Publications by authors named "Kazım Baser"

32 Publications

Obstructive sleep apnea and cardiovascular disease: It is not how much we know but rather how much more we need to learn.

Postgrad Med 2020 Jun 6;132(5):403-405. Epub 2020 Apr 6.

Department of Internal Medicine, University of Arkansas for Medical Sciences, Divisions of Cardiology , Little Rock, AR, USA.

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http://dx.doi.org/10.1080/00325481.2020.1750183DOI Listing
June 2020

Neutrophil-to-lymphocyte ratio predicts functionally significant coronary artery stenosis in patients with stable coronary artery disease.

Turk Kardiyol Dern Ars 2018 03;46(2):129-135

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

Objective: The aim of this study was to determine the relationship between the neutrophil-to-lymphocyte ratio (NLR) and the functional severity of coronary stenosis assessed according to the fractional flow reserve (FFR) in stable coronary artery disease (CAD).

Methods: The clinical and laboratory data of 420 patients who underwent index coronary angiography for stable angina pectoris were analyzed retrospectively. The functional severity of an intermediate lesion was determined by FFR. An FFR value of >0.80 was considered non-significant (Group 1), whereas ≤0.80 was accepted as significant stenosis (Group 2).

Results: A total of 137 (32.6%) patients had functionally significant coronary artery stenosis. The median NLR value was significantly greater in Group 2 compared with Group 1 [3.13 (0.93-9.75) vs 2.22 (0.75-6.02); p<0.001]. In multivariable logistic regression analysis, the Gensini score [odds ratio (OR): 1.04; 95% confidence interval (CI): 1.02-1.06; p<0.001], diabetes mellitus (OR: 2.56; 95% CI: 1.38-4.75; p=0.003), smoking (OR: 2.09; 95% CI: 1.12-3.94; p=0.021), and NLR (OR: 1.62; 95% CI:1.26-2.09; p<0.001) were found to be independent predictors of the presence of functionally significant coronary stenosis using an FFR value of ≤0.80. The optimal cut-off value of NLR for predicting functionally significant coronary stenosis was 2.3. An NLR value greater than 2.3 had a sensitivity of 72% and a specificity of 61% to predict stenosis with an FFR value of ≤0.80.

Conclusion: The pre-angiographic NLR is a simple, noninvasive, and inexpensive biomarker that was significantly higher in patients with functionally significant coronary stenosis; it can be used to predict the hemodynamic severity of intermediate coronary stenosis in patients with stable CAD.
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http://dx.doi.org/10.5543/tkda.2017.16709DOI Listing
March 2018

Changes in neutrophil-to-lymphocyte ratios in postcardiac arrest patients treated with targeted temperature management.

Anatol J Cardiol 2017 Sep 25;18(3):215-222. Epub 2017 Jul 25.

Department of Internal Medicine, Texas Tech University Health Sciences Center at Lubbock; TX-USA.

Objective: The prognostic value of changes in neutrophil-to-lymphocyte ratios (NLR) in cardiac arrest survivors receiving targeted temperature management (TTM) is unknown. The current study investigated NLR in postcardiac arrest (PCA) patients undergoing TTM.

Methods: This retrospective single-center study included 95 patients (59 males, age: 55.0±17.0 years) with in-hospital and out-of-hospital cardiac arrests who underwent TTM for PCA syndrome within 6 h of cardiac arrest. Hypothermia was maintained for 24 h at a target temperature of 33°C. NLR was calculated as the absolute neutrophil count divided by the absolute lymphocyte count.

Results: Of the 95 patients, 59 (62%) died during hospital stay. Fewer vasopressors were used in patients who survived. Out-of-hospital cardiac arrest was more frequent in decedents (p=0.005). Length of stay in the hospital and intensive care unit were significantly longer in patients who survived (p=0.0001 and p=0.001, respectively). NLR on admission and during rewarming did not differ between survivors and decedents. NLR during cooling was significantly higher in decedents (p=0.014). Delta NLR cut-off of 13.5 best separated survivors and decedents (AUC=0.68, 95% CI: 0.57-0.79, p=0.003 with a sensitivity and specificity of 64% and 67%, respectively). In multivariate logistic regression analysis, larger increase in NLR was significantly associated with decreased survival (OR: 0.96, 95% CI: 0.94-0.99, p=0.008).

Conclusion: Changes in NLR are an independent determinant of survival in patients with return of spontaneous circulation PCA treated with TTM. An NLR change can be used to predict survival in these patients.
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http://dx.doi.org/10.14744/AnatolJCardiol.2017.7716DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5689054PMC
September 2017

Perception paradox between the doctors and patients in the industrial-bureaucratic age of medicine: Defensive versus offensive medicine in anticoagulation and atrial fibrillation ablation.

Pacing Clin Electrophysiol 2017 08 21;40(8):979-980. Epub 2017 Jul 21.

Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.

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http://dx.doi.org/10.1111/pace.13124DOI Listing
August 2017

Right ventricular outflow tract function in chronic heart failure.

Indian Heart J 2016 Apr 10;68 Suppl 1:S10-4. Epub 2015 Nov 10.

Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey.

Background: Heart failure (HF) is a common, progressive, complex clinical syndrome and a subset of HF patients has symptoms out of proportion to the resting hemodynamics and left ventricular ejection fraction (LVEF). Right ventricular (RV) function is a powerful prognostic factor in HF, but assessing it is a challenge because of the right ventricle's complex geometry.

Objective: The aim of this study was to investigate the clinical application value of RV outflow tract (RVOT) function measured by transthoracic echocardiography in HF patients.

Method: We prospectively investigated 36 chronic HF patients with dilated heart and LV systolic dysfunction and 21 healthy control subjects (normal ventricular function and ECG, and no cardiac risk factors). In addition to clinical and conventional echocardiographic parameters, RVOT size and fractional shortening (RVOT-FS) parameters were analyzed.

Results: The RVOT-FS was less in HF patients than healthy controls (18.8±15.7 vs 55.8±6.7, p<0.001) and correlated positively with TAPSE (r=0.814, p<0.001) and inversely with SPAP (r=-0.728, p<0.001) and functional capacity (r=-0.842, p<0.001). There was a statistically significant difference in RVOT-FS among the HF subgroups with regard to NYHA functional capacity (p<0.001), although there was no statistically significant difference with regard to LVEF.

Conclusion: Although the apparent discordance between LVEF and the degree of functional impairment in HF is not well understood, it may be explained in part by alterations in RV function. We found that the RVOT-FS was a noninvasive and easily applicable measure of RV function and might be used for a comprehensive evaluation and follow-up of HF patients with a combined assessment of RV by other RV parameters.
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http://dx.doi.org/10.1016/j.ihj.2015.07.028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4824327PMC
April 2016

Defensive medicine due to different fears by patients and physicians in geriatric atrial fibrillation patients and second victim syndrome.

Int J Cardiol 2016 Jun 24;212:251-2. Epub 2016 Mar 24.

Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey.

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http://dx.doi.org/10.1016/j.ijcard.2016.03.093DOI Listing
June 2016

Similarities between the renal artery and pulmonary vein denervation trials: Do we have to use sham procedures for atrial fibrillation catheter ablation trials?

Int J Cardiol 2016 May 2;211:55-7. Epub 2016 Mar 2.

Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey.

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http://dx.doi.org/10.1016/j.ijcard.2016.02.158DOI Listing
May 2016

Left coronary cusp cryoablation guided by electroanatomic mapping for outflow ventricular arrhythmias.

Int J Cardiol 2016 May 3;211:137-9. Epub 2016 Mar 3.

Turkiye Yuksek Ihtisas Hospital, Department of Cardiology, Ankara, Turkey.

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http://dx.doi.org/10.1016/j.ijcard.2016.02.156DOI Listing
May 2016

Arrhythmogenic Noncompaction Cardiomyopathy: Is There an Echocardiographic Phenotypic Overlap of Two Distinct Cardiomyopathies?

J Cardiovasc Ultrasound 2015 Sep 24;23(3):186-90. Epub 2015 Sep 24.

Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.

The clinical diagnosis of right ventricular (RV) cardiomyopathies is often challenging. It is difficult to differentiate the isolated left ventricular (LV) noncompaction cardiomyopathy (NC) from biventricular NC or from coexisting arrhythmogenic ventricular cardiomyopathy (AC). There are currently few established morphologic criteria for the diagnosis other than RV dilation and presence of excessive regional trabeculation. The gross and microscopic changes suggest pathological similarities between, or coexistence of, RV-NC and AC. Therefore, the term arrhythmogenic right ventricular cardiomyopathy is somewhat misleading as isolated LV or biventricular involvement may be present and thus a broader term such as AC should be preferred. We describe an unusual case of AC associated with a NC in a 27-year-old man who had a history of permanent pacemaker 7 years ago due to second-degree atrioventricular block.
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http://dx.doi.org/10.4250/jcu.2015.23.3.186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4595707PMC
September 2015

Single- and dual-site pace mapping of idiopathic septal intramural ventricular arrhythmias.

Heart Rhythm 2016 01 29;13(1):72-7. Epub 2015 Aug 29.

Division of Cardiovascular Medicine. Electronic address:

Background: Pace mapping (PM) is used to identify the origin of ventricular arrhythmias (VAs). For intramural VAs, the site of origin often cannot be reached and therefore PM is less accurate.

Objective: The purpose of this study was to assess the value of single- and dual-site pace maps to differentiate intramural from nonintramural VAs.

Methods: In 18 consecutive patients with idiopathic intramural VAs, pace mapping was performed at 2 breakthrough sites in adjacent anatomic structures. Twelve-lead electrocardiograms of the 2 pace maps were averaged in MATLAB and compared (correlation coefficient [CC]) with the targeted VA. Dual-site pace mapping was performed in a control group of 18 patients with nonintramural VAs at the sites of earliest electrical activation and a breakthrough site in an adjacent anatomic location.

Results: Dual-site pace maps had a higher CC than did best single-site pace maps (0.87 ± 0.1 vs 0.81 ± 0.16; P = .02) in patients with intramural VAs. At the site of origin, single-site pace maps had a higher CC than did dual-site pace maps obtained from adjacent anatomic locations (0.93 ± 0.04 vs 0.89 ± 0.05; P = .0004) in patients with nonintramural VAs. Sensitivity, specificity, positive predictive value, and negative predictive value of dual-site pace maps for identifying an intramural VA were 89%, 82%, 84%, 88%, and 86%, respectively. Furthermore, the receiver operating characteristic curve analysis revealed that a CC cutoff value of ≤0.86 for a single-site pace map best differentiated intramural from nonintramural VAs.

Conclusion: A higher CC value for a dual-site pace map obtained from the earliest breakthrough site as well as a CC cutoff value of ≤0.86 for a single-site pace map obtained from the site of earliest electrical activation can best differentiate intramural from nonintramural VAs.
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http://dx.doi.org/10.1016/j.hrthm.2015.08.032DOI Listing
January 2016

The classical "R-on-T" phenomenon.

Indian Heart J 2015 Jul-Aug;67(4):392-4. Epub 2015 Apr 27.

Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey.

The polymorphic ventricular tachycardia (PVT) is uncommon arrhythmia with multiple causes and has been classified according to whether they are associated with long QT interval or normal QT. Whereas "Torsade de pointes (TdP)" is an uncommon and distinctive form of PVT occurring in a setting of prolonged QT interval, which may be congenital or acquired (congenital or acquired), "PVT with normal QT" is associated with myocardial ischemia, electrolyte abnormalities (hypokalemia), mutations of the cardiac sodium channel (Brugada syndrome), and the ryanodine receptor (catecholaminergic PVT). This distinction is crucial because of the differing etiologies and management of these arrhythmias. Moreover, the PVT in the setting of acute MI generally occurs during the hyperacute phase, is related to ischemia ("ischemic PVT") and is not associated with QT prolongation. It is triggered by ventricular extrasystoles with very short coupling interval (the "R-on-T" phenomenon) and is not pause-dependent. However, recently there has been described a new PVT during the "healing phase" of MI in patients with no evidence of ongoing ischemia and following excessive QT prolongation, the electrophysiologic abnormality being a "pause-dependent infarct-related TdP" due to a LQTS in healing MI patients. Therefore, "ischemic PVT" differs from "infarct-related TdP" in terms of pathophysiology and ECG manifestations.
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http://dx.doi.org/10.1016/j.ihj.2015.02.030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4561790PMC
December 2016

Effect of circadian variability in frequency of premature ventricular complexes on left ventricular function.

Heart Rhythm 2016 Jan 3;13(1):98-102. Epub 2015 Aug 3.

Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan. Electronic address:

Background: Frequent idiopathic premature ventricular complexes (PVCs) can result in a reversible form of cardiomyopathy.

Objective: The purpose of this study was to assess the impact of variability in PVC frequency throughout the day on PVC-induced cardiomyopathy.

Methods: The subjects of this study were 107 consecutive patients (58 men [54%]; mean age 49.7 ± 15.0 years; left ventricular ejection fraction 50.4% ± 11.4%) referred for ablation of frequent PVCs. All patients underwent 24-hour Holter monitoring before the ablation procedure. The circadian variation in PVC burden was determined and correlated with the presence or absence of cardiomyopathy.

Results: A total of 43 patients (40%) had cardiomyopathy. Patients with cardiomyopathy had an ejection fraction of 38.4% ± 6.9%, a higher PVC burden (28.5% ± 11.5% vs 19.5% ± 10.5%; P = .0001), less variability in circadian PVC distribution (coefficient of variation hourly: 31.5% ± 21% vs 59.8% ± 32.4%; P = .0001), and more frequent interpolated PVCs (20 patients [47%] vs 15 patients [23%]; P = 0.022), and were more frequently asymptomatic than patients without cardiomyopathy (56% vs 19%; P = .0001). In multivariate analysis, consistency in PVC burden throughout the day was an independent predictor of PVC-induced cardiomyopathy (odds ratio 16.3; 95% confidence interval 1.7-155.3; p = 0.015).

Conclusion: In patients with frequent PVCs, consistency in hourly PVC frequency throughout the day is an independent predictor of PVC-induced cardiomyopathy.
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http://dx.doi.org/10.1016/j.hrthm.2015.07.038DOI Listing
January 2016

Occult obstructive sleep apnea and clinical outcomes of radiofrequency catheter ablation in patients with atrial fibrillation.

J Interv Card Electrophysiol 2015 Sep 3;43(3):279-86. Epub 2015 Jun 3.

Division of Cardiovascular Medicine, Cardiovascular Center, University of Michigan Health System, Room 2722, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5853, USA,

Background: Recurrent atrial fibrillation (AF) after successful cardioversion can be predicted by obstructive sleep apnea (OSA) diagnosed by polysomnography. However, it is not known whether the validated STOP-BANG questionnaire can predict AF recurrence after radiofrequency ablation (RFA). Our objective is to determine the prevalence of unrecognized OSA in patients with AF and its relation to freedom from AF after RFA.

Methods: Validated surveys were administered to 247 consecutive AF patients following radiofrequency ablation from January to October 2011. OSA status was assessed at baseline RFA. Clinical follow up occurred at 3-6 month intervals.

Results: OSA had been previously diagnosed in 94/247 (38%). Among 153 patients without prior diagnosis of OSA, 121 (79%) had high risk STOP-BANG scores for OSA. Probability of maintaining sinus rhythm after RFA was similar among patients with known OSA (66/94, 70%) and high risk OSA scores (95/124, 77%) and higher than among patients with low risk OSA scores (29/32, 91%, P=0.03). Among patients without prior OSA, a high risk STOP-BANG score did predict recurrent AF (OR = 3.7, 95 % CI 1.4-11.4, P = 0.0005). Multivariate analysis showed a higher risk of atrial arrhythmia recurrence for non-paroxysmal AF patients (OR = 3.1, ± 95 % CI 1.4-7.1, P = 0.005).

Conclusions: The majority of AF patients undergoing RFA have high risk OSA scores, suggesting that OSA is vastly underdiagnosed in this population. STOP-BANG independently predicted recurrent AF in patients without a prior diagnosis of OSA.
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http://dx.doi.org/10.1007/s10840-015-0014-4DOI Listing
September 2015

Predictive value of programmed ventricular stimulation after catheter ablation of post-infarction ventricular tachycardia.

J Am Coll Cardiol 2015 May 22;65(18):1954-9. Epub 2015 Apr 22.

Division of Cardiology, University of Michigan, Ann Arbor, Michigan. Electronic address:

Background: A recent meta-analysis demonstrated a survival benefit in post-infarction patients whose ventricular tachycardia (VT) was rendered noninducible by catheter ablation. Furthermore, patients with noninducible VT had a lower VT recurrence rate than did patients whose VT remained inducible after ablation.

Objectives: The purpose of this multicenter cohort study was to assess whether noninducibility after VT ablation is independently associated with improved survival.

Methods: Data from 1,064 patients who underwent VT ablation for post-infarction VT at seven international centers were analyzed. The ablation procedure was considered successful if no VT was inducible at the end of the procedure and unsuccessful if VT remained inducible or if programmed stimulation was not performed at the end of the ablation.

Results: Median follow-up time was 633 days. Noninducibility was independently associated with lower mortality (adjusted hazard ratio: 0.65; 95% confidence interval: 0.53 to 0.79; p<0.001). Atrial fibrillation, diabetes, and age were other independent predictors of higher mortality. Ablation of only the clinical VT in patients who also had inducible, nonclinical VTs was not associated with improved survival.

Conclusions: Noninducibility after VT ablation in patients with post-infarction VT is independently associated with lower mortality during long-term follow-up.
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http://dx.doi.org/10.1016/j.jacc.2015.02.058DOI Listing
May 2015

Recurrence of PVCs in patients with PVC-induced cardiomyopathy.

Heart Rhythm 2015 Jul 16;12(7):1519-23. Epub 2015 Mar 16.

Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan. Electronic address:

Background: The natural history of premature ventricular complex (PVC)-induced cardiomyopathy is incompletely understood.

Objective: The purpose of this study was to assess long term follow-up data in patients who underwent successful PVC ablation for PVC-induced cardiomyopathy.

Methods: The subjects of this study were 60 patients (17 women; mean age 52.5 ± 16.8 years; ejection fraction [EF] 37.3 ± 8.5%, median 40%, interquartile range [IQR] 15) with PVC-induced cardiomyopathy who underwent successful ablation of their predominant PVCs between 2005 and 2012. Patients were followed up for a mean of 23.6 ± 17.2 months. EF improved to 57.2 ± 4.7% (median 55%, IQR 5; P = .0001) within 9.6 ± 8.4 months of the ablation procedure. During follow-up, 10 of 60 patients (16.7%) had recurrent frequent PVCs and 50 patients (83.3%) did not. Patients underwent repeat assessment of EF and PVC burden.

Results: During follow-up of 23.6 ± 17.2 months, 10 patients had recurrent frequent PVCs, with an increase of their PVC burden from 1.4 ± 0.9% (median 1.05%, IQR 1.59) after the initial ablation to 27.2 ± 8.8% (median 26.0%, IQR 18.2; P = .018). Their EF decreased from 55.7 ± 3.4% (median 55%, IQR 5.8) after the initial ablation to 40.2 ± 5.1% (median 40%, IQR 15; P = .005). In the remaining patients with PVC-induced cardiomyopathy, EF and PVC burden remained unchanged during follow-up. Patients with PVC recurrence had a higher number of pleomorphic PVC morphologies during initial presentation (4.7 ± 2.2 vs 2.5 ± 2.8, P = .002).

Conclusion: Recurrence of frequent PVCs in patients with a history of PVC cardiomyopathy can result in recurrence of cardiomyopathy. Follow-up in patients with PVC-induced cardiomyopathy is important, especially if patients were asymptomatic from the PVCs and have pleomorphic PVCs.
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http://dx.doi.org/10.1016/j.hrthm.2015.03.027DOI Listing
July 2015

Noninducibility in postinfarction ventricular tachycardia as an end point for ventricular tachycardia ablation and its effects on outcomes: a meta-analysis.

Circ Arrhythm Electrophysiol 2014 Aug 30;7(4):677-83. Epub 2014 May 30.

From the Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor (H.G., K.B., M.Y., F.M., F.B.); Department of Internal Medicine, Cardiovascular Division, Brigham and Women Hospital, Boston, MA (W.S.); Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele Hospital, Milano, Italy (P.D.B., P.V.); Klinik für Kardiologie II, Herz- und Gefäß-Klinik GmbH, Bad Neustadt, Germany (T.D.); Hanseatisches Herzzentrum, Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K.); Department of Electrophysiology, Klinik Hirslanden, Zürich, Switzerland (H.K.); and Department of Internal Medicine, Division of Cardiology, Peking University Third Hospital, Beijing, China (S.F.).

Background: Although ventricular tachycardia (VT) ablation is a widely used therapy for patients with VT, the ideal end points for this procedure are not well defined. We performed a meta-analysis of the published literature to assess the predictive value of noninducibility of postinfarction VT for long-term outcomes after VT ablation.

Methods And Results: We performed a systematic review of MEDLINE (1950-2013), EMBASE (1988-2013), the Cochrane Controlled Trials Register (Fourth Quarter, 2012), and reports presented at scientific meetings (1994-2013). Randomized controlled trials, case-control, and cohort studies of VT ablation were included. Outcomes reported in eligible studies were freedom from VT/ventricular fibrillation and all-cause mortality. Of the 3895 studies evaluated, we identified 8 cohort studies enrolling 928 patients for the meta-analysis. Noninducibility after VT ablation was associated with a significant increase in arrhythmia-free survival compared with partial success (odds ratio, 0.49; 95% confidence interval, 0.29-0.84; P=0.009) or failed ablation procedure (odds ratio, 0.10; 95% confidence interval, 0.06-0.18; P<0.001). There was also a significant reduction in all-cause mortality if patients were noninducible after VT ablation compared with patients with partial success (odds ratio, 0.59; 95% confidence interval, 0.36-0.98; P=0.04) or failed ablation (odds ratio, 0.32; 95% confidence interval, 0.10-0.99; P=0.049).

Conclusions: Noninducibility of VT after VT ablation is associated with improved arrhythmia-free survival and all-cause mortality.
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http://dx.doi.org/10.1161/CIRCEP.113.001404DOI Listing
August 2014

Infrequent intraprocedural premature ventricular complexes: implications for ablation outcome.

J Cardiovasc Electrophysiol 2014 Oct 19;25(10):1088-92. Epub 2014 Jun 19.

Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.

Background: Frequent premature ventricular complexes (PVCs) can be eliminated with an ablation procedure. Ablation success rates have been reported to be in the 80% range. Reasons for failure of ablation have not been described in detail. The purpose of this study was to determine whether the paucity of PVCs at the beginning of the ablation procedure affects the outcome.

Methods: Catheter ablation was attempted in a consecutive series of 194 patients (age: 50 ± 14 years, 91 male, ejection fraction: 56.4 ± 8.4%) with frequent idiopathic PVCs. Based on receiver operator characteristics (ROC) analysis, patients were divided into 2 groups: Patients with frequent PVCs (≥32 PVCs within the first 30 minutes of the procedure: n = 135 [70%]); and patients with infrequent PVCs (<32 PVCs within the first 30 minutes of the procedure: n = 59 [30%]). Procedural outcomes were compared at 3 months postablation. A successful ablation was defined as a ≥80% reduction in the PVC burden compared to baseline.

Results: A successful procedure was performed in 148 patients (76%) resulting in a decrease in the PVC burden from 19.1 ± 13.6% to 0.38 ± 0.98%(P < 0.0001). Patients with frequent intraprocedural PVCs had a higher success rate than patients with infrequent intraprocedural PVCs (85% vs. 56%, P = 0.0001). Administration of sedation was no different in the 2 groups. The paucity of PVCs was independent of the site of origin in predicting procedural failure (OR: 6.9, 95% CI: 3.0-16.2 P = 0.0001).

Conclusion: Paucity of PVCs at the beginning of an ablation procedure is associated with a lower ablation success rate independent of the site of origin.
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http://dx.doi.org/10.1111/jce.12454DOI Listing
October 2014

Mortality and cerebrovascular events after radiofrequency catheter ablation of atrial fibrillation.

Heart Rhythm 2014 Sep 6;11(9):1503-11. Epub 2014 May 6.

Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan. Electronic address:

Background: Atrial fibrillation (AF) is associated with a significant increase in the risk of stroke and mortality. It is unclear whether maintaining sinus rhythm (SR) after radiofrequency ablation (RFA) is associated with an improvement in stroke risk and survival.

Objective: The purpose of this study was to determine whether SR after RFA of AF is associated with an improvement in the risk of cerebrovascular events (CVEs) and mortality during an extended 10-year follow-up.

Methods: RFA was performed in 3058 patients (age 58 ± 10 years) with paroxysmal (n = 1888) or persistent AF (n = 1170). The effects of time-dependent rhythm status on CVEs and cardiac and all-cause mortality were assessed using multivariable Cox models adjusted for baseline and time-dependent variables during 11,347 patient-years of follow-up.

Results: Independent predictors of a higher arrhythmia burden after RFA were age (estimated beta coefficient [β] = 0.017 per 10 years, 95% confidence interval [CI] 0.006-0.029, P = .003), left atrial (LA) diameter (β = 0.044 per 5-mm increase in LA diameter, 95% CI 0.034-0.055, P <.0001), and persistent AF (β = 0.174, 95% CI 0.147-0.201, P <.0001). CVEs and cardiac and all-cause mortality occurred in 71 (2.3%), 33 (1.1%), and 111 (3.6%), respectively. SR after RFA was associated with a significantly lower risk of cardiac mortality (hazard ratio [HR] 0.41, 95% CI 0.20-0.84, P = .015). There was not a significant reduction in all-cause mortality (HR 0.86, 95% CI 0.58-1.29, P = .48) or CVEs (HR 0.79, 95% CI 0.48-1.29, P = .34) in patients who remained in SR after RFA.

Conclusion: Maintenance of SR after RFA is associated with a reduction in cardiovascular mortality in patients with AF.
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http://dx.doi.org/10.1016/j.hrthm.2014.05.003DOI Listing
September 2014

Predictors of outcome after catheter ablation of premature ventricular complexes.

J Cardiovasc Electrophysiol 2014 Jun 28;25(6):597-601. Epub 2014 Mar 28.

Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.

Background: The purpose of this study was to assess how well acute procedural outcomes predict the clinical outcome of catheter ablation of premature ventricular complexes (PVCs).

Methods: A consecutive series of 50 patients (28 women, age: 51 ± 13 years) with frequent PVCs was referred for PVC ablation. Acute failure was defined as inability to eliminate the predominant PVC or recurrence of the predominant PVC within 12 hours. The PVC burden was reassessed 3 months after the ablation procedure. A successful procedure was defined as reduction of the PVC burden at 3 months by ≥80% of the initial burden.

Results: The procedure was acutely effective in 37 patients (74%) and at 3 months in 40 patients (80%). The presence or absence of the predominant PVC in the 12 hours postablation had the highest accuracy for outcome at 3 months (accuracy: 90%). From among the 13/50 patients (26%) with evidence of acute failure, 4 had a PVC reduction of ≥80% at 3 months and 10 had a PVC reduction of >50% resulting in symptomatic improvement at 3 months.

Conclusion: The presence or absence of the predominant PVC within 12 hours postablation best correlated with the 3-month-efficacy data. Recurrence of the predominant PVC shortly after ablation did not indicate a procedural failure and the necessity for a repeat procedure. The majority of these patients had a significant, clinically meaningful reduction in their PVC burden. Acute predictors for procedural outcome at 3 months have a high positive but rather low negative predictive value.
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http://dx.doi.org/10.1111/jce.12400DOI Listing
June 2014

A shift in the balance of regulatory T and T helper 17 cells in rheumatic heart disease.

J Investig Med 2014 Jan;62(1):78-83

From the *Department of Cardiology, Gazi University Faculty of Medicine; †Cardiology Department, Ankara Turkiye Yuksek Ihtisas Hospital; and ‡Department of Immunology, Immunology Research Center, Gazi University Faculty of Medicine, Ankara, Turkey.

Background: Autoimmunity plays an essential role in the pathogenesis of rheumatic heart disease (RHD); however, cellular mechanisms of autoimmune response are unclear. Whereas T helper 17 (TH17) and regulatory T cells (Treg) cells share a common differentiation pathway, they play opposite roles in the immune tolerance and autoimmune diseases. Although high TH17/Treg ratio has been shown in several autoimmune diseases, no data are available in RHD. This study investigated the balance between TH17 and Treg in rheumatic mitral valve disease (MVD).

Methods: Forty patients with rheumatic MVD and 23 control subjects were enrolled into the study. All subjects underwent clinical, electrocardiographic, and echocardiographic evaluation. The percentages of circulating TH17 and Treg cells were analyzed by flow cytometry. Serum levels of high-sensitivity C-reactive protein (hs-CRP) and cytokines were assessed by enzyme-linked immunosorbent assay.

Results: As compared with control subjects, rheumatic MVD patients showed significant increase in peripheral TH17 percentage, high serum levels of TH17-related cytokine interleukin 17A, and an obvious decrease in the percentage of Treg cells. T helper 17/Treg ratio was significantly high in rheumatic MVD patients compared with control subjects (P = 0.0001). Serum concentrations of hs-CRP in rheumatic MVD group were higher than those of the control subjects, and hs-CRP levels correlated with the TH17/Treg ratio (r = 0.71, P = 0.0001). Serum levels of transforming growth factor β1 were increased in rheumatic MVD group compared with those of the control subjects.

Conclusions: The results indicated that high TH17/Treg ratio exists inrheumatic MVD. This imbalance may play a role in the pathogenesis, and TH17/Treg balance may be a promising therapeutic approach in RHD.
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http://dx.doi.org/10.2310/JIM.0000000000000023DOI Listing
January 2014

The relationship of plasma neuropeptide Y levels with coronary collateral development.

Coron Artery Dis 2014 Jan;25(1):73-8

Departments of aCardiology bBiochemistry, Gazi University School of Medicine cDepartment of Cardiology, Ankara Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey.

Objective: Neuropeptide Y (NPY), a sympathetic cotransmitter, has been shown to promote angiogenesis in in-vitro models. The aim of this study was to evaluate the relationship of plasma NPY levels with coronary collateral vessel development in patients with coronary artery disease.

Methods: The study included 81 patients with at least one coronary stenosis with at least 80% narrowing in coronary angiography. Collateral vessels were graded according to the Rentrop classification. The study patients were divided into two groups, namely patients with well-developed collaterals and patients with poorly developed collaterals. Well-developed collaterals were defined as Rentrop collateral score of at least 2. Plasma levels of NPY, vascular endothelial growth factor, fibroblast growth factor, and noradrenaline were measured using an enzyme-linked immunosorbent assay.

Results: Plasma NPY was significantly higher in patients with well-developed collaterals as compared with patients with poorly developed collaterals (P=0.026). In contrast, plasma noradrenaline was significantly lower in patients with well-developed collaterals (P=0.022). There was no statistically significant difference in vascular endothelial growth factor and fibroblast growth factor levels between groups. The NPY level was positively correlated with the presence of diabetes (r=0.528, P<0.001). The extent of coronary artery disease (Gensini score) was significantly higher in patients with well-developed collaterals (P<0.001). After confounding variables were controlled for, the NPY level in patients with well-developed collaterals was significantly higher than those patients with poorly developed collaterals.

Conclusion: In this study, NPY levels were found to be significantly higher in patients with well-developed coronary collaterals compared with patients with poorly developed collaterals. New studies are needed to show whether this relationship is causal.
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http://dx.doi.org/10.1097/MCA.0000000000000039DOI Listing
January 2014

Comparison of serum gamma-glutamyltransferase levels between patients with cardiac syndrome X and healthy asymptomatic individuals.

Kardiol Pol 2012 ;70(1):31-7

Department of Cardiology, Doctor Sadi KONUK Education and Research Hospital, Istanbul, Turkey.

Background: Gamma-glutamyltransferase (GGT) enzyme has an increasing importance in the pathophysiology and prognosis of cardiovascular diseases. It is an indirect marker of microvascular endothelial dysfunction, atherosclerosis, and elevated oxidative stress. There are no adequate data on the relationship between GGT and cardiac syndrome X.

Aim: To compare serum GGT levels between patients with cardiac syndrome X and asymptomatic healthy individuals.

Methods: Fifty consecutive patients (29 female, 21 male, aged 28-81 years) who underwent coronary angiography due to objective ischaemia and were eventually diagnosed with cardiac syndrome X between July 2009 and January 2010, and 50 healthy asymptomatic control individuals (28 female, 22 male, aged 30-78 years) were studied. Venous blood samples were collected for GGT measurements. A metabolic syndrome (MS) subgroup composed of 15 individuals was formed within the cardiac syndrome X group.

Results: Serum total cholesterol, LDL-cholesterol, and triglyceride (TG) levels were significantly higher in the cardiac syndrome X patients than in the control group (195.28 ± 33.71 mg/dL and 168.82 ± 31.45 mg/dL, p < 0.01, 121.62 ± 30.53 mg/dL and 98.44 ± 27.28 mg/dL, p < 0.01, 144.30 ± 68.54 mg/dL and 108.94 ± 43.59 mg/dL, p < 0.01, respectively). Serum GGT levels were also significantly higher in the cardiac syndrome X patients than in the control group (30.48 ± 16.36 and 17.88 ± 6. 89 U/L, p < 0.001). The MS patients (n = 15) had significantly higher TG and GGT levels (230.00 ± 41.37 mg/dL and 107.57 ± 37.90 mg/dL, p < 0.01, 38.47 ± 21.27 U/L and 27.06 ± 12.61 U/L, p < 0.001, respectively) and lower HDL levels (35.47 ± 6.91 mg/dL and 48.26 ± 9.97 mg/dL, p < 0.05) compared to patients without MS. The cardiac syndrome X group exhibited a significant positive correlation between GGT and body mass index, and GGT and TG (r = 0.321, p = 0.023, r = 0.293, p = 0.039, respectively).

Conclusions: GGT activity in patients with cardiac syndrome X was higher than in healthy controls. Moreover, GGT activity was further increased in those patients with cardiac syndrome X who had also MS.
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May 2012

High ventricular lead impedance of a DDD pacemaker after cranial magnetic resonance imaging.

Pacing Clin Electrophysiol 2012 Sep 8;35(9):e251-3. Epub 2011 Feb 8.

Cardiology Department, Turkiye Yuksek Ihtisas Hastanesi, Ankara, Turkey.

Management of electromagnetic interference in the form of magnetic resonance imaging (MRI) in patients with pacemakers (PMs) may be challenging. Serious consequences, especially in PM-dependent patients, may be encountered. Changes in device programming, asynchronous pacing, heating of the lead tip(s), and increased thresholds or even device dislocation may be experienced. We report of a patient with a DDD PM who underwent an emergent MRI, after which there was an increase in ventricular impedance as well as increased cardiac biomarkers.
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http://dx.doi.org/10.1111/j.1540-8159.2011.03027.xDOI Listing
September 2012

Do all hemolytic anemias that occur after mitral valve repair require surgical treatment?

Clin Cardiol 2010 Dec;33(12):E76-8

Department of Internal Medicine, S.B. Dıskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.

We report on a 29-year-old woman with severe hemolytic anemia following mitral valve annuloplasty. Although hemolysis due to mechanical prosthetic mitral valve is well recognized, hemolytic anemia associated with mitral valve repair is an uncommon condition. Reoperation may be considered if the patient has serious and persistent anemia. Although valve replacement is suggested to be a unique intervention, it may not be the solution every time because of mechanical effects. Various mechanisms of hemolysis related to mitral valve repair were suggested, but sufficient and precise data is not available. In this case, we tried to emphasize whether all hemolytic anemias that occur after mitral valve repair require surgical treatment.
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http://dx.doi.org/10.1002/clc.20393DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6653213PMC
December 2010

Impaired aortic elasticity in patients with psoriasis.

Acta Cardiol 2009 Oct;64(5):597-602

Department of Cardiology, Ministry of Health Dişkapi Yildirim Beyazit Research and Educational Hospital, Ankara, Turkey.

Background: Psoriasis vulgaris is a chronic inflammatory disease involving 1-3% of the human population worldwide. Many systemic diseases including cardiovascular disturbances have been described in psoriatic patients. The effect of psoriasis on aortic elasticity parameters has not been well-defined previously. The aim of this study was to determine whether there was any change in aortic elasticity in psoriasis.

Methods: Twenty-seven psoriatic patients without cardiovascular involvement and 22 healthy subjects were enrolled into the study. The severity of the disease was evaluated by the "Psoriasis Area and Severity Index (PASI)". Aortic strain, distensibility and stiffness index were calculated from aortic diameters measured by echocardiography and blood pressures simultaneously measured by sphygmomanometry.

Results: The aortic strain and distensibility in the psoriasis group were significantly lower than those in the control group. The aortic stiffness index in the psoriasis group was higher than that in the control group. There was a positive correlation between aortic stiffness index and PASI and longevity of psoriasis disease, whereas a negative correlation between aortic strain and PASI and longevity of psoriasis disease was found.

Conclusion: We found that in psoriatic patients without cardiac involvement, aortic elasticity was decreased and this decrease was correlated with the duration and the severity of the disease.
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http://dx.doi.org/10.2143/AC.64.5.2042688DOI Listing
October 2009

Hepatocellular carcinoma with right atrial extension causing clinical deterioration in a patient with ischemic cardiomyopathy.

Anadolu Kardiyol Derg 2008 Jun 7;8(3):E19. Epub 2008 Jun 7.

Department of Cardiology, Yüksek Ihtisas Hospital, Ankara, Turkey.

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June 2008

A severe coarctation of the aorta incidentally diagnosed during cardiac catheterization of a 40-year-old male patient presenting acute coronary syndrome.

Anadolu Kardiyol Derg 2007 Dec 7;7(4):E1-2. Epub 2007 Dec 7.

Department of Cardiology, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey.

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December 2007

Evaluation of left ventricular diastolic functions in patients with frequent premature ventricular contractions from right ventricular outflow tract.

Heart Vessels 2007 Sep 20;22(5):328-34. Epub 2007 Sep 20.

Department of Cardiology, Türkiye Yuksek Ihtisas Hospital, Ankara, Turkey.

This study was sought to examine the effects of repetitive monomorphic premature ventricular contractions (PVCs) on left ventricular (LV) diastolic function. Thirty-three symptomatic patients (Study group, 10 males, mean age 40 +/- 8 years) with normal LV systolic function and repetitive PVCs originating from the right ventricular outflow tract (RVOT-PVCs) on 24-h Holter monitoring, and 30 healthy controls (Control group, 9 males, mean age 37 +/- 9 years) were enrolled in the study. None of the patients had structural heart disease. Diastolic function was assessed by echocardiographic mitral inflow pattern and tissue Doppler imaging. The study group displayed a lower E/A ratio, longer isovolumetric relaxation time (IVRT), and longer E-wave deceleration time (EDT). In the study group 13 patients showed impaired relaxation. While mean values of the systolic velocity (Sa), early diastolic velocity (Ea), and early/late diastolic velocity (Ea/Aa) ratio were significantly lower in the study group, the Aa velocity and E/Ea ratio were significantly higher. Ea velocity was <10 cm/s in 7 study patients. Mitral inflow pattern and Ea velocity was normal in all controls. Significant correlations were found between ventricular premature beats percentage and early to late transmitral flow velocity ratio, EDT, IVRT, Ea velocity, the Ea/Aa ratio, and the E/Ea ratio. In multivariate analysis, total PVC count and age were found to be independent predictors of impaired relaxation. These results suggest that repetitive monomorphic RVOT-PVCs lead to abnormalities of LV diastolic function that may contribute to clinical symptoms in patients with structurally normal hearts.
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http://dx.doi.org/10.1007/s00380-007-0978-9DOI Listing
September 2007
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