Publications by authors named "Erkan Köklü"

51 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

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

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

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

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

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

Evaluation of mean platelet volume and platelet distribution width in patients with asymptomatic intermediate carotid artery plaque.

Kardiol Pol 2017 7;75(1):35-41. Epub 2016 Oct 7.

Kartal Kosuyolu Research and Education Hospital, Istanbul, Turkey.

Background: Platelets play a significant role in the pathogenesis of atherosclerosis. In atherosclerotic plaques, the risk of plaque rupture is more crucial than the severity of the stenosis they cause. Non-calcified carotid artery plaques are more unstable than calcified plaques, and they are associated with a higher risk of rupture, thromboembolism, and consequently, stroke.

Aim: The purpose of the present study is to compare calcified and non-calcified plaques that cause intermediate carotid artery stenosis, with respect to mean platelet volume (MPV) and platelet distribution width (PDW).

Methods: A total 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 MPV and PDW.

Results: Mean platelet volume was statistically significantly higher in the non-calcified plaque group compared to the cal-cified plaque group (MPV in non-calcified/calcified plaque groups [fL]: 10.0/9.0, respectively) (p < 0.01). PDW was not significantly different between the two groups (p = 0.09). Platelet count was statistically significantly higher in the calcified plaque group compared to the non-calcified plaque group (platelet count in calcified/non-calcified plaque groups [10³/mm³]: 250 ± 63/226 ± 56, respectively) (p = 0.019). Multivariate regression analysis showed that MPV was independently associ-ated with non-calcified carotid artery plaque (odds ratio 5.95, 95% confidence interval 2.63-13.45, p < 0.001).

Conclusions: Mean platelet volume is increased in the presence of non-calcified carotid artery plaques that cause asymp-tomatic intermediate stenosis. Increased MPV can be used as a marker to predict the risk of rupture of the non-calcified carotid artery plaques.
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http://dx.doi.org/10.5603/KP.a2016.0129DOI Listing
July 2017

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

Proximal embolization of Edwards SAPIEN prosthesis in transcatheter aortic valve implantation.

Turk Kardiyol Dern Ars 2016 Jan;44(1):75-8

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

Transcatheter aortic valve implantation (TAVI) is considered an alternative therapy in high-risk patients with severe aortic stenosis (AS). However, this minimally invasive procedure carries potential complications, such as valve embolization at time of TAVI. We present a case of balloon-expandable aortic valve embolization which was managed nonsurgically. Valve embolization was managed conservatively, as the patient refused open heart surgery for definitive treatment. The patient was transferred to the intensive care unit in stable hemodynamic condition and discharged 1 week following the procedure.
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http://dx.doi.org/10.5543/tkda.2015.71240DOI Listing
January 2016

Assessment of Impact of Weight Loss on Left and Right Ventricular Functions and Value of Tissue Doppler Echocardiography in Obese Patients.

Echocardiography 2016 Jun 29;33(6):854-61. Epub 2016 Jan 29.

Department of Cardiology, Ankara Ataturk Education and Research Hospital, Ankara, Turkey.

Objective: In our study, we aimed to evaluate the effect of weight loss on left and right ventricular functions in obese patients.

Methods: Thirty patients with a BMI greater than 30 kg/m(2) and without any exclusion criteria were included in the study. Left ventricular systolic and diastolic functions were assessed with conventional and tissue Doppler echocardiography (TDE). At the end of 3 months, echocardiographic examination was repeated in patients with weight loss for cardiac function evaluation and it was compared to the baseline echocardiographic parameters.

Results: At the end of 3 months of weight loss period, conventional Doppler echocardiography revealed an improvement in diastolic functions 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 ascertained shortened and Tei index decreased. TDE showed an increase in left ventricular lateral wall systolic wave (Sm) and E-wave velocity (Em). Mitral septal annular isovolumetric acceleration time (IVA), Sm and Em, were found to be increased, whereas Tei index was ascertained reduced. Right ventricular tissue Doppler examination following weight loss revealed an increase in RV- IVA, RV-Sm, and RV-Em, and a decrease in Tei index.

Conclusion: We disclosed that left ventricular structural changes and diastolic dysfunction occur in obese patients, and by weight loss, these abnormalities may be reversible which we demonstrated both by conventional and TDE. In addition, obesity might impair RV function as well, and we observed an enhancement in right ventricular functions by weight loss.
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http://dx.doi.org/10.1111/echo.13185DOI Listing
June 2016

Subarachnoid hemorrhage that electrocardiographically mimics acute coronary syndrome: a case report.

Turk Kardiyol Dern Ars 2015 Dec;43(8):730-3

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

Electrocardiography alterations and cardiac enzyme elevation have been reported in patients with cerebrovascular events in various articles. This case reports a case of syncope with an electrocardiography of atrioventricular complete block and extensive ST segment elevation. However, it was finally diagnosed as subarachnoid hemorrhage. To the best of our knowledge, this patient is the first case of subarachnoid hemorrhage mimicking ST elevation myocardial infarction with atrioventricular complete block.
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http://dx.doi.org/10.5543/tkda.2015.26546DOI Listing
December 2015

Is Elevated Neutrophil-to-Lymphocyte Ratio a Predictor of Stroke in Patients with Intermediate Carotid Artery Stenosis?

J Stroke Cerebrovasc Dis 2016 Mar 17;25(3):578-84. Epub 2015 Dec 17.

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

Objective: An increased neutrophil-to-lymphocyte ratio (NLR) is associated with poor clinical prognosis in patients with cardiovascular disease. In this study, we aimed to investigate if there was a correlation between NLR and the risk of stroke in patients with intermediate carotid artery stenosis.

Methods: A total of 254 patients with a 50%-70% stenosis in the carotid artery, 115 of whom were symptomatic and 139 of whom were asymptomatic, were included in the study. Patients with a history of ischemic cerebrovascular event with or without sequelae, transient ischemic attack, and amaurosis fugax in the last 1-6 months were included in the symptomatic group of the study. The symptomatic and asymptomatic groups were compared in terms of total neutrophil count, lymphocyte count, and NLR.

Results: The total white blood cell count (WBC), neutrophil count, and NLR were found to be higher and the lymphocyte count was found to be lower in the symptomatic patients than those in the asymptomatic patients (symptomatic/asymptomatic, respectively, WBC [10(3)/mm(3)]: 9.0/8.2, neutrophil count [10(3)/mm(3)]: 6.1/5.0, NLR: 3.08/2.2, lymphocyte count [10(3)/mm(3)]: 1.9/2.2) (P < .001). The cutoff value for NLR was found to be 2.6 or higher. In the multivariate regression analysis, an NLR value of 2.6 or higher was shown to be an independent variable for carotid artery stenosis to become symptomatic.

Conclusions: NLR is increased in symptomatic intermediate carotid artery stenosis. An increased NLR value is an independent variable for carotid artery plaques to become symptomatic.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2015.10.031DOI Listing
March 2016

A case of transcatheter aortic valve implantation complication with total femoral artery thrombosis due to failure of the ProStar device.

Turk Kardiyol Dern Ars 2015 Oct;43(7):651-4

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

Vascular complications in transfemoral transcatheter aortic valve implantation are relatively frequent and there is increased morbidity and mortality risk in the procedure. This report presents successful surgical repair of a femoral artery thrombosis case following an implantation procedure.
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http://dx.doi.org/10.5543/tkda.2015.47650DOI Listing
October 2015

Predictors of Symptom Development in Intermediate Carotid Artery Stenosis: Mean Platelet Volume and Platelet Distribution Width.

Angiology 2016 08 29;67(7):622-9. Epub 2015 Oct 29.

Cardiology Clinic, Antalya Training and Research Hospital, Antalya, Turkey.

Platelets play an important role in the pathogenesis of atherothrombosis. Platelet activation is associated with increased mean platelet volume (MPV) and platelet distribution width (PDW). In this study, we investigated the relation of MPV and PDW with the risk of stroke in patients with intermediate (50%-70%) carotid artery stenosis. A total of 254 patients (115 symptomatic and 139 asymptomatic) with intermediate carotid artery stenosis were enrolled in this study. Symptomatic and asymptomatic patients were compared in regard to MPV and PDW. Mean platelet volume was significantly greater in the symptomatic group compared with the asymptomatic group (11.1 and 9.4 fL, respectively; P < .001). Platelet distribution width was significantly greater in the symptomatic group compared with the asymptomatic group (15.0% and 11.9%, respectively; P < .001). Multivariate regression analysis showed that an MPV ≥10.2 fL and a PDW ≥14.3% were independent predictors of developing symptomatic carotid artery stenosis. Mean platelet volume and PDW are increased in the presence of symptomatic intermediate carotid artery stenosis. Increased MPV and PDW may be independent predictors of developing symptomatic carotid artery plaque.
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http://dx.doi.org/10.1177/0003319715613916DOI Listing
August 2016

Impact of aortic stiffness on the frequency of paroxysmal atrial fibrillation recurrences.

Acta Cardiol 2015 Aug;70(4):414-21

Background: The relationship between arterial stiffness (AS) and atrial fibrillation (AF) incidence is well-known. In this study we aimed to investigate the relationship between AS parameters and AF occurence as well as AF recurrence post catheter ablation (CA) in patients with paroxysmal AF (PAF).

Methods: We enrolled 103 patients with PAF diagnosis and 103 control subjects with similar demographic characteristics. We measured AS parameters and central aortic pressure (CAP) parameters by an oscillometric device in both groups. In the patient group 51 patients underwent CA for AF and recurrence rates at 3 and 6 months postprocedurally were recorded. AS parameters were compared between patients with and without AF recurrence.

Results: In the PAF patient group central systolic pressure, central diastolic pressure, central pulse pressure, augmentation pressure, augmentation index, and pulse wave velocity were significantly higher than in the control group (for each listed parameter P<0.05). AS parameters were not associated with AF recurrence post CA. Left atrial size (LAS) was found as an independent predictor for recurrence in multivariate analysis (0: 2.30; P = 0.02; OR: 9.97; 95% CI [1.28-77.48]).

Conclusion: Increased AS is associated with PAF occurence. Nevertheless, LAS, a traditional risk factor, was the most powerful predictor for recurrence post CA; whereas AS or CAP were not associated with recurrence.
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http://dx.doi.org/10.1080/ac.70.4.3094650DOI Listing
August 2015

An elderly patient with atresia of the left main stem.

Turk Kardiyol Dern Ars 2015 Sep;43(6):582

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

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http://dx.doi.org/10.5543/tkda.2015.87262DOI Listing
September 2015

An unusual thrombolytic therapy decision in prosthetic valve thrombosis during early pregnancy.

Turk Kardiyol Dern Ars 2015 Sep;43(6):554-7

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

Pregnancy is among the risk factors for mechanical valve thrombosis, and even though thrombolytic therapy is contraindicated during pregnancy, it may be used in the treatment of this life-threatening complication. This case report describes a pregnant patient, whose echocardiogram showed evident gradient increase on her mechanical prosthetic mitral valve, and who was treated successfully with tissue plasminogen activator for mechanical valve thrombosis.
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http://dx.doi.org/10.5543/tkda.2015.68327DOI Listing
September 2015

Nebivolol-induced gynecomastia.

J Pharmacol Pharmacother 2015 Jul-Sep;6(3):166-8

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

Adverse drug reactions play a substantial role in the etiology of gynecomastia. Gynecomastia as an adverse drug reaction, related to some cardiovascular drugs, has been reported in literature. Nebivolol is a third generation beta-blocker, and gynecomastia as an adverse effect on the consumption of this drug has not been reported in any article yet. We herein present the case of a 42-year-old male, who developed bilateral gynecomastia following nebivolol use and complete regression after discontinuation of nebivolol. Other reasons causing gynecomastia were excluded. Discontinuation of the responsible drug is quite sufficient with regard to the treatment of drug-induced gynecomastia, without any pharmacological or surgical treatment.
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http://dx.doi.org/10.4103/0976-500X.162009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4544141PMC
August 2015

Is Acute Carotid Artery Stent Thrombosis an Avoidable Complication?

J Stroke Cerebrovasc Dis 2015 Oct 21;24(10):2219-22. Epub 2015 Aug 21.

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

The most serious complication of carotid artery stenting (CAS) is acute carotid artery stent thrombosis (ACAST). ACAST is a very rare complication, but it may lead to dramatic and catastrophic consequences. The most important cause is inadequate or ineffective antiaggregant therapy. It is very important to identify, before CAS, those patients who might be candidates for ACAST and to start antiplatelet therapy for them. Testing patients who are candidates for CAS for acetylsalicylic acid and clopidogrel resistance may prevent this complication.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2015.05.029DOI Listing
October 2015

Usefulness of mean platelet volume for predicting stroke risk in paroxysmal atrial fibrillation patients.

Blood Coagul Fibrinolysis 2015 Sep;26(6):669-72

aAntalya Training and Research Hospital, Antalya bTürkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey.

Atrial fibrillation is the most common sustained arrhythmia in clinical practice. It is important to specify patients with a high risk of thromboembolus due to elevated procoagulant and prothrombotic state. The aim of this study is to assess the relation of stroke/transient ischaemic attack (TIA) with mean platelet volume (MPV), which is an indicator of platelet activation in patients with paroxysmal atrial fibrillation (PAF). Patients with PAF were enrolled in this study during years of 2012-2014. Patients were divided into two groups according to the presence or absence of stroke/TIA. Demographic data were registered and CHA2DS2VASc scores of patients were calculated. It was investigated whether there was a difference among groups regarding MPV levels. Ninety patients, 31 of whom had history of stroke/TIA (symptomatic group), were enrolled to study. CHA2DS2VASc score of symptomatic group was 4.77 ± 1.26, while CHA2DS2VASc score of asymptomatic group was 2.63 ± 1.41. Nevertheless, there was not any difference regarding CHA2DS2VASc score among two groups when 2 points due to stroke/TIA were subtracted in symptomatic patients. MPV was detected higher in symptomatic patients than asymptomatic patients (11.1 ± 1.3 vs. 9.1 ± 1.0 fL, P < 0.001, respectively). A value of 9.85 for the MPV ascertained with receiver operating characteristic (ROC) curve analysis to predict stroke/TIA was found to have a sensitivity of 87% and specificity of 78%. Elevated MPV levels were ascertained to be related with stroke/TIA in patients with PAF. Assessment of MPV apart from CHA2DS2VASc score in patients with PAF might be subsidiary to specify patients with an enhanced risk of stroke/TIA.
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http://dx.doi.org/10.1097/MBC.0000000000000334DOI Listing
September 2015

Clinical and morphological features of patients who underwent endovascular interventions for lower extremity arterial occlusive diseases.

Postepy Kardiol Interwencyjnej 2015 22;11(2):114-8. Epub 2015 Jun 22.

Antalya Training and Research Hospital, Antalya, Turkey.

Introduction: Patients with peripheral arterial disease (PAD) are at increased risk for all-cause mortality and cardiovascular mortality.

Aim: To present anatomical and morphological characteristics of patients who underwent endovascular stenting with laboratory and our mid-term results.

Material And Methods: One hundred fifty-three patients (mean age: 62.8, 86% male) who underwent percutaneous intervention of lower extremity arteries were included in the study. Demographic characteristics, medical history, physical examination and laboratory findings of patients were analyzed. Patients' lesions were classified according to the TransAtlantic Inter-Society Consensus (TASC). Clinical outcomes included complications and mortality, 6-minute walking distance, functional class (NYHA) and patency rates.

Results: Seventy percent of patients had hypertension, 42% were smokers, 78% had coronary artery disease, 20% had coronary artery bypass grafting, 55% had diabetes mellitus and 71% had dyslipidemia. Six patients with diabetes mellitus and poor wound healing despite medical therapy were treated with stenting leading to alleviation of pain and avoidance of amputation. The initial technical success rate of revascularization was 95.6% (153/160). Our mid-term results show that percutaneous procedures in lower extremity arterial diseases can be performed with low complication and high success rates. Patients' 6-minute walk distance, ankle/brachial index values, functional class and the status of foot ulcers were evaluated.

Conclusions: Especially in patients with distal vascular disease, poor wound healing and no chance of surgical revascularization, percutaneous endovascular revascularization may provide good blood flow and prevent amputation.
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http://dx.doi.org/10.5114/pwki.2015.52284DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4495127PMC
July 2015