of Cardiology, 2016) Bayramoğlu, Adil; Taşolar, Hakan; Otlu, Yılmaz Ömür; Hidayet, Şıho; Kurt, Fuat; Doğan, Adil; Pekdemir, Hasan
Abstract: Objective: Mitral annular calcification (MAC) is degeneration of the fibrous annular ring of the mitral valve. Left atrial (LA) function and volume have been evaluated by many methods; however, none have used real-time three-dimensional echocardiography (RT3DE) in patients with MAC. Our study is the first to evaluate LA volume and mechanical function using RT3DE in patients with MAC.Methods: Our study was a prospective cross-sectional study. In total, 32 patients with echocardiographic evidence of MAC and 30 volunteers without MAC were enrolled in the study. Kolmogorov-Smirnov test, Student's t-test, Mann-Whitney U test, chi-square test, Pearson's correlation test, and multiple linear regression analyses were used in this study.Results: LA diameter was significantly higher in patients with MAC (38.5±3.8 vs. 31.1±2.9, p<0.001). Maximum LA volume (49.6±11.2 vs. 35.6±2.5, p<0.001), minimum LA volume (23.8±7.9 vs. 12.6±2.3, p<0.001), and LA volume index (LAVI) (26.9±6.1 vs. 20.5±2.4, p<0.001) were also higher in the MAC group. LAVI was correlated with age (p<0.001), blood urea nitrogen levels (p=0.089), total cholesterol levels (p=0.055), left ventricular systolic myocardial velocity (p=0.048), E/A ratio (p<0.001), and MAC (p<0.001). Multiple linear regression analyses revealed that age (?=0.390, p<0.001) and MAC (?=0.527, p<0.001) were independent predictors of LAVI.Conclusion: We found that LA mechanical function was impaired in patients with MAC. Furthermore, age and MAC were independent predictors of increased LAVI according to our RT3DE examination
Assessment of left atrial volume and mechanical functions using real-time three-dimensional echocardiography in patients with mitral annular calcification
(Turkish Soc Cardiology, 2016) Bayramoglu, Adil; Tasolar, Hakan; Otlu, Yilmaz Omur; Hidayet, Siho; Kurt, Fuat; Dogan, Adil; Pekdemir, Hasan
Objective: Mitral annular calcification (MAC) is degeneration of the fibrous annular ring of the mitral valve. Left atrial (LA) function and volume have been evaluated by many methods; however, none have used real-time three-dimensional echocardiography (RT3DE) in patients with MAC. Our study is the first to evaluate LA volume and mechanical function using RT3DE in patients with MAC. Methods: Our study was a prospective cross-sectional study. In total, 32 patients with echocardiographic evidence of MAC and 30 volunteers without MAC were enrolled in the study. Kolmogorov-Smirnov test, Student's t-test, Mann-Whitney U test, chi-square test, Pearson's correlation test, and multiple linear regression analyses were used in this study. Results: LA diameter was significantly higher in patients with MAC (38.5 +/- 3.8 vs. 31.1 +/- 2.9, p<0.001). Maximum LA volume (49.6 +/- 11.2 vs. 35.6 +/- 2.5, p<0.001), minimum LA volume (23.8 +/- 7.9 vs. 12.6 +/- 2.3, p<0.001), and LA volume index (LAVI) (26.9 +/- 6.1 vs. 20.5 +/- 2.4, p<0.001) were also higher in the MAC group. LAVI was correlated with age (p<0.001), blood urea nitrogen levels (p=0.089), total cholesterol levels (p=0.055), left ventricular systolic myocardial velocity (p=0.048), E/A ratio (p<0.001), and MAC (p<0.001). Multiple linear regression analyses revealed that age (beta=0.390, p<0.001) and MAC (beta=0.527, p<0.001) were independent predictors of LAVI. Conclusion: We found that LA mechanical function was impaired in patients with MAC. Furthermore, age and MAC were independent predictors of increased LAVI according to our RT3DE examination.
Assessment of left ventricular volume and functions by real-time three-dimensional echocardiography in patients with compensated and decompensated heart failure
(Turkish Soc Cardiology, 2012) Akturk, Erdal; Kurtoglu, Ertugrul; Ermis, Necip; Yagmur, Julide; Acikgoz, Nusret; Karakus, Yasin; Pekdemir, Hasan
Objectives: The aim of the study was to evaluate congestive heart failure (HF) patients with real-time three-dimensional echocardiography (3DE) to investigate why some of them present with acute decompensation despite having two-dimensional echocardiographic (2DE) parameters with compensated HF patients. Study design:The study population consisted of 36 patients with decompensated HF (24 males, 12 females; mean age 65.8 10.4 years) and 30 patients with compensated HF (21 males, 9 females; mean age 63.2 +/- 11.5 years).The levels of pro-brain natriuretic peptide (pro-BNP), serum electrolytes, renal function tests and complete blood counts were determined. All patients underwent 2DE and 3DE evaluations. Results: Heart rate and blood urea nitrogen levels were higher in patients with decompensated HF than those with compensated HF (95.8 +/- 21.4 vs, 81.2 +/- 14.9, p=0.002; 28.3 +/- 15.7 mg/di vs. 18 +/- 6.8 mg/di, p=0.001, respectively). Pro-BNP levels and NYHA class were significantly higher in patients with decompensated heart failure [4925 pg/ml (2199-8711) vs. 330 pg/ml (197-756), p<0.0001 and 2.3 +/- 0.6 vs. 1.2 +/- 0.4, p<0.0001, respectively]. Although 2DE parameters were similar between groups, left ventricular ejection fraction was lower in patients with decompensated HF while end-diastolic and end -systolic volumes by 3DE were significantly higher in the same group (26.3 +/- 3.8% vs, 30.3 +/- 4.0%; 205.6 +/- 55.5 ml vs. 145.0 +/- 33.7 ml; 178.4 +/- 55.6 ml vs. 115.7 +/- 32.5 ml, all p<0.0001, respectively). However, systolic volume was higher in patients with compensated HF (52.0 +/- 15.5 ml vs. 62 +/- 12 ml, p=0.005). Conclusion: We think that 3DE provides more reliable information about left ventricular volume and functions in the evaluation of patients with HF.
Atriyoventriküler nodal reentrant taşikardili hastaların klinik ve ekokardiyografik özelliklerinin değerlendirilmesi
(MN Kardiyoloji, 2010) Açıkgöz, Nusret; Ermiş, Necip; Yağmur, Julide; Karakuş, Yasin; Müezzinoğlu, Kübra; Cansel, Mehmet; Pekdemir, Hasan; Özdemir, Ramazan
Öz: Amaç: Atriyoventriküler nodal reentrant taşikardi (AVNRT) klinikte en sık görülen düzenli ritim bozukluğudur. Bu çalışmada AVNRT’li hastaların klinik ve ekokardiyografik yönden değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Çalışmaya elektrofizyolojik çalışması (EFÇ) yapılan ve AVNRT tanısı konulan 30 hasta ile EFÇ’si yapılan ve normal saptanan 30 kontrol birey alındı. Çalışmaya tüm katılanların klinik ve ekokardiyografik değerlendirilmesi yapıldı. Bulgular: Her iki grup arasında yaş, cinsiyet ve diğer demografik özellikler açısından fark saptanmadı (p>0.05). Ancak vücut kitle indeksi (VKİ) AVNRT’li hasta grubunda kontrol grubuna göre anlamlı olarak daha yüksek bulundu (28,7 ± 2,7’e karşın 24,6 ± 3,5 kg/m2; p<0,0001). Ekokardiyografik olarak değerlendirilen sol ventrikül duvar kalınlıkları, sol atriyum çapı, sol ventrikül çapları ve sol ventrikül ejeksiyon fraksiyonu her iki grupta benzerdi (p>0,05). Ancak Doppler mitral akım parametrelerinden geç diyastolik akım velositesi (A) (p=0,012), deselerasyon zamanı (p=0,002) ve izovolümetrik gevşeme (p=0,001) zamanı AVNRT’li hasta grubunda kontrol grubuna göre anlamlı olarak daha yüksek bulundu. Ayrıca E/A oranı AVNRT’li hasta grubunda kontrol grubuna göre anlamlı olarak daha düşük bulundu (p<0,0001). Sonuç: AVNRT’li hastalarda diyastolik fonksiyonlar kontrol grubuna göre bozulmuştur. Artmış VKİ AVNRT gelişiminde önemli bir faktör olabilir.
Bruselloziste Torakal Vertebra Tutulumu ve Paraspinal Apse : Olgu Sunumu
(Turgut Özal Tıp Merkezi Dergisi, 1998) Pekdemir, Hasan; Büyükberber, Süleyman; Kaygusuz, Akif; Baysal, Tamer; Ak, Gürsel; Gürer, İnanç; Nuray Büyükberber, Nuray
Brusellozis'te torakal vertebra tutulumu nadir görülen ciddi bir komplikasyondur. Bu olgu sunumunda torakal vertebra tutulumu olan ve paraspinal apse gelişmiş yaşlı bir bayan hasta sunulmuştur. Hastada brusella tanısı hem kemik iliği hem de T9 vertebra korpusundan yapılan biopsilerin histopatolojik değerlendirilmesi ve serolojik testlerle konulmuştur. Paraspinal apselerin direne edilmesinden sonra hastaya kombine antimikrobiyal tedavi başlanmıştır. Endemik bölgelerde, açıklanamayan süpüratif vertebra hastalıklarında ve paraspinal apselerde brusellozis mutlaka akla gelmelidir. [Turgut Özal Tıp Merkezi Dergisi 1998;5(l):68-70]
Çevresel asbest maruziyetine bağlı plevral kalsifikasyonları olan hastalarda kardiyak fonksiyonların noninvaziv değerlendirilmesi
(İnönü Üniversitesi, 1999) Pekdemir, Hasan
Özellikle doğu anadoluda olmak üzere ülkemizin bazı bölgelerinde çevresel olarak asbest maruziyetine bağlı mezotelyoma, diffüz plevral kalınlaşma ve kalsifıye plevral plaklar gibi akciğer ve plevra hastalıkları yaygın olarak görülmektedir. Son zamanlarda asbest liflerinin sadece akciğer ve plevrayı değil, direkt ve/veya kan ve lenf yoluyla yayılarak diğer organları da etkileyebileceği iddia edilmektedir. Çalışmamızda çevresel asbest maruziyetinin etkin olduğu bir yöre olan Hekimhan ilçesinde yaşayan ve asbest maruziyetine bağlı plevral plak ve kalsifikasyon olan hastalarda miyokardiyal elektiriksel aktivite standart ve sağ taraflı EKG, 24 saatlik holter EKG ve kalbin sağ ve sol ventrikül fonksiyonları ekokardiyografi ile değerlendirildi. Bu bulguların SFT ve kan gazı sonuçlarıyla ilişkileri incelendi. Kontrol grubunun kan gazı analizi ve SFT sonuçlan normaldi. Hasta grubunda; FEVı/FVC oranı normal, FVC ortalaması (67 ± 19) ise hafif restriktif tipte SFT bozukluğu ile uyumluydu. FVC oranını kontrol grubuyla karşılaştırdığımızda aradaki fark istatistiksel olarak anlamlıydı (p<0,004). Hastalarda FVC oranları normal (Beklenenin % 80’i veya daha fazlası), hafif (Beklenenin % 65-80’i), orta (Beklenenin % 64-51 ’i) ve ağır (beklenenin %50’sinden az) derecede bozukluk olarak sınıflandırıldığında; FVC değerleri 13 hastada (% 37) normal, 6 hastada (%17) hafif, 8 hastada (% 23) orta, 8 hastada (%23) ağır derecede restriktif bozukluk ile uyumluydu. Kan gazı analizinde de hafif derecede hipoksemi olduğu görüldü (PaC>2 = 70±10 mmHg). PaC02 ve pH normal olarak bulundu. Sol ventrikül ekokardiyografi parametrelerinde hastalar ve kontrol grubu arasında istatistiksel olarak anlamlı bir fark bulunmazken, bir çok sağ ventrikül ekokardiyografi parametreleri, hastalarda kontrollere göre anlamlı olarak bozuk bulundu (p<0.05). EKG parametreleri ile SFT ve arteryel oksijen basıncı arasında korelasyon yoktu. EKG parametrelerinden hastalarda ve kontrol gurubunda RR mesafesi farklı değildi. Standart, sağ taraf (RV3.6) ve sağ+standart derivasyonlardaki QT intervali, QTc intervali ve bu intervallerinin dispersiyonları (d) (QT-d, QTc-d) hastalarda
Çevresel asbest maruziyetinin ventriküler repolarizasyon parametreleri üzerine etkisi
(MN Kardiyoloji, 1999) Yıldırım, Zeki; Özdemir, Ramazan; Pekdemir, Hasan; Tuncer, Cemal; Hasanoğlu, H. Canan; Gökırmak, Münire; Köksal, Nurhan; Komsuoğlu, Baki
Öz: AMAÇ: Özellikle Doğu Anadolu'da olmak üzere, ülkemizin bazı bölgelerinde çevresel olarak asbest maruziyetine bağlı akciğer ve plevra hastalıkları yaygın olarak görülmektedir. Son zamanlarda asbest liflerinin sadece akciğer ve plevrayı değil, direkt ve/veya kan ve lenf yoluyla yayılarak diğer organları da etkileyebileceği iddia edilmektedir. MATERYAL VE METOD: Çalışmamızda çevresel asbest maruziyetinin etkin olduğu bir yöre olan Hekimhan ilçesinde yaşayan ve asbest maruziyetine bağlı plevral plak ve kalsifikasyon olan hastalarda miyokardiyal elektriksel aktivite, Holter, standart ve sağ taraflı EKG ile değerlendirildi. Bu bulguların SFT ve kan gazı sonuçlarıyla ilişkileri incelendi. BULGULAR: FEV1/FVC oranı kontrol grubuyla benzerdi. FVC, kontrol grubunun tümünde normal olmasına karşın, 16 hastada (%46) hafif, 13 hastada (%37) orta ve 6 hastada (%17) ağır derecede restriktif bozukluk saptandı. Kan gazı analizlerinde ise hafif derecede hipoksemi mevcuttu (Pa02 = 67,9±14,7). Standart, sağ taraf (RV3-6) ve sağ taraf + standart derivasyonlardaki QT intervali, QTc intervali ve bu intervallerin dispersiyonları (d) (QT-d QTc-d) hastalarda kontrol grubuna göre daha uzun bulundu (p<0.001). Holler EKG parametrelerinden, 24 saatteki toplam kalp vurularının ortalama QT ve QTc uzunluğu, 2 saatlik kayıt süresi içinde, QTc intervallerinin 450 ms 'den daha uzun olduğu kalp vuru sayısı ve maksimum QT intervali, hasta grubunda kontrol grubuna göre daha uzundu. SONUÇ: Abstet maruziyetine bağlı olarak gelişen restriktif bozukluk nedeniyle oluşan hipoksemi ve muhtemelen miyokardiyal fibrozis gibi mekanizmalarla, abstet liflerinin miyokardiyal elektriksel homojeniteyi olumsuz yönde etkileyebileceği düşünülmüştür.
Clinical outcome of B2/C type isolated proximal LAD disease treated with drug-eluting stents
(Aves Yayincilik, 2011) Cicek, Davran; Pekdemir, Hasan; Kalay, Nihat; Muderrisoglu, Haldun
[Abstract Not Available]
Comparision of pain levels of transradial versus transfemoral coronary catheterization: a prospective and randomized study
(Aves, 2014) Akturk, Erdal; Kurtoglu, Ertugrul; Ermis, Necip; Acikgoz, Nusret; Yagmur, Julide; Altuntas, Mehmet Sait; Pekdemir, Hasan
Objective: The aim of the present study was to assess access site pain levels of patients undergoing coronary catheterization via transradial route. Methods: We performed a prospective and randomized study in which 408 patients underwent coronary angiography (CAG) and/or percutaneous coronary intervention (PCI) via transradial approach (TRA) and 428 patients underwent CAG and/or PCI via transfemoral approach (TFA). Pain levels of patients were assessed with Visual Analog Scale (VAS) after catheterization and at 30 days. Student-t, Mann-Whitney U and chi-square tests were used for statistical analysis. Results: Patients in the TRA group showed higher VAS scores than those in TFA group after catheterization [CAG alone, 3 (2-5) vs. 1 (1-3), p<0.0001; PCI, 4 (2-6) vs. 2 (1-3), p<0.0001, respectively]. One month later, patients in TRA group also showed higher VAS scores than those in TFA group [CAG alone, 1 (0-1) vs. 0 (0-1), p<0.0001; PCI, 1 (0-2) vs. 0 (0-1), p<0.0001, respectively]. By the ROC analysis in TRA group, a level of BMI < 24.3 kg/m(2) predicted unacceptable pain with a 87.3% sensitivity and 91.6% specificity [area under curve (AUC): 0.875, 95% CI: 0.839-0.906, p<0.0001], while a wrist circumference <16.7 cm predicted unacceptable pain with 84.6% sensitivity and 89.8% specificity (AUC: 0.900, 95% CI: 0.867-0.928, p<0.0001). Conclusion: The current study suggests that a radial approach for CAG and PCI in patients with a low BMI and small wrist circumference may cause more access site pain as compared with a femoral approach.
Early single clinical experience with the new Figulla ASD Occluder for transcatheter closure of atrial septal defect in adults
(Elsevier Masson, 2011) Cansel, Mehmet; Pekdemir, Hasan; Yagmur, Julide; Tasolar, Hakan; Ermis, Necip; Kurtoglu, Ertugrul; Acikgoz, Nusret
Background. Recently, the Occlutech Figulla ASD Occluder (FSO) has been introduced for transcatheter closure of atrial septal defects. This device can be used for transcatheter closure of small as well as large atrial septal defects. Aims. To evaluate the feasibility and short-term results of transcatheter closure of secundum type atrial septal defects using the FSO device in adult patients. Methods. Seventy-four consecutive adult patients were referred for transcatheter closure of secundum large atrial septal defects (stretched diameter > 20 mm and/or invasive pulmonary/systemic flow [Qp/Qs] ratio > 1.5) using the FSO device. Results. The FSO device was successfully implanted in 68 patients (mean +/- SD [range] age: 31.8 +/- 12.3 [17-64] years; weight: 71.5 +/- 18.4 [49-98] kg). All patients had right atrial and ventricular volume overload with a mean Qp/Qs ratio of 2.5 +/- 0.6 (range 1.5-3.8). Mean atrial septal defect diameter was 22.3 +/- 4.8 (range 12-33) mm and the size of the implanted FSO was 24.1 +/- 4.9 (range 12-36) mm. Two patients had trivial (jet width <1 mm in diameter) residual shunts and one patient had a small (1-2 mm) residual shunt. There were no moderate or severe residual shunts. No device embolization or other serious complication occurred during either the procedure or the follow-up. Conclusion. The present study found that transcatheter closure of isolated secundum atrial septal defects using the novel design of the FSO device was safe, effective, and had an excellent outcome during the 6 month follow-up period. (C) 2011 Elsevier Masson SAS. All rights reserved.
Effects of Coronary Collateral Circulation on Tp-e interval, Tp-e/QT and Tp-e/QTc Ratios in Coronary Artery Disease Patients
(Elsevier Science Inc, 2013) Tasolar, Hakan; Otlu, Omur; Bayramoglu, Adil; Balli, Mehmet; Cetin, Mustafa; Altun, Burak; Pekdemir, Hasan
[Abstract Not Available]
The effects of Ramadan fasting on heart rate variability in healthy individuals: A prospective study
(Aves, 2014) Cansel, Mehmet; Tasolar, Hakan; Yagmur, Julide; Ermis, Necip; Acikgoz, Nusret; Eyupkoca, Ferhat; Pekdemir, Hasan
Objective: Ramadan fasting is one of the five fundamental rituals of Islam. Heart rate variability (HRV) is an independent predictor of increased mortality of patients with myocardial infarction and congestive heart failure. Although many patients in this region fast once a year, the effects of fasting on the HRV, which has a prognostic significance for patients with myocardial infarction and congestive heart failure, are not known. Therefore, the study on the effects of one month fast of HRV in healthy volunteers seems to be reasonable to address. Methods: Our study is a prospective cohort study that includes a total of 40 healthy volunteers with sinus rhythm between 19 and 40 years of age (16 female and 24 male). HRV was determined twice by ambulatory 24-hour Holter recordings at fasting in the middle of Ramadan and first week after Ramadan month. Mean values of continuous variables were compared by using the Student t-test or Mann-Whitney U test. Paired t-test or Wilcoxon test were used for comparison of variables between groups. Results: When two groups compared, statistically significant differences were found in terms of RR (p=0.049), SDNNI (p=0.010), rMSSD (p=0.009), pNN50 (p=0.015), T power (p=0.009), LF (p=0.008), Lfnu (p=0.002), HF (p=0.022) and Hfnu (p=0.013) values. Conclusion: In our study, HRV parameters were found to be increased in Ramadan month, so we think that Ramadan fasting enhances the activity of the parasympathetic system.
Effects of the transcatheter closure of atrial septal defect on electrocardiographic and echocardiographic parameters six months after the closure
(2017) Ataş, Halil; Cansel, Mehmet; Kurtoğlu, Ertuğrul; Pekdemir, Hasan; Özdemir, Ramazan
Abstract: Although percutaneous transcatheter atrial septal defect (ASD) closure (TCC) has been performed on adults for a long time there is limited data about the effects of the procedure in the literature and the majority of studies have been performed on children. The study purposed to evaluate the impact of TCC on cardiac remodeling, electrical changes and exercise capacity in adults. Transthoracic echocardiography and electrocardiography were performed one day before and six months after TCC in 27 consecutive patients who underwent successful TCC. Twenty-seven age and sex matched healthy subjects were used as control group. Right ventricular (RV) diameter (had decreased from 44±6.3 to 34±3.9; p<0.001), right atrial (RA) diameter (had decreased from 38±5.6 to 34±4.7; p<0.001), systolic pulmonary artery pressure (sPAP) (had decreased from 38±5.1 to 32±4.3; p<0.001) and P dispersion (Pd) times (had decreased from 59±9.9 to 45.2±16.3; p<0.001) significantly decreased in patients with ASD after TCC. However, these parameters obtained after TCC were still higher compared with parameters of healthy controls. There were not significant differences regarding QT dispersion (QTd) times between ASD patients before and after TCC and healthy controls. New York Heart Association (NYHA) functional class of patients with ASD was significantly improved after TCC. The findings of the present study indicate that although TCC leads to significant improvements regarding right heart dimensions and sPAP and Pd values of ASD patients; residual deterioration still persists up to 6 months after the procedure
Efficacy of Sirolimus-Eluting Stents Compared With Paclitaxel-Eluting Stents in an Unselected Population With Coronary Artery Disease: 24-Month Outcomes of Patients in a Prospective Non-randomized Registry in Southern Turkey
(Ivyspring Int Publ, 2010) Cicek, Davran; Pekdemir, Hasan; Kalay, Nihat; Binici, Sueleyman; Altay, Hakan; Muderrisoglu, Haldun
Background: The efficacy of drug-eluting stents has been shown in randomized trials, but some controversy exists regarding which stent sirolimus-eluting or paclitaxel-eluting is more effective in unselected Turkish patients. Therefore, we investigated the clinical outcomes of patients who were treated with one type of these drug-eluting stents in the real world. Methods: We created a registry and prospectively analyzed data on a consecutive series of all patients who presented to our institution with symptomatic coronary artery disease between February 2005 and March 2007 and who were treated with the sirolimus- or the paclitaxel-eluting stent. The follow-up period after stent implantation was approximately 24 months. The primary end point was a major cardiac event, and the secondary end point was stent thrombosis. Informed consent was obtained from all subjects, and the study protocol was approved by the local ethical committee. Results: In total, 204 patients were treated with either the sirolimus-eluting stent (n = 103) or the paclitaxel-eluting stent (n = 101). The lesions in the 2 arms of the study were treated similarly by conventional technique. At 24-month follow-up, patients who received the paclitaxel-eluting stent showed significantly higher rates of non-Q-wave myocardial infarction (1.9% vs 5.9%; P: .002), target vessel revascularization (1.9% vs 4.9%; P: .002), coronary artery bypass graft surgery (1.9% vs 6.9%; P: .001), and late stent thrombosis (1.9% vs 3.9%, P: .002). Conclusions: Patients who received the sirolimus- eluting stent showed better clinical outcomes compared with those who had the paclitaxel-eluting-stent.

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