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Öğe Accessory mitral valve tissue manifesting cerebrovascular thromboembolic event in a 34-year-old woman(Elsevier Sci Ireland Ltd, 2003) Yetkin, E; Turhan, H; Atak, R; Senen, K; Cehreli, SAccessory mitral valve tissue is an extremely rare congenital cardiac anomaly. Most of the cases reported in the medical literature were associated with left ventricular outflow tract obstruction. The majority of cases of accessory mitral valve tissue, causing left ventricular outflow tract obstruction, occur in association with other congenital cardiac anomalies. In this reported case, a patient with accessory mitral valve tissue complicated with thromboembolic cerebrovascular event is presented. The patient also had an associated idiopathic hypertrophic subaortic stenosis. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.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 Comparison of low-dose dobutamine stress echocardiography and echocardiography during glucose-insulin-potassium infusion for detection of myocardial viability after anterior myocardial infarction(Lippincott Williams & Wilkins, 2002) Yetkin, E; Senen, K; Ileri, M; Atak, R; Tandogan, I; Yetkin, Ö; Kosar, FBackground Low-dose dobutamine stress echocardiography (LDDSE) is one of the methods most used to assess myocardial viability. Glucose-insulin-potassium (GIK) infusion has been shown to increase contraction of the ischemic zone. The aim of this study was to compare LDDSE and echocardiography during GIK infusion for detection of myocardial viability. Methods Thirty-two patients who had first anterior myocardial infarction (MI) without previous MI were included in the study. Echocardiographic evaluation was carried out on the 7th +/- 2 days after MI. During continuous electrocardiographic, blood pressure and echocardiographic monitoring, an intravenous infusion of dobutamine (3 mug/kg body weight/min) was started with an infusion pump, continued for 5 min and then increased to 5 mug/kg/min and 10 mug/kg/min for another 5 min. The GIK protocol consisted of a fixed dose of insulin (100 muU/kg/h intravenously) and a variable glucose/potassium infusion rate. GIK echocardiography was done at baseline and after 60 min of GIK. The detected viable myocardium was defined as one or two scores decreasing in at least two adjacent abnormal segments during LDDSE and GIK echocardiography. Results Under resting conditions 225 segments (44%) were normokinetic, 21 segments (4%) dyskinetic, 117 segments (23%) akinetic and 149 segments (29%) hypokinetic. Viability was detected in 20% (57 segments) of the asynergic segments at baseline with GIK echocardiography and in 22% (62 segments) of those segments with LDDSE (P < 0.05). Left ventricular wall motion score index at baseline was 1.87 and it decreased significantly indicating improvement in left ventricular systolic function during both LDDSE and GIK echocardiography (P < 0.001, versus 1.75 and 1.76 respectively). The agreement between LDDSE and GIK echocardiography for detection of myocardial viability was 96%. Conclusion We have shown that GIK echocardiography is similar to LDDSE for detection of myocardial viability. With the support of further clinical studies GIK echocardiography could be used to detect myocardial viability after acute MI.Öğe Comparison of P-wave duration and dispersion in patients aged ?65 years with those aged ?45 years(Churchill Livingstone Inc Medical Publishers, 2003) Turhan, H; Yetkin, E; Sahin, O; Yasar, AS; Senen, K; Atak, R; Sasmaz, HP-wave dispersion (PWD) is a Dew electrocardiographic marker that reflects discontinuous and inhomogeneous propagation of sinus impulses, which has been studied in some cardiac conditions as a useful predictor of paroxysmal atrial fibrillation (AF). The aim of the peresent study was to compare P-wave duration and PWD in patients less than or equal to45 versus greater than or equal to65 years of age. The study consisted of 2 groups. Group I included 118 patients aged greater than or equal to65 years (86 men, 32 women, mean age = 69 +/- 4 years). Group II included 72 patients aged less than or equal to45 years (53 men, 19 women, mean age = 41 +/- 4 years). All patients were selected from those who were undertaken coronary angiography in our hospital with a suspicion of coronary artery disease and detected as having angiographically normal coronary arteries. All patients were undertaken transthoracic echocardiography to evaluate the presence of any structural and functional cardiac abnormality. Maximum and minimum P-wave durations and PWD were calculated from 12-lead surface electrocardiogram. Maximum P-wave duration and PWD were significantly higher in group I patients than in group II patients (P <.00 1). However, there was no statistically significant difference between group I patients and group H patients regarding minimum P-wave duration (p =0.9). Left atrial diameter, left ventricular wall thicknesses, mitral A velocity, deceleration time and isovolumic relaxation time were significantly higher in group I patients than in group 11 patients. However, mitral E velocity were significantly lower in group I patients than in group II patients. A significant positive correlation was detected between PWD and age, left atrial diameter, mitral A velocity, deceleration time and isovolumic relaxation time. in addition, we found a significant negative correlation between PWD and mitral E velocity. PWD, indicating increased risk for paroxysmal AF, was found to be significantly higher in patients greater than or equal to65 years of age than in those less than or equal to45 years of age. Further prospective studies that include larger series and long term follow-up are needed to clarify the clinical utility of PWD as a predictor of increased risk for paroxysmal AF in old patients.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 Diagnostic value of aVL derivation for right ventricular involvement in patients with acute inferior myocardial infarction(Wiley, 2003) Turhan, H; Yilmaz, MB; Yetkin, E; Atak, R; Biyikoglu, SF; Senen, K; Ileri, MBackground: Right ventricular (RV) involvement is associated with increased morbidity and mortality in patients with acute inferior myocardial infarction (MI). Although electrocardiography is probably the most useful, simple, and objective tool for the diagnosis of acute MI, there are no well-defined criteria in the standard 12-lead electrocardiogram to properly identify RV involvement in patients with acute inferior MI. Our objective was to evaluate the value of ST-segment depression in lead aVL in diagnosing RV involvement in patients with acute inferior MI. Materials and Methods: Sixty-seven patients, hospitalized with acute inferior myocardial infarction, were included in this study. The diagnosis of acute inferior myocardial infarction was based on the clinical history, characteristic enzyme pattern of CK-MB values, and the appearance of ST-segment elevation greater than or equal to 1 mm in at least two of the leads (leads II, III, aVF). RV infarction was defined by ST segment elevation greater than or equal to 1 mm in lead V4R. ST-segment depression in lead aVL that is more than 1 mm was accepted as a diagnostic criterion for RV involvement in patients with acute inferior MI. Results: Thirty-one patients had >1 mm ST-segment depression and 28 of them had right ventricular infarction according to lead V4R. Thirthy-six patients showed less than or equal to1 mm ST-segment depression indicating no right ventricular involvement but four of them also had right ventricular infarction according to V4R. Conclusion: More than 1 mm ST-segment depression in lead aVL was found to have high sensitivity (87%), specificity (91%), high positive and negative predictive value (90%, 88%, respectively), and high diagnostic accuracy (89%) in diagnosing RV involvement in patients with acute inferior MI. Therefore, by using a simple 12-lead electrocardiographic sign, ST-segment depression >1 mm in lead aVL, obtained on admission, it is possible to identify RV involvement in patients with acute inferior MI.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 Documentation of slow coronary flow by the TIMI frame count in habitual smokers with normal coronary arteries(W B Saunders Co Ltd, 2002) Yetkin, E; Turhan, H; Atak, R; Ileri, M; Senen, K; Yetkin, O; Tandogan, I[Abstract Not Available]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 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 Effects of slow coronary artery flow on QT interval duration and dispersion(Blackwell Futura Publishing, Inc, 2003) Atak, R; Turhan, H; Sezgin, AT; Yetkin, O; Senen, K; Ileri, M; Sahin, OBackground: The coronary slow-flow phenomenon is an angiographic phenomenon characterized by delayed opacification of vessels in the absence of any evidence of obstructive epicardial coronary disease. Several studies have demonstrated myocardial ischemia in patients with slow coronary artery flow. In the present study, we aimed at evaluating the effects of slow coronary artery flow on QT interval duration and QT dispersion as a possible indicator of increased risk for ventricular arrhythmias and sudden cardiac death. Methods: The study population included 49 patients with angiographically proven normal coronary arteries and slow coronary flow in all three coronary vessels (group 1, 33 males, 16 females, mean age = 48 9 years), and 71 patients with angiographically proven normal coronary arteries without associated slow coronary flow (group 11, 47 males, 24 females, mean age = 50 8 years). Coronary flow rates of all subjects were documented by thrombolysis in myocardial infarction frame count (TIMI frame count). QT interval duration and QT dispersion of all subjects were measured on the standard 12-lead electrocardiogram. Results: There was no statistically significant difference between the two groups in respect to age, gender, presence of hypertension, and diabetes mellitus. There was a significant difference between the two groups in respect to the presence of cigarette smoking, typical angina, and positive exercise test results. TIMI frame counts of group I patients were significantly higher than those of group II patients for all three coronary arteries (P < 0.001). Maximum corrected QT interval (QTcmax) of group I did not differ from the QTcmax of group II (P > 0.05). However, minimum corrected QT interval (QTcmin) of group I was significantly lower than that for group II (P = 0.008). Consequently, corrected QT dispersion (QTcd) in group I was found to be significantly higher than in group II (P < 0.001). Conclusion: QTcd, indicating increased risk for ventricular arrhythmias and cardiovascular mortality, was found to be significantly higher in patients with slow coronary artery flow. However, further long-term prospective studies should be carried out to establish the significance of QTcd as a risk factor for ventricular arrhythmias and subsequent sudden cardiac death in patients with slow coronary artery flow.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 Identification of viable myocardium after anterior myocardial infarction: Comparison of combined low dose dobutamine-nitrate echocardiography and low dose dobutamine stress echocardiography(Lippincott Williams & Wilkins, 2002) Senen, K; Yetkin, E; Ileri, M; Atak, R; Turhan, H; Tandogan, I; Cehreli, S[Abstract Not Available]Öğe Identification of viable myocardium in patients with chronic coronary artery disease and myocardial dysfunction: Comparison of low-dose dobutamine stress echocardiography and echocardiography during glucose-insulin-potassium infusion(Sage Publications Inc, 2002) Yetkin, E; Senen, K; Ileri, M; Atak, R; Battaoglu, B; Yetkin, O; Tandogan, ILow-dose dobutamine stress echocardiography (LDDSE) is one of the methods most used to assess myocardial viability. Glucose-insulin-potassium (GIK) has been shown to increase contraction of the ischernic zone. The aim of this study was to compare LDDSE and echocardiography during GIK infusion for detection of myocardial viability in patients with chronic coronary artery disease (CAD) and myocardial dysfunction. Twenty-one patients who had chronic CAD and myocardial dysfunction were included in the study. Glucose-insulin-potassium protocol consisted of a fixed dose of insulin (100 muU/kg/hour IV) and a variable glucose/potassium infusion rate. GIK echocardiography was made at baseline and after 60 minutes of GIK infusion. During continuous electrocardiographic, blood pressure, and echocardiographic monitoring, an intravenous infusion of dobutamine (3 mug/kg body weight/min) was started with an infusion pump and continued for 5 minutes and then increased to 5 mug/kg/min and 10 mug/kg/min for another 5 minutes. The detected viable myocardium was defined as I or 2 scores decreasing in at least 2 adjacent abnormal segments during LDDSE and GIK echocardiography. Viability was detected in 19% (52 segments) of the asynergic segments at baseline with GIK echocardiography and 16% (44 segments) of those segments with LDDSE (p > 0.05). Left ventricular wall motion score index at baseline was 2.24 +/- 0.35 and it decreased significantly during both LDDSE (p=0.004 vs 2.11 +/- 0.36) and GIK echocardiography (p=0.001 vs 2.09 +/- 0.32). The agreement between LDDSE and GIK echocardiography for detection of myocardial viability was 95%. This study shows that GIK echocardiography is similar to LDDSE for detection of myocardial viability. With the support of further clinical studies GIK echocardiography can be used to detect myocardial viability in patients with chronic CAD.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 P-wave duration and P-wave dispersion in patients with aortic stenosis(Blackwell Futura Publishing, Inc, 2003) Turhan, H; Yetkin, E; Atak, R; Altinok, T; Senen, K; Ileri, M; Sasmaz, HBackground: P-wave dispersion (PWD), defined as the difference between the maximum and minimum P-wave duration, has been proposed as being useful for the prediction of paroxysmal atrial fibrillation (AF). AF is the most common arrhythmia and an important prognostic indicator for clinical deterioration in patients with aortic stenosis (AS). The,aim of the present study was to evaluate PWD in patients with AS. Methods: The study population consisted of two groups: Group I consisted of 98 patients with AS (76 men, 22 women; aged 63 8 years) and group II consisted of 98 healthy subjects (same age and sex) without any cardiovascular disease. A 12-lead electrocardiogram was recorded for each subject. The P-wave duration was calculated in all leads of the surface electrocardiogram. The difference between the maximum and minimum P-wave duration was calculated and was defined as the PWD. All patients and control subjects were also evaluated by echocardiography to measure the left atrial diameter, left ventricular ejection fraction, left ventricular wall thicknesses, and the maximum and mean aortic gradients. Patients were also evaluated for the presence of paroxysmal AF. Results: Maximum P-wave duration and PWD of group I were found to be significantly higher than those of group II. In addition, patients with paroxysmal AF had significantly higher PWD than those without paroxysmal AF. There was no significant difference between the two groups regarding minimum P-wave duration. In addition, there was no significant correlation between echocardiographic variables and PWD. Conclusion: PWD, indicating increased risk for paroxysmal AF, was found to be significantly higher in patients with AS than in those without it. Further assessment of the clinical utility of PWD for the prediction of paroxysmal AF in patients with severe AS will require longer prospective studies.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 systemic and regional coagulation activity in patients with mitral stenosis and sinus rhythm(Westminster Publ Inc, 2003) Atak, R; Yetkin, E; Yetkin, O; Ayaz, S; Ileri, M; Senen, K; Turhan, HA hypercoagulable state has been reported in patients with mitral stenosis (MS) and sinus rhythm (SR). However it has been suggested that the coagulation activity may be increased only within the left atrium in MS, with normal peripheral blood levels. The aim of the present study was to assess regional left atrial and systemic coagulation activities by measuring PF1+2 in patients with severe mitral stenosis and sinus rhythm, normal blood clotting times, and no left atrial thrombus. The study was conducted in 25 consecutive patients with moderate-to-severe MS and sinus rhythm who underwent percutaneous balloon mitral valvuloplasty. Transesophageal echocardiography was performed before the valvuloplasty procedure in all patients to exclude the presence of left atrial thrombus and left atrial spontaneous echo contrast (LASEC). There were no statistically significant differences between LASEC-positive and LASEC-negative patients with respect to age, gender, fibrinogen levels, prothrombin time, mitral valve area, mean mitral gradient, pulmonary artery pressure (in all p > 0.05). Regional (left atrial) PF1+2 levels of both LASEC-positive and LASEC-negative patients were significantly elevated when compared to control subjects (p < 0.01). Statistically significant elevated systemic level of PF1+2 was observed only in LASEC-positive patients when compared to control subjects (p < 0.01, p > 0.05, respectively). In conclusion patients with severe mitral stenosis and SR have increased regional coagulation activity in both LASEC-negative and LASEC-positive groups. Although this increased regional coagulation activity has been reflected in peripheral blood of LASEC-positive patients, it has not been reflected in peripheral blood of LASEC-negative patients.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.
