Publications by authors named "Ergün Barış Kaya"

132 Publications

Impaired Balance and Gait Characteristics in Patients With Chronic Heart Failure.

Heart Lung Circ 2022 Jun 15;31(6):832-840. Epub 2022 Feb 15.

Hacettepe University, Faculty of Medicine, Department of Cardiology, Ankara, Turkey.

Background And Aims: Heart failure affects most systems of the body and causes various problems in patients. Balance deficits and gait deviations can be a result of these effects. There is little information in the literature about balance and gait parameters in chronic heart failure (CHF). This study aimed to investigate balance abnormalities together with gait deficits for possible associations in patients with CHF and compare them to healthy controls.

Methods: Twenty-two (22) patients with CHF (59±2.5 years) and 22 age- and gender-matched healthy subjects (59.4±6.8 years) participated in the study. This study is a cross-sectional/comparison study. Balance was evaluated using the Activity-Specific Balance Confidence Scale (ABC) and the Mini-Balance Evaluation Systems Test (Mini-BESTest) balance battery, which includes the timed up-and-go test (TUG) and dual-task TUG. Gait analysis was performed using a Biodex Gait Trainer. Peripheral muscle strength (quadriceps muscle and handgrip strength) was assessed using a hand dynamometer and exercise capacity using the six-minute walk test (6MWT).

Results: The CHF patients had significantly lower Mini-BESTest total, reactive postural control, and gait stability scores, significantly longer TUG/dual-task TUG time, and lower ABC score compared to the healthy control group (p<0.05). Chronic heart failure patients also showed significantly lower gait speed, stride length, gait cycle and step length (p<0.05). Dominant-side quadriceps muscle and handgrip strength and 6MWT distance were significantly reduced in CHF (p<0.05). Anticipatory postural adjustments and sensory orientation did not differ between groups.

Conclusions: Our study demonstrated impaired balance and gait performance and reduced muscle strength and exercise capacity in patients with CHF. Cardiac rehabilitation including balance and walking training should be planned for CHF patients to eliminate balance disorders, gait impairment and prevent falls in this patient group.
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http://dx.doi.org/10.1016/j.hlc.2021.10.015DOI Listing
June 2022

CT dose management for neurologic events in patients with cardiac devices: Radiation exposure variation in patients with cardiac devices.

Diagn Interv Radiol 2022 Jan;28(1):98-102

Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Purpose: To compare the inter-center cranial computed tomography (CT) acquisition rates, CT findings, CT related radiation dose, and variability of CT acquisition parameters for neurologic events among patients with implantable cardioverter-defibrillator (ICD) or left ventricular assist device (LVAD).

Methods: A total of 224 patients [ICD group (n = 155) and LVAD group (n = 69)] who had at least one cranial CT scan were enrolled from three medical centers. The variability and effect of the number, indication, and findings of cranial CT scans as well as CT acquisition parameters including tube potential, tube current, tube rotation time (TI), slice collimation (cSL), and spiral or sequential scanning techniques on CT dose index volume (CTDIvol), total dose length product (DLP) were analyzed.

Results: The mean DLP value of Center A and mean CTDIvol values of Center A and C were significantly lower than Center B (p < 0.001). The mean CTDIvol and DLP values in the ICD group were substantially lower than the LVAD group (p<0.001). The most potent parameters causing the changes in CTDIvol and DLP were kV, mAs values, and CT scanning technique as sequential or spiral according to multivariate linear regression analysis.

Conclusion: Cranial CT acquisition parameters and radiation doses vary significantly between centers, which necessitates optimization of cranial CT protocols to overcome the cumulative radiation dose burden in patients with neurologic events.
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http://dx.doi.org/10.5152/dir.2021.20673DOI Listing
January 2022

Evaluation of Atrial Fibrosis in Atrial Fibrillation Patients with Three Different Methods.

Turk J Med Sci 2021 Sep 21. Epub 2021 Sep 21.

Background The presence of atrial fibrosis has already been known as a risk factor for atrial fibrillation (AF) development. Objective We aimed to evaluate atrial fibrosis with previously defined three different methods, which were cardiac magnetic resonance imaging (C-MRI), echocardiographic strain imaging, and biomarkers, and show the relationship between these methods, in patients with AF scheduled for cryoballoon ablation. Method 30 patients were enrolled. Atrial T1 relaxation durations were measured using C-MRI before the procedure of atrial fibrillation catheter ablation. Fibroblast growth factor-21 (FGF-21) and fibroblast growth factor-23 (FGF-23) levels were measured at serum derived from the femoral artery (Peripheral FGF 21 and 23) and left atrium blood samples (Central FGF 21 and 23) before catheter ablation. Preprocedural transthoracic echocardiography was performed. The Median follow-up duration for atrial tachyarrhythmia (ATa) recurrence was 13 (12-18 months) months. Results The mean ages of the study group were 55.23 ± 12.37 years and there were 17 (56.7%) female patients in study population. There were negative correlations between post contrast T1 relaxation durations of both posterior and posterosuperior atrium, and central FGF-23 (r:-0.561; p=0.003; r:-0.624; p=0.001; Posterior T1 vs central FGF-23 levels and Posterosuperior T1 vs central FGF-23 levels respectively). The positive correlations were observed between postcontrast posterior T1 relaxation durations and left ventricle ejection fraction (r:0.671; p=0.001); left atrial emptying fraction (r:0.482; p=0.013); peak atrial longitudinal strain (r:0.605; p=0.001), and peak atrial contraction strain (r:0.604; p=0.001). Also negative correlation was observed between postcontrast posterior T1 relaxation durations, and left atrial volume index (r:-0.467; p=0.016). Conclusion Our studies showed that there are correlations between T1 mapping of atrial tissue, biomarkers, and atrial mechanics evaluated with transthoracic echocardiography. Our findings are significant as they demonstrate the compatibility of these techniques for the atrial fibrosis evaluation.
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http://dx.doi.org/10.3906/sag-2103-194DOI Listing
September 2021

The relationship between retinal microcirculation and right heart catheterization and echocardiography findings in patients with idiopathic pulmonary arterial hypertension.

Microcirculation 2021 08 24;28(6):e12704. Epub 2021 May 24.

Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Objective: To determine the possible alterations of retinal microcirculation associated with right-sided intracardiac pressures in patients with IPAH.

Methods: Twenty patients with IPAH and 20 age- and sex-matched healthy controls were included in the study. Hemodynamic data were obtained from the most recent right heart catheterization. Echocardiographic examination was performed within 24 h of ophthalmological examination. For the right eyes of all participants, high-resolution scans of chorioretinal microvascular networks at different depths of the retina were captured via OCT angiography.

Results: The perfusion of the superficial and deep capillary plexus (SCP and DCP), and choriocapillaris (CCP) flow area were significantly lower than those in healthy control subjects (p < .05 for all). In IPAH group, PVR and mPAP were correlated significantly with the perfusion measurements at SCP and DCP (r = .461, r = .626 and r = .625, r =0.730, respectively, p < .05). sPAP and TRV were positively correlated with the perfusion measurements at SCP and DCP (r = .600, r = .662 and r = .670, r = .655 p < .05).

Conclusions: The positive correlation of retinal perfusion at SCP and DCP with right-sided echocardiographic and hemodynamic measurements unveiled that retinal microcirculation is affected by the pressure alterations in the pulmonary circulation of IPAH patients.
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http://dx.doi.org/10.1111/micc.12704DOI Listing
August 2021

Assessment of Diastolic Function and Thiol-Disulphide Homeostasis in Arsenic-Exposed Workers.

Acta Cardiol Sin 2021 Jan;37(1):86-96

Department of Medical Biochemistry, Yildirim Beyazit University, Ankara, Turkey.

Objectives: Exposure to arsenic is associated with various cardiovascular diseases. The imbalance between antioxidant and oxidant homeostasis plays a crucial role in the cardiovascular effects of arsenic. The aim of this study was to investigate the effect of arsenic exposure on diastolic function by measuring thiol and disulphide in arsenic-exposed workers.

Methods And Results: A total of 107 male arsenic-exposed workers and 36 healthy subjects were enrolled. Mitral inflow velocity and parameters of diastolic function were measured. As oxidative stress indicators, total thiol, native thiol, disulphide, and their percent ratios were determined. The mean age was 39.1 ± 9.5 years in the arsenic-exposed group and 37.4 ± 9.6 years in the controls. The median blood arsenic level was 42 μg/dL in the arsenic-exposed group and 3.75 μg/dL in the controls. E-wave, E/A ratio, and e' wave were lower and left atrial diameter, A-wave, average E/e' ratio, and tricuspid regurgitation velocity were higher in the arsenic-exposed group. Native and total thiol concentrations were lower, and disulphide/native and disulphide/total thiol ratios were higher in the arsenic-exposed group. Fourteen (13.1%) workers had diastolic dysfunction, 26 (24.3%) had indeterminate, and 67 (62.6%) had normal diastolic function, compared to 1 (2.8%), 2 (5.6%), and 33 (97.7%) in the control group, respectively. In regression analysis, disulphide/native thiol ratio (p < 0.001) and blood arsenic level (p < 0.001) predicted increased average E/e' ratio in the arsenic-exposed group.

Conclusions: This study showed strong associations among arsenic exposure, oxidative stress, and diastolic function, and revealed the influence of arsenic exposure on diastolic dysfunction through oxidative stress.
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http://dx.doi.org/10.6515/ACS.202101_37(1).20200711ADOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7814322PMC
January 2021

Long-term follow-up outcomes in a real-world study cohort after percutaneous patent foramen ovale closure.

Turk Kardiyol Dern Ars 2021 01;49(1):29-39

Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Objective: In recent years, percutaneous closure of a patent foramen ovale (PFO) has gained widespread use. This study is an evaluation of the safety and efficacy of the Figulla and Amplatzer devices for PFO closure, including long-term follow-up results.

Methods: A total of 305 patients (43.6% male; mean age: 43.25±10.98 years) who underwent percutaneous PFO closure between 2003 and 2019 were enrolled. The Risk of Paradoxical Embolism (RoPE) score was calculated to predict the recurrence risk of cerebrovascular events due to PFO. Transthoracic echocardiography was used during the procedure.

Results: The devices were successfully implanted in all patients. The in-hospital periprocedural complications recorded were atrial fibrillation in 1 patient (0.3%), supraventricular tachycardia in 1 patient (0.3%), and femoral hematoma in 3 patients (1%). The procedure time and fluoroscopy time was 21.92±2.93 minutes and 2.19±0.24 minutes, respectively. Recurrent ischemic stroke or transient ischemic attack (TIA) was observed in 7 (2.2%) patients during the median 85.77 months (25th-75th percentile: 10.21-108.00 months) follow-up. The RoPE score was significantly lower in patients with recurrent ischemic cerebral event (stroke or TIA) compared with asymptomatic patients (p<0.001). Kaplan-Meier curve analysis revealed that there was no significant difference between PFO device types (Amplatzer: 2.4% vs. Figulla: 3.3%) in terms of recurrent ischemic cerebral events during follow-up (log-rank; p=0.642).

Conclusion: Percutaneous PFO closure was safe, feasible, and effective. Our study confirmed the efficacy and safety of transthoracic echocardiogram guidance during percutaneous closure of PFO, which shortens the procedure time. A lower RoPE score was related to the recurrence risk of ischemic cerebrovascular events.
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http://dx.doi.org/10.5543/tkda.2020.06699DOI Listing
January 2021

How did the updated hemodynamic definitions affect the frequency of pulmonary hypertension in patients with systemic sclerosis?

Anatol J Cardiol 2021 01;25(1):30-35

Department of Cardiology, Faculty of Medicine, Hacettepe University; Ankara-Turkey.

Objective: Pulmonary hypertension (PH) is a one of the major causes of death in patients with systemic sclerosis (SSc). In this study, we investigated the impact of updated hemodynamic definition proposed by the 6th PH World Symposium (6th WSPH) on the frequency of PH and its subtypes in patients with SSc.

Methods: Patients with SSc admitted between 2015 and 2019 and who underwent right heart catheterization (RHC) were included. The frequency of PH and its subgroups based on the hemodynamic definitions of both 2015 European Society of Cardiology/European respiratory Society (ESC/ERS) PH guidelines and 6th WSPH was compared.

Results: Of the 65 patients with SSc, 23 (35.4%) had normal mean pulmonary arterial pressure (mPAP), 20 (30.8%) had mildly elevated mPAP (21-24 mm Hg), and 22 (33.8%) had PH [pulmonary arterial hypertension (PAH) (n=16, 24.6%), group 2 PH (n=5, 7.7%), group 3 PH (n=1, 1.5%)] according to the 2015 ESC/ERS PH definition. Based on the updated criteria, 7 (10.8% of total cohort) additional patients were reclassified as having PH [PAH (n=3), group 2 PH (n=3), group 3 PH (n=1)].

Conclusion: The impact of the updated definition on the frequency of PH and PAH in our cohort was greater than previously reported, which may be caused by the difference in screening strategies for PAH.
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http://dx.doi.org/10.14744/AnatolJCardiol.2020.46625DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7803798PMC
January 2021

Long-Term Prognostic Value of Coronary Atherosclerotic Plaque Characteristics Assessed by Computerized Tomographic Angiography.

Angiology 2021 03 29;72(3):252-259. Epub 2020 Oct 29.

Department of Cardiology, 37515Hacettepe University Faculty of Medicine, Ankara, Turkey.

We aimed to present the long-term prognostic role of coronary computed tomography angiography (CTA) in a cohort of patients with coronary artery disease (CAD) and noncritical stenosis. A total of 1138 patients who underwent coronary CTA for suspected CAD were included in the study. For the categorization of the coronary atherosclerotic plaque (CAP), the coronary system was divided into 16 segments. For each segment, CAPs were categorized as calcified, noncalcified, and mixed. All-cause and cardiovascular (CV) mortality data were collected for prognostic evaluation. Coronary CTA analyses showed that 34.5% of patients had noncalcified CAP, 14.5% of patients had calcified CAP, and 11% of patients had mixed CAP. During a median of 141.5 months follow-up, CV and all-cause mortality was observed in 57 (5%) and 149 (13.1%) patients, respectively. In multivariable Cox regression analysis, calcified CAP morphology and the extent of involved segments were significant predictors of both CV and all-cause mortality. The presence of calcified CAP morphology and the higher number of diseased coronary segments via coronary CTA might help stratify patients at risk for adverse CV outcomes during long-term follow-up. Patients with these features at index coronary CTA may be evaluated more closely with aggressive preventive measures.
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http://dx.doi.org/10.1177/0003319720963677DOI Listing
March 2021

Four-Dimensional Echocardiographic Evaluation of Left Ventricular Systolic Functions in Patients with Chronic Myeloid Leukaemia Receiving Tyrosine Kinase Inhibitors.

Cardiovasc Toxicol 2021 03 17;21(3):216-223. Epub 2020 Oct 17.

Department of Hematology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Tyrosine kinase inhibitors (TKIs) are established treatment for haematological malignancies. However, cardiac adverse effects, including the reduction in left ventricular ejection fraction and symptomatic heart failure remain clinical problems. The purpose of this study was to evaluate the left ventricular systolic functions in patients with chronic myeloid leukaemia receiving TKIs. A cross-sectional and observational study was conducted of 37 patients with chronic myeloid leukaemia receiving dasatinib or nilotinib after imatinib failure. Left ventricular systolic functions were evaluated using four-dimensional speckle tracking echocardiography derived global longitudinal (GLS), circumferential (GCS), radial (GRS), and area (GAS) strain indices. Mean ejection fraction, stroke volume, cardiac output and left ventricular mass index were similar between control and patient groups and within normal limits. GLS (- 16.7% vs - 20.8%, p < 0.001), GCS (- 13.0% vs - 15.6%, p = 0.002), and GAS (- 26.2% vs - 31.0, p < 0.001) values were significantly higher in the patient population than those of the controls. Dasatinib and nilotinib groups did not show differences regarding strain indices. In multivariate regression analysis, only the usage of dasatinib or nilotinib was found to be an independent risk factor for diminished GAS (β = 4.406, p = 0.016), GLS (β = 3.797, p = 0.001), and GCS (β = 2.404, p = 0.040). Although imatinib, nilotinib, and dasatinib seem to be clinically safe in terms of cardiac function, monitoring of systolic functions using strain imaging, and long-term observation of patients may provide early detection of the possible cardiac toxicity.
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http://dx.doi.org/10.1007/s12012-020-09613-2DOI Listing
March 2021

Is Takayasu's arteritis more severe in children?

Clin Exp Rheumatol 2021 Mar-Apr;39 Suppl 129(2):32-38. Epub 2020 Sep 16.

Hacettepe University Vasculitis Center, and Division of Paediatric Rheumatology, Department of Paediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Objectives: Takayasu's arteritis (TAK) is a chronic vasculitis, affecting predominantly the aorta and/or its major branches. The aim of this study was to compare the differences between childhood and adult onset TAK.

Methods: We retrospectively evaluated 179 TAK patients followed between August 2005 and July 2019. Demographic characteristics, laboratory features, disease activity, echocardiographic data at diagnosis and treatment regimens in the disease course were compared between the paediatric and adult onset patients.

Results: Twenty-five paediatric-onset (<18 years of age at diagnosis) and 154 adult-onset patients (≥18 years of age at diagnosis) were enrolled. The mean age at diagnosis for children and adults were 13.6±4 and 35.6±13, respectively. Paediatric onset TAK patients had more intense inflammation at the time of diagnosis reflected in their clinical findings. Acute phase reactants were high in all paediatric patients and significantly higher in patients with paediatric-onset TAK (p=0.006 and p=0.005, respectively). Abdominal predominant disease was more common in the paediatric group, in contrast, focal disease and aortic arch predominant disease were more common in the adult group. Ascending aortic dilatation, left ventricular hypertrophy and moderate-severe aortic insufficiency were more frequent in echocardiography findings of paediatric onset TAK patients. In comorbidities, hypertension was more common in paediatric TAK patients during follow-up, whereas cerebrovascular disease was more common in adult patients.

Conclusions: Our paediatric onset TAK patients presented with a more severe inflammation and more widespread vascular involvement. Multicentre studies from different geographic areas are needed to verify our observation and understand the underlying causes.
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http://dx.doi.org/10.55563/clinexprheumatol/kr357tDOI Listing
May 2021

Transseptal access through atrial flow regulator device during ventricular tachycardia ablation.

Pacing Clin Electrophysiol 2021 02 22;44(2):378-379. Epub 2020 Sep 22.

Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hacettepe University School of Medicine, Ankara, Turkey.

Novel interventional therapies for heart failure patients are emerging like atrial flow regulator (AFR). Our case showed that endocardial ventricular tachycardia (VT) ablation could be performed safely by passing through the AFR device lumen without additional transseptal puncture in these patients.
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http://dx.doi.org/10.1111/pace.14075DOI Listing
February 2021

Rebuttal to "LAA Closure With Thrombus: There is More To It Than Meets the Eye!"

J Invasive Cardiol 2020 07;32(7):E204-E205

Ankara City Hospital, Cardiology, Üniversiteler Mahallesi Bilkent Cad. No:1 Çankaya/ANKARA, Ankara, Çankaya 06800, Turkey.

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July 2020

Left Atrial Appendage Occlusion in Patients With Thrombus in Left Atrial Appendage.

J Invasive Cardiol 2020 Jun 24;32(6):222-227. Epub 2020 Apr 24.

Ankara City Hospital, Cardiology, Üniversiteler Mahallesi Bilkent Cad. No:1 Çankaya/ANKARA, Ankara, Çankaya 06800, Turkey.

Background: Atrial appendage (LAA) occlusion is a therapeutic option for thromboembolic prevention in atrial fibrillation (AF) patients who have contraindications to oral anticoagulation (OAC) or high risk of bleeding. Traditionally, thrombus in the LAA has been considered a contraindication for LAA occlusion. Recently, resistant thrombus formation in patients using OACs was suggested as an indication for LAA occlusion.

Methods And Results: In this single-center study, we evaluated the safety and efficacy of LAA occlusion in patients with a thrombus in the LAA. Twelve non-valvular AF patients who had a thrombus in the LAA were enrolled. The mean age was 71.8 years (range, 62-83 years). Permanent AF was present in all patients. Mean CHA2DS2-VASc score was 4.9 (range, 2-8) and mean HAS-BLED score was 4.8 (range, 3-6). Thrombi in the LAA were classified as type 1 (proximal to mid) and type 2 (distal) in 3 and 9 patients, respectively. Median follow-up duration was 12 months (interquartile range, 6-24 months). LAA occlusion was performed successfully with Amplatzer Amulet device without any significant periprocedural adverse events in all 12 patients. Transesophageal echocardiography (TEE) was performed at 1 and 6 months post procedure. Cardiovascular and all-cause mortality, significant ischemic cerebrovascular events, worsening heart failure, and major bleeding events did not occur during follow-up. Device-related thrombus was not observed with TEE in any patient.

Conclusion: Our study showed that percutaneous LAA closure could be a therapeutic option for patients with resistant LAA thrombus.
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June 2020

Pulmonary balloon valvuloplasty in a pregnant woman with severe pulmonary stenosis.

Turk Kardiyol Dern Ars 2019 Oct;47(7):619-621

Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Pulmonary valvular stenosis is a rare valvular disease; it accounts for 7% to 12% of all patients with congenital heart disease. Patients with mild or moderate pulmonary stenosis (PS) are usually asymptomatic and the stenosis is often detected incidentally with echocardiography performed for another reason. Severe PS typically presents with symptoms related to increased right ventricular pressure and right heart failure. Valvular heart diseases are associated with increased morbidity and mortality in pregnancy due to cardiovascular alterations that occur during the gestational period, such as increased extracellular volume, a faster heart rate, and decreased venous return due to compression of the vena cava inferior by the enlarged uterus. While mild or moderate PS can be well tolerated in pregnancy, severe PS can lead to maternal and fetal perinatal complications. Presently described is the case of a pregnant patient with severe PS who successfully underwent balloon valvuloplasty in the third trimester.
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http://dx.doi.org/10.5543/tkda.2018.55136DOI Listing
October 2019

The association between serum angiogenin and osteopontin levels and coronary collateral circulation in patients with chronic total occlusion.

Anatol J Cardiol 2019 Aug;22(2):77-84

Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara-Turkey.

Objective: A well-developed coronary collateral circulation lowers both in-hospital and long-term morbidity and mortality limiting the infarct. Angiogenin (AGN) and osteopontin (OPN) are known to be potent inducers of angiogenesis. The aim of the present study was to investigate the relationship between serum ANG and OPN levels and collateral filling grade in subjects with stable coronary artery disease (SCAD).

Methods: A total of 122 age- and gender-matched consecutive patients who were found to have total occlusion (n=70) and no significant stenosis in epicardial coronary arteries (n=52) who underwent coronary angiography due to SCAD between January 2015 and July 2017 were included in the study. AGN and OPN levels were measured using enzyme linked immunosorbent assay. Coronary collateral circulation was graded using Rentrop's classification of collateral filling.

Results: A total of 52 patients (61.60±11.78 years, 61.5% male) without significant epicardial coronary artery stenosis and 70 patients (62.87±8.24 years, 65.7% male) with totally occluded coronary arteries were included in the study. Subjects with total occlusion had significantly higher levels of AGN [122.00 (79.00-623.00) pg/mL vs. 98.00 (18.00-160.00) pg/mL, p<0.001] and OPN [1863.50 (125.00-6500.00) pg/mL vs. 451.00 (112.00- 1850.00) pg/mL, p<0.001] than those without significant stenosis. In addition, AGN [127.00 (87.00-623.00) pg/mL vs. 110.00 (79.00-188.00) pg/mL, p=0.011] and OPN [2681.00 (126.00-6500.00) pg/mL vs. 649.00 (125.00-4255.00) pg/mL, p=0.001] levels were significantly higher in patients with better developed collaterals. Serum AGN and OPN levels were found to be significantly associated with coronary collateral development.

Conclusion: AGN and OPN are associated with better developed coronary collateral circulation and may have therapeutic implications for the promotion of coronary collateral development.
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http://dx.doi.org/10.14744/AnatolJCardiol.2019.88555DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6735440PMC
August 2019

Left Atrial Appendage Transcatheter Occlusion with AMPLATZER™ Amulet™ Device: Real Life Data with Mid-Term Follow-Up Results.

Arq Bras Cardiol 2019 29;113(4):712-721. Epub 2019 Jul 29.

Hacettepe Universitesi Tip Fakultesi - Department of Cardiogly, Ankara - Turkey.

Background: Left atrial appendage (LAA) occlusion is an alternative therapy for atrial fibrillation patients who have high embolic risk and contraindications to anticoagulant therapy.

Objective: To evaluate the feasibility, safety, and mid-term outcomes of percutaneous LAA occlusion, including device-related thrombosis.

Methods: Sixty consecutive patients who had undergone percutaneous LAA occlusion with AMPLATZER™ Amulet™ device from September 2015 to March 2018 were enrolled. Patients were followed for 21 ± 15 months (median - 20 months, interquartile range - 9 to 27 months). The postprocedural assessment was done at the 1(st), 6(th), and 12(th) month. Patients were clinically evaluated, and transesophageal echocardiography was performed at each visit. We evaluated the condition of normality of variables using the Kolmogorov-Smirnov test. P-values < 0.05 were statistically significant.

Results: The most common indication for the procedure was major bleeding with anticoagulants (n: 53, 88.3%). The procedure was completed successfully in 59 (98.3%) patients. Periprocedural mortality was observed in one patient. Postprocedural antiplatelet treatment was planned as dual or single antiplatelet therapy or low-dose anticoagulant therapy in 52 (88.1%), 2 (3.4%), and 5 (8.5%) patients, respectively. We found no clinically significant cerebrovascular events, device-related thrombus, or embolization in any patient during the follow-up. Two (3.4 %) patients presented significant peri-device leak (>3 mm) at the 1st month evaluation, which disappeared at the 12th month follow-up.

Conclusion: We concluded that LAA occlusion using the Amulet™ LAA occluder can be performed with high procedural success and acceptable outcomes.
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http://dx.doi.org/10.5935/abc.20190138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7020865PMC
April 2020

Incidental Findings Diagnosed during Preprocedural Evaluation of TAVR.

Cardiol Res Pract 2019 2;2019:7478608. Epub 2019 Apr 2.

Hacettepe University, Department of Cardiology, Ankara, Turkey.

Introduction: Transcatheter aortic valve replacement is an important therapeutic option for aortic stenosis (AS) patients who have high surgical risk. TAVR is a complex procedure. Proper preparation of the patient is of significant importance for the final success and affects the morbidity and mortality of the TAVR directly. Pre-TAVR computed tomography is one of the corner stones of these preparation steps, and many patients get some incidental diagnoses.

Materials And Methods: In this trial, we have investigated 155 patients who had underwent TAVR between February 2013 and March 2017 at Hacettepe University Adult Hospital Cardiology Clinic.

Results: Total number of incidental diagnoses was 541, and 451 of them were the first diagnoses. Total number of cardiovascular findings and noncardiovascular findings was 369 and 172, respectively. The most common cardiovascular finding is atherosclerotic heart disease (139, 89.6%). The most common noncardiovascular finding is pulmonary nodule (41, 26.4%). 143 of 155 patients had at least one incidental diagnosis after the reassessment, and 33 different diagnoses were identified with computed tomography. The mean STS-PROM was 8.38% (range 2.8% to 23%), and the mean STS-PROM was calculated 9.4% (range 3.6% to 23%) after the reassessment of computed tomography.

Conclusion: Preprocedural evaluation is one of the most important steps in TAVR. Computed tomography imaging provides extensive information, not only for procedure planning. Our findings emphasize that computed tomography has a crucial role for the preprocedural evaluation of TAVR candidates.
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http://dx.doi.org/10.1155/2019/7478608DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6466941PMC
April 2019

Left atrial appendage closure using Amulet device in a patient with prior percutaneous atrial septal defect closure.

Turk Kardiyol Dern Ars 2018 06;46(4):306-308

Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Percutaneous left atrial appendage (LAA) occlusion is an alternative therapeutic option for stroke prevention in patients with atrial fibrillation and contraindications for oral anticoagulation. There are few data available regarding the technical success of percutaneous LAA closure in patients with the previous implantation of an atrial septal defect (ASD) or a patent foramen ovale closure device. This is the description of a case of a successful LAA closure performed with an Amplatzer Amulet occluder device (St. Jude Medical, Inc., St. Paul, MN, USA) in a patient with a previous history of percutaneous ASD.
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http://dx.doi.org/10.5543/tkda.2018.44884DOI Listing
June 2018

Association between reverse electrical remodeling and cardiac fibrosis markers in patients with cardiac resynchronization therapy.

Turk Kardiyol Dern Ars 2018 03;46(2):84-91

Department of Cardiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.

Objective: Cardiac resynchronization therapy (CRT) induces structural and electrical reverse remodeling of the failing heart. However, the association between native QRS narrowing and cardiac fibrosis markers has not been investigated in patients with an implanted CRT device.

Methods: A total of 41 symptomatic patients diagnosed with systolic heart failure who underwent CRT implantation were included in this study. Electrocardiogram findings and cardiac fibrosis marker levels [galectin-3, growth-differentiation factor-15 (GDF-15) and procollagen III N-terminal propeptide (P3TD)] were collected before and 12 months after initiation of biventricular pacing. Reverse electrical remodeling was defined as a decrease in 12-month intrinsic QRS (iQRS) duration by ≥20 milliseconds after CRT implantation.

Results: The median QRS duration decreased from 155 milliseconds (interquartile range [IQR]: 142-178 milliseconds) before CRT to 142 milliseconds (IQR: 130-161 milliseconds) (p=0.001) after 12 months of CRT. According to the predefined criteria, electrical remodeling was detected in 16 (39.0%) patients. The median galectin-3, GDF-15, and P3TD levels were significantly decreased after CRT implantation in patients with electrical remodeling [27.65 ng/mL (IQR: 24.4-35.2 ng/mL) vs 23.00 ng/mL (IQR: 16.0-36.7 ng/mL), p=0.017; 3104 pg/mL (IQR: 2923-4825 pg/mL) vs 2276 pg/mL (IQR: 1294-3209 pg/mL), p=0.002; 0.43 ng/mL (IQR: 0.23-0.64) vs 0.15 ng/mL (IQR: 0.04-0.29 ng/mL), p=0.034, respectively]. The galectin-3, GDF-15, and P3TD levels were not significantly changed in patients without electrical remodeling [26.80 ng/mL (IQR: 23.9-31.5 ng/mL) vs 28.80 ng/mL (IQR: 23.0-34.8 ng/mL), p=0.211; 4221 pg/mL (IQR: 2709-4995 pg/mL) vs 3035 pg/mL (IQR: 2038-4872 pg/mL), p=0.143; and 0.34 ng/mL (IQR: 0.11-0.68 ng/mL) vs 0.21 ng/mL (IQR: 0.09-0.37 ng/mL), p=0.112, respectively].

Conclusion: The results from the small sample used in this study indicated that electrical reverse remodeling after CRT was associated with a decrease in cardiac fibrosis.
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http://dx.doi.org/10.5543/tkda.2017.80236DOI Listing
March 2018

Echocardiographic assessment of regional right ventricular systolic function using two-dimensional strain echocardiography and evaluation of the predictive ability of longitudinal 2D-strain imaging for pulmonary arterial hypertension in systemic sclerosis patients.

Int J Cardiovasc Imaging 2018 Jun 10;34(6):883-892. Epub 2018 Jan 10.

Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Systemic sclerosis (SSc) is a generalized connective tissue disorder, and SSc patients are at risk of developing pulmonary arterial hypertension (PAH). The aims of this study are to evaluate the right ventricular regional systolic function using two-dimensional speckle-tracking echocardiography (2D STE) and to determine the predictive ability of peak longitudinal systolic strain (PLSS) at the RV lateral wall for PAH in SSc patients. 80 SSc patients (mean age 51 ± 12 years) were included in the study. Echocardiography and 2D STE were performed at baseline and after 12 months. RHC was performed only in SSc patients with clinical indications. PLSS at the apical segment of the RV free wall was significantly impaired in PAH patients compared with non-PH patients (-14.6 ± 5.9 vs. - 22.2 ± 7.5%, p = 0.034). PLSS at the basal, mid, and apical segments of the RV free wall was lower in both groups at follow-up compared to baseline, but the drop in strain values was statistically significant only in the non-PH group (p < 0.05). Right atrial area (OR 1.758; p = 0.023), peak tricuspid regurgitation velocity (OR 24.23; p = 0.011) and PLSS at the apical segment of the RV lateral wall (OR 2.47; p = 0.005) were independent predictors of PAH. A cut-off value of - 14.48% PLSS at the apical segment of the RV lateral wall resulted in 100% specificity for predicting PAH in SSc patients. RV pressure overload affects RV systolic function as manifested by impaired RV longitudinal deformation. Evaluating RV regional systolic function with 2D STE could be useful as an additional echocardiographic parameter for screening PAH in SSc patients.
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http://dx.doi.org/10.1007/s10554-018-1299-zDOI Listing
June 2018

Case series of three different scenarios with drug-induced Brugada patterns: fact or fiction?

Turk Kardiyol Dern Ars 2017 Oct;45(7):650-654

Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey.

Brugada syndrome is an inherited cardiac arrhythmia condition characterized by coved-type ST elevation and J point elevation of at least 2 mm in at least 2 of the right precordial electrocardiogram (ECG) leads (V1-3). An increasing number of noncardiac agents, including psychotropic and anesthetic drugs, have been shown to induce a characteristic Brugada ECG pattern, predisposing the patient to fatal ventricular arrhythmias. However, there are scarce data regarding the clinical significance. In this case series, a typical Brugada pattern was unmasked by lithium, valproic acid, and thiocolchicoside; however, the clinical scenario was different in all 3 cases, ranging from an asymptomatic patient to sudden cardiac arrest.
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http://dx.doi.org/10.5543/tkda.2017.02717DOI Listing
October 2017

Evaluating the effects of cardiac resynchronization therapy on pathophysiological pathways of heart failure using surrogate biomarkers.

Cardiol J 2018 5;25(1):42-51. Epub 2017 Oct 5.

Ministry of Health Dışkapı Yıldırım Beyazıt Research and Educational Hospital.

Background: Several studies have investigated the effects of cardiac resynchronization therapy (CRT) on heart failure (HF), but none have evaluated the pathophysiological pathways involved in a single group of patients. Therefore, this study aims to assess the long-term effects of CRT on six different patho-physiological pathways involved in the process of HF by the use of surrogate biomarkers.

Methods: In a group 44 patients with HF, six groups of biomarkers were measured, both at baseline and 1 year after CRT implantation: inflammation (interleukin [IL]-4, IL-6, tumor necrosis fac-tor [TNF]-a, high sensitive C-reactive protein [hsCRP]); oxidative stress (myeloperoxidase [MPO], oxidized low-density lipoprotein [oxLDL], uric acid); extracellular matrix (ECM) remodeling (matrix metalloproteinase [MMP]-2 and -9, galectin-3, procollagen III N-terminal propeptide [prokol-3NT]); neurohormonal pathways (endothelin-1, chromogranin-A); myocyte injury (troponin T, creatine kinase MB fraction [CK-MB]), myocyte stress (B-type natriuretic peptide [BNP]). CRT responders were de-fined as patients with ≥ 15% reduction in left ventricular end-systolic volume at 12 months post-CRT.

Results: At 1-year follow-up, 72.7% (n = 32) of the patients were categorized as CRT responders. In these patients, the levels of IL-6, MPO, oxLDL, MMP-2, galectin-3, troponin T, and BNP were significantly reduced as compared to baseline values. While the biomarkers for myocyte stress (effect size = 0.357; p = 0.001), ECM remodeling (effect size = 0.343; p = 0.015) and oxidative stress (effect size = 0.247; p = 0.039) showed a significant change in the CRT responders during follow-up, the biomarkers for other pathophysiological pathways did not show a significant alteration.

Conclusions: In the present study, a significant reduction was only observed in the biomarkers of myo-cardial stress, ECM remodeling, and oxidative stress among all the CRT responder subjects. (Cardiol J 2018; 25, 1: 42-51).
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http://dx.doi.org/10.5603/CJ.a2017.0111DOI Listing
November 2018

Vitamin D levels predict the response to cardiac resynchronization therapy in patients with systolic heart failure.

Turk Kardiyol Dern Ars 2016 Dec;44(8):670-676

Department of Cardiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.

Objective: The aim of this study was to examine the relationship between vitamin D levels in patients with heart failure (HF) and response to cardiac resynchronization therapy (CRT).

Methods: We studied 57 patients (mean age: 60.47±13.09 years) with New York Heart Association Class II or III heart failure, QRS duration ?120 milliseconds, and ejection fraction <35% (mean: 27.1±4.4%) who underwent CRT. All patients were taking optimal medical treatment for HF. Patients were classified as CRT responders if they had >15% decrease in left ventricular end-systolic volume at 6 months compared with baseline measurements. Vitamin D levels were evaluated before CRT implantation with ELISA.

Results: Of the 57 patients, 34 patients (59.6%) were classified as responders and 23 patients (40.4%) were classified as non-responders. Baseline features, laboratory findings, and echocardiographic characteristics were nearly the same in both groups. High vitamin D level was detected in responder group compared to non-responder group (26.17±7.5 ng/mL vs 21.15±5.9 ng/mL; p=0.009). Age, hypertension, diabetes mellitus, ischemic cardiomyopathy, QRS morphology and duration, and levels of B-type natriuretic peptide (BNP) and vitamin D were associated with CRT response in our study population. In multivariate regression analysis, preimplantation QRS duration, and BNP and vitamin D levels remained independent predictors (QRS duration Odds ratio [OR]: 1.047, CI: 1.019-1.417, p=0.006; BNP OR: 0.997, 95% CI: 0.994-0.999, p=0.029; vitamin D OR: 1.121, 95% CI: 1.011-1.242, p=0.030).

Conclusion: In the present study, preimplantation level of vitamin D was found to be predictor of response to CRT.
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http://dx.doi.org/10.5543/tkda.2016.28848DOI Listing
December 2016

Physical inactivity and low quality of life of Turkish women after hospitalization for coronary heart disease: Inferences from EUROASPIRE III.

Turk Kardiyol Dern Ars 2016 Sep;44(6):488-97

Department of Cardiology, Atatürk Training and Research Hospital, İzmir, Turkey.

Objective: The present objective was to compare changes in lifestyle between (i) Turkish women and Turkish men, and (ii) Turkish women and European women, after hospitalization for coronary heart disease (CHD). Risk factor management, physical activity, mood, and quality of life (QOL) indices were compared.

Methods: A total of 2268 women (25.3% of 8966 patients, mean age: 65.8±9.0 years) were interviewed using the European Action on Secondary and Primary Prevention by Intervention to Reduce Events III (EUROASPIRE III). In the Turkey cohort, 65 women (mean age: 63.3±9.9 years) and 273 men (mean age: 59.1±9.6 years) were interviewed, and underwent clinical and biochemical tests at a minimum of 6 months after hospital admission. Patients completed the Godin Leisure-Time Exercise Questionnaire (GLTEQ), the International Physical Activity Questionnaire (IPAQ), the Hospital Anxiety and Depression Scale (HADS), and questionnaires assessing QOL.

Results: After hospitalization for CHD, (i) Turkish women have lower participation in cardiac rehabilitation (CR) programs and lower physical activity indices than European women, (ii) Turkish women have lower physical activity indices than Turkish men, (iii) HADS anxiety scores and HADS depression scores were higher for Turkish women than for Turkish men, (iv) HADS anxiety scores and HADS depression scores were higher for Turkish women than for European women, (v) QOL indices were lower for Turkish women than for either European women or Turkish men.

Conclusion: Turkish women engage in less physical activity, have lower QOL, and have higher rates of depression and anxiety after hospitalization for CHD than either of the other groups assessed. Every effort should be made to increase physical activity, and CR program adherence in general, particularly in female patients.
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http://dx.doi.org/10.5543/tkda.2016.30788DOI Listing
September 2016

Percutaneous Implantation of the self-expanding valve Prosthesis a patient with homozygous familial hypercholesterolemia severe aortic stenosis and porcelain aorta.

Int J Cardiol 2016 Oct 29;220:661-4. Epub 2016 Jun 29.

Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey.

Transcatheter aortic valve implantation (TAVI) has shown favorable outcomes in patients with severe symptomatic aortic valve stenosis who are at high surgical risk or inappropriate for open heart surgery. However, concerns exist over treating patients who have porcelain aorta and familial hypercholesterolemia, due to the potential complications of aortic root and aortic annulus. In this case report, we present a patient with familial hypercholesterolemia, symptomatic severe aortic stenosis, previous coronary artery bypass grafting and porcelain aorta, who was successfully treated with TAVI using a CoreValve.
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http://dx.doi.org/10.1016/j.ijcard.2016.06.316DOI Listing
October 2016

Prolonged Tp-e interval and Tp-e/QT correlates well with modified Rodnan skin severity score in patients with systemic sclerosis.

Cardiol J 2016 13;23(3):242-9. Epub 2016 May 13.

Department of Cardiology, Memorial Ankara Hospital, Ankara, Turkey.

Background: Ventricular arrhythmias can be seen in systemic sclerosis (SSc) patients and are thought to be a result of fibrosis or ischemia of the ventricular myocardium. Tp-e interval and Tp-e/QT ratio are electrocardiographic (ECG) indices to predict ventricular tachyarrhythmia and cardiovascular mortality. We aimed to evaluate Tp-e interval and Tp-e/QT ratio in patients with SSc.

Methods: A total of 107 patients with SSc (mean age, 48.6 ± 14.0 years; 96 females) and 100 healthy controls (mean age, 49.4 ± 8.6 years; 90 females) were enrolled. The standard 12-lead ECG was recorded; QTc, Tp-e interval and Tp-e/QT ratio were measured. Modified Rodnan skin severity score (MR-SSS) calculated for all SSc patients.

Results: Tp-e interval (90.7 ± 23.8 ms vs. 84.0 ± 20.6 ms, p = 0.032) and Tp-e/QT ratio (0.20 ± 0.05 vs. 0.18 ± 0.04, p = 0.007, respectively) were significantly prolonged in SSc patients than in the control group. Pearson's correlation analyses revealed positive correlations of MR-SSS with QTc (r = 0.427, p = 0.001), Tp-e interval (r = 0.620, p = 0.001) and Tp-e/ /QT ratio (r = 0.615, p = 0.001). MR-SSS (b = 2.108, p = 0.001) and CRP (b = 2.273, p = 0.027) were found to be significant independent predictors of Tp-e interval. Similarly, MR-SSS (b = 0.004, p = 0.001) was only a significant independent predictor of Tp-e/QT ratio among patients with SSc.

Conclusions: The patients with SSc had a prolonged Tp-e interval and Tp-e/QT ratio compared with normal subjects. Furthermore, this prolongation was well correlated with clinical severity score among patients with SSc. Ventricular repolarization dispersion as a predictor of ventricular arrhythmias was found to be diminished in patients with SSc. Patients with SSc, particularly with higher MR-SSS, should be followed closely for adverse cardiovascular outcomes.
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http://dx.doi.org/10.5603/CJ.a2016.0021DOI Listing
March 2017

Monocyte Toll-Like Receptor Expression in Patients With Atrial Fibrillation.

Am J Cardiol 2016 May 17;117(9):1463-7. Epub 2016 Feb 17.

Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Atrial fibrillation (AF) is the most common sustained arrhythmia. Inflammation has been suggested to play a vital role in the pathogenesis. Previous studies have investigated expression of inflammatory markers in AF. Several studies have focused on the effects of toll-like receptors (TLRs) on heart in terms of capability of modulating inflammation. In this study, we aimed to investigate whether peripheral monocyte TLR expression was associated with the AF presence, and recurrence of AF after cryoablation, as a reflection of inflammatory status. Patients with AF who were scheduled for cryoballoon-based ablation for AF and age- and gender-matched subjects in sinus rhythm were included. Peripheral monocyte TLR-2 and TLR-4 expressions were evaluated by flow cytometric analysis in peripheral venous blood samples obtained during evaluation in outpatient clinics: 172 patients (56.5 ± 6.6 years, 52.3% men) were included in the study. Peripheral monocyte TLR-2 and TLR-4 expression levels were significantly higher in patients with AF (p <0.05). Among patients with AF, 12 patients (14.0%) developed AF recurrence at a follow- up of 17 months. Multivariate Cox regression analysis showed that left atrial volume index (hazard ratio 2.040, 95% CI 1.197 to 3.477, p = 0.009) and monocyte TLR-4 expression (hazard ratio 1.226, 95% CI 1.042 to 1.443, p = 0.014) were independent predictors of AF recurrence after blanking period following second-generation cryoballoon-based pulmonary vein isolation for paroxysmal AF. In conclusion, our study highlights the role of TLR-mediated inflammation in the pathogenesis of AF. This link may also constitute a therapeutic target in patients with AF.
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http://dx.doi.org/10.1016/j.amjcard.2016.02.014DOI Listing
May 2016

Increased left atrial pressure predicts recurrence following successful cryoablation for atrial fibrillation with second-generation cryoballoon.

J Interv Card Electrophysiol 2016 Aug 29;46(2):145-51. Epub 2016 Jan 29.

Department of Cardiology, Faculty of Medicine, Hacettepe University, 06100, Ankara, Sihhiye, Turkey.

Purpose: Several studies have demonstrated that left ventricular diastolic dysfunction (LVDD) and left atrial pressure (LAP), as a surrogate marker of LVDD, were associated with atrial fibrillation (AF) recurrence following radiofrequency catheter ablation (RFCA) for AF. In this study, we aimed to investigate the individual impact of several left ventricular diastolic function parameters on outcomes of cryoablation for paroxysmal AF using second-generation cryoballoon.

Methods: One hundred seventy patients who were scheduled for cryoablation with second-generation cryoballoon were included in this prospective study. All patients underwent comprehensive transthoracic and transesophageal echocardiographic examinations during sinus rhythm a day before catheter ablation. LAP was measured via transseptal sheath at the beginning of the ablation procedure.

Results: One hundred seventy patients (57.09 ± 11.80 years, 47.06 % male) were involved in the study. At a median follow-up of 19 months, when blanking period of 3 months was considered, freedom from AF after a single ablation procedure was 84.71 %. Patients with AF recurrence had significantly greater left atrial volume index (LAVI) (p = 0.005) and LAP (p < 0.001). Patients with AF recurrence had lower septal e' wave (p = 0.013), and higher E/e' ratio (p = 0.014). LAVI (p = 0.007) and LAP (p = 0.006) were independent predictors of AF recurrence. A cut-off value of 13.50 mmHg for LAP measured during the procedure was associated with a sensitivity and specificity of 80.8 and 84.7 % (p = 0.005) for predicting AF recurrence.

Conclusions: Pre-procedural LAVI and procedural LAP measurement have clinical importance in predicting AF recurrence in patients undergoing cryoablation with second-generation cryoballoon. Effectiveness of cryoablation is reduced in patients with greater LAVI and LAP.
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http://dx.doi.org/10.1007/s10840-016-0107-8DOI Listing
August 2016
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