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Öğe Increased P-wave duration and P-wave dispersion in patients with aortic stenosis(Turkish Anaesthesiology and Intensive Care Society, 2002) Turhan H.; Yetkin E.; Şenen K.; Ileri M.; Atak R.; Biçer A.; Şaşmaz H.P-wave dispersion (PWD), defined as the difference between maximum and minimum P-wave duration, has been reported 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. The study population consisted of two groups: Group I consisted of 98 patients with degenerative AS (76 men, 22 women; aged 63±8 years) and group II consisted of 98 age and sex matched healthy subjects without any cardiovascular disease. Twelve-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 this difference was defined as 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, maximum and mean aortic gradients. Patients were also evaluated for the presence of documented paroxysmal AF. Maximum P-wave duration (126 ms) and PWD of group I were found to be significantly higher than those of group II (108 ms). In addition, patients with paroxysmal AF (130 ms) had significantly higher PWD (121 ms) than those without paroxysmal AF. There was no significant difference between two groups regarding minimum P-wave duration. There was no significant correlation between echocardiographic variables and PWD. 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 Plasminogen activator inhibitor -1 levels in patients with primary varicose vein(2012) Erguzel N.; Yetkin E.; Erdem G.; Erdil N.; Yetkin G.; Heper G.; Celik T.Aim. Plasmin is involved in extracellular matrix remodeling by activating some matrix metallo-proteinases and degrading extracellular matrix; therefore component of fibrinolytic system such as tissue plasminogen activator and plasminogen activators inhibitors (PAI-1) might have a role in the pathogenesis of vascular remodeling. In our study we aimed to investigate the levels of PAI-1 levels in patients with primary varicose veins (VV) and in their age and gender matched control group. Methods. Forty-one consecutive patients with peripheral varicose veins and 37 healthy age and gender-matched control subjects were included in the study from the outpatient cardiology and cardiovascular surgery clinic. Study population consisted of 41 consecutive patients who met the inclusion criteria and diagnosed as having class II primary VV according to CEAP classification. Routine biochemical and hematological analysis were performed in all patients and control subjects. Results. Plasma levels of PAI-1 were found to be lower in patients than those in control subjects (5.19±2.2 ng/mL vs. 6.47±2.6 ng/mL, P=0.025). Logistic regression analysis revealed that only the plasma levels of PAI-1 were found to be independently but inversely associated with the presence of primary VVs (Odds ratio: 0.80 CI: 0.64-0.99, P=0.04). Conclusion. We have shown that PAI-1 levels are significantly decreased in patients with pVVs and it has an independent association with the presence of pWs. However, its exact relation and role via matrix metlalloproteinases on the pathogenesis of the disease remains to be elucidated in further studies.Öğe Relationship between myocardial viability and the predischarge electrocardiographic pattern in patients with first anterior wall acute myocardial infarction(2003) Atak R.; Turhan H.; Senen K.; Ileri M.; Yetkin E.; Ozbakir C.; Demirkan D.Background: The assessment of residual viability in the infarcted area after an acute myocardial infarction is relevant to subsequent management and prognosis. Objective: The aim of this study was to investigate the correlation between myocardial viability after an acute anterior myocardial infarction (AMI) as assessed by low dose dobutamine stress echocardiography (LDDSE) and the electrocardiographic patterns of ST segment and T wave abnormalities at the end of the first week of the acute event. Methods: Sixty-nine consecutive patients (51 men, 18 women, mean age±standard deviation=57±11 years) who admitted to our clinic due to a first episode of transmural AMI were included in this study. Two-dimensional echocardiography was performed to all patients during rest and low dose dobutamine administration at the end of the first week of admission (7±2 days). Patients were classified into four groups according to ST segment and T wave morphology: group A, ST elevation ?0.1 mV and negative T waves; group B, ST elevation ?0.1 mV and positive T waves; group C, ST elevation ?0.1 mV and negative T waves and group D, ST elevation ?0.1 mV and positive T waves. Results: Myocardial viability was detected more often in patients with isoelectric ST segments (22/24, 92%) than those with elevated ST segments (21/45, 47%) (P<0.001). Similarly patients with negative T waves had myocardial viability more frequently compared to those with positive T waves (32/45, 71% vs. 11/24, 46%, P<0.01). Seventeen (94%) of 18 patients in group A and 5 (83%) of six patients in group B had viable myocardium (P>0.05). Myocardial viability was found in 15 (56%) of 27 patients in group C and six (33%) of 18 patients in group D (P<0.01). As a marker of viable myocardium, isoelectricity of ST segment was specific (92%) but only moderately sensitive (51%), with a 92% positive predictive accuracy and a poor (53%) negative predictive value. T wave negativity was less spesific but more sensitive than isoelectricity of ST segment for myocardial viability. Conclusion: The presence of isoelectric ST segment and negative T wave indicates a high probability of myocardial viablitiy. However, absence of these electrocardiographic patterns does not exclude the presence of viable myocardium. © 2003 Elsevier Ireland Ltd. All rights reserved.
