Publications by authors named "Göksel Çağırcı"

78 Publications

Supraventricular arrhythmia in mitral valve prolapse : Predictive value of P-wave dispersion and atrial conduction time.

Herz 2021 Apr 21. Epub 2021 Apr 21.

Emergency Medicine Department, SBU Kanuni Sultan Suleyman Training and Research Hospita, Istanbul, Turkey.

Background: The incidence of supraventricular arrhythmia (SVA) is high in patients with mitral valve prolapse (MVP). The purpose of our study was to determine the role of parameters showing atrial conduction heterogeneity such as P‑wave dispersion (PWD) and atrial electromechanical delay (AEMD) in predicting the development of SVA in MVP patients.

Methods: A total of 76 patients with MVP (56 female, 20 male) were included in the study. The patients were divided into two groups according to the presence or absence of SVA: 36 patients were allocated to the non-SVA group and 40 patients to the SVA group. Heart rate variability (HRV), PWD, and AEMD values were determined and compared.

Results: The PWD was found to be higher in the SVA group. Interatrial EMD was 32.00 ms (25.00-35.00) in patients with SVA while it was 18.00 ms in patients without SVA (11.00-23.75); the intra-atrial EMD was 17.0 ms (10.00-20.00) in patients with SVA whereas it was 10.00 ms (4.00-14.00) in patients without SVA. Lower HRV was found in the SVA group.

Conclusion: In the SVA group, PWD and AEMD were increased while HRV values were decreased. Noninvasive parameters may help predict the presence and incidence of SVA during the follow-up of this group of patients.
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http://dx.doi.org/10.1007/s00059-021-05034-1DOI Listing
April 2021

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

Clavipectoral fascial plane block for implantable cardioverter defibrillator implantation.

J Clin Anesth 2021 Feb 15;71:110197. Epub 2021 Feb 15.

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

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http://dx.doi.org/10.1016/j.jclinane.2021.110197DOI Listing
February 2021

An irregular supraventricular tachycardia: What is the mechanism?

Pacing Clin Electrophysiol 2019 12 6;42(12):1586-1588. Epub 2019 Nov 6.

Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey.

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http://dx.doi.org/10.1111/pace.13822DOI Listing
December 2019

Pulmonary vein isolation using multi-electrode radiofrequency vs conventional point-by-point radiofrequency ablation: A meta-analysis of randomized and non-randomized studies.

Indian Pacing Electrophysiol J 2017 Mar - Apr;17(2):36-43. Epub 2017 Feb 20.

Department of Cardiology, Division of Arrhythmia and Electrophysiology, Antalya Education and Research Hospital, Antalya, Turkey.

Aims: Pulmonary vein isolation is effective in reducing atrial fibrillation (AF) episodes. Previous studies suggest single-shot techniques are effective and safe for this purpose. Procedural and clinical outcomes were compared between multi-electrode and point-by-point radiofrequency ablations by performing a meta-analysis of all randomized and non-randomized studies.

Methods And Results: Systematic reviews of MEDLINE and Cochrane Library databases were performed. Studies comparing procedural (procedure and fluoroscopy times) and clinical (AF recurrence) outcomes were included in the meta-analysis. A total of 13 clinical studies (5 randomized and 8 non-randomized) including 2152 patients met the inclusion criteria. In patients underwent multi-electrode ablation, there were significant reductions in both total procedure and fluoroscopy times, compared with point-by-point ablation (mean difference = -34.3 min [95% CI (-50.1 to -18.5)], p < 0.001 and mean difference = -7.1 min [95% CI (-12.0 to -2.2)], p < 0.01, respectively). These significances also continued in patients with paroxysmal AF. No such difference was observed in regard to AF recurrence between the 2 ablation strategies (RR = 0.90 [95% CI (0.80-1.01)], p = 0.066). This insignificance was also observed in patients with paroxysmal AF.

Conclusions: In a heterogeneous AF population, multi-electrode ablation is as effective as point-by-point ablation, with better procedural and fluoroscopy durations.
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http://dx.doi.org/10.1016/j.ipej.2017.02.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5405748PMC
February 2017

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Vitamin D Trials and Their Limitations.

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

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

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

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

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

Assessment of Aortic Elasticity in Patients with Celiac Disease.

Korean Circ J 2016 Mar 21;46(2):239-45. Epub 2016 Mar 21.

Internal Medicine Department, Antalya Education and Research Hospital, Antalya, Turkey.

Background And Objectives: Celiac disease (CD) is a chronic autoimmune disorder induced by dietary gluten intake by individuals who are genetically sensitive. Many studies report an increased risk of cardiovascular diseases in such patients. The aim of this study is to assess aortic elasticity properties in patients with CD that may be associated with an increased risk of cardiovascular disease.

Subjects And Methods: Eighty-one patients diagnosed with CD by antibody test and biopsy and 63 healthy volunteers were included in this prospective study. Electrocardiographic and echocardiographic examinations were performed.

Results: The CD group did not have any differences in the conventional echocardiographic parameters compared to the healthy individuals. However, patients in the CD group had an increased aortic stiffness beta index (4.3±2.3 vs. 3.6±1.6, p=0.010), increased pressure strain elastic modulus (33.6±17.0 kPa vs. 28.5±16.7 kPa, p=0.037), decreased aortic distensibility (7.0±3.0×10(-6) cm(2)/dyn vs. 8.2±3.6×10(-6) cm(2)/dyn, p=0.037), and similar aortic strain (17.9±7.7 vs. 16.0±5.5, p=0.070) compared to the control group. Patients with CD were found to have an elevated neutrophil/lymphocyte ratio compared to the control group (2.54±0.63 vs. 2.24±0.63, p=0.012). However, gluten-free diet and neutrophil/lymphocyte ratio were not found to be associated with aortic elasticity.

Conclusion: Patients with CD had increased aortic stiffness and decreased aortic distensibility. Gluten-free diet enabled the patients with CD to have a reduction in the inflammatory parameters whereas the absence of a significant difference in the elastic properties of the aorta may suggest that the risk of cardiovascular disease persists in this patient group despite a gluten-free diet.
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http://dx.doi.org/10.4070/kcj.2016.46.2.239DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4805569PMC
March 2016

Evaluation of the association between stroke/transient ischemic attack and atrial electromechanical delay in patients with paroxysmal atrial fibrillation.

Anatol J Cardiol 2016 Aug 25;16(8):572-578. Epub 2015 Nov 25.

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

Objective: This study aimed to evaluate the association between the history of stroke/transient ischemic attack (TIA) and inter- and intra-atrial electromechanical delay (EMD) in patients with paroxysmal atrial fibrillation (PAF).

Methods: Patients diagnosed with PAF were included in this retrospective study. Patients who had a history of stroke or TIA were defined as the symptomatic group, whereas those who did not have such a history were defined as the asymptomatic group. On the basis of the transthoracic echocardiographic records, atrial electromechanical coupling (time interval from the onset of the P wave on the surface electrocardiogram to the beginning of the A' wave interval with tissue Doppler echocardiography) and intra- and interatrial EMD were measured.

Results: In this study, 160 patients were included, 52 of whom were symptomatic. While the intra-left atrial EMD was 68.2±6.1 ms in the symptomatic group, it was found to be 50.8±6.5 ms in the asymptomatic group (p<0.001). Interatrial EMD was 91.3±5.0 ms in the symptomatic group, whereas it was 71.5±7.0 ms in the asymptomatic group (p<0.001). In multiple logistic regression analysis, intra-left atrial [odds ratio (OR): 1.417, 95% confidence interval (CI): 1.193-1.684, p<0.001] and interatrial EMDs (OR: 1.398, 95% CI: 1.177-1.661, p<0.001) were found to be independently associated with the presence of stroke/TIA.

Conclusion: Prolonged inter- and intra-left atrial EMDs in patients with PAF is associated with stroke/TIA. Evaluating this parameter in addition to the CHA2DS2-VASc score in patients with PAF may be helpful in identifying patients who are at a high risk of stroke/TIA.
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http://dx.doi.org/10.5152/AnatolJCardiol.2015.6424DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5368512PMC
August 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

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

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

Corrected balloon occlusive diameter to determine device size during percutaneous atrial septal defect closure.

Turk Kardiyol Dern Ars 2015 Jul;43(5):420-6

Department of Pediatric Cardiology, Atatürk University Faculty of Medicine, Erzurum, Turkey.

Objective: The aim of this trial was to investigate the impact of corrected balloon occlusive diameter (cBOD) on successful performance of percutaneous atrial septal defect (ASD) closure.

Methods: The trial comprised 86 patients (60 female, 26 male; mean age 36.5±14.3) on whom percutaneous ASD closure was performed. Patients were evaluated using transesophageal echocardiography (TEE). Relation of the defect to surrounding tissues and size of rims was also investigated. Balloon sizing was performed intraoperatively on all patients. Size of device was ascertained according to both durability of rims and whether or not they formed significant indentation, both of which determine cBOD.

Results: The ASD closure device was successfully implanted in 84 (97.5%) patients. Mean maximum defect size was 17.4±5.9 mm, and mean color flow diameter was 16.8±5.4 mm. Mean maximum defect size at the moment of loss of shunt flow was 18.4±5.9 mm with TEE, and 18.8±6.1 mm with fluoroscopy. Mean size of Amplatzer occluder device was 20.0±6.5 mm. Device embolization was observed in 2 patients. However, no death occurred during or after the procedure.

Conclusion: Percutaneous secundum ASD closure is a safe and effective treatment modality in experienced centers. Utilizing corrected balloon occlusive diameter may be of benefit in deciding the size of ASD occluder device.
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http://dx.doi.org/10.5543/tkda.2015.68217DOI Listing
July 2015

The Relationship between Spontaneous Multi-Vessel Coronary Artery Dissection and Celiac Disease.

Korean Circ J 2015 May 27;45(3):242-4. Epub 2015 May 27.

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

Celiac disease (CD) is an immune-mediated enteropathy involving the small intestines. Genetic and environmental risk factors as well as autoimmunity have been linked to its etiology. Studies have shown that coronary artery disease, autoimmune myocarditis, arrhythmias and premature atherosclerosis are more prevalent in individuals with CD compared to individuals without the disease. In this case report a young male patient with CD presented with acute myocardial infarction with spontaneous coronary artery dissections of two vessels. To the best of our knowledge, this is the first case report of spontaneous multi-vessel coronary artery dissection in a patient with CD.
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http://dx.doi.org/10.4070/kcj.2015.45.3.242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4446819PMC
May 2015

Assessment of Left Atrial Function in Patients with Celiac Disease.

Echocardiography 2015 Dec 28;32(12):1802-8. Epub 2015 Apr 28.

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

Background: There is some evidence suggesting increased risk of atrial fibrillation (AF) in patients with celiac disease (CD). Impaired left atrial function plays a significant role in the development of AF. This study aimed at assessing the electrical and mechanical functions of the left atrium in patients with CD.

Methods: A total of 71 patients with biopsy-proven, antibody-positive CD and 52 age-matched healthy controls were included in this prospective study. P-wave dispersion (PWD) was measured to assess the electrical functions of the left atrium through the use of surface electrocardiography. A tissue Doppler echocardiography was performed to determine the atrial conduction and electromechanical delay (EMD) time. To evaluate the mechanical functions of the left atrium, maximum, minimum, and presystolic atrial volumes were estimated to calculate the contractile, conduit, and reservoir functions.

Results: In terms of transthoracic echocardiographic parameters, CD and control subjects were not significantly different. However, as compared to controls, patients with CD had significantly increased PWD (median 52 ms [interquartile range 46-58 ms] vs. 38 [36-40], P < 0.001). Also, significantly higher interatrial (49 ms [32-60] vs. 26 ms [22-28], P < 0.001), intra-left atrial (26 ms [17-44] vs. 14 ms [12-18], P < 0.001), and intra-right atrial (15 ms [8-22] vs. 10 ms [8-14], P < 0.001) EMD was found among CD subjects than controls. Despite an increase in the left atrial volume in patients with CD, conduit and reservoir functions were comparable.

Conclusions: Although atrial mechanical functions are preserved in patients with CD, a slower electrical conduction was found, suggesting an increased risk of AF in this group of patients.
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http://dx.doi.org/10.1111/echo.12963DOI Listing
December 2015

Assessment of morphology of patent foramen ovale with transesophageal echocardiography in symptomatic and asymptomatic patients.

J Stroke Cerebrovasc Dis 2015 Jun 20;24(6):1282-6. Epub 2015 Apr 20.

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

Background: The frequency of patent foramen ovale (PFO) is greater in patients who have had a stroke and transient ischemic attack (TIA) than that in the general population. However, it is not well defined, which PFO would cause stroke or TIA. In this trial, we aimed to evaluate whether there was a difference regarding morphologic features of PFO in patients who were symptomatic (cryptogenic stroke or history of TIA) or asymptomatic according to the neurologic findings.

Methods: Symptomatic patients with PFO and cryptogenic stroke or TIA and asymptomatic patients with PFO who were symptomatic in terms of neurologic findings as well as patients without any neurologic symptoms in whom PFO was diagnosed incidentally by transesophageal echocardiography were enrolled to this retrospective study on the condition that they were aged younger than 55 years. Not only the clinical and demographic characteristics of 2 groups were compared but also their morphological features were assessed. The morphologic features of PFO that were assessed included the length and height of tunnel, atrial septal excursion distance, thickness of septum primum, and thickness of septum secundum.

Results: One hundred fifty-six patients, 64 of whom were symptomatic, were enrolled to this study. The height of PFO (median, 3.0 [interquartile range, 2.0-3.8]mm versus 2.0 [2.0-2.0]mm, P < .001), thickness of septum secundum (5.0 [5.0-7.0] versus 3.0 [2.0-3.0], P < .001), and septal excursion distance (7.0 [6.0-10.5] versus 4.0 [4.0-5.0], P < .001) were found to be greater in the symptomatic group than those in the asymptomatic group. There was no significant difference regarding the length of tunnel and thickness of septum primum. The ratio of length to height of PFO tunnel was less in the symptomatic group (3.0 [3.0-3.23] versus 5.0 [4.0-6.25], P < .001).

Conclusions: Our findings appear to indicate that a higher PFO tunnel, relatively greater interatrial septal mobility, thicker septum pellucidum, and the presence of an atrial septal aneurysm may help identifying the subjects at the age of or younger than 55 years with PFO who are at greater risk for cryptogenic stroke or TIA.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2015.01.036DOI Listing
June 2015