Publications by authors named "Ismail Dogu Kilic"

66 Publications

Severe Preeclampsia is Associated with Functional and Structural Cardiac Alterations: A Case-control Study.

Z Geburtshilfe Neonatol 2021 Apr 9. Epub 2021 Apr 9.

Department of Cardiology, Pamukkale University, Denizli, Turkey.

Background: The aim of the current study is to compare electrocardiographic and echocardiographic changes in patients with severe preeclampsia (PE) and those with uncomplicated pregnancies.

Methods: This is a case-controlled prospective study consisting of 21 pregnant women with severe preeclampsia and a control group consisting of age- and gestational age-matched 24 healthy pregnant women. All patients underwent electrocardiographic and echocardiographic investigation.

Results: QRS intervals were shorter and PR intervals were longer in the PE group (QRS duration: 80 (60-120) ms and 80 (40-110) ms, p=0.035; PR duration: 160 (100-240) ms and 120 (80-200) ms, respectively; p=0.046). The left ventricular end-systolic diameters of the patients with severe PE group were significantly larger than the control group (31 (24-36) mm and 30 (24-33) mm, respectively; p=0.05). Similarly, posterior wall thickness values of the PE group were significantly higher compared to the control group (9 (7-11) mm vs. 8 (6-10) mm, respectively; p=0.020). Left ventricular mass (146.63±27.73 g and 128.69±23.25 g, respectively; p=0.033) and relative wall thickness values (0.385±0.054 and 0.349±0.046, respectively; p=0.030) were also higher in the PE group. In addition, patients with early-onset severe PE had significantly a higher left ventricular end-diastolic diameter and volume compared with late-onset PE patients.

Conclusions: The structural changes detected in the severe PE group suggest a chronic process rather than an acute effect. In addition, diastolic dysfunction and left ventricular remodeling are most marked in patients with severe early-onset PE.
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http://dx.doi.org/10.1055/a-1403-3585DOI Listing
April 2021

Interarm blood pressure differences and 2-year mortality in acute coronary syndrome patients.

Blood Press Monit 2021 Mar 15. Epub 2021 Mar 15.

Department of Cardiology, Pamukkale University, Denizli Department of Cardiology, Hamidiye Sisli Etfal Training and Research Hospital, Istanbul Department of Cardiology, Ceylanpinar State Hospital, Sanliurfa Department of Cardiology, Memorial Bahcelievler Hospital, Istanbul Department of Cardiology, Denizli State Hospital, Turkey Department of Cardiology, Elias University Hospital Department of Cardiology, Carol Davila University of Medicine, Bucharest, Romania Department of Biostatistics, Pamukkale University, Denizli, Turkey.

Background And Aims: Interarm blood pressure difference (IABPD) was associated with increased cardiovascular and all-cause mortality in various cohorts previously. In this study, we planned to explore the association between the IABPD obtained with simultaneous measurements in both arms and the risk of mortality over a 2-year follow-up of patients with acute coronary syndrome (ACS).

Methods: Simultaneous blood pressure (BP) measurements were performed during initial admission in patients with ACS. Systolic ≥10 mmHg and diastolic ≥5 mmHg absolute IABPD was defined as cutoff values in this study. The relationship of IABPD and all-cause mortality was assessed using Kaplan-Meier curves and Cox analysis.

Results: A total of 532 patients with ACS were included in the study. Mean age of the study participants was 60.1 ± 12.6. Patients included in the study were followed for 23.2 ± 7.2 months (median 25.3, min: 0, max: 28.7 months). Survival was assessed using Kaplan-Meier curves. Patients with systolic IABPD ≥ 10 mmHg and systolic IABPD < 10 mmHg had an average survival time of 25.94 ± 0.84 and 25.92 ± 0.38 months (P = 0.925), respectively. Survival times of diastolic IABPD ≥5 mmHg and diastolic IABPD <5 mmHg were 26.44 ± 0.62 and 25.71 ± 0.41 (P = 0.251) months, respectively.

Conclusions: In the current study, we did not find a significant association between IABPD and all-cause mortality in patients with ACS in 2-years follow-up. Future studies may be required for further evaluation of the prognostic importance of IABPD in patients with ACS.
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http://dx.doi.org/10.1097/MBP.0000000000000526DOI Listing
March 2021

Feasibility of Same-Day Discharge Approach After Transcatheter Mitral Valve Repair Procedures.

J Invasive Cardiol 2021 Feb 14;33(2):E123-E126. Epub 2021 Jan 14.

UT Houston MD Anderson Cancer Center, Houston, TX and University of Hawaii John Burns Medical School, Honolulu, Hawaii, USA.

Introduction: Early discharge strategies are increasingly adopted after percutaneous cardiac interventions. However, there is a paucity of data on early discharge after transcatheter mitral valve repair (TMVRep) procedures. In this report, we aimed to present our data on same-day discharge after MitraClip (Abbott Structural) procedures.

Methods: A total of 82 patients who underwent TMVRep and were discharged the same day were included in the study. Patients who underwent the procedure with moderate conscious anesthesia, and without periprocedural complications and a stable early course post procedure, were considered candidates for same-day discharge. A next-day follow-up exam at the cardiology clinic was scheduled for all patients for removal of the groin access figure-of-eight subcutaneous sutures and for echocardiographic examination.

Results: Thirty-nine patients had primary mitral regurgitation (MR), while 43 patients had secondary MR. A mean of 1.4 ± 0.4 clips were implanted per patient (range, 1 to 2 clips). Postprocedural MR grade was 1+ or lower in 64 patients (63.6%) and 2+ in 38 patients (36.4%). All patients were evaluated in the office clinic the next day, and had no major complications.

Conclusion: Same-day discharge approach can be safely performed in selected patients after TMVRep procedures. However, further studies with larger sample sizes are needed.
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February 2021

Association between endometriosis and increased arterial stiffness.

Kardiol Pol 2021 01 8;79(1):58-65. Epub 2020 Dec 8.

Background: Endometriosis is a common gynecologic disease associated with systemic inflammation and atherogenic risk factors. Therefore, women with endometriosis may have increased cardiovascular risk.

Aims: We aimed to evaluate arterial stiffness using cardio-ankle vascular index (CAVI) in women with and without endometriosis.

Methods: We enrolled 44 patients with endometriosis and 76 age‑matched controls without endometriosis.Endometriosis was diagnosed based on histopathologic examination or magnetic resonance imaging. Arterial stiffness was evaluated using CAVI in all study participants.

Results: No differences were observed between patients and controls in terms of age (median [interquartile range, IQR], 30 [24.25-5] years and 26 years [24-35] years, respectively), body mass index (median [IQR], 23.31 [20.82-24.98] kg/m2 and 23.74 [21.13-26.78] kg/m2, respectively), or waist circumference (median [IQR], 69 [64-75] cm and 72 [65-81.25] cm, respectively). C‑reactive protein levels were higher in women with endometriosis than in controls (median [IQR], 0.27 [0.14-0.68] mg/dl vs 0.12 [0.06-0.24] mg/dl; P <0.001). Left ventricular ejection fraction, left ventricular mass index (LVMI), relative wall thickness, as well as systolic and diastolic blood pressures were similar in both groups. Women with endometriosis had higher CAVI than controls (mean [SD], 5.961 [0.644] vs 5.554 [0.654]; P = 0.001). Elevated arterial stiffness was observed in the endometriosis group also after adjustment for age and LVMI.

Conclusions: Our results indicate increased arterial stiffness measured by CAVI in women with endometriosis. Therefore,clinicians should be aware that these patients may be at increased cardiovascular risk.
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http://dx.doi.org/10.33963/KP.15706DOI Listing
January 2021

Drug-eluting stent, drug eluting balloon controversy in peripheral artery disease; what is the verdict?

Catheter Cardiovasc Interv 2020 11;96(6):1315-1316

Med/Card, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, USA.

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http://dx.doi.org/10.1002/ccd.29355DOI Listing
November 2020

The Effects of Endobronchial Coil Therapy on Right Ventricular Functions.

COPD 2020 12 9;17(6):699-705. Epub 2020 Nov 9.

Department of Cardiology, Pamukkale University Hospitals, Denizli, Turkey.

Lung hyperinflation is an important therapeutic target in symptomatic emphysema patients. Endobronchial therapies that reduce end-expiratory lung volume are increasingly being used in advanced cases. However, there is paucity of data regarding the effects of these therapies on the heart functions. The aim of this study is to evaluate the right ventricular functions before and after the procedure in patients who underwent endobronchial coil therapy (EBCT).Patients who were between 18 and 80 years of age and scheduled for EBCT with GOLD 3-4 were enrolled in the study. Right heart functions were evaluated using MPI, TAS, TAPSE. Right atrium area and maximum velocity of tricuspid regurgitation were also noted.A total of 23 patients were enrolled in the study. 21 patients underwent bilateral intervention, while only 2 patients received unilateral treatment. There was an improvement in MPI (0.49 ± 0.15 vs 0.39 ± 0.11,  < 0.001) and TAS (11.6 (9 - 15) vs 13.2 (9.80 - 17.0),  = 0.001). Peak TRV (2.52 ± 0.6, 2.38 ± 0.6,  = 0.02) and PASP values were lower in the post-operative period (41.15 ± 5.94 vs 36.83 ± 8.01  = 0.019).In this current study, we found improved echocardiographic RtV parameters in patients who received EBCT treatment.
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http://dx.doi.org/10.1080/15412555.2020.1839875DOI Listing
December 2020

Arterial stiffness measured by cardio-ankle vascular index is greater in non-obese young women with polycystic ovarian syndrome.

J Obstet Gynaecol Res 2021 Feb 4;47(2):521-528. Epub 2020 Nov 4.

Department of Obstetrics and Gynecology, Pamukkale University Medical School, Denizli, Turkey.

Aim: The association of metabolic abnormalities and polycystic ovarian syndrome (PCOS) has been documented, but few studies have focused on cardiovascular risk in these women. The aim of this study was to compare arterial stiffness by using the cardio-ankle vascular index (CAVI) in PCOS women with controls, and to evaluate whether any clinical or laboratory variables had independent associations with it.

Methods: A group of 160 women, matched for age and body mass index were recruited. Diagnosis of PCOS was made according to the Rotterdam criteria. Arterial stiffness using CAVI was evaluated in non-obese young woman, with and without PCOS.

Results: In the PCOS group (n = 80), 60 cases (75%) had findings of hyperandrogenism, 59 (73.8%) had ovulatory dysfunction, and 70 (87.5%) had an ultrasonographic appearance of polycystic ovaries. Women with PCOS had significantly higher mean CAVI values when compared to subjects without PCOS (5.78 ± 0.64 vs 5.28 ± 0.77, P < 0.001). Multiple regression analysis revealed that androgen excess was associated with increased arterial stiffness, independent of ovulatory dysfunction, polycystic ovaries, body mass index and age.

Conclusion: This data suggests that vascular compliance is decreased in young women with PCOS. Androgen excess is independently associated with increased arterial stiffness.
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http://dx.doi.org/10.1111/jog.14543DOI Listing
February 2021

Intra-coronary Imaging for the Evaluation of Plaque Modifications Induced by Drug Therapies for Secondary Prevention.

Curr Atheroscler Rep 2020 Oct 6;22(12):76. Epub 2020 Oct 6.

Cardio-toraco-vascular Department, Careggi University Hospital, Florence, Italy.

Purpose Of Review: Patients diagnosed with coronary artery disease are at a high risk of subsequent cardiovascular events; therefore, secondary prevention in the form of therapeutic lifestyle changes, and drug therapies is vital. This article aims to review potential application of intra-coronary imaging for the evaluation of plaque modifications, induced by medications for secondary prevention for CAD.

Recent Findings: Intra-coronary imaging provides detailed information on the atherosclerotic plaque which is the primary pathological substrate for the recurrent ischemic cardiovascular events. These modalities can detect features associated with high risk and allow serial in vivo imaging of lesions. Therefore, intravascular imaging tools have been used in landmark studies and played a role in improving our understanding of the disease processes. Changes in size and plaque composition over time can be evaluated by these tools and may help understanding the impact of a treatment. Moreover, surrogate imaging end points can be used when testing new drugs for secondary prevention.
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http://dx.doi.org/10.1007/s11883-020-00890-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538414PMC
October 2020

Molecular and Biochemical Parameters Related to Plasma Mannose Levels in Coronary Artery Disease Among Nondiabetic Patients.

Genet Test Mol Biomarkers 2020 Sep 6;24(9):562-568. Epub 2020 Aug 6.

Department of Cardiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey.

Nondiabetic patients were studied to determine whether modest elevations in plasma mannose may be associated with a greater incidence of coronary artery disease (CAD). Plasma insulin, mannose, glucose, hexokinase 1-2, GLUT1-GLUT4 levels, and serum mannose phosphate isomerase enzyme levels were evaluated with respect to subsequent CAD using records from 120 nondiabetic CAD patients and 120 healthy volunteers. CAD was identified from myocardial infarction and new diagnoses of angina. Of 120 nondiabetic CAD patients studied, their plasma GLUT4 and HK1 levels were significantly lower than those of the control group. In addition, a significant increase in plasma mannose levels was found in the patient group compared to the control group. Our findings showed that elevated baseline mannose levels in plasma are associated with an increased risk of CAD over time.
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http://dx.doi.org/10.1089/gtmb.2020.0095DOI Listing
September 2020

Genome-wide DNA Methylation Profiling of Blood from Monozygotic Twins Discordant for Myocardial Infarction.

In Vivo 2020 Jan-Feb;34(1):361-367

Department of Molecular, Cell and Developmental Biology, David Geffen School of Medicine, University of California, Los Angeles, CA, U.S.A.

Background/aim: This study aimed to measure the DNA methylation state of thousands of CpG islands in the blood of two monozygotic twins that were discordant for cardiovascular disease (CVD). Twin 1 had suffered myocardial infarction, while the other was healthy.

Patients And Methods: Since the aim of this study was to identify differentially methylated regions which might act as potential markers, reduced-representation bisulfite libraries were used for whole-genome methylation analysis.

Results: According to the analysis, 11 genes lipid droplet associated hydrolase (LDAH), apolipoprotein B (APOB), acyl-CoA synthetase medium chain family member 2A (ACSM2A), acyl-CoA synthetase medium chain family member 5(ACSM5), acyl-CoA synthetase family member 3 (ACSF3), carboxylesterase 1 (CES1), carboxylesterase 1 pseudogene 1 (CES1P1), AFG3 like matrix AAA peptidase subunit 2 (AFG3L2), iron-sulfur cluster assembly enzyme (ISCU), SEC14 like lipid binding 2 (SEC14L2) and microsomal triglyceride transfer protein (MTTP) were all hypomethylated in DNA from twin 2, the unaffected twin. Methylation changes were observed at different multiple loci between the twins, suggesting loci that are affected by disease status in identical genetic backgrounds.

Conclusion: This twin study may contribute significantly to the understanding of the genetic basis of CVD and resulting myocardial infarction. This approach may allow identification of possible target loci associated with aberrant epigenetic regulation in CVD.
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http://dx.doi.org/10.21873/invivo.11782DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6984093PMC
June 2020

Peripheral blood mononuclear cell microRNAs in coronary artery disease.

J Cell Biochem 2020 04 1;121(4):3005-3009. Epub 2019 Dec 1.

Department of Cardiology, Pamukkale University Hospital, Denizli, Turkey.

The accuracy of risk prediction for coronary artery disease can be improved with the use of novel molecular or genetic biomarkers. In this study, we investigated the difference of five selected microRNAs (miR or miRNA) in patients with coronary artery disease (CAD) and controls, assessed by coronary angiography. The study population consisted of 85 subjects, aged between 18 and 75 years and underwent invasive coronary angiography. Subjects with more than 30% stenosis in at least one coronary artery, patients with a history of prior percutaneous coronary intervention or coronary by-pass surgery were allocated to the patient group; whereas the subjects without at least 30% stenosis consisted the control group. Groups were similar in age, presence of hypertension, and smoking status. However, the proportion of males and subjects taking angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta blockers, nitrates, and statins were higher in the patient group. miR-221 and miR-155 were downregulated (P = .02 and .001, respectively), while miR-21 levels were significantly increased (P = .003) in the patient group compared to controls. Changes in miR-145 and miR-126 did not reach statistical significance (P > .05). miRNA- 21, miR-155, and miR-221 were differentially expressed between the patients and controls. miRNAs are promising biomarkers for CAD diagnosis, however, this requires further research with larger groups.
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http://dx.doi.org/10.1002/jcb.29557DOI Listing
April 2020

Predictive Value of Endoplasmic Reticulum Stress Markers in Low Ejection Fractional Heart Failure.

In Vivo 2019 Sep-Oct;33(5):1581-1592

Department of Cardiology, Pamukkale University Medical Faculty, Denizli, Turkey.

Background/aim: Endoplasmic reticulum (ER) stress plays a critical role in the development of cardiac hypertrophy and heart failure. Heart failure is a crucial health problem that affects 23 million people worldwide, causes approximately 2.4 million people to be hospitalized every year in the USA, and leads to the death of more than 300,000 people. In this study, we aimed to investigate the clinical significance of ER stress markers and the predictive value of acute decompensated heart failure in patients with low ejection fraction heart failure (ADHF).

Patients And Methods: This is a prospective case control study. The data included laboratory parameters pertaining to patients with ADHF in the emergency service and lipid parameters obtained during their admission to the hospital. In addition, the same parameters obtained from the control group patients with chronic heart failure (CHF) during their routine polyclinic control were recorded in the data set. Admission time to the hospital and length of hospital stay were included in the data. The levels of glucose regulated protein (GRP78), protein kinase RNA-like endoplasmic reticulum kinase (PERK), and C/EBP homologous protein (CHOP) in peripheral blood serum obtained from the patients and the control group were measured using the ELISA method.

Results: Serum GRP78 concentration was lower in the HF group (p=0.003) compared to the control. The median value of serum PERK concentration in the HF group was higher than that of the control group (573 pg/ml, IQR=477.5-650 vs. 495.5 pg/ml, IQR=294-648, respectively) (p=0.001). However, there were no statistically significant differences in GRP78 and PERK serum concentrations between ADHF and CHF subgroups. Receiver operating characteristic (ROC) curve analysis showed greater area under the curve (AUC) for the serum GRP78 levels of the healthy individuals (AUC=0.748, 95% CI=0.681-0.814, p=0.0003). The serum GRP78 level was found to be 80% sensitive and 70% specific at 147.5 pg/ml (p=0.0003) for distinguishing healthy individuals from HF patients. In the ADHF subgroup, there was a moderate correlation between hospitalization time and serum CHOP concentrations (Spearman rho=0.586 and p=0.001).

Conclusion: High GRP78 serum concentration may protect the patient from ER stress. In addition, the serum PERK level is high in patients with HF, whereas it is insufficient in predicting acute decompensation. CHOP may be useful in predicting the length of hospital stay in patients with ADHF.
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http://dx.doi.org/10.21873/invivo.11640DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6754997PMC
February 2020

Percutaneous revascularisation of a chronic total occlusion in a surgically reconstructed vessel.

EuroIntervention 2020 Aug 7;16(6):e489-e490. Epub 2020 Aug 7.

Department of Cardiology, Bahcelievler Memorial Hospital, Istanbul, Turkey.

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http://dx.doi.org/10.4244/EIJ-D-18-00915DOI Listing
August 2020

How Do Patients Understand Safety for Cardiac Implantable Devices? Importance of Postintervention Education.

Rehabil Res Pract 2018 24;2018:5689353. Epub 2018 Jun 24.

Department of Biostatistics, Faculty of Medicine, University of Pamukkale, Denizli, Turkey.

Aim: This study was designed to assess the effect of patient education on the knowledge of safety and awareness about living with cardiac implantable electronic devices (CIEDs) within the context of phase I cardiac rehabilitation.

Methods: The study was conducted with 28 newly implanted CIED patients who were included in "education group (EG)". Patients were questioned with a survey about living with CIEDs and electromagnetic interference (EMI) before and 1 month after an extensive constructed interview. Ninety-three patients who had been living with CIEDs were included in the "without education group (woEG)".

Results: Patients in EG had improved awareness on topics related to physical and daily life activities including work, driving, sports and sexual activities, EMI of household items, harmful equipment, and some of the medical devices in the hospital setting (p<0.05). Patients in EG gave significantly different percent of correct answers for doing exercise or sports, using the arm on the side of CIEDs, EMI of some of the household appliances, medical devices, and all of the harmful equipment compared to woEG (p<0.05).

Conclusion: It was demonstrated that a constructed education interview on safety of CIEDs and living with these devices within the context of phase I cardiac rehabilitation is important for improving the awareness of patients significantly. Thus, patients might achieve a faster adaptation to daily life and decrease disinformation and misperceptions and thus promote the quality of life after the device implantation.
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http://dx.doi.org/10.1155/2018/5689353DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6035822PMC
June 2018

Nonselective Beta-Blockers Do Not Affect Survival in Cirrhotic Patients with Ascites.

Dig Dis Sci 2018 07 3;63(7):1737-1746. Epub 2018 May 3.

Gastroenterology Unit, Department of Medical Sciences, University of Foggia, AOU Ospedali Riuniti, Viale Pinto, 1, 71100, Foggia, Italy.

Background: The role of nonselective beta-blockers in cirrhotic patients with ascites has been recently questioned; however, definitive evidence in this regard is still lacking.

Aims: To analyze published data on the influence of nonselective beta-blockers as compared to control group on survival of cirrhotic patients with ascites.

Methods: Computerized bibliographic search on the main databases was performed. Hazard ratios from Kaplan-Meier curves were extracted in order to perform an unbiased comparison of survival estimates. Secondary outcomes were mortality in patients with refractory ascites, pooled rate of nonselective beta-blockers interruption, spontaneous bacterial peritonitis and hepato-renal syndrome incidence.

Results: Three randomized controlled trials and 13 observational studies with 8279 patients were included. Overall survival was comparable between the two groups (hazard ratio = 0.86, 0.71-1.03, p = 0.11). Study design resulted as the main source of heterogeneity in sensitivity analysis and meta-regression. Mortality in refractory ascites patients was similar in the two groups (odds ratio = 0.90, 0.45-1.79; p = 0.76). No difference in spontaneous bacterial peritonitis (odds ratio = 0.78, 0.47-1.29, p = 0.33) and hepato-renal syndrome incidence (odds ratio = 1.22, 0.48-3.09; p = 0.67) was observed. Pooled rate of nonselective beta-blockers interruption was 18.6% (5.2-32.1%).

Conclusions: Based on our findings, nonselective beta-blockers should not be routinely withheld in patients with cirrhosis and ascites, even if refractory.
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http://dx.doi.org/10.1007/s10620-018-5092-6DOI Listing
July 2018

Coronary Artery Aneurysms: A Review of the Epidemiology, Pathophysiology, Diagnosis, and Treatment.

Front Cardiovasc Med 2017 5;4:24. Epub 2017 May 5.

Department of Cardiology, Pamukkale University, Denizli, Turkey.

Coronary artery aneurysms (CAAs) are uncommon and describe a localized dilatation of a coronary artery segment more than 1.5-fold compared with adjacent normal segments. The incidence of CAAs varies from 0.3 to 5.3%. Ever since the dawn of the interventional era, CAAs have been increasingly diagnosed on coronary angiography. Causative factors include atherosclerosis, Takayasu arteritis, congenital disorders, Kawasaki disease (KD), and percutaneous coronary intervention. The natural history of CAAs remains unclear; however, several recent studies have postulated the underlying molecular mechanisms of CAAs, and genome-wide association studies have revealed several genetic predispositions to CAA. Controversies persist regarding the management of CAAs, and emerging findings support the importance of an early diagnosis in patients predisposed to CAAs, such as in children with KD. This review aims to summarize the present knowledge of CAAs and collate the recent advances regarding the epidemiology, etiology, pathophysiology, diagnosis, and treatment of this disease.
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http://dx.doi.org/10.3389/fcvm.2017.00024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418231PMC
May 2017

Turkey: coronary and structural heart interventions from 2010 to 2015.

EuroIntervention 2017 May;13(Z):Z80-Z82

Department of Cardiology, Pamukkale University Hospitals, Denizli, Turkey.

Growing populations and ageing demographics lead to an increased burden of ischaemic heart disease and related cardiovascular interventions, resulting in pressure on healthcare systems. Although the healthcare system in Turkey has undergone comprehensive remodelling over the last decade, there are many challenges to overcome, including better reimbursement for cardiovascular interventions, standardisation of interventional cardiology services and research-related activities. In this manuscript, we present an overview of coronary and structural heart interventions in Turkey, as well as providing information on current reimbursement policies and the healthcare system.
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http://dx.doi.org/10.4244/EIJ-D-16-00858DOI Listing
May 2017

Intracoronary Imaging.

Heart 2017 05 5;103(9):708-725. Epub 2017 Jan 5.

The NIHR Cardiovascular BRU Royal Brompton & Harefield NHS Foundation Trust, London, UK.

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http://dx.doi.org/10.1136/heartjnl-2015-307888DOI Listing
May 2017

Coronary covered stents.

EuroIntervention 2016 11;12(10):1288-1295

The NIHR Cardiovascular BRU, Royal Brompton Hospital & NHLI Imperial College, London, United Kingdom.

Covered stents offer an effective bail-out strategy in vessel perforations, are an alternative to surgery for the exclusion of coronary aneurysms, and have a potential role in the treatment of friable embolisation-prone plaques. The aim of this manuscript is to offer an overview of currently available platforms and to report results obtained in prior studies.
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http://dx.doi.org/10.4244/EIJV12I10A210DOI Listing
November 2016

Bioresorbable vascular scaffold radial expansion and conformation compared to a metallic platform: insights from in vitro expansion in a coronary artery lesion model.

EuroIntervention 2016 09;12(7):834-44

National Heart Centre Singapore and Duke-NUS Medical School, Singapore.

Aims: This study aimed to compare the acute expansion behaviour of a polymer-based bioresorbable scaffold and a second-generation metallic DES platform in a realistic coronary artery lesion model. Experimental mechanical data with conventional methods have so far shown little difference between metallic stents and currently available polymer-based bioresorbable scaffolds (BRS). Nevertheless, differences in acute results have been observed in clinical studies comparing BRS directly with metallic DES platforms.

Methods And Results: We examined the expansion behaviour of the bioresorbable vascular scaffold (3.0×18 mm Absorb BVS; Abbott Vascular, Santa Clara, CA, USA) and a metallic DES (3.0×18 mm XIENCE Prime; Abbott Vascular) after expansion at 37°C using identical coronary artery stenosis models (in total 12 experiments were performed). Device expansion was compared during balloon inflation and after deflation using microscopy to allow assessment of plaque recoil. Minimal lumen diameter (MLD) and minimal lumen area (MLA) and stent eccentricity were quantified from optical coherence tomography (OCT) imaging at nominal diameter and after post-dilation at 18 atm. The MLA in the models with BVS deployed was 4.92±0.17 mm² while in the metallic DES it was 5.40±0.13 mm2 (p=0.02) at nominal pressure (NP), and 5.41±0.20 and 6.07±0.25 mm2 (p=0.02), respectively, after expansion at 18 atm. Stent eccentricity index at the MLA was 0.71±0.02 in BVS compared to 0.81±0.02 in the metal stent at NP (p=0.004), and 0.73±0.03 compared to 0.75±0.02 at 18 atm (p=0.39).

Conclusions: Results obtained in this in vitro lesion model were comparable to the results in randomised clinical trials comparing BVS and XIENCE stents in vivo. Such models may be useful in future BRS developments to predict their acute response in vivo in eccentric lesions.
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http://dx.doi.org/10.4244/EIJV12I7A138DOI Listing
September 2016

Optical coherence tomography guidance for percutaneous coronary intervention with bioresorbable scaffolds.

Int J Cardiol 2016 Oct 5;221:352-8. Epub 2016 Jul 5.

National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom. Electronic address:

Background: The effect of optical coherence tomography (OCT) guidance on the implantation strategy during all phases of percutaneous coronary intervention (PCI) with bioresorbable vascular scaffolds (BVSs) in a real-world scenario has been poorly investigated.

Methods: Consecutive patients undergoing BVS implantation at our institution were included in this registry. Frequency-domain OCT pullbacks were performed at the operator's discretion during all phases of BVS implantation procedures to optimize preparation of lesions, confirm BVS size, and optimize expansion and apposition of scaffolds.

Results: Between September 2012 and July 2015, 203 BVSs were implanted in 101 consecutive patients at our institution (2.01 BVSs/patient). In 66 patients, the procedure was performed under OCT guidance. In the OCT subgroup, 66 (77.6%) of the 85 treated lesions were complex (B2/C AHA/ACC type). Overall, 147 OCT pullbacks were performed and 72/147 (49.0%) pullbacks indicated the need for changing strategy. After angiography-only-guided optimisation of BVS in 27 (31.8%) lesions, an OCT examination prompted performance of a second post-expansion. This resulted in an increase in the minimal scaffold area (5.5 to 6.3mm(2), p=0.004) and a decrease in the incomplete scaffold apposition area (1.1 to 0.6mm(2), p=0.082), with no new stent fractures. When the population was divided according to the time of BVS implantation, an initial learning adaptation became evident, with the number of OCT-guided changes in strategy significantly decreasing between the initial and final time periods (p=0.017).

Conclusions: OCT guidance for BVS implantation significantly affects the procedural strategy, with favourable effects on acute results and the learning curve.
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http://dx.doi.org/10.1016/j.ijcard.2016.07.033DOI Listing
October 2016

Percutaneous closure of an unusually large patent ductus arteriosus in a patient with a giant pulmonary artery and congenital single coronary artery.

Rev Port Cardiol 2016 Jul-Aug;35(7-8):451-2. Epub 2016 Jul 8.

Department of Cardiology, Pamukkale University, Medical Faculty, Denizli, Turkey.

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http://dx.doi.org/10.1016/j.repc.2015.11.026DOI Listing
March 2018

Evaluation of heart rate variability in patients with coronary artery ectasia and coronary artery disease.

Turk Kardiyol Dern Ars 2016 Jun;44(4):306-14

Department of Cardiology, Pamukkale University Faculty of Medicine, Denizli, Turkey.

Objective: The present study compared heart rate variability (HRV) parameters in patients with coronary artery ectasia (CAE) and coronary artery disease (CAD).

Methods: The study population consisted of 60 consecutive patients with CAE (14 women; mean age 51.63±7.44 years), 60 consecutive patients with CA (15 women; mean age 53.67±9.31 years), and 59 healthy individuals (13 women; mean age 52.85±8.19 years). Electrocardiograms, 24-hour Holter analyses, and routine biochemical tests were performed, and clinical characteristics were evaluated. Coronary angiography images were analyzed. Time-domain HRV parameters, including the standard deviation (SD) of normal-to-normal intervals (SDNN) and the root mean square of difference in successive normal-to-normal intervals (RMSSD) were evaluated, as were frequency-domain HRV parameters including low-frequency (LF), very low-frequency (VLF), high-frequency (HF), the proportion derived by dividing low- and high-frequency (LF/HF), and total power (TP).

Results: SDNN was lower in both the CAE and CAD groups, compared to the healthy group (140.85±44.21, 96.51±31.28, and 181.05±48.67, respectively). A significant difference in RMSSD values among the groups was determined (p=0.004). Significantly decreased VLF and HF values were found in the CAE group, compared with the healthy group (VLF p<0.001; HF, p=0.007). TP, VLF, and HF values were significantly lower (p<0.001, p<0.001, and p<0.001, respectively), but LF and LF/HF values were significantly higher (p<0.001 for both) in the CAD group than in the healthy group. TP values were significantly higher (p<0.001), and LF and LF/HF values were lower in the CAE group, compared with the CAD group (p<0.001 for both).

Conclusion: A decrease in vagal modulation or an increase in sympathetic activity of cardiac function, assessed by HRV analysis, is worse in patients with CAD than in patients with CAE.
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http://dx.doi.org/10.5543/tkda.2015.84899DOI Listing
June 2016

Retrieval of fractured guide wire with balloon support in intermediate coronary artery: A rare complication and management.

Indian Heart J 2016 May-Jun;68(3):361-3. Epub 2016 Mar 3.

Professor, Pamukkale University, Medical Faculty, Department of Cardiology, Denizli, Turkey.

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http://dx.doi.org/10.1016/j.ihj.2016.02.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4912383PMC
May 2017

The current status of endovascular treatment for acute ischaemic stroke.

EuroIntervention 2016 Jun;12(2):e130-2

Department of Cardiology, Pamukkale University Hospitals, Denizli, Turkey.

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http://dx.doi.org/10.4244/EIJV12I2A24DOI Listing
June 2016

Nonatherosclerotic Coronary Artery Narrowing.

JACC Cardiovasc Imaging 2016 Mar;9(3):317-20

National Institute for Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, National Heart and Lung Institute Imperial College, London, United Kingdom. Electronic address:

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http://dx.doi.org/10.1016/j.jcmg.2015.03.016DOI Listing
March 2016

Impressions from the PCR İstanbul Peripheral.

Anatol J Cardiol 2016 Feb;16(2):148-50

Department of Cardiology, Faculty of Medicine, Bezmialem University, İstanbul-Turkey.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5336738PMC
http://dx.doi.org/10.14744/AnatolJCardiol.2015.6993DOI Listing
February 2016

An extraordinary case of cardiac pacemaker lead self-extraction.

Turk Kardiyol Dern Ars 2015 Dec;43(8):750

Department of Cardiology, Pamukkale University Faculty of Medicine, Denizli, Turkey.

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http://dx.doi.org/10.5543/tkda.2015.12823DOI Listing
December 2015