Publications by authors named "Şakir Arslan"

139 Publications

Transcatheter aortic valve implantation through the brachial artery.

Turk Kardiyol Dern Ars 2021 Apr;49(3):237-241

Department of Cardiology, Antalya Training and Research Hospital, Antalya, Turkey.

Summary- Transcatheter aortic valve implantation (TAVI) has been increasingly used in patients with severe aortic stenosis. The femoral artery is the most commonly used entry site for TAVI; however, other entry sites were also reported as transapical, transaortic, transaxillary/subclavian, and transcarotid in patients with occlusive peripheral arterial disease. In this report, a case of TAVI procedure through the brachial artery is presented.
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http://dx.doi.org/10.5543/tkda.2021.51892DOI Listing
April 2021

Transcatheter valve-in-valve implantation for sutureless bioprosthetic aortic paravalvular leak in the era of COVID-19.

Anatol J Cardiol 2021 03;25(3):209-211

Department of Cardiology, University of Health Sciences, Antalya Training and Research Hospital; Antalya-Turkey.

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http://dx.doi.org/10.14744/AnatolJCardiol.2020.62884DOI Listing
March 2021

Increased Intima-Media Thickness of the Ascending Aorta May Predict Neurological Complications Associated with TAVI.

J Stroke Cerebrovasc Dis 2021 May 23;30(5):105665. Epub 2021 Feb 23.

Antalya Training and Research Hospital, Cardiology Department, University of Health Sciences, Antalya, Turkey.

Objectives: Neurological complications associated with transcatheter aortic valve implantation (TAVI) are important due to its morbidity and mortality risks. The purpose of this study was to investigate the importance of the features of the aortic valve and ascending aorta to predict the neurological complications associated with TAVI.

Methods: The patients for whom the heart team decided to perform TAVI were included in the study. In order to assess possible neurological complications, cerebral diffusionweighted magnetic resonance imaging(MRI) was performed pre- and post-operatively. The diameter of the patients' aortic root and ascending aorta, aortic valve scores, intima media thickness of the ascending aorta were measured from their transesophageal echocardiography records.

Results: A total of 108 patients constituted the study population. 31 patients were found to develop a new lesion (MR+) detected on MRI after TAVI, while 76 patients did not have any new lesions (MR-). The groups did not have any significant differences in their aortic valve features and scores. However, AA-IMT was found to be higher in the MR+ group (1.8mm [1.6-2.3] vs 1.4mm [1.2-1.8] interquartile range). The multivariate logistic regression analysis conducted to detect new lesions revealed that AA-IMT led to a significantly increased risk.

Conclusion: The features of the ascending are more important than the demographic characteristics of patients and features of the native valve in predicting new lesions on MRI scans and thus neurological events after TAVI.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2021.105665DOI Listing
May 2021

Visceral fat index: a novel predictor for coronary collateral circulation.

Arch Endocrinol Metab 2020 Apr 27;64(2):150-158. Epub 2020 Mar 27.

Departments of Cardiology, Training and Research Hospital, University of Health Sciences Antalya, Antalya, Turkey.

Objective This study was designed to investigate the role of visceral adiposity along with other clinical parameters in predicting poor coronary collateral circulation (CCC) among patients with severe obstructive coronary artery disease (CAD). Subjects and methods A total of 135 patients with severe obstructive CAD and good (n = 70) or poor (n = 65) CCC were included. Data on angiographically detected CCC, the quality criteria for CCC (Rentrop scores) and visceral fat index (VFI) obtained via bioelectrical impedance were compared between good and poor CCC groups. Independent predictors of poor CCC, the correlation between VFI and Rentrop score and the role of VFI in the identification of CCC were analyzed. Results A significant negative correlation was noted between VFI and Rentrop scores (r = -0.668, < 0.001). The presence of hypertension (OR 4.244, 95% CI 1.184 to 15.211, p = 0.026) and higher VFI (OR 1.955, 95% CI 1.342 to 2.848, p < 0.001) were shown to be independent predictors of an increased risk for poor CCC. ROC analysis revealed a VFI > 9 (AUC [area under the curve] (95% CI): 0.898 (0.834-0.943), p < 0.0001) to be a potential predictor of poor CCC with a sensitivity of 95.38% and specificity of 85.71%. Conclusion In conclusion, our findings revealed comorbid hypertension and higher VFI to significantly predict the risk of poor CCC in patients with severe obstructive CAD.
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http://dx.doi.org/10.20945/2359-3997000000218DOI Listing
April 2020

Echocardiographic assessment of right ventricular function in peritoneal dialysis patients.

Turk Kardiyol Dern Ars 2019 03;47(2):88-94

Department of Cardiology, Health Science University, Antalya Training and Research Hospital, Antalya, Turkey.

Objective: Cardiovascular disease is the leading cause of mortality in patients undergoing dialysis. Most of the available studies focus on left ventricular (LV) function in peritoneal dialysis (PD) patients; data about the effect of PD on right ventricular (RV) function are scarce. The aim of this study was to evaluate echocardiographic parameters of the RV in patients with end-stage renal disease (ESRD) undergoing PD.

Methods: A total of 73 individuals were grouped as follows: PD patients (n=36) and healthy controls (n=37). Echocardiography of the RV was performed in all of the patients using tissue Doppler imaging (TDI).

Results: The LV mass index (LVMI), left atrial (LA) diameter, posterior wall, and interventricular septum thicknesses were significantly greater in the PD group. The LV peak late diastolic atrial contraction (A) velocity was higher, and the peak early diastolic (E) velocity and the early diastolic velocity of the lateral mitral annulus (Em) were lower in the PD group compared with the control group. The right atrial (RA) diameter, RA area, RV fractional area change, RV myocardial performance index, and pulmonary vascular resistance values were similar in both groups, whereas the tricuspid annular plane systolic excursion (TAPSE) value was lower in the PD patients. The RV E; early diastolic (Ea), late diastolic (Aa), and systolic (Sa) velocities; deceleration time; and tricuspid regurgitation velocity were also similar in the 2 groups. Only the RV A velocity and the Ea/Aa ratio were significantly higher in the PD group, and the E/A ratio was lower in the PD group than in the control group.

Conclusion: The results of conventional and TDI echocardiography indicated that RV systolic and diastolic functions were preserved in PD patients.
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http://dx.doi.org/10.5543/tkda.2018.31391DOI Listing
March 2019

Extremely late stent thrombosis after more than 7 years (2691 days) of sirolimus-eluting stent implantation.

Anatol J Cardiol 2018 Apr 13;19(4):287-288. Epub 2018 Mar 13.

Department of Cardiology, Health Sciences University, Antalya Education and Research Hospital; Antalya-Turkey.

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http://dx.doi.org/10.14744/AnatolJCardiol.2018.57983DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5998849PMC
April 2018

Unexpected complication during transcatheter aortic valve replacement: Balloon that cannot inflate!

Anatol J Cardiol 2018 May 13;19(5):351-353. Epub 2018 Mar 13.

Department of Cardiology, Antalya Training and Research Hospital; Antalya-Turkey.

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http://dx.doi.org/10.14744/AnatolJCardiol.2018.02170DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6280271PMC
May 2018

Simultaneous subacute thrombosis in two new-generation drug-eluting stents in different vessels.

Anatol J Cardiol 2018 Jan;19(1):80-81

Department of Cardiology, Antalya Training and Research Hospital; Antalya-Turkey.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5864798PMC
http://dx.doi.org/10.14744/AnatolJCardiol.2017.8092DOI Listing
January 2018

A novel biomarker for prediction of atrial fibrillation susceptibility in patients with celiac disease.

PLoS One 2018 9;13(1):e0190382. Epub 2018 Jan 9.

Department of Biophysics, Akdeniz University Faculty of Medicine, Antalya, Turkey.

Background: Celiac disease (CD), a serious autoimmune disorder that occurs in people who are genetically predisposed, is induced by dietary gluten intake and affects primarily the small intestine. Many studies have identified an increased risk of cardiovascular problems in patients with CD. Moreover, these patients are susceptible to certain liver diseases, as well as fibrosis.

Objective: The aim of this study was to assess the presence of fibrosis using the De Ritis ratio, determining its effect on the electromechanical features of the left atrium and its susceptibility to atrial fibrillation (AF) in patients with CD.

Methods: A total of 97 patients diagnosed with CD by antibody test and biopsy were included in this prospective study. Two groups were created from these patients, a fibrosis-prone (FP) group and a non-fibrosis-prone (NFP) group, according to the cut-off value, as defined in previously published reports, for the AST/ALT ratio. Electrocardiographic and echocardiographic examinations were performed as part of the study.

Results: There were no differences in the baseline characteristics and conventional echocardiographic parameters of the defined groups. However, the patients in the FP group, as compared to those in the NFP group, had significantly increased PWD (56.68±6.48 ms vs. 37.49±6.22 ms, P<0.001). Additionally, significantly higher interatrial (60.50±13.05 ms vs. 29.40±11.55 ms, P<0.001), intra-left atrial (44.18±14.12 ms vs. 21.02±11.99 ms, P<0.001), and intra-right atrial (15.61±8.91 ms vs. 8.38±4.50 ms, P<0.001) EMD was found among the patients in the FP group compared to that of the NFP group.

Conclusion: It is believed that the susceptibility to AF cited in previous studies may be related to fibrosis. Our study is the first to examine the possible effects of fibrosis on AF susceptibility in patients with CD, whereby we propose a new biomarker for prediction of AF susceptibility of these patients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0190382PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5760044PMC
February 2018

Heart Rate Recovery as a Novel Test for Predicting Cardiac Involvement in Beta-Thalassemia Major.

Acta Cardiol Sin 2017 Jul;33(4):410-419

Department of Cardiology, Antalya Education and Research Hospital, Antalya.

Background: Abnormal heart rate recovery (HRR) is predictive of cardiac mortality. Autonomic abnormalities in beta-thalassemia major (TM) patients have been reported in previous studies. However, the importance of low HRR in exercise stress test in TM patients has not yet been ascertained. Therefore, this study will be the first of its kind in the literature.

Methods: Exercise stress test was performed on 56 TM patients who were being treated at the Thalassemia Center of our hospital, along with 46 non-TM iron deficiency anemia (IDA) patients as a control group. Values for HHR were recorded at 1, 2, 3, 4 and 5 min, and HRR was calculated by the difference of heart rate at peak exercise and at a specific time interval following the onset of recovery.

Results: All HRR values were found to be lower in TM patients compared to those in the IDA group. Exercise capacity [metabolic equivalents (METs)] was also found to be low in these patients (p < 0.001) as well. Total exercise time was significantly lower in the TM group compared to the IDA group (8.40 ± 1.7 min vs. 11.17 ± 1.51 min, p < 0.001). Exercise capacity (METs) was also lower in the TM group compared to the IDA group. Mean T2* value was 28.3 ± 13.7 ms in TM patients on magnetic resonance imaging (MRI). In addition, there are 18 TM patients with T2* value was < 20 ms.

Conclusions: This study found that TM was independently associated with low HRR. Such a condition is an indicator of autonomic dysfunction in TM patients, since abnormal HRR is related to impaired autonomic response. In addition, impaired HRR may be a marker of early cardiac involvement in patients, whose T2* value is high on MRI. Modifying HRR with a cardiac rehabilitation program in TM patients with impaired HRR is a field open for further investigation.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5534421PMC
http://dx.doi.org/10.6515/acs20161104aDOI Listing
July 2017

[Do Turkish reimbursement recommendations cover current European Lipid Guidelines? A retrospective analysis of patients presenting with first acute coronary syndrom].

Turk Kardiyol Dern Ars 2017 Oct;45(7):623-629

Department of Cardiology, Health Sciences University Antalya Training and Research Hospital, Antalya.

Objective: This study was a comparison of the statin therapy protocol issued by the European Society of Cardiology (ESC) and the Ministry of Health's Health Implementation Directive (SUT) in Turkey, performed in order to assess the adequacy of hyperlipidemia treatment indications for primary prevention.

Methods: A total of 582 patients with first acute coronary syndrome were included in the study. Patients with noncritical stenosis observed on coronary angiography or a history of atherosclerotic disease were excluded. The risk calculation was determined using age, sex, smoking status, presence of diabetes mellitus, total cholesterol, and lipoprotein levels. Statin treatment indications were evaluated according to the ESC guidelines (2016) and the SUT (2016).

Results: Statin treatment was indicated for 96% of diabetic patients, and according to the ESC, it was appropriate for 13.5% of nondiabetic patients, while the SUT recommendation included 13.3% of nondiabetic patients (p<0.05). For patients younger than 60 years of age, the SUT had more guidelines than the ESC; however, for patients aged 70 to 90, the ESC had more guidelines than the SUT. For patients over 90, the indications were the same. For patients with low-density lipoprotein-cholesterol (LDL-C) >190 mg/dL there was greater discrepancy between the SUT and ESC guidelines. According to the SUT, all patients >190 mg/dL are to receive treatment. The ESC had more guidelines than the SUT for cases of LDLC <160b mg/dL.

Conclusion: The scope of the SUT guidelines is generally not narrower than the ESC indications. However, the indications for patients >60 years of age and those with LDL-C >160 mg/ dL should be reassessed, as they are more limited than those of the ESC. A new treatment algorithm should be defined.
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http://dx.doi.org/10.5543/tkda.2017.22796DOI Listing
October 2017

The association between apelin gene polymorphism and coronary artery disease in young patients with acute obstructive coronary syndrome.

Turk Kardiyol Dern Ars 2017 Sep;45(6):520-526

Department of Emergency Medicine, Bitlis State Hospital, Bitlis, Turkey.

Objective: The purpose of this study was to evaluate the association between V103V, 6140AG, TGA-Stop-TAA Stop, and 6016CA polymorphisms of the apelin (APLN) gene detected for the first time among young patients with acute coronary syndrome (ACS) and coronary artery disease (CAD).

Methods: This was a prospective cross-sectional study. The study population was divided into 2 groups. The first group included 132 patients who were found to have critical lesions in their coronary arteries, while the control group consisted of 41 patients who were found to have normal coronary arteries or non-critical atherosclerotic lesions.

Results: Among the gene polymorphisms, V103V was found to be more common in the critical CAD patients with the GG genotype compared with the control group (67.4% vs. 46.3%). On the other hand, the GT genotype was more common in the control group (53.7% vs. 32.6%). Univariate and multivariate logistic regression analysis revealed that the GG genotype of V103V was an independent predictor for the presence of critical CAD (odds ratio: 2.397; 95% confidence interval, 1.174-4.892; p=0.016).

Conclusion: In cases of V103V polymorphism of the APLN gene, patients with the GG genotype were at a greater risk for the presence of atherosclerotic critical lesions compared with the control group.
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http://dx.doi.org/10.5543/tkda.2017.95849DOI Listing
September 2017

Assessment of the association between the personality traits of young patients with acute coronary syndrome and the severity of coronary artery disease.

Turk Kardiyol Dern Ars 2017 Sep;45(6):514-519

Department of Cardiology, Antalya Training and Research Hospital, Antalya, Turkey.

Objective: The role of psychosocial risk factors is becoming increasingly important in the etiology of acute coronary syndrome (ACS). The purpose of this study was to assess an association between the personality types of young patients with ACS and the prevalence and severity of coronary artery disease (CAD).

Methods: Patients younger than 45 years of age who presented with ACS and who underwent coronary angiography in the period from 2012 to 2016 were included in the study. The coronary angiography records of the patients were examined and their Gensini score (GS) was calculated; GS ≥20 was considered to be severe CAD. The Eysenck Personality Questionnaire-Revised Short Form scales were used to measure psychoticism, extraversion, lying, and neuroticism.

Results: A total of 139 patients were included in the study. The median psychoticism score of patients with GS <20 was found to be significantly higher than that of patients with GS ≥20 [1.0 (25th and 75th percentile: 0.0-2.0) vs. 1.0 (25th and 75th percentile: 0.0-1.0); p=0.015]. The median psychoticism score was 1.0 (25th and 75th percentile: 1.0-2.0) in the unstable angina pectoris group, 0.5 (25th and 75th percentile: 0.0-1.0) in the ST segment elevation myocardial infarction group, and 1.0 (25th and 75th percentile: 0.0-1.0) in the non-ST segment elevation myocardial infarction group (p=0.004).

Conclusion: The presence of psychoticism characteristics in patients who present with ACS is associated with less severe CAD.
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http://dx.doi.org/10.5543/tkda.2017.32379DOI Listing
September 2017

Is neutrophyl to lymphocyte ratio really a useful marker for all grades of degenerative aortic stenosis?

Turk Kardiyol Dern Ars 2017 Sep;45(6):506-513

Department of Cardiology, Antalya Training and Research Hospital, Antalya, Turkey.

Objective: Inflammatory processes play an important role in cardiac valve calcification and ossification. The aim of this study was to investigate the relationship between the neutrophil-lymphocyte ratio (NLR) and degenerative aortic stenosis (AS).

Methods: A total of 220 patients with AS and 158 healthy individuals who were a control group were included in the study. The NLR was calculated by dividing the number of neutrophils by number of lymphocytes in peripheral blood samples.

Results: The study group consisted of 220 AS patients (mild/ moderate group: n=110; severe group: n=110) and 157 healthy controls. Both the mild/moderate AS group (p<0.001) and the severe AS group (p<0.001) had a significantly higher NLR compared with the control group. The NLR in the severe AS group was significantly higher than that of the mild/moderate AS group (p<0.001). The groups were similar with respect to other baseline characteristics. A receiver operating characteristic curve analysis yielded a strong predictive ability of NLR for the presence of AS (Area under the curve=0.930; 95% CI [confidence interval], 0.898-0.963; p<0.001). A cut-off value of 2.310 for NLR had a sensitivity and specificity of 80.4% and 92.4%, respectively, for the presence of AS. In multivariate logistic regression analysis, NLR (Odds ratio: 43.8; 95% CI, 14.7-130.7) was the only independent predictor of AS.

Conclusion: The discriminative performance of NLR for AS is high. NLR is strongly and independently associated with AS.
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http://dx.doi.org/10.5543/tkda.2017.32389DOI Listing
September 2017

Assessment of left ventricular function with tissue Doppler echocardiography and of B-type natriuretic peptide levels in patients undergoing transcatheter aortic valve implantation.

Rev Port Cardiol 2017 May 9;36(5):377-383. Epub 2017 May 9.

Mus State Hospital, Department of Emergency Medicine, Antalya, Turkey.

Introduction: Transcatheter aortic valve implantation (TAVI) is an emerging minimally invasive treatment modality in high surgical risk or inoperable patients.

Aim: The aim of this study was to ascertain the effect of TAVI on left ventricular (LV) systolic and diastolic function and serum B-type natriuretic peptide (BNP) levels in high surgical risk or inoperable patients with severe aortic stenosis.

Methods: Fifty-five patients were included in our retrospective study. LV systolic and diastolic function was assessed with conventional and tissue Doppler imaging (TDI) prior to and after TAVI. Additionally, BNP was measured 24 h before and three months after the procedure. Echocardiographic controls were performed at one, three and six months and one year and mean values were taken. At the end of the study, LV systolic and diastolic function, serum BNP levels and New York Heart Association functional capacity were assessed and compared to baseline parameters.

Results: The TAVI procedure was successful in all patients. In-hospital mortality was 1.8% (one patient). There was a substantial improvement in LV function and functional capacity at follow-up. In addition, a statistically significant decrease was detected in serum BNP levels post-TAVI (median 380 pg/ml [176.6-929.3] vs. 215 pg/ml [96.0-383.0], p=0.0001). Only one patient required a permanent pacemaker (1.8%) and there was no mortality after TAVI during follow-up. There were significant increases in LV ejection fraction and aortic valve area (51.0±13.1% vs. 58.4±9.1%, p<0.001, and 0.6±0.1 cm vs. 2.1±0.2 cm, p=0.0001, respectively). At the end of the study, conventional Doppler echocardiography revealed improvement in diastolic function, with an increase in mitral E wave, a decrease in mitral A wave and an increase in E/A ratio. Deceleration time and isovolumetric relaxation time were shortened and myocardial performance (Tei) index decreased. TDI showed an increase in systolic myocardial velocity (Sm) and early diastolic velocity (Em). Septal mitral annular Sm and Em were increased, whereas MPI was reduced.

Conclusion: We found that LV structural changes and diastolic dysfunction occur in patients with severe aortic stenosis and that TAVI is able to reverse these abnormalities, which we demonstrated by both conventional echocardiography and TDI. In addition, serum BNP levels were decreased after TAVI.
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http://dx.doi.org/10.1016/j.repc.2016.10.008DOI Listing
May 2017

Which Came First, the Chicken or the Egg? Paradox in Peripheral Arterial Diseases.

Angiology 2018 01 9;69(1):83-84. Epub 2017 May 9.

1 Department of Cardiology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey.

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http://dx.doi.org/10.1177/0003319717709176DOI Listing
January 2018

Should physicians instead of industry representatives be the main actor of cardiac implantable electronic device follow-up? (Super Follow-up).

Anatol J Cardiol 2017 Jul 19;18(1):23-30. Epub 2017 Apr 19.

Department of Cardiology, Antalya Education and Research Hospital; Antalya-Turkey.

Objective: This retrospective study sought to research the adequacy of the follow-up and optimization of cardiac implantable electronic devices (CIEDs) performed by industry representatives.

Methods: A total of 403 consecutive patients (35% females; median age, 67 years; age range 18-97 years) with either pacemakers (n=246), implantable cardioverter-defibrillators (ICDs), (n=117) or cardiac resynchronization therapy with defibrillator (CRT-D) (n=40) applied to our hospital's outpatient pacemaker clinic for follow-up. These patients had been followed up by industry representatives alone until September 2013 and then by a cardiologist who is dealing with cardiac electrophysiology and has a knowledge of CIED follow-up.

Results: It was ascertained that 117 (47.6%) of 246 patients with pacemakers had a programming error. Forty-three (36.8%) of 117 patients were symptomatic, and after reprogramming, all symptoms diminished partially or completely during the follow-up. Moreover, 30 (25.6%) of 117 patients with ICDs had a programming error. Furthermore, 6 (15%) of 40 patients with CRT-Ds had a programming error. To conclude, when all patients with CIEDs were assessed together, it was ascertained that 153 (38%) of 403 patients had programming errors.

Conclusion: The prevalence of inappropriate programming of CIEDs by industry representatives was quite higher than expected. Therefore, our study strongly demonstrates that CIED follow-up should not be allowed to be performed entirely by manufacturers' representatives alone.
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http://dx.doi.org/10.14744/AnatolJCardiol.2017.7374DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5512194PMC
July 2017

The Relationship between Vitamin D and Coronary Artery Ectasia in Subjects with a Normal C-Reactive Protein Level.

Korean Circ J 2017 Mar 13;47(2):231-237. Epub 2017 Mar 13.

Department of Cardiology, Antalya Education and Research Hospital, Antalya, Turkey.

Background And Objectives: Vitamin D is generally known to be closely related to inflammation. The effects of vitamin D on coronary artery disease (CAD) are not fully explained. Nowadays, coronary artery ectasia (CAE) cases are common and are regarded as being a kind of CAD. We aimed to investigate, in a case-control study, the relationship between vitamin D and CAE without an associated inflammatory process.

Subjects And Methods: This study population included 201 patients (CAE group, 121 males; mean age, 61.2±6.4 years) with isolated CAE; and 197 healthy individuals (control group, 119 males; mean age, 62.4±5.8 years), comprising the control group, who had normal coronary arteries. These participants concurrently underwent routine biochemical tests, tests for inflammatory markers, and tests for 25-OH vitamin D in whole-blood draws. These parameters were compared.

Results: There are no statistical significance differences among the groups for basic clinical characteristics (p>0.05). Inflammatory markers were recorded and compared to exclude any inflammatory process. All of them were similar, and no statistical significance difference was found. The average parathyroid hormone (PTH) level of patients was higher than the average PTH level in controls (41.8±15.1 pg/mL vs. 19.1±5.81 pg/mL; p<0.001). Also, the average 25-OH vitamin D level of patients was lower than the average 25-OH vitamin D level of controls (14.5±6.3 ng/mL vs. 24.6±9.3 ng/mL; p<0.001). In receiver operating characteristic curve analysis, the observed cut-off value for vitamin D between the control group and patients was 10.8 and 85.6% sensitivity and 75.2% specificity (area under the curve: 0.854, 95% confidence interval: 0.678-0.863).

Conclusion: We found that there is an association between vitamin D and CAE in patients who had no inflammatory processes. Our study may provide evidence for the role of vitamin D as a non-inflammatory factor in the pathophysiology of CAE.
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http://dx.doi.org/10.4070/kcj.2016.0198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5378030PMC
March 2017

Management of Left Ventricular Free Wall Rupture Associated with Acute Myocardial Infarction.

J Acute Med 2017 Mar;7(1):31-34

Antalya Education and Research Hospital Cardiology Department Antalya Turkey.

Left ventricular free wall rupture is one of the mechanical complications of acute myocardial infarction and it may result in cardiac tamponade as well as limiting itself by forming a pseudoaneurysm. In this report, a case of left ventricular free wall rupture and pseudoaneurysm that developed during the course of posterior myocardial infarction has been presented. Left ventricular free wall rupture and pseudoaneurysm were identified by three-dimensional transthoracic echocardiography and surgically repaired at a late stage.
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http://dx.doi.org/10.6705/j.jacme.2017.0701.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7517979PMC
March 2017

Vitamin D Trials and Their Limitations.

Angiology 2017 07 14;68(6):560. Epub 2016 Dec 14.

1 Department of Cardiology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey.

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http://dx.doi.org/10.1177/0003319716683494DOI Listing
July 2017

Relationship between mean platelet volume and ischemic stroke in patients with patent foramen ovale.

Turk Kardiyol Dern Ars 2017 Jan;45(1):9-15

Department of Cardiology, Antalya Training and Research Hospital, Antalya, Turkey.

Objective: Patent foramen ovale (PFO) is commonly encountered in patients with cryptogenic stroke. Mean platelet volume (MPV), an indicator of platelet reactivity, has been reported in recent trials to be higher in patients with PFO than in normal population. The aim of this study was to investigate whether there is a difference in MPV between patients with PFO and stroke or transient ischemic attack (TIA) and that of patients with asymptomatic PFO.

Methods: Patients with PFO who were younger than 55 years of age were enrolled in this retrospective study. Hemogram parameters of patients with ischemic stroke or TIA (symptomatic group) were obtained during hospitalization once they had stable clinical status.

Results: Total of 108 patients, 51 of whom were symptomatic, were included in the study. MPV was determined to be higher in symptomatic group compared with asymptomatic group (median 10.0 fl [25th-75th percentile: 9.0-11.0] vs median 8.56 fl [25th-75th percentile: 8.0-9.0], respectively; p<0.001,. Cut-off point of 9.0 fl for MPV had 70% sensitivity and 86% specificity in predicting symptomatic PFO patients.

Conclusion: MPV is higher in symptomatic than in asymptomatic PFO patients. This finding may be a subsidiary risk factor to identify patients with PFO and high risk of cardioembolic stroke.
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http://dx.doi.org/10.5543/tkda.2016.17971DOI Listing
January 2017

C-Reactive Protein Is the Origin for Novel Biomarkers.

Angiology 2017 07 26;68(6):562. Epub 2016 Dec 26.

1 Department of Cardiology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey.

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http://dx.doi.org/10.1177/0003319716685483DOI Listing
July 2017

Myocardial Infarction after Ozone Therapy: Is Ozone Therapy Dr. Jekyll or Mr. Hyde?

Cardiology 2017 15;137(1):20-21. Epub 2016 Dec 15.

Department of Cardiology, Antalya Education and Research Hospital, Antalya, Turkey.

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http://dx.doi.org/10.1159/000454759DOI Listing
January 2018

Association of Neutrophil/Lymphocyte Ratio with Plaque Morphology in Patients with Asymptomatic Intermediate Carotid Artery Stenosis.

Korean Circ J 2016 Sep 28;46(5):699-705. Epub 2016 Sep 28.

Department of Cardiology, Medipol University Faculty of Medicine, Istanbul, Turkey.

Background And Objectives: Non-calcified carotid plaques are more unstable than calcified plaques, and they are associated with a higher risk of rupture, thromboembolism, and consequently, stroke. The purpose of the present study is to compare calcified and non-calcified plaques that cause intermediate carotid artery stenosis with respect to neutrophil/lymphocyte ratio (NLR).

Subjects And Methods: A total number of 139 asymptomatic patients with 50-70% stenosis of the carotid artery were included in this study. Carotid Doppler ultrasound imaging and computed tomography angiography were performed to divide the carotid artery plaques into two groups as calcified and non-calcified. Patients included in the calcified (n=73) and non-calcified (n=66) plaque groups were compared with respect to total neutrophil count, lymphocyte count and NLR.

Results: Total lymphocyte count was statistically significantly lower in the non-calcified plaque group compared to the calcified plaque group (total lymphocyte count in non-calcified/calcified plaque groups [10/mm]: 2.1/2.3, respectively) (p=0.002). NLR was statistically significantly higher in the non-calcified plaque group compared to the calcified plaque group (NLR in non-calcified/calcified plaque groups: 2.6/2.1, respectively) (p<0.001). The cut-off value for NLR was found to be >2.54. Multivariate regression analysis showed that NLR was independently associated with non-calcified carotid artery plaques (odds ratio 5.686, 95% CI 2.498-12.944, p<0.001).

Conclusions: NLR is increased in the presence of non-calcified carotid artery plaques that cause asymptomatic intermediate stenosis. Increased NLR can be used as a marker to assess the risk of rupture of non-calcified carotid artery plaques.
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http://dx.doi.org/10.4070/kcj.2016.46.5.699DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5054183PMC
September 2016

Ozone Therapy and Its Use in Medicine: Dr. Jekyll or Mr. Hyde?

Cardiology 2017 13;136(2):145-146. Epub 2016 Sep 13.

Department of Cardiology, Antalya Education and Research Hospital, Antalya, Turkey.

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http://dx.doi.org/10.1159/000447996DOI Listing
January 2018

Successful lysis in massive pulmonary embolism with thrombus entrapped in PFO.

Am J Emerg Med 2017 Jan 25;35(1):198.e3-198.e5. Epub 2016 Jul 25.

Clinic of Cardiology, Antalya, Education and Research Hospital, Antalya, Turkey.

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http://dx.doi.org/10.1016/j.ajem.2016.07.039DOI Listing
January 2017

Aortopulmonary window in adulthood: Surviving at 22 years without intervention or pulmonary vascular disease.

Turk Kardiyol Dern Ars 2016 Jun;44(4):332-4

Department of Cardiology, Antalya Training and Research Hospital, Antalya, Turkey.

Aortopulmonary window is a rare anomaly, a communication between the ascending aorta and the main pulmonary artery. Prognosis in the absence of correction is poor, with mortality of around 40% in the first year of life. A case of aortopulmonary window without pulmonary vascular disease in adulthood is described in the present report.
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http://dx.doi.org/10.5543/tkda.2016.94224DOI Listing
June 2016

Short and Long-Term Effect of Carotid Artery Stenting on Arterial Blood Pressure Measured through Ambulatory Blood Pressure Monitoring.

Acta Cardiol Sin 2016 May;32(3):343-50

Clinic of Cardiology, Antalya Education and Research Hospital, Antalya;

Background: The aim of this study was to assess the short and long-term effects of carotid artery stenting (CAS) procedure on blood pressure (BP) through ambulatory BP monitoring.

Methods: One hundred fifty three patients who underwent CAS for primary or secondary protection from December 2010 to September 2013 were enrolled to our study. The BP levels of total of 123 patients were monitored for 1 year. Thereafter, the pre-procedure levels of BP were compared with BP levels at the 24-hour and the first year intervals after the procedure.

Results: Systolic and diastolic BP levels at the 24-hour and the first year intervals after CAS were significantly lower than the pre-procedure BP levels. The mean 24-hour systolic BP was 113 ± 13 mmHg and diastolic BP was 63 ± 8 mmHg, both of which were significantly lower (p < 0.001 and p < 0.001 respectively), while the pre-procedure mean systolic BP was 133 ± 10 mmHg and the mean diastolic BP was 75 ± 9 mmHg. Moreover, the mean first-year systolic BP was 125 ± 10 mmHg with a decline of 8 ± 8 mmHg and mean diastolic BP was 71 ± 8 mmHg with a decline of 4 ± 7 mmHg, both of which were again significantly lower compared to the pre-procedure levels (p < 0.001 and p < 0.001 respectively).

Conclusions: The results of our study suggested that systolic and diastolic BP levels diminished after CAS. Additionally, BP reduction continued even 1 year after the CAS.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4884763PMC
http://dx.doi.org/10.6515/acs20150604aDOI Listing
May 2016

Aortic embolization of an Edwards SAPIEN prosthesis due to sigmoid left ventricular hypertrophy: Case report.

Rev Port Cardiol 2016 Jun 30;35(6):379.e1-3. Epub 2016 May 30.

Cardiology Department, Antalya Education and Research Hospital, Antalya, Turkey.

Transcatheter aortic valve implantation (TAVI) is considered an alternative therapy in high-risk patients with severe aortic stenosis. Although a minimally invasive procedure, it is not free from complications, one of which is valve embolization at the time of TAVI. We present a case of embolization of a balloon-expandable aortic valve due to sigmoid left ventricular hypertrophy and managed with a second valve without surgery. The embolized valve was repositioned in the aortic arch between the left common carotid artery and the brachiocephalic trunk.
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http://dx.doi.org/10.1016/j.repc.2015.09.033DOI Listing
June 2016

The Association between Serum Ferritin Level, Tissue Doppler Echocardiography, Cardiac T2* MRI, and Heart Rate Recovery in Patients with Beta Thalassemia Major.

Acta Cardiol Sin 2016 Mar;32(2):231-8

Department of Cardiology;

Background: It is generally well-understood that iron-mediated cardiomyopathy is the major complication that can arise from beta thalassemia major (TM). Therefore, early diagnosis, risk stratification, and the effective treatment of beta TM patients are clinically important to optimize long-term positive outcomes.

Methods: This study included 57 beta TM patients with a mean age of 25 ± 7 years. We determined the serum ferritin level, echocardiography, heart rate recovery (HRR), and cardiac magnetic resonance (CMR) T2* in all patients. CMR T2* findings were categorized as normal myocardium (T2* > 20 ms), and myocardial involvement (T2* ≤ 20 ms). HRR values at 1-5 min (HRR1-5) were recorded; Subsequently. HRR was calculated by subtracting the heart rate at each time point from the heart rate at peak exercise.

Results: There was a significant negative correlation between the serum ferritin level and the cardiac T2* MRI findings (r = -0.34, p = 0.009). A similar result was found in the negative correlation between serum ferritin and all heart rate recovery values. There was a significant positive correlation between HRR1, HRR2, and HRR3 values, and CMR T2* (T2* heart rate recovery (HRR)1: r = 0.51, p < 0.001; T2* HRR2: r = 0.48, p < 0.001; T2* HRR3: r = 0.47, p < 0.001, respectively).

Conclusions: The serum ferritin level and echocardiography can be used to predict the presence of myocardial iron load in beta TM patients. Therefore, HRR can be used to screen beta TM patients, and the clinical use of HRR can be a predictive marker for autonomic dysfunction in beta TM patients.

Key Words: Beta thalassemia major • Cardiac magnetic resonance T2* • Heart rate recovery • Iron overload • Serum ferritin level • Tissue Doppler imaging.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4816922PMC
http://dx.doi.org/10.6515/acs20150824aDOI Listing
March 2016