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Öğe Aortic valve calcification: association with bone mineral density and cardiovascular risk factors(Lippincott Williams & Wilkins, 2005) Aksoy, Y; Yagmur, C; Tekin, GO; Yagmur, J; Topal, E; Kekilli, E; Turhan, HBackground: Cardiovascular risk factors are reported to increase the incidence of aortic valve calcification. Among older women, low bone mineral density appears to be associated with increased prevalence of aortic calcification. We aimed to assess and compare cardiovascular risk factors and bone mineral density of patients with and without aortic valve calcification. Materials: and methods Cardiovascular risk factors and bone mineral density measurements have been assessed in 49 patients with aortic valve calcification and in 65 patients without aortic valve calcification. All patients were subsequently referred to the nuclear medicine department to measure bone mineral density after echocardiographic evaluation. Results: No statistically significant differences were observed between the two groups with respect to sex, body mass index, history of coronary artery disease, diabetes mellitus, hypercholesterolemia, and smoking status. Although height and weight of the patients with aortic valve calcification were significantly lower than those of patients without aortic valve calcification, they were not independent risk factors. Age and hypertension were found to be independent positive risk factors for aortic valve calcification, whereas T score was found to be negatively associated with aortic valve calcification. Conclusion: We have shown that aortic valve calcification is positively associated with age and hypertension, whereas bone mineral density is negatively associated with aortic valve calcification. The mechanism underlying the association between decreased bone mineral density and aortic valve calcification remains to be clarified in further studies.Öğe A case of vasospastic angina resulting from coronary emboli in a patient with prosthetic valves(Int Heart Journal Assoc, 2004) Kosar, F; Gullu, H; Sahin, I; Acikgoz, N; Topal, E; Erdil, NIn addition to coronary atherosclerotic disease, coronary thromboembolisin can also lead to acute coronary syndromes. However, coronary thromboembolism due to prosthetic heart valves is very rare and not very well-known. It has Only a few cases have been reported. In this paper, we present a rare case with vasospastic angina pectoris secondary to coronary thromboembolism in a patient with prosthetic heart valves.Öğe Decreased serum lipoprotein levels as a guide for clinical severity in patients with idiopathic dilated cardiomyopathy(Tohoku Univ Medical Press, 2005) Sezgin, N; Sezgin, AT; Gullu, H; Karabulut, A; Barutcu, I; Topal, E; Yalcintas, DHyperlipidemia is a cardiovascular risk factor. In patients with idiopathic dilated cardiomyopathy (IDC), prognostic roles of endogenous lipoproteins are not fully clarified. It has been known that there is a direct relationship between the levels of cytokines (tumor necrosis factor-alpha [TNF-alpha] and interleukin-6 [IL-6]) and deteriorating functional classes of heart failure and mortality. The present study compared the levels of circulating TNF-alpha, IL-6, lipoproteins, and apolipoproteins in patients with stable IDC (n = 28) with those of patients with unstable IDC (n = 26) and controls (n = 24). Mean serum total. cholesterol (TC) was significantly lower in stable IDC patients than controls (p < 0.05). In unstable IDC patients, mean serum TC was also lower than controls but not statistically significant. The IDC patients had significantly higher concentrations of IL-6 and TNF-alpha than the controls (p < 0.01). Serum IL-6 and Apo AI levels were significantly different between stable and unstable IDC patients (p = 0.021 and p = 0.012, respectively). Increased levels of IL-6 were associated with decreased levels of TC (r = -0.266, p = 0.019), LDL-C (r = -0.376, p = 0.001) and apolipoprotein AI (apo AI) (r = -0.495, p < 0.001) in all IDC patients. TNF-a was also inversely related to apo AI (r = -0.455, p < 0.001) and LDL-C (r = -0.364, p = 0.001) in all patients. Thus, elevated serum levels of cytokines in patients with IDC are associated with decreased lipoprotein concentrations, which may indicate impaired prognosis. (c) 2005 Tohoku University Medical Press.Öğe Determination of risk factors in obese and non-obese patients with coronary artery disease(Acta Cardiologica, 2005) Yologlu, S; Sezgin, AT; Sezgin, N; Ozdemir, R; Yesilada, E; Topal, EObjective - Obesity is a complex multifactorial chronic disorder recently classified by the American Heart Association (AHA) as a modifiable risk factor for coronary artery disease (CAD). This study was designed to assess conventional and novel risk factors in obese and non-obese patients with CAD. Methods and results - This study evaluates the association between conventional and novel coronary risk factors and CAD in obese and non-obese patients by using multivariate stepwise logistic regression analysis. The obese CAD group was identified by the following predictors of CAD: age, sex, hypertension, diabetes mellitus, smoking, family history of CAD, low level of HDL cholesterol, high LDL cholesterol, high C-reactive protein, high homocysteine. In a non-obese CAD group, the identified predictors of CAD were age, sex, hypertension, smoking, family history of CAD, levels of high C-reactive protein, and high homocysteine. Hypertension was found to be the strongest predictor for both obese (OR: 39.91, 95% confidence intervals (Cl): 5.51-280.3, p < 0.001) and non-obese (OR: 14.39, 95% CI: 4.4-25.8, p < 0.001) patients with CAD. Conclusions - From our data, we conclude that hypertension appears to be the strongest independent predictor of CAD regardless of body mass index (BMI).Öğe Effect of ectasia size or the ectasia ratio on the thrombosis in myocardial infarction frame count in patients with isolated coronary artery ectasia(Springer, 2005) Kosar, F; Acikgoz, N; Sahin, I; Topal, E; Aksoy, Y; Cehreli, SCoronary blood flow was quantified using the thrombosis in myocardial infarction (TIMI) frame-count method. This measurement has been significantly correlated with flow velocity measured invasively by use of a Doppler flow wire. Coronary artery ectasia or aneurysm (CEA) is thought to be present in patients with a slow blood flow. In this study, we aimed to assess the relationship between the ectasia size or ectasia ratio and TIMI frame count in patients with CEA. The study population included 58 patients with isolated CEA of the right coronary artery. In patients with CEA, an ectasia ratio was calculated as diameter of the ectatic segment/diameter of the adjacent normal segment. According to the ectasia ratio, ectatic vessels were divided into two groups: ectasias with a 1.5- to 2.0-fold increase (group A) and more than 2.0-fold increase (group B) in normal vessel diameter. Patients with a significant stenotic lesion (> 50%) in the ectatic vessel were excluded. The control group was formed from a matched population of 35 patients with angiographically proven normal coronary arteries. Characteristics of the ectasia and control groups are similar. The TIMI frame counts for the right coronary artery (RCA) were significantly higher in the ectasia group as compared with the control group (43 +/- 12 vs 23 +/- 8, P < 0.001). The ectasia group had 38 patients in group A and 20 patients in group B. The TIMI frame counts were significantly higher in group B than in group A (43 +/- 10 vs 51 +/- 15, P < 0.05). The TIMI frame count of the RCA showed a significant correlation with the ectasia ratio and the maximum diameter of the ectatic segment (r = 0.578, P < 0.001 and r = 0.435, P < 0.001, respectively). Our data suggest that TIMI frame count measurement depends on the ectasia size or ectasia ratio, and an increased ectasia ratio is markedly associated with decreased TIMI frame counts in patients with CEA.Öğe Effects of mobile telephones on the function of implantable cardioverter defibrillators(Blackwell Publishing, 2005) Tandogan, I; Ozin, B; Bozbas, H; Turhan, S; Ozdemir, R; Yetkin, E; Topal, EObjective: We investigated whether mobile telephones affect the function of implantable cardioverter defibrillators (ICDs). Background: It is well known that electromagnetic fields can affect medical devices. Methods: The study included 43 patients with ventricular tachycardia and/or fibrillation treated with transvenous pectoral ICDs. Testing was done under continuous electrocardiograph monitoring under supervision of an ICD programmer. Initially, each patient was tested during spontaneous rhythm. Then the ICD was programmed to a pace rhythm higher than the patient's heart rate, and the tests were repeated at paced rhythm. In 7 patients, tests were performed during the implantation procedure as well. In 3 of the patients, only a single defibrillation zone was active. The other 40 patients had one or more active ventricular tachycardia zones. Two mobile phones (both GSM 900 MHz) were positioned 50 cm away from the implanted device in opposite directions and switched on. Communication was established between these phones, two investigators had a 20-second conversation, and then the phones were switched off. The same procedure was repeated at 30, 20, and 10 cm away from the implantation site, respectively. Finally, the procedure was performed-with the antennae of both phones touching the device pocket. In the above-mentioned 7 cases where testing was done during implantation of the ICD, a call was made from one phone to the other, ringing occurred for 5 seconds, and then two investigators conversed while the device was implanted. Results: There was no change in the function of the ICDs during any of the phone testing procedures. In 5 cases, artifacts were noted on the surface lectrocardiographic (ECG) screen of the programmer during the tests, but no such changes were observed on the simultaneous intracardiac ECGs. Conclusion: The results of the study suggest that mobile phones have no effects on ICD function.Öğe The effects of trimetazidine on heart rate variability in patients with slow coronary artery flow(Churchill Livingstone Inc Medical Publishers, 2006) Topal, E; Ozdemir, R; Barutcu, I; Aksoy, Y; Sincer, I; Akturk, E; Çehreli, SObjective: We sought to examine the effect of trimetazidine (TMZ) on heart rate variability (HRV), endothelin-1 (ET-1), NO, and anginal symptoms in patients with slow coronary artery flow (SCAF). Methods: The 48 patients with SCAF (29 women and 19 men; mean age, 52 +/- 9 years) were included in the study. Twenty milligrams TMZ 3 times a day or matched placebo were given randomly in a double-blinded fashion for 4 weeks. Patients were divided into 4 groups as follows: exercise-positive, TMZ-given group (group A, n = 12); exercise-positive, placebo-given group (group B, n = 12); exercise-negative, TMZ-given group (group C, n = 12); and exercise-negative, placebo-given group (group D, n = 12). Results: After TMZ treatment, HRV parameters, including SD of the all R-R intervals, SD of the averages of R-R intervals in all 5-minute segments of the entire recording, percentage of R-R intervals with more than 50-millisecond variation, and the square root of the mean of the sum of the squares of differences between adjacent R-R intervals, significantly improved both in exercise-positive and exercise-negative groups when compared with baseline. After TMZ treatment, ET-1 and NO levels significantly altered both in exercise-positive and exercise-negative groups when compared with baseline (17.7 +/- 2.7 vs 13.9 +/- 2.8 pg/mL [P = .01] and 18.1 +/- 3.8 vs 14.2 +/- 2.6 pg/mL [P = .01], respectively). After TMZ treatment, NO levels significantly increased in both exercise-positive and exercise-negative groups when compared with baseline (36.4 +/- 5.4 vs 43.3 +/- 6.8 pmol/L [P = .01] and 36.8 +/- 7.8 vs 43.3 +/- 4.8 mu mol/L [P = .01], respectively). However, in placebo group, neither HRV parameters nor ET-1 and NO levels altered when compared with baseline. Also, after treatment, a significant correlation was detected between HRV parameters, including SID of the averages of R-R intervals in all 5-minute segments of the entire recording, SID of the all R-R intervals, percentage of R-R. intervals with more than 50-millisecond variation, and the square root of the mean of the sum of the squares of differences between adjacent R-R intervals, and NO and ET-1 levels in TMZ group but not placebo. Conclusion: Short-term TMZ therapy improved HRV parameters and endothelial products such as ETLI and NO as well as anginal symptom in patients with SCAR Improvement in HRV parameters was correlated with ET-1 and NO levels. (c) 2006 Elsevier Inc. All rights reserved.Öğe Elevated plasma homocysteine level in slow coronary flow(Elsevier Ireland Ltd, 2005) Barutcu, I; Sezgin, AT; Sezgin, N; Gullu, H; Esen, AM; Topal, E; Ozdemir, RBackground: Slow flow velocity of dye in coronary arteries is not an infrequent finding during routine coronary angiography and its precise mechanism is unknown. In this study, we measured the plasma homocysteine level in patients with slow coronary flow (SCF) in comparison with subjects having normal coronary flow (NCF). Method: The study consisted 39 patients (mean age, 47 +/- 8 years) with angiographically diagnosed SCF. SCF was defined according to TIMI frame count (TFC) method. Thirty subjects (mean age 46 8 years) with NCF served as control group. Plasma homocysteine levels were measured after 12 h fasting period in each subject. Results: Baseline demographic properties were similar in both groups. In patients with SCF, TFC was significantly higher than those with NCF. Similarly, in patients with SCF plasma homocysteine level was significantly higher than that of control group (14.1 +/- 2.2 vs. 5.5 +/- 1.3 mu mol/l, respectively p < 0.001). Conclusion: Elevated plasma homocysteine level supports the hypothesis that endothelial function is impaired in slow coronary flow. (c) 2004 Elsevier Ireland Ltd. All rights reserved.Öğe Endothelial function and slow coronary flow(Elsevier Science Inc, 2003) Sezgin, A; Sigirci, A; Barutcu, I; Topal, E; Sezgin, N; Ozdemir, R; Gullu, H[Abstract Not Available]Öğe Evaluation of right and left ventricular function using pulsed-wave tissue Doppler echocardiography in patients with subclinical hypothyroidism(Springer, 2005) Kosar, F; Sahin, I; Turan, N; Topal, E; Aksoy, Y; Taskapan, CPrevious studies showed that subclinical hypothyroidism (SH) was associated with cardiovascular disorders, such as endothelial dysfunction, atherosclerosis and myocardial dysfunction. Only one study investigated left ventricular (LV) function using pulsed tissue Doppler echocardiography (TDE) in patients with SH. However, no study has used this technique in the identification of right ventricular (RV) function in these patients. We aimed to investigate the effect of SH on RV and LV function using TDE technique. The present study included 36 newly diagnosed SH patients and 28 healthy controls. For each subjects, serum free T-3 (FT3), free T-4 (FT4), total T-3 (TT3), total T-4 (TT4), TSH, peroxidase antibody (TPOab) and thyroglobulin antibody (TGab) levels were measured, and standard echocardiography and TDE were performed. In patients with SH, TSH levels were significantly higher, and TPOab and TGab levels were significantly higher when compared to healthy controls. TDE showed that the patients had significantly lower early diastolic mitral and tricuspid annular velocity (Ea) and early/late (Ea/Aa) diastolic mitral and tricuspid annular velocity ratio (p < 0.05, p < 0.05 and p < 0.001, p < 0.001, respectively), and significantly longer isovolumetric relaxation time (IRT) of left and right ventricles (p < 0.001 and p < 0.001, respectively). However, Aa, Sa, and isovolumetric contraction time (ICT) and ET (ejection time) of left and right ventricle did not significantly differ (p=ns for all). In addition, a negative correlation between TSH and TD-derived tricuspid Ea velocity and Ea/Aa ratio, and a positive correlation between TSH and IRT of right ventricle were observed. Our findings demonstrated that SH is associated with impaired RV diastolic function in addition to impaired LV diastolic function.Öğe Exercise-induced changes in QT interval duration and dispersion in patients with isolated myocardial bridging(Elsevier Ireland Ltd, 2004) Barutcu, I; Sezgin, AT; Gullu, H; Topal, E; Acikgoz, N; Ozdemir, RBackground: Isolated myocardial bridging (NIB) often is considered to be an unimportant angiographic finding; however, its association with cardiovascular event has been shown. In this study we aimed to assess exercise-induced electrocardiographic (ECG) changes and susceptibility to arrhythmia in patients with MB. Method: 21 consecutive patients who had angiographically proven MB (group 1) and 25 subjects (group 11) who had normal coronary arteries underwent exercise test using Bruce protocol. Before and after the exercise test the changes in QT interval duration and dispersion were compared. Results: Baseline characteristics of both groups were similar. Heart rate significantly increased after exercise test in both groups. In group 1, after exercise mean QT(max) and QT(min) durations did not change significantly compared to baseline values, respectively. (QT(max): 411 +/- 20 vs. 421 +/- 18 ms, p > 0.05 and QT(min) : 380 +/- 12 vs. 378 +/- 10 ms, p>0.05). However, following exercise test QT dispersion (QT(d)) and corrected QT dispersion (QT(cd)) significantly increased when compared to baseline values, respectively. (34 +/- 13 vs. 66 +/- 14 ms, p<0.05 and 37 +/- 14 vs. 69 +/- 17 ms, p<0.05) On the other hand, in control group QT(max) and QT(min) durations, QT(c) and QT(cd) did not change significantly compared to baseline values, respectively. (QT(max): 408 +/- 18 vs. 412 +/- 17 ms, p>0.05 and QT(min) : 390 +/- 11 vs. 387 +/- 10 ms, p>0.05; QT(d): 25 +/- 14 vs. 31 +/- 16 ms, p>0.05; QT(cd): 27 +/- 15 vs. 33 +/- 17 ms, p>0.05). Conclusion: Treadmill exercise test significantly increased QT dispersion in patients with MB. This increase may result from exercise-induced ischemia at the area perfused by bridged artery. (C) 2004 Elsevier Ireland Ltd. All rights reserved.Öğe Findings of ambulatory blood pressure monitoring and heart rate variability in patients with Behcet's disease(Excerpta Medica Inc-Elsevier Science Inc, 2003) Ozdemir, R; Sezgin, AT; Topal, E; Kutlu, R; Barutcu, I; Gullu, HAlthough we found lack of a decrease in nocturnal blood pressure; impaired heart rate variability; and diastolic dysfunction inpatients with Behcet's disease, we could not demonstrate, whether or not this finding has a prognostic value in patients with this disease. (C) 2003 by Excerpta Medica, Inc.Öğe Identifying risk factors in a mostly overweight patient population with coronary artery disease(Westminster Publ Inc, 2003) Yologlu, S; Sezgin, AT; Ozdemir, R; Sezgin, N; Colak, C; Topal, E; Barutcu, IOverweight/obesity is a complex multifactorial chronic disorder, and the American Heart Association (ANA) has recently classified as a modifiable risk factor for coronary heart disease (CAD). This study (1) evaluates the association between CAD in a patient population mostly overweight (MOP) and conventional and novel coronary risk factors by using univariate and multivariate logistic regression analysis and (2) seeks to find the best model by comparing univariate and multivariate logistic regression analysis algorithms, which were systematically applied to risk factors by using Hosmer-Lemeshow statistic test. In univariate analysis, there were significant associations between CAD in MOP and conventional and novel risk factors. However, the model's sensitivity, specificity, and accuracy levels were weak. In multivariate analysis, although some risk factors were not found as predictors of coronary artery disease, the model showed good fit to data and had high sensitivity, specificity, and accuracy levels. This was also confirmed by using the Hosmer-Lemeshow goodness of fit test, more specifically.Öğe Impaired left ventricle filling in slow coronary flow phenomenon: An echo-Doppler study(Westminster Publ Inc, 2005) Sezgin, AT; Topal, E; Barutcu, I; Ozdemir, R; Gullu, H; Bariskaner, E; Ermis, NSlow coronary flow (SCF) in a normal-appearing coronary angiogram is a well-recognized clinical entity, but its etiopathogenesis remains unclear. The aim of the study was to evaluate echocardiographic features in patients with SCF Thirty-four patients with angiographically proven SCF (group I) and 25 patients with normal coronary flow (group II) were enrolled in the study. The diagnosis of SCF was made with use of the TIMI frame count (TFC) method. All patients underwent complete transthoracic echocardiographic examination (M-mode, 2-dimensional [2-D], and Doppler parameters such as color, continuous, pulsed wave). There were no significant differences with respect to systolic parameters between the 2 groups; in spite of these, group I showed impaired left ventricular diastolic patterns compared to group II. Group I patients had higher peak late diastolic filling velocities due to enhanced atrial systole (A), lower peak (E/A) diastolic filling velocity ratios, and longer isovolumetric relaxation times compared with group II, and these were statistically significant (p < 0.001). In conclusion; the authors detected diastolic filling abnormalities and showed diastolic dysfunction in patients with SCF.Öğe Plasma homocysteine level in slow coronary flow(W B Saunders Co Ltd, 2003) Barutcu, I; Sezgin, A; Ozdemir, R; Gullu, H; Topal, E[Abstract Not Available]Öğe Tissue Doppler velocities of the right and left ventricles and their association with C-reactive protein and homocysteine levels in Behcet's disease(Excerpta Medica Inc-Elsevier Science Inc, 2005) Topal, E; Ozdemir, R; Aksoy, Y; Acikgoz, N; Ermis, N; Sincer, I; Akturk, EIn the present study, we aimed to investigate whether tissue Doppler imaging could provide more information than standard echocardiography about left and right ventricular functions and their relations to homocysteine and C-reactive protein (CRP) levels in the course of Behcet's disease (BD). In the right ventricle, patients with BD had lower early diastolic tricuspid annular velocity and early diastolic/late diastolic tricuspid annular velocity ratios than the control group. Mitral and tricuspid annular systolic velocities did not significantly differ; however, diastolic velocities were correlated with duration of the disease. In addition, early/late diastolic mitral annular velocity,ratio and early/late diastolic tricuspid annular velocity ratios showed an inverse relation with ocular involvement, serum homocysteine, and CRP levels in patients with BD. (C) 2005 Elsevier Inc. All rights reserved.Öğe Vascular endothelial function and plasma homocysteine levels in Behcet's disease(Excerpta Medica Inc, 2004) Ozdemir, R; Barutcu, I; Sezgin, AT; Acikgoz, N; Ermis, N; Esen, AM; Topal, EThe purpose of the present study was to test endothelial function and to determine if plasma homocysteine levels are associated with endothelial injury in patients with Behcet's disease (BD). Flow-mediated dilation in patients with BD was smaller than. that of control subjects (p = 0.001), and mean plasma homocysteine levels in patients with BD were significantly higher (p = 0.0001). On regression analysis, only mean plasma homocysteine concentration was independently related to flow-mediated dilation (F = 5.7; p = 0.001). (C) 2004 by Excerpta Medica, Inc.Öğe Vascular endothelial function in patients with slow coronary flow(Lippincott Williams & Wilkins, 2003) Sezgin, AT; Sigirci, A; Barutcu, I; Topal, E; Sezgin, N; Ozdemir, R; Yetkin, EBackground Slow coronary flow (SCF) in a normal coronary angiogram is a well-recognized clinical entity, but its etiopathogenesis remains unclear. Design The aim of the study was to determine endothelial function in patients with SCF using a flow-mediated dilatation (FMD) technique in the brachial artery. Methods Coronary flow was quantified using the corrected thrombosis in myocardial infarction (TIMI) frame count (CTFC) method. Endothelial function was studied in 27 patients with SCF (23 men, four women, mean age 476 8.7 years) and in 30 people with normal coronary flow (NCF) (22 men and eight women, mean age 475 74 years). Results The flow-mediated diameter increase in the SCF group was significantly smaller than that in the NCF group (3.48 +/- 0.10% compared with 9.11 +/- 0.10%, P < 0.001). The percentage of nitroglycerine (NTG)-induced dilatation was not significantly different between patients with SCF and people with NCF (16.8 +/- 1.1% compared with 171 +/- 1.1%, P = 0.87). Simple regression analysis showed that mean CTFC (CTFCm) was strongly and inversely related to the percentage of FMD (r = -0.29, P < 0.01) in all participants. When the patients with SCIF were excluded, CTFC, was still inversely related to the percentage of FMD (r = -0.36, P < 0.05). CTFC, was also inversely related to NTG-induced dilatation in the 57 participants (r = -0.23, P < 0.05). Multiple regression analysis showed that CTFC, was inversely related to the percentage of FMD only (r = -0.37, P < 0.05). Conclusions These findings suggest that endothelial function is impaired in people with SCF and that CTFC correlates well with endothelial dysfunction.
