Publications by authors named "Kamuran Kalkan"

46 Publications

Comparison of Functional Capacity and Symptoms of COPD Patients with and without Pulmonary Hypertension.

Eurasian J Med 2020 Jun 2;52(2):166-170. Epub 2020 Jun 2.

Department of Pulmonary Diseases, Ataturk University School of Medicine, Erzurum, Turkey.

Objective: Pulmonary hypertension (PH) is a common complication of chronic obstructive pulmonary disease (COPD) associated with a decrease in the survival rate of patients with COPD. Our aim was to investigate whether PH impairs the functional capacity and symptoms in patients with COPD. In addition, we aimed to evaluate the correlation between the functional capacity and symptoms score in patients with COPD.

Materials And Methods: This prospective cross-sectional study enrolled 64 patients with moderate to severe COPD, prospectively. All patients underwent the pulmonary function test, echocardiography, 6-minute walk test (6MWT), and cardiopulmonary exercise testing (CPET). We applied the modified Medical Research Council (mMRC) dyspnea scale and COPD Assessment Test (CAT) to all patients. The mean pulmonary arterial pressure (mPAP) >30 mmHg with echocardiography was considered as PH. The patients were grouped according to the presence of PH as COPD-PH (n=30) and COPD-nonPH (n=34).

Results: Hospitalization rate was higher in the COPD-PH group than in the COPD-nonPH group (p=0.006). The 6MWT results were lower in the COPD-PH group compared to the COPD-nonPH group (325±61 m vs. 354±46 m, respectively, p=0.025). In the COPD-PH group, the maximum oxygen consumption (VO) was lower, but the difference did not reach statistical significance (p=0.118). Although the maximum load and minute ventilation were lower in the COPD-PH group, the end-tidal pressure of CO (PETCO) was higher (p=0.033, p=0.036, and p=0.009, respectively). However, the CAT score and mMRC were similar between the groups (p=0.405 and p=0.238, respectively).

Conclusion: An elevated PAP in patients with COPD limits the exercise capacity. Using CPET in the functional evaluation of patients with COPD may be beneficial in the early detection of PH.
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http://dx.doi.org/10.5152/eurasianjmed.2020.19391DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311132PMC
June 2020

An investigation into hemodynamically significant coronary artery lesions predictors assessed by fractional flow reserve: A propensity score matching analysis.

North Clin Istanb 2020 10;7(1):35-39. Epub 2019 Mar 10.

Department of Cardiology, Ataturk University Faculty of Medicine, Erzurum, Turkey.

Objective: Fractional flow reserve (FFR) provides more useful information regarding myocardial metabolism and demand-supply convenience as compared to anatomical measurements. In this study, we aimed to investigate FFR predictors after propensity score matching (PSM) analysis in patients with intermediate coronary lesions.

Methods: Patients who underwent coronary angiography between January 2014 and March 2015 due to suspicion of coronary artery disease were included in this study. Patients were divided into two groups according to the FFR status and predictors of FFR before and after PSM analysis were investigated.

Results: A total of 290 patients (a total of 310 lesions) were included in this study (61±12 years, 75.5% male). In univariate analysis, after PSM analysis, Diameter stenosis (DS) and proximal LAD lesion (PLL) were associated with lower FFR values.

Conclusion: This study indicated that the majority of traditional FFR predictors did not reach the limit of significance after PSM analysis and we suggest that DS and PLL are one step ahead of predicting lesion severity compared to other traditional risk factors.
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http://dx.doi.org/10.14744/nci.2019.79058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103741PMC
March 2019

Assessment of right ventricular dysfunction in patients with mitral stenosis: A speckle tracking study.

J Clin Ultrasound 2020 Jun 3;48(5):269-274. Epub 2019 Dec 3.

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

Purpose: Although it is affected at an early stage, there is a lack of studies investigating right ventricular (RV) function in patients with mitral stenosis (MS). We aimed to investigate the correlation between conventional echocardiographic variables and tricuspid annular plane systolic excursion (TAPSE), used as an indicator of RV dysfunction.

Methods: We enrolled 59 consecutive patients with MS and assigned them in group 1 if TAPSE ≤16, or group 2 if: TAPSE >16.

Results: The mean age of the patients was 42.2 ± 8 years, and 74.6% were females. In univariate analysis, maximal mitral valve gradient, mean mitral valve gradient, systolic pulmonary arterial pressure, RV strain, and RV strain rates were associated with RV dysfunction. In multivariate analysis, both strain variables were found to be independent predictors of RV dysfunction. Kaplan Maier survival analysis showed that patients with lower RV strain had more rehospitalization rate during the one-year follow-up period.

Conclusions: RV dysfunction is common in patients with MS and is associated with higher rehospitalization rate and morbidity. Evaluation of RV strain and strain rate for early detection of RV dysfunction and prediction of rehospitalization may be an appropriate approach in mitral stenosis.
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http://dx.doi.org/10.1002/jcu.22798DOI Listing
June 2020

The prognostic value of altitude in patients with heart failure with reduced ejection fraction.

Anatol J Cardiol 2019 Nov;22(6):300-308

Department of Cardiology, Hisar Intercontinental Hospital; İstanbul-Turkey.

Objective: It is well known that the altitude may affect the cardiovascular system. However, there were a few data related to the effect of altitude on the adverse outcome in patients with heart failure with reduced ejection fraction (HFREF). The aim of the present study was to investigate the role of intermediate high altitude on the major adverse cardiovascular outcome in patients with HFREF.

Methods: Patients with HFREF admitted to the outpatient clinics at the first center at sea level and the second center at 1890 m were prospectively enrolled in the study. HFREF was defined as symptoms/signs of heart failure and left ventricular ejection fraction <40%. The major adverse cardiac outcome (MACE) was defined as all-cause death, stroke, and re-hospitalization due to heart failure. The median follow-up period of the study population was 27 months.

Results: The study included 320 (58.55% male, mean age 65.7±11.2 years) patients. The incidence of all-cause death was 8.5%, stroke 6.1%, re-hospitalization due to decompensated heart failure 34.3%, and MACE 48.9%. In Kaplan-Meier analysis, patients with HFREF living at high altitude had more MACE (71.1% vs. 25.3%, log rank p=0.005) and presented with more stroke (11.3% vs. 2.1%, log rank p=0.001) and re-hospitalization due to heart failure (65.1% vs. 20.1%, log rank p<0.001) rates than those at low altitude in the follow-up; however, the rate of all-cause death was similar (9.4% vs. 8.1%, log rank p=0.245).

Conclusion: In the present study, we demonstrated that the intermediate high altitude is the independent predictor of MACE in patients with HFREF. High altitude may be considered as a risk factor in decompensating heart failure.
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http://dx.doi.org/10.14744/AnatolJCardiol.2019.81535DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6955054PMC
November 2019

Hemodynamic Stability and Contrast Nephropathy Development in Patients With Acute Myocardial Infarction.

Angiology 2020 03 10;71(3):289. Epub 2019 Sep 10.

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

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http://dx.doi.org/10.1177/0003319719873805DOI Listing
March 2020

The role of the right atrium in development of postoperative atrial fibrillation: A speckle tracking echocardiography study.

J Clin Ultrasound 2019 Oct 17;47(8):470-476. Epub 2019 May 17.

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

Purpose: Atrial fibrillation (AF) is relatively frequent in the postoperative period, and is associated with an increased frequency of adverse events. The role of right atrial (RA) volume and functions in the development of AF is unknown. In this study, we investigated the effect of RA echocardiographic indices on AF development in the postoperative period.

Method: We enrolled 142 consecutive patients who underwent coronary artery bypass surgery, and assigned them into two groups depending on the occurrence or not of AF development in the postoperative period.

Results: A propensity score matching analysis was performed to balance the groups, and 37 pairs were eventually included in the analysis. The median age was 67.5 (63-75) years and 73.3% of them were males. In the univariate analysis, right atrial volume index (RAVi), right atrial strain during reservoir phase (RASr), left ventricular global longitudinal strain, right ventricular strain, left atrial volume index, left atrial strain during reservoir phase, and systolic pulmonary artery pressure were associated with AF development. In the regression analysis, we found that RAVi (OR: 3.1, 95% CI: 2.2-6.3, P: .033) and RASr (OR: 0.82, 95% CI: 0.67-0.93, P: .048) were independent predictors of AF development.

Conclusions: RA structure and functions are closely associated with AF development in the postoperative period, and screening of RA functions prior to surgery may be useful for preventing AF development.
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http://dx.doi.org/10.1002/jcu.22736DOI Listing
October 2019

Acute cardiac effects of high dose steroid treatment: A speckle tracking echocardiography study.

J Clin Ultrasound 2019 Jul 20;47(6):351-355. Epub 2019 Feb 20.

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

Purpose: High-dose steroid therapy (HDST) has frequent side-effects that appear at its cessation and depend on its dose. However, there is a lack of studies about the acute effects of HDST on cardiac function in adult patients.

Methods: We included in this study 30 patients who underwent HDST (intravenously at doses ranging from 250 to 1000 mg) and 30 healthy control subjects with similar demographic and clinical characteristics, between September and December 2016. Echocardiographic measurements were made before and during the first 3 hours after the end of treatment, and results were compared between patients and controls.

Results: There was no difference in baseline biochemical and echocardiographic characteristics between the patient and control groups. While left ventricular global longitudinal strain (LVGLS) and strain rate E were higher after treatment, no significant change was observed in conventional echocardiographic variables.

Conclusions: LVGLS, but not conventional echocardiographic variables, showed an increase in cardiac systolic function at the acute phase of HDST.
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http://dx.doi.org/10.1002/jcu.22716DOI Listing
July 2019

Endocan and Major Adverse Cardiovascular Events: Understanding Regression Methods.

Angiology 2019 11 10;70(10):982. Epub 2019 Feb 10.

1 Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey.

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http://dx.doi.org/10.1177/0003319719828911DOI Listing
November 2019

The association between CRP / Albumin ratio and in-stent restenosis development in patients with ST-segment elevation myocardial infarction.

J Clin Lab Anal 2019 May 8;33(4):e22848. Epub 2019 Feb 8.

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

Background: Although interventional methods are the first-line treatment options in ST-segment elevation myocardial infarction (STEMI), the incidence of stent restenosis (SR) is frequent. We investigated the relationship between CRP/albumin ratio (CAR), a novel indicator of inflammatory response, and SR in this study.

Method: This study was carried out on the patients who underwent coronary angiography in our clinic between January 2017 and September 2017. Two groups were generated according to restenosis status (group 1: restenosis (-), group 2: restenosis (+)), and clinical biochemical and angiographical features were compared. As baseline demographic and angiographic characteristics are slightly different in two groups, propensity score matching analysis was performed to reduce bias. 45 SR patients were matched on a 1:1 basis were enrolled final cohort.

Results: The mean age of the patients was 55 ± 5.1 and 80% were male; Cox regression model was performed to demonstrate independent predictor of restenosis development; and during the one-year follow-up period, CAR (P < 0.001) was found an independent predictor of SR CONCLUSION: In this study, we demonstrate that there may be a strong relationship between SR development and CAR. We implied that inflammatory reaction may be an important diagnostic tool for prediction of SR development in STEMI patients.
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http://dx.doi.org/10.1002/jcla.22848DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528603PMC
May 2019

Evaluation of ventricular repolarization parameters during migraine attacks.

J Electrocardiol 2019 Mar - Apr;53:66-70. Epub 2018 Dec 21.

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

Aims: Migraine is a chronic neurovascular disorder characterized by intermittent episodes of severe headache. Abnormalities in the autonomic nervous system (sympathetic and parasympathetic nervous systems) have been detected during migraine-free periods in patients with migraine. In these patients, disrupted autonomic innervations of the heart and coronary arteries may lead to electrocardiographic changes during a migraine attack. T-wave peak-to-end interval (Tp-e interval) and Tp-e/QT ratio are relatively new markers of ventricular arrhythmogenesis and repolarization heterogeneity. In the present observational study, we investigated the changes in ventricular repolarization during migraine attacks and attack-free periods by performing 12‑lead electrocardiography (ECG).

Methods: This study included 63 patients (54 [86%] women; mean age: 33.3 ± 9.9 years) with migraine. The QT and corrected QT (QTc) intervals, Tp-e interval, and Tp-e/QT ratio of the patients during migraine attacks and attack-free periods were measured by performing 12‑lead ECG.

Results: The QT and QTc intervals, Tp-e interval, and Tp-e/QT ratio were higher during migraine attacks than during attack-free periods (P < 0.001 for all).

Conclusion: These results indicate that migraine attacks are associated with an increase in ventricular repolarization parameters compared with attack-free periods possibly because of the dysregulation of the autonomic nervous system.
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http://dx.doi.org/10.1016/j.jelectrocard.2018.12.014DOI Listing
July 2020

Long-Term Mortality and Contrast-Induced Nephropathy.

Angiology 2019 09 7;70(8):783. Epub 2019 Jan 7.

2 Department of Cardiology, Atatürk University, Erzurum, Turkey.

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http://dx.doi.org/10.1177/0003319718823628DOI Listing
September 2019

A Novel Marker of Inflammation: Azurocidin in Patients with ST Segment Elevation Myocardial Infarction.

Int J Mol Sci 2018 Nov 29;19(12). Epub 2018 Nov 29.

Department of Cardiology, University of Health Sciences, Erzurum Training and Research Hospital, 25100 Erzurum, Turkey.

(1) To investigate the role of azurocidin, an antimicrobial protein, in patients with ST segment elevation myocardial infarction (STEMI). (2) This single-center prospective observational study included patients with STEMI and healthy age- and sex-matched control subjects. Baseline demographic, clinical and biochemical data were compared between the two groups. Azurocidin levels at baseline were determined using an enzyme-linked immunosorbent assay. Multivariate linear regression analysis with enter method was used to test the association between azurocidin and independent variables, such as the thrombolysis in myocardial infarction (TIMI) score, synergy between percutaneous coronary intervention with TAXUS and cardiac surgery score, global registry of acute coronary events score, Killip class, C-reactive protein (CRP), and creatinine kinase-myocardial band (CK-MB). (3) A total of 76 patients with STEMI and 30 healthy control subjects were enrolled in the study. Mean ± SD azurocidin levels were significantly higher in patients compared with healthy controls (18.07 ± 13.99 versus 10.09 ± 5.29 ng/mL, respectively). In a receiver-operating characteristic curve analysis, an azurocidin cut-off level of >11.46 ng/mL had 74% sensitivity and 58% specificity in predicting myocardial infarction. Azurocidin levels had a positive correlation with TIMI score ( = 0.651). In multivariate linear regression analysis, the TIMI score was an independent predictor of the azurocidin level. (4) Azurocidin is an infection marker that may be important in patients with STEMI.
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http://dx.doi.org/10.3390/ijms19123797DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6321077PMC
November 2018

Evaluating the Association Between the Three Different Ejection Fraction Measurement Techniques and Left Ventricle Global Strain.

Eurasian J Med 2018 Oct;50(3):173-177

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

Objective: The prognosis of cardiovascular diseases (CVDs) is directly associated with systolic function based on the measurement of ejection fraction (EF), and many studies have indicated that the left ventricular global strain (LVGS) provides better predictivity than the EF measurement in the diagnosis, prognosis, survival, and CVD staging. However, these studies did not investigate the correlation between the EF measurement and the LVGS parameters, or which parameters are better correlated with LVGS, but we analyzed the association between three EF measurement methods and LVGS.

Materials And Methods: This study included 62 patients that applied to the clinic between October 2015 and March 2016. An echocardiography examination of these patients was performed. The exclusion criteria were atrial fibrillation and suboptimal image quality.

Results: Sixty-two patients (the average age 61.0±12.6 years; 56% male and 44% female) were enrolled in the study. A statistically significant association was found between the visual EF and Simpson EF measurements and the LVGS parameters (p<0.001). While the visual EF was moderately correlated with the LVGS parameters (r=0.44), there was a good correlation between the Simpson EF and the LVGS parameters (r=0.710).

Conclusion: In this study, we demonstrate that the Simpson's rule LVEF correlates better with LVGS than the Teicholtz method or visual EF and that it has a better area under the curve value for determining an abnormal LVGS. Therefore, we recommend the use of the Simpson EF for the EF measurement that has a better correlation with the LVGS values in the patients whose ventricle functions should be evaluated.
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http://dx.doi.org/10.5152/eurasianjmed.2018.17409DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6263235PMC
October 2018

The effect of dialysis type on left atrial functions in patients with end-stage renal failure: A propensity score-matched analysis.

Echocardiography 2018 03 11;35(3):308-313. Epub 2017 Dec 11.

Department of Cardiology, Ataturk University Medical School, Erzurum, Turkey.

Introduction: Despite the widespread use of both hemodialysis (HD) and peritoneal dialysis (PD), there is no study comparing the effects of these dialysis methods on the left atrial (LA) volume and functions. In this study, we investigated the impact of different dialysis methods on the LA volume and function in the patients exposed to chronic pressure overload and volume overload.

Method: This study was carried out on the patients who received dialysis treatment at our healthcare center between March, 2015 and January, 2016. Twenty-eight patients receiving hemodialysis (HD) treatment and 24 patients under PD treatment were enrolled into the study. Patients were divided into 2 groups according to the dialysis therapy, and the atrial volumetric and mechanical functions were investigated.

Results: As the basal demographical characteristics of patients in the PD and HD groups were significantly different, 44 patients matched on a 1:1 basis were taken for final analysis (22 HD, 22 PD, and the average age of 42.4 ± 4.8; 73% was male). After propensity score matching analysis, it was determined that left atrial volume index (LAVi) was higher in the HD group while peak LA strain and LA contraction strain were higher in the PD group. Additionally, both strain parameters showed a good negative correlation with LAVi.

Conclusion: We demonstrated that the left atrial structure and functions were better in the PD group suggesting that PD may be a relatively better option for the preservation and maintenance of the left atrial functions as compared to HD.
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http://dx.doi.org/10.1111/echo.13774DOI Listing
March 2018

The association between left ventricular global strain and coronary artery disease.

Int J Cardiol 2017 11;246:14

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

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http://dx.doi.org/10.1016/j.ijcard.2017.05.021DOI Listing
November 2017

The Comparison of Angiographic Scoring Systems With the Predictors of Atherosclerosis.

Angiology 2018 Feb 8;69(2):158-163. Epub 2017 Jun 8.

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

Syntax score (SS) and Gensini score (GS) are used to determine the complexity and severity of coronary artery disease. Although there are some studies indicating the individual relationship of these scoring systems with the carotid intima-media thickness (cIMT) and epicardial fat tissue (EFT), there was no previous study that compared the SS and GS in that respect. We aimed to assess the relationship of SS and GS with predictors of atherosclerosis. We enrolled 522 patients. There were positive correlations between GS and SS tertiles with cIMT and EFT. According to multivariate linear regression analysis for GS, EFT (β: 0.035, t: 2.63, and P = .49) and cIMT (β: 0.339, t: 2.97, and P = .053) were not independently associated. For SS, EFT (β: 0.009, t: 6.5, and P = .006) and cIMT (β: 1.2, t: 10.1, and P = .001) were independently and significantly associated. We showed that the SS is significantly associated more with surrogate markers of atherosclerosis such as EFT and cIMT than the GS.
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http://dx.doi.org/10.1177/0003319717712118DOI Listing
February 2018

Aortic valve sclerosis is associated with the extent of coronaryartery disease in stable coronary artery disease.

Turk J Med Sci 2017 Apr 18;47(2):614-620. Epub 2017 Apr 18.

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

Background/aim: Aortic valve sclerosis (AVS) is characterized by lipid deposition and calcific infiltration on the edge of aortic leaflets without significant restriction of motion. The SYNTAX Score (SS) is an important method for evaluating coronary artery disease (CAD). Many studies showed that there is an important relation between the SS and undesired cardiac outcomes. In our study, we investigated the correlation between the SS and AVS by including both ACS and stable CAD cases.

Materials And Methods: We enrolled 543 patients with CAD who underwent coronary angiography into this cross-sectional study between September 2013 and September 2014.

Results: The study population was divided into two groups according to SS values above and below 22. Diabetes mellitus (DM) incidence was greater in the group with high SS values (26.3% vs. 19.2%, P = 0.052.). Left ventricular ejection fraction (LVEF) and glomerular filtration rate were lower. Low-density lipoprotein cholesterol and triglyceride levels were lower while platelet counts were higher. In multivariate analysis, for the stable coronary artery group AVS existence, platelet count, LVEF value, and chronic obstructive pulmonary disease were found as independent predictors.

Conclusion: Our study results demonstrated that AVS is significantly associated with the complexity of CAD, especially in patients with stable CAD. This study provides new information regarding the role of AVS in CAD complexity.
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http://dx.doi.org/10.3906/sag-1601-19DOI Listing
April 2017

The prevalence of coronary artery anomalies with coronary computed tomography.

Turk J Med Sci 2017 Feb 27;47(1):188-193. Epub 2017 Feb 27.

Department of Radiology, Faculty of Medicine, Atatürk University, Erzurum, Turkey.

Background/aim: In this study, the aim is to investigate the prevalence of various coronary artery anomalies (CAAs), evaluated by 256-detector row coronary computed tomography (CCT), within the Turkish population.

Materials And Methods: We included 2973 patients who had received CCT. The high take-off right coronary artery (RCA) and left coronary artery (LCA), the RCA arising from the left sinus (LS), the LCA arising from the right sinus (RS), the circumflex artery (CX) arising from the RS, the single coronary ostium originating from the RS, the CX arising from the RCA, and the RCA arising from the pulmonary artery were evaluated.

Results: Seventy-nine patients (2.65%) were diagnosed with CAAs. The frequency of high take-off of the RCA, LCA, and both was 0.1%, 0.67%, and 0.06%, respectively. Frequency of separate ostium of the left anterior descending artery and CX was 0.67%. The frequency of RCA originating from the LS, CX originating from the RS, LCA originating from the RS, LCA and RCA originating from the pulmonary artery, and CX originating from the RCA was 0.50%, 0.10%, 0.23%, 0.03%, and 0.20%, respectively.

Conclusion: In this study, CCT was demonstrated to be a high-quality imaging modality for the detection of CAAs.
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http://dx.doi.org/10.3906/sag-1602-87DOI Listing
February 2017

Comparison of standard and Lewis ECG in detection of atrioventricular dissociation in patients with wide QRS tachycardia.

Int J Cardiol 2016 Dec 26;225:4-8. Epub 2016 Sep 26.

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

Background: The atrioventricular (AV) dissociation, which is frequently used in differential diagnosis of wide QRS complex tachycardia (WQCT), is the most specific finding of ventricular tachycardia (VT) with lower sensitivity. Herein, we aimed to show the importance of Lewis lead ECG records to detect 'visible p waves' during WQCT.

Method: A total of 21 consecutive patients who underwent electrophysiologic study (EPS) were included in the study. During EPS, by using a quadripolar diagnostic catheter directed to the right ventricular apex, a fixed stimulus was given and the ventriculoatrial (VA) Wenkebach point was found, and a VT was simulated by a RV apical stimulus at 300ms. The standard and Lewis lead ECG records were taken during this procedure.

Result: We detected 'visible p waves' in 7 (33.3%) and 14 (66.7%) patients in the standard and Lewis lead ECG groups, respectively. In terms of the 'visible p waves', there was a statistically significant difference between groups (p=0.022). The sensitivity of standard and Lewis lead ECG in determination of the visible p waves was 33.3% and 66.7%, respectively.

Conclusion: The Lewis lead ECG can be more informative about AV dissociation than the standard 12 lead ECG. As a result, we could suggest the assessment of the Lewis lead ECG recording in addition to the standard 12 lead ECG in differential diagnosis of VT in patients with WQCT.
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http://dx.doi.org/10.1016/j.ijcard.2016.09.087DOI Listing
December 2016

The Role of Serum Bilirubin Levels in Predicting Troponin Positivity in Non-ST-Segment Elevation Acute Coronary Syndrome.

Angiology 2017 May 18;68(5):414-418. Epub 2016 Jul 18.

4 Department of Emergency Medicine, Erzurum Education and Research Hospital, Erzurum, Turkey.

Data are scant regarding serum bilirubin levels in non-ST-segment elevation acute coronary syndrome (NSTE-ACS). In this study, we evaluated the role of serum bilirubin levels in NSTE-ACS. We enrolled 782 patients who presented to the emergency department with acute chest pain. Patients were divided into 2 groups based on the troponin positivity. Patients with NSTE-ACS who had troponin positivity were included in group 1 (n = 382), and group 2 consisted of the control patients (n = 400). Direct bilirubin (DB) levels (group 1: 0.31 ± 0.37 mg/dL, group 2: 0.20 ± 0.25 mg/dL, P < .001) and total bilirubin (TB) levels (group 1: 0.78 ± 0.56 mg/dL, group 2: 0.62 ± 0.45 mg/dL, P < .001) were significantly higher in group 1. There was a significant and moderate correlation between serum bilirubin levels and admission troponin values ( r = .34, P < .001 for TB and r = .42, P < .001 for DB). These results show that serum bilirubin levels were associated with troponin positivity in patients with NSTE-ACS.
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http://dx.doi.org/10.1177/0003319716659583DOI Listing
May 2017

Prognostic value of left ventricular reverse remodeling.

Int J Cardiol 2016 Nov 30;222:1055. Epub 2016 Apr 30.

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

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http://dx.doi.org/10.1016/j.ijcard.2016.01.164DOI Listing
November 2016

Ruling out white coat hypertension with NT-proBNP.

Int J Cardiol 2016 07 19;214:512. Epub 2016 Feb 19.

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

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http://dx.doi.org/10.1016/j.ijcard.2016.02.104DOI Listing
July 2016

Total Bilirubin Levels Predict Subclinical Atherosclerosis in Patients With Prediabetes.

Angiology 2016 11 11;67(10):909-915. Epub 2016 Jul 11.

5 Department of Cardiology, Dr. Ersin Arslan State Hospital, Gaziantep, Turkey.

Bilirubin may have important antiatherosclerotic effects. Prediabetes (PD), the intermediate stage before diabetes mellitus, is associated with increased cardiovascular morbidity and mortality. We evaluated the relationship between serum bilirubin levels and carotid intima-media thickness (cIMT), as a surrogate marker of subclinical atherosclerosis, in patients with PD. We enrolled 170 consecutive patients with PD. The patients underwent ultrasonography to evaluate cIMT. The patients were divided into groups according to cIMT values (<0.9 vs ≥0.9 mm). The patients with cIMT ≥ 0.9 mm had significantly higher diastolic blood pressure, neutrophil-lymphocyte ratio (NLR), and glycated hemoglobin values compared with patients having cIMT < 0.9 mm, whereas total and direct bilirubin values were significantly lower in this group. Multivariate regression analyses revealed NLR and total bilirubin as the independent predictors of subclinical atherosclerosis. The present study demonstrated that NLR and lower total bilirubin levels were independent predictors of subclinical atherosclerosis in patients with PD. Simple measures such as NRL and total bilirubin may provide predictive information regarding the risk of cardiovascular disease in patients with PD.
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http://dx.doi.org/10.1177/0003319716632394DOI Listing
November 2016

Assessment of right ventricular systolic and diastolic parameters in pulmonary sarcoidosis.

J Investig Med 2016 Mar 12;64(3):759-63. Epub 2016 Feb 12.

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

The clinical manifestations of cardiac involvement are seen in about 5% of patients with sarcoidosis; however, the incidence of cardiac involvement is higher in the autopsy series. About 14% of patients with pulmonary sarcoidosis (PS) without known cardiac involvement had diastolic dysfunction.We aimed to determine the role of parameters of right ventricular (RV) systolic and diastolic function in patients with PS without evidence of cardiac symptoms. Our study population consisted of 28 patients with grades 1-4 PS and 24 healthy subjects. This study was a clinical prospective cohort study. RV end-diastolic area was found to be significantly higher in the PS group (p=0.032). RV fractional area change (RVFAC) and tricuspid annular plane systolic excursion (TAPSE) were shown to be statistically lower in the PS group as compared to the control group (p<0.001). However, pulmonary arterial systolic pressure was significantly higher in the PS group (p=0.003). The tricuspid E velocity and E/A ratio were found to be significantly lower in the PS group (p=0.025 and 0.009, respectively), while the tricuspid A velocity and myocardial performance index (MPI) were found to be significantly lower in the control group (p=0.034 and 0.007, respectively). Early detection of cardiac involvement in PS is crucial because of the increased morbidity and risk of sudden cardiac death. RV diastolic Doppler parameters, tissue Doppler MPI, RVFAC and TAPSE are practical and cheap techniques in the diagnosis of cardiac involvement in patients with PS. A thorough transthorasic echocardiographic examination including RV systolic and diastolic functions and tissue Doppler MPI should constitute the mainstay of initial management and follow-up in PS.
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http://dx.doi.org/10.1136/jim-2015-000027DOI Listing
March 2016

The evaluation of myocardial function of patients in the early stage of acute ischemic stroke by two-dimensional speckle tracking echocardiography.

J Clin Ultrasound 2016 Jun 17;44(5):305-11. Epub 2016 Feb 17.

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

Purpose: To evaluate the myocardial dysfunction in the early stage of nonhemorrhagic stroke and its association with the National Institutes of Health Stroke Scale (NIHSS) score, by two-dimensional speckle tracking echocardiography.

Methods: We included 29 patients with acute ischemic stroke, in whom NIHSS scores were calculated and stroke infarct volumes recorded. Within 48 hours of admission, cardiac evaluation with speckle tracking echocardiography was performed and left ventricular global longitudinal strain (GLS) and global longitudinal systolic strain rate were obtained. These measurements were repeated on the 10th day.

Results: NIHSS score improved, but infarct volume increased (p = 0.011 and 0.065, respectively) from admission to day 10. Ejection fraction was 53.2% and 55.8%, respectively, at admission and day 10 (p = 0.482), while GLS improved from -16.41% to -18.76% (p = 0.003).

Conclusions: GLS and global longitudinal systolic strain rate showed significant improvement together with NIHSS score. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:305-311, 2016.
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http://dx.doi.org/10.1002/jcu.22332DOI Listing
June 2016

Utility of γ-Glutamyl Transferase in Predicting Troponin Elevation in Emergency Departments.

Angiology 2016 09 29;67(8):737-41. Epub 2015 Oct 29.

Department of Biochemistry, Ataturk University Medicine Faculty, Erzurum, Turkey.

Serum γ-glutamyl transferase (GGT) activity is a risk predictor for the development of coronary artery disease and is related to cardiovascular morbidity and mortality. We evaluated the clinical utility of GGT activity in predicting high troponin levels in patients with acute coronary syndrome (ACS) admitted to the emergency department with chest pain. A total of 200 troponin-positive and 203 troponin-negative patients were classified into groups 1 and 2, respectively. γ-Glutamyl transferase activity was significantly higher in group 1 (44 ± 34 U/L) compared with group 2 (31 ± 26 U/L, P = .001). A GGT activity cutoff >25.5 showed 62% sensitivity and 61% specificity in predicting troponin positivity. Logistic regression analysis demonstrated a significant predictive value of GGT for troponin positivity. Spearman rank correlation analysis showed a moderately strong relationship between GGT activity and troponin positivity. Considering the predictive value of high GGT activity for troponin positivity, GGT activity may complement other diagnostic biomarkers for predicting troponin positivity in patients having ACS admitted with chest pain.
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http://dx.doi.org/10.1177/0003319715613923DOI Listing
September 2016

Massive pulmonary embolism mimicking electrocardiographic pattern of Brugada syndrome.

Am J Emerg Med 2016 May 21;34(5):933.e1-2. Epub 2015 Sep 21.

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

Brugada syndrome is an inherited heart disease without structural abnormalities that is thought to arise as a result of accelerated inactivation of Na channels and predominance of transient outward K current to generate a voltage gradient in the right ventricular layers. Brugada syndrome occurs in patients with structurally normal heart and predisposes patients to malignant ventricular arrhythmias. Acute pulmonary embolism has been associated with a variety of electrocardiograms,and rarely, it may mimic electrocardiographic pattern of Brugada syndrome and this condition was defined as Brugada phenocopy.
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http://dx.doi.org/10.1016/j.ajem.2015.09.029DOI Listing
May 2016

Bilirubin Levels and Thrombus Burden in Patients With ST-Segment Elevation Myocardial Infarction.

Angiology 2016 07 2;67(6):565-70. Epub 2015 Sep 2.

Department of Cardiology, Faculty of Medicine, Erzincan University, Erzincan, Turkey.

We investigated whether serum bilirubin level (a marker of heme oxygenase activity) is a predictor of thrombus burden in patients with acute myocardial infarction. Patients (n = 229; male 72.9%; mean age 63 ± 13.4 years) who were admitted with ST-segment elevation myocardial infarction (STEMI) were enrolled. Patients were divided into 2 groups. Group 1 was defined as low thrombus burden and group 2 was defined as high thrombus burden. Patients with high thrombus burden had higher total bilirubin levels (14.4 [4.3-22.9] vs 7.7 [2.4-20.3] µmol/L, P ≤ .001), (0.84 [0.25-1.34] vs 0.45 [0.14-1.19] mg/dL P ≤ .001) and direct bilirubin levels (3.1 [2.1-8.4] vs 1.7 [0.5-6.5] µmol/L, P ≤ .001), (0.18 [0.03-0.49] vs 0.10 [0.03-0.38] mg/dL, P ≤ .001). At multivariate analysis, total bilirubin (odds ratio: 1.05, 95% confidence interval: 1.03-1.08, P ≤ .001) was the independent predictor of high thrombus burden. In conclusion, total bilirubin level is independently associated with high thrombus burden in patients with STEMI.
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http://dx.doi.org/10.1177/0003319715603899DOI Listing
July 2016

Diastolic mitral and tricuspid regurgitation in a patient with 2:1 AV block.

Int J Cardiol 2015 Sep 22;195:111-2. Epub 2015 May 22.

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

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http://dx.doi.org/10.1016/j.ijcard.2015.05.091DOI Listing
September 2015

Association of atrial fibrillation and erectile dysfunction.

Int J Cardiol 2015 Sep 22;195:76. Epub 2015 May 22.

Atatürk University, Faculty of Medicine Department of Cardiology, Erzurum, Turkey. Electronic address:

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http://dx.doi.org/10.1016/j.ijcard.2015.05.138DOI Listing
September 2015