Publications by authors named "Mehmet Onur Omaygenc"

27 Publications

  • Page 1 of 1

Long-term comparison of everolimus- vs. novolimus-eluting bioresorbable vascular scaffolds in real world patients.

Postepy Kardiol Interwencyjnej 2020 Dec 29;16(4):391-398. Epub 2020 Dec 29.

Department of Cardiology, Istanbul Medipol University, Istanbul, Turkey.

Introduction: Elevated risk of adverse events in comparison to metallic stents resulted in withdrawal of everolimus-eluting bioresorbable scaffolds (eBVS), known as the most intensively studied BVS. There is a paucity of data comparing the two different BVS.

Aim: To evaluate the long-term clinical outcomes of the novolimus-eluting bioresorbable vascular scaffold (nBVS) compared with eBVS.

Material And Methods: Consecutive patients treated with nBVS or eBVS in our center were screened. The primary outcome was the 3-year rate of major adverse cardiovascular events (MACE), defined as the composite of cardiac death, target vessel myocardial infarction (TV-MI), and target-lesion revascularization (TLR).

Results: After matching, 98 patients treated with 135 eBVS were compared with 98 patients treated with 136 nBVS. Baseline characteristics, clinical presentation, and lesion characteristics were comparable in both groups. The 3-year MACE rate was higher in the eBVS group (17.3% vs. 6.1%; log-rank = 0.02). The occurrence of TLR (16.3% vs. 5.1%; log-rank = 0.02) and TV-MI (8.2% vs. 0 %; log-rank = 0.004) was also higher in the eBVS group except for cardiac deaths (1% vs. 2%; log-rank = 0.98, eBVS vs. nBVS, respectively). Of note, definite device thrombosis rate was markedly increased in the eBVS group (5.1% vs. 0%; log-rank = 0.03).

Conclusions: The present study revealed that the 3-year event risk was lower for nBVS compared to eBVS. More evidence is needed to evaluate long-term performance of novolimus-eluting biovascular platforms.
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http://dx.doi.org/10.5114/aic.2020.101763DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863837PMC
December 2020

Cystatin C and uncontrolled hypertension.

Anatol J Cardiol 2020 11;24(5):309-315

Department of Cardiology, Faculty of Medicine, İstanbul Medipol University; İstanbul-Turkey.

Objective: Increased serum level of cystatin C, a sensitive biomarker for renal function, seems to predict adverse cardiovascular events. We investigated the predictive value of serum cystatin C for controlling hypertension in an observational study.

Methods: We screened 1037 adults residing in both rural and urban communities. They were grouped based on their diagnosis and control of hypertension.

Results: Serum cystatin C levels in patients with uncontrolled hypertension were higher than those in patients with controlled hypertension (0.98±0.23 mg/L vs. 0.89±0.19 mg/L, p=0.001). However, serum creatinine levels were similar between these groups (0.72±0.20 mg/dL vs. 0.70±0.18 mg/dL, p=0.89). Serum cystatin C levels increased the probability of uncontrolled hypertension independent from confounding factors (odds ratio, 1.48; 95% confidence interval, 1.09-5.64; p=0.03).

Conclusion: Subtle kidney dysfunction may be detected using serum cystatin C concentrations among patients with poor blood pressure control and normal serum creatinine levels.
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http://dx.doi.org/10.14744/AnatolJCardiol.2020.78974DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7724385PMC
November 2020

Value of Renal Vascular Doppler Sonography in Cardiorenal Syndrome Type 1.

J Ultrasound Med 2021 Feb 23;40(2):321-330. Epub 2020 Jul 23.

Department of Cardiology, Istanbul Medipol University, Faculty of Medicine, Istanbul, Turkey.

Objectives: Worsening of renal function in a patient with acute decompensated heart failure is called cardiorenal syndrome (CRS) type 1. Recent studies have shown an association of persistent systemic venous congestion with renal dysfunction. This trial was set up to investigate the changes of renal Doppler parameters with diuretic therapy in patients with CRS type 1.

Methods: Cases of CRS type 1 were identified among patients hospitalized for decompensated heart failure. Serial measurements of the renal venous impedance index (VII) and arterial resistive index (ARI) were calculated by pulsed wave Doppler sonography.

Results: A total of 30 patients who had creatinine improvement with diuresis (group 1) and 34 patients without any improvement (group 2) were analyzed. Patients in group 1 had higher median VII and ARI (VII, 0.86 versus 0.66; P < .001; ARI, 0.78 versus 0.65; P < .001) on admission. A high ARI on admission (odds ratio, 6.25; 95% confidence interval, 1.84-14.3; P = .003) predicted the improvement of serum creatinine levels with diuretic therapy independent of confounding factors in patients with CRS type 1.

Conclusions: Renal vascular Doppler parameters might offer guidance on the diagnostic and therapeutic strategies in prescribing decongestive therapy for decompensated heart failure.
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http://dx.doi.org/10.1002/jum.15404DOI Listing
February 2021

Relationship between histopathological features of aspirated thrombi and long-term left ventricular function in patients with ST-segment elevation myocardial infarction.

Turk Kardiyol Dern Ars 2020 03;48(2):116-126

Department of Cardiology, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, İstanbul, Turkey.

Objective: This study was an investigation of the severity of inflammation (SOI) in aspirated material and thrombus age to examine any association with pre-discharge and long-term left ventricular (LV) function after ST-elevation myocardial infarction (STEMI).

Methods: The study group comprised 25 patients with STEMI from whom an occlusive thrombus was aspirated from the infarct-related artery with a 7-F catheter. The SOI in the aspirate was determined according to the mean leukocyte count in 5 high-power magnification fields and graded as mild in the presence of ≤100 leukocytes per field or significant if there were >100 leukocytes per field. The thrombi were categorized as fresh or lytic/organized (L/O) using predefined criteria. Echocardiographic assessment was performed prior to discharge and at 1 year. Adverse left ventricular remodeling (LVR) was defined as a 20% increase in LV end-diastolic volume in comparison with baseline values.

Results: LVR was observed in 8 patients. The mean leukocyte count of the aspirate (127.5±86.0 vs 227.2±120.7; p=0.026) and frequency of significant inflammation (35% vs 75% p=0.046) were significantly higher in the group with LVR. The serum high-sensitivity C-reactive protein (hsCRP) level was significantly correlated with the leukocyte count of the aspirate (r=0.532; p=0.006). An L/O thrombus was related to better pre-discharge and long-term LV volumes and ejection fraction values compared with a fresh thrombus.

Conclusion: A significant increase in the leukocyte count in the aspirate and a fresh thrombus might predict long-term LV functional deterioration irrespective of the clinical and procedure-related characteristics. In addition, serum markers of inflammation, like hsCRP, might also reflect the intensity of the local inflammatory response at the site of occlusion.
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http://dx.doi.org/10.5543/tkda.2019.62121DOI Listing
March 2020

Successful transcatheter mitral valve replacement in a patient with bioprosthetic valvular degeneration and severe regurgitation.

Turk Kardiyol Dern Ars 2019 Apr;47(3):228-231

Department of Cardiology, İstanbul Medipol University Faculty of Medicine, İstanbul, Turkey.

The implantation of aortic transcatheter heart valves has been successfully performed throughout the world in hundreds of patients with severe dysfunction of a degenerated mitral bioprosthesis or those at high surgical risk for re-operation. The transseptal approach may be more technically challenging, but is a less invasive procedure and may have a lower mortality rate compared with a transapical approach, and also offers a quick patient recovery. This report is a description of a rare case in Turkey: a successful transseptal mitral valve replacement in a case of a failed bioprosthetic valve. This case illustrates the feasibility and safety of percutaneous valve-in-valve implantation to treat a degenerated bioprosthesis.
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http://dx.doi.org/10.5543/tkda.2018.69679DOI Listing
April 2019

Effect of cardiac resynchronization therapy on mitral valve geometry: a novel aspect as "reversed mitral remodeling".

Int J Cardiovasc Imaging 2018 Jul 31;34(7):1029-1040. Epub 2018 Jan 31.

Cardiac Electrophysiology Department, Faculty of Medicine, Medipol University, Istanbul, Turkey.

Amelioration of the valvular geometry is a possible mechanism for mitral regurgitation (MR) improvement in patients receiving cardiac resynchronization therapy (CRT). We aimed to establish the precise definition, incidence, and predictors of reversed mitral remodeling (RMR), as well as the association with MR improvement and short-term CRT outcome. Ninety-five CRT recipients were retrospectively evaluated for the end-point of "MR response" defined as the absolute reduction in regurgitant volume (RegV) at 6 months. To identify RMR, changes in mitral deformation indices were tested for correlation with MR response and further analyzed for functional and echocardiographic CRT outcomes. Overall, MR response was observed in 50 patients (53%). Among the echocardiographic indices, the change in tenting area (TA) had the highest correlation with the change in RegV (r = 0.653, p < 0.001). The mean TA significantly decreased in MR responders (4.15 ± 1.05 to 3.67 ± 1.01 cm at 6 months, p < 0.001) and increased in non-responders (3.68 ± 1.04 to 3.98 ± 0.97 cm, p = 0.014). The absolute TA reduction was used to identify patients with RMR (47%) which was found to be associated with higher rates of functional improvement (p = 0.03) and volumetric CRT response (p = 0.036) compared to those without RMR. Non-ischemic etiology and the presence of LBBB independently predicted RMR at multivariate analysis. In conclusion, reduction in TA is a reliable index of RMR, which relates to MR response, and functional and echocardiographic improvement with CRT. LBBB and non-ischemic etiology are independent predictors of RMR.
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http://dx.doi.org/10.1007/s10554-018-1308-2DOI Listing
July 2018

The relationship between the S-wave in lead 1 and recurrence of RVOT PVC ablation.

J Electrocardiol 2018 May - Jun;51(3):519-523. Epub 2017 Dec 14.

Medipol University Faculty of Medicine, Cardiology Department, Istanbul, Turkey.

Background: Radiofrequency catheter ablation (CA) is a common non-pharmacological treatment option for ventricular premature contractions (PVCs) originating from right ventricular outflow tract (RVOT). In this study, we aimed to investigate the relationship between recurrence after CA for RVOT-PVC and S-wave in lead 1 that was shown to be associated with RVOT depolarization.

Methodology: A total of 104 patients who were referred to our clinic for CA for idiopathic RVOT-PVC between 2012 and 2015years were enrolled. All ECG parameters were measured before and after the ablation procedure.

Results: Ablation was successful in 100 patients (96,1%). These patients with successful ablation were followed for a mean duration of 1078days. 13 patients (13%) had recurrence. Univariate logistic regression analysis revealed age (odds ratio: 1.916, p:0,012), presence of post-procedural S1 (odds ratio:1.040 p:0,028), post-procedural S1 area (oddsratio:1.023 p:0,041), ΔS1 area (odds ratio:1.242 p:0,004) as predictors for recurrence. Multivariate logistic regression analysis detected age (odds ratio:1.053 p:0,032) and ΔS1 area (odds ratio:0.701 p:0,009) as predictors for recurrence.

Conclusion: Radiofrequency CA for RVOT-PVC can be performed with high procedural success and low complication rates. Age and ΔS1 area might be helpful for prediction of recurrence after CA.
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http://dx.doi.org/10.1016/j.jelectrocard.2017.12.033DOI Listing
March 2019

Pocket haematoma after cardiac electronic device implantation in patients receiving antiplatelet and anticoagulant treatment: a single-centre experience.

Acta Cardiol 2017 Feb;72(1):47-52

a Medipol University Medicine Faculty, Cardiology Department , Istanbul , Turkey.

Objective In modern cardiology practice, implantation of cardiac electronic devices in patients taking anticoagulant or antiplatelet therapy is a common clinical scenario. Bleeding complications are of particular concern in this patient population and pocket haematoma is one of the most frequent complications. We sought to determine the relationship between periprocedural antiplatelet/anticoagulant therapy and pocket haematoma formation in patients undergoing cardiac implantable electronic device (CIED) implantation. Methods We conducted a retrospective study including 232 consecutive patients undergoing CIED implantation in the department of cardiology of the Medipol University Hospital. Patients were divided into six groups: clopidogrel group (n = 12), acetylsalicylic acid (ASA) group (n = 73), ASA + clopidogrel group (n = 29), warfarin group (n = 34), warfarin + ASA group (n = 21) and no antiplatelet-anticoagulant therapy group as the control group (n = 63). CIED implantations were stratified under four subtitles including implantable cardioverter/defibrillator (ICD), cardiac resynchronization therapy (CRT), permanent pacemaker and the last group as either device upgrade or generator replacement. Results The mean age of the patients was 63 ± 14 years and 140 patients were male (60.3%). A pocket haematoma was documented in 6 of 232 patients (2.6%). None of the patients with pocket haematoma needed pocket exploration or blood transfusion. The type of the device did not have a significant effect on pocket haematoma incidence (P = 0.250). Univariate logistic regression showed that platelet level and ASA plus clopidogrel use were significantly associated with haematoma frequency after CIED implantations, respectively (OR: 0.977, CI 95% [0.958-0.996]; OR: 16.080, CI 95% [2.801-92.306]). Multivariate analysis revealed that dual antiplatelet treatment (β = 3.016, P = 0.002, OR: 2.410, 95% CI [3.042-136.943]) and baseline platelet level (β = -0.027, p:0.025, OR: 0.974, 95% CI [0.951-0.997]) were independent risk factors for pocket haematoma formation. Conclusion Dual antiplatelet therapy and low platelet levels significantly increased the risk of pocket haematoma formation in patients undergoing CIED implantations.
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http://dx.doi.org/10.1080/00015385.2017.1281539DOI Listing
February 2017

Real-life data regarding acute procedural success and 1-year clinical outcome of desolve bioresorbable scaffolds.

J Interv Cardiol 2017 Jun 25;30(3):189-194. Epub 2017 Apr 25.

Faculty of Medicine, Cardiology Department, Medipol University, Istanbul, Turkey.

Objectives: We aimed to evaluate the peri-procedural success of DESolve bio-resorbable scaffolds (BRSs) and analyzed real-life data about major cardiac events during 1-year follow-up.

Background: There is little information about real-life data of DESolve BRS which is a novel stent technology offering various advantages over drug eluting stents and commonly used in daily cardiology practice.

Methods: We conducted this single-center and non-randomized cross-sectional study from June 2015 through August 2016 in Medipol University Department of Cardiology and included 117 patients undergoing single or multivessel percutaneous coronary interventions (PCI) with novolimus-eluting BRS devices (152 scaffolds) (Elixir Medical Corporation). Study end points were acute device and procedural success, scaffold thrombosis and major adverse cardiac event (MACE) rates of DESolve BRS.

Results: Device success was 96.7% and procedural success was 99.3%. We detected MACE rate as 0.9% while clinical-driven target lesion revascularization was performed in one patient. None of the patients experienced scaffold thrombosis or death. Peri-procedural complications were reported in three patients.

Conclusions: High rates of successful scaffold implantations, low rates of peri-procedural complications, and major cardiac events in long-term suggest that DESolve scaffolds can safely and effectively be used in daily intervention practice by particularly experienced operators.
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http://dx.doi.org/10.1111/joic.12386DOI Listing
June 2017

Relationship between serum osteopontin level and atrial fibrillation recurrence in patients undergoing cryoballoon catheter ablation.

Turk Kardiyol Dern Ars 2017 Jan;45(1):26-32

Department of Cardiology, İstanbul Medipol University Faculty of Medicine, İstanbul, Turkey.

Objective: Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with increased morbidity and mortality. Atrial fibrosis augments recurrence rate following AF catheter ablation. Osteopontin is a multifunctional molecule involved in several pathophysiological pathways, including fibrosis. Presently described is investigation of relationship between serum osteopontin level and AF recurrence after AF cryoablation.

Methods: The study was designed to be prospective and observational; 60 patients with paroxysmal (n=47) and persistent (n=13) AF were included. Osteopontin level was measured both before and 6 months after AF ablation with cryoballoon.

Results: Preprocedure and postprocedure osteopontin level did not differ between the 2 groups of AF patients (p=0.286, p=0.493, respectively). Postprocedure osteopontin level was significantly higher compared with preprocedure value (32.18 ng/mL vs 15.58 ng/mL; p=<0.001). Left atrial diameter, AF type, and preprocedure osteopontin level were related to AF recurrence (p≤0.05). An age-adjusted multivariate logistic regression analysis was conducted to determine independent predictors of AF recurrence. Among these, AF type (ß=2.211; p=0.004; odds ratio [OR]: 9.124; 95% confidence interval [CI]: 2.026-41.094) was found to be the most important factor related to AF recurrence. Preprocedure osteopontin level also predicted AF recurrence independently (ß=0.059; p=0.048; OR: 1.061; 95% CI 1.001-1.125).

Conclusion: Study results revealed persistency of AF and high preprocedure osteopontin level independently predicted AF recurrence in patients undergoing cryoballoon AF ablation. Association of a biochemical marker with AF recurrence might be beneficial to selection of appropriate patients for cryoballoon procedure and assessment of long-term procedural success.
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http://dx.doi.org/10.5543/tkda.2016.21855DOI Listing
January 2017

Changes in Electrocardiographic P Wave Parameters after Cryoballoon Ablation and Their Association with Atrial Fibrillation Recurrence.

Ann Noninvasive Electrocardiol 2016 Nov 28;21(6):580-587. Epub 2016 Mar 28.

Faculty of Medicine, Cardiology Department, Medipol University, Istanbul, Turkey.

Background: Changes in P wave parameters after circumferential pulmonary vein isolation (CPVI) have been previously identified. In this study, we aimed to determine the changes in P wave parameters surface electrocardiogram (ECG) after cryoballoon ablation (CBA) for atrial fibrillation (AF) and evaluate their relationship with AF recurrence.

Methods: Sixty-one patients (mean age 53 ± 11 years, 50.8% male) with paroxysmal AF who underwent CBA were enrolled. A surface ECG was obtained from all patients immediately before the procedure, and repeated 12 hours after the procedure. P wave amplitude (Pamp), P wave duration (Pwd), and P wave dispersion (Pdis) values in preprocedural and postprocedural ECGs were measured and compared. Recurrence rates of AF in 3, 6, and 9 months following ablation were recorded for all patients. Changes in P wave parameters were compared between patients with and without AF recurrence.

Results: Compared to preprocedural measurements, Pamp (from 0.58 ± 0.18 mV at baseline to 0.48 ± 0.17 mV, P < 0.001), Pwd (from 109.72 ± 18.43 ms at baseline to 91.36 ± 22.53 ms, P < 0.001), and Pdis (from 55.44 ± 20.45 ms at baseline to 45.30 ± 15.31 ms, P < 0.001) were significantly decreased after CBA. The difference in Pamp between pre- and postprocedural values (∆Pamp) was significantly higher in patients without AF recurrence compared to those with recurrence (0.10 ± 0.06 mV vs 0.04 ± 0.01 mV, P = 0.002). There was no difference in Pwd difference (∆Pwd) and Pdis difference (∆Pdis) between patients with and without AF recurrence (P > 0.05).

Conclusion: Pamp, Pwd, and Pdis parameters exhibited significant decrease after CBA compared to preprocedural measurements. Decreased Pamp was shown to be a predictor for good clinical outcomes following CBA.
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http://dx.doi.org/10.1111/anec.12364DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6931592PMC
November 2016

Predicting Ventricular Arrhythmias in Cardiac Resynchronization Therapy: The Impact of Persistent Electrical Dyssynchrony.

Pacing Clin Electrophysiol 2016 Sep 23;39(9):969-77. Epub 2016 Jul 23.

Cardiac Electrophysiology, Medipol University Faculty of Medicine, Istanbul, Turkey.

Background: Although response to cardiac resynchronization therapy (CRT) has been conventionally assessed with left ventricular volume reduction, ventricular arrhythmias (ventricular tachycardia/ventricular fibrillation [VT/VF]) are of critical importance associated with unfavorable outcomes even in the "superresponders" to therapy. We evaluated the predictors of VT/VF and the association of residual dyssynchrony during follow-up.

Methods: Ninety-five patients receiving CRT were followed-up for 9 ± 3 months. Post-CRT dyssynchrony was defined as a prolonged QRS duration (QRSd) for persistent electrical dyssynchrony (ED), and a Yu index ≥ 33 ms for persistent mechanical dyssynchrony. The first VT/VF episode, including nonsustained VT detected on device interrogation and/or appropriate antitachycardia pacing or shock for VT/VF, were the end points of the study.

Results: Forty-five patients who reached the study end points had significantly lower mean ΔQRS (baseline QRSd - post-CRT QRSd) values than those without VT/VF (-20.8 ± 28.9 ms vs -6.6 ± 30.7 ms, P = 0.022). Both the baseline and post-CRT QRSds, along with the Yu index values, were not different in two groups. Patients with VT/VF were statistically more likely to have persistent ED (38% vs 9%, P = 0.021). Kaplan-Meier curves showed that a negative ΔQRS was associated with a higher incidence of VT/VF during follow-up (P = 0.016). A multivariate Cox model revealed that QRS prolongation was an independent predictor of VT/VF after CRT (P = 0.029).

Conclusions: A negative ΔQRS, also called persistent ED, is associated with VT/VF. Narrowest possible QRSd might be a reliable goal of both implantation and optimization of devices to reduce arrhythmic events after CRT.
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http://dx.doi.org/10.1111/pace.12908DOI Listing
September 2016

Native Electrocardiographic QRS Duration after Cardiac Resynchronization Therapy: The Impact on Clinical Outcomes and Prognosis.

J Card Fail 2016 Oct 4;22(10):772-80. Epub 2016 Apr 4.

Department of Cardiac Electrophysiology, Medipol University Faculty of Medicine, Istanbul, Turkey.

Background: We investigated whether reversed electrical remodeling (RER), defined as narrowing of the native electrocardiographic QRS duration after cardiac resynchronization therapy (CRT), might predict prognosis and improvement in echocardiographic outcomes.

Methods And Results: A total of 110 CRT recipients were retrospectively analyzed for the end points of death and hospitalization during 18 ± 3 months. Native QRS durations were recorded at baseline and 6 months after CRT (when pacing was switched off to obtain an electrocardiogram) to determine RER. CRT response and mitral regurgitation (MR) improvement were defined as ≥15% reduction in left ventricular end-systolic volume and absolute reduction in regurgitant volume (RegV) at 6 months, respectively. Overall, 48 patients (44%) had RER, which was associated with functional improvement (77% vs 34%; P < .001) and CRT response (81% vs 52%; P < .001) compared with those without RER. The change in the intrinsic QRS duration correlated with the reduction in RegV (r = 0.51; P < .001) and in tenting area (r = 0.34; P < .001). RER was a predictor of MR improvement (P = .023), survival (P = .043), and event-free survival (P = .028) according to multivariate analyses.

Conclusions: Narrowing of the intrinsic QRS duration is associated with functional and echocardiographic CRT response, reduction in MR, and favorable prognosis after CRT.
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http://dx.doi.org/10.1016/j.cardfail.2016.04.001DOI Listing
October 2016

Effect of QRS Narrowing After Cardiac Resynchronization Therapy on Functional Mitral Regurgitation in Patients With Systolic Heart Failure.

Am J Cardiol 2016 Feb 18;117(3):412-9. Epub 2015 Nov 18.

Cardiology Department, Medipol University Faculty of Medicine, Istanbul, Turkey.

The determinants of improvement in functional mitral regurgitation (FMR) after cardiac resynchronization therapy (CRT) remain unclear. We evaluated the predictors of FMR improvement and hypothesized that CRT-induced change in QRS duration (ΔQRS) might have an impact on FMR response after CRT. One hundred ten CRT recipients were enrolled. CRT response (≥ 15 reduction in left ventricular end-systolic volume) and FMR response (absolute reduction in FMR volume) were assessed with echocardiography before and 6 months after CRT. The study end points included all-cause death or hospitalization assessed in 12 ± 3 months (range 1 to 18). A total of 71 patients (65%) responded to CRT at 6 months. FMR response was observed in 49 (69%) of the CRT responders and 8 (20%) of the CRT nonresponders (p <0.001). Although the baseline QRS durations were similar, the paced QRS durations were shorter (p = 0.012) and the ΔQRS values were greater (p = 0.003) in FMR responders compared with FMR nonresponders. There was a linear correlation between ΔQRS and change in regurgitant volume (r = 0.49, p <0.001). At multivariate analysis, baseline tenting area (p = 0.012) and ΔQRS (p = 0.028) independently predicted FMR response. A ΔQRS ≥ 20 ms was related to CRT response, FMR improvement, and lower rates of death or hospitalization during follow-up (p values <0.05). In conclusion, QRS narrowing after CRT independently predicts FMR response. A ΔQRS ≥ 20 ms after CRT is associated with a favorable outcome in all clinical end points.
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http://dx.doi.org/10.1016/j.amjcard.2015.11.010DOI Listing
February 2016

Impact of Intracoronary Adenosine on Myonecrosis in Patients with Unstable Angina Pectoris Undergoing Percutaneous Coronary Intervention.

Cardiovasc Drugs Ther 2015 Dec;29(6):519-526

Faculty of Medicine, Cardiology Department, Medipol University Hospital, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1 Bağcılar, 34214, İstanbul, Turkey.

Background: In this study, we aimed to investigate the impact of prophylactic intracoronary adenosine administered during percutaneous coronary intervention (PCI) due to unstable angina pectoris on myonecrosis by measuring post-procedural levels of cardiac troponin I (cTnI) and creatine kinase-myocardial band (CK-MB).

Methods: A total of 122 patients with unstable angina undergoing PCI were included in this single-center, double-blind, randomized study. The patients were randomly allocated to adenosine and placebo groups. In the adenosine group, a single-dose of intracoronary adenosine (100 μg for the right coronary artery and 150 μg for the left coronary artery) was administered. Primary endpoint was post-PCI myonecrosis, which was defined as abnormal levels of periprocedural cTnI. Secondary endpoints were defined as elevated cTnI levels [5 × upper limit of normal (ULN)], abnormal CK-MB levels, angiographic coronary flow measured by Thrombolysis In Myocardial Infarction (TIMI) frame count (TFC), the cumulative incidence of in-hospital death and in-hospital urgent target vessel revascularization (TVR).

Results: Clinical and angiographic characteristics of both adenosine (61 patients, 61 ± 9 years) and placebo (61 patients, 59 ± 10 years) groups were similar (p > 0.05 for all). Post-procedural abnormal cTnI levels in the adenosine group were significantly lower than the placebo group (32 % vs. 55 %, p: 0.011). cTnI >5 × ULN (21 % vs. 31 %, p: 0.217) and abnormal CK-MB levels (11 % vs. 19 %, p: 0.263) were similar in both groups. Post-procedural TFCs in the adenosine group were significantly lower than the placebo group (24 ± 4 vs. 27 ± 5, p: 0.004). In-hospital events including death and urgent TVR were not observed in either group.

Conclusion: Intracoronary administration of single-dose adenosine in patients with unstable angina undergoing PCI is associated with decreased periprocedural myonecrosis and improved coronary blood flow.
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http://dx.doi.org/10.1007/s10557-015-6631-4DOI Listing
December 2015

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

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

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

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

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

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

Case images: A giant left main coronary artery aneurysm.

Turk Kardiyol Dern Ars 2015 Jun;43(4):414

Department of Cardiology, Medipol University Faculty of Medicine, İstanbul, Turkey.

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http://dx.doi.org/10.5543/tkda.2015.84890DOI Listing
June 2015

Case images: A totally extruded pacemaker.

Turk Kardiyol Dern Ars 2015 Jun;43(4):412

Department of Cardiology, İstanbul Medipol University Hospital, İstanbul, Turkey.

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http://dx.doi.org/10.5543/tkda.2015.72673DOI Listing
June 2015

Comparison of fluoro and cine coronary angiography: balancing acceptable outcomes with a reduction in radiation dose.

J Invasive Cardiol 2015 Apr;27(4):199-202

Istanbul Medipol University, Department of Cardiology, Istanbul, Turkey.

Unlabelled: Use of last fluoro hold (LFH) mode in fluoroscopy, which enables the last live image to be saved and displayed, could reduce radiation during percutaneous coronary intervention when compared with cine mode. No previous study compared coronary angiography radiation doses and image quality between LFH and conventional cine mode techniques.

Methods: We compared cumulative dose-area product (DAP), cumulative air kerma, fluoroscopy time, contrast use, interobserver variability of visual assessment between LFH angiography, and conventional cine angiography techniques. Forty-six patients were prospectively enrolled into the LFH group and 82 patients into the cine angiography group according to operator decision.

Results: Mean cumulative DAP was higher in the cine group vs the LFH group (50058.98 ± 53542.71 mGy•cm² vs 11349.2 ± 8796.46 mGy•cm²; P<.001). Mean fluoroscopy times were higher in the cine group vs the LFH group (3.87 ± 5.08 minutes vs 1.66 ± 1.51 minutes; P<.01). Mean contrast use was higher in the cine group vs the LFH group (112.07 ± 43.79 cc vs 88.15 ± 23.84 cc; P<.001). Mean value of Crombach's alpha was not statistically different between visual estimates of three operators between cine and LFH angiography groups (0.66680 ± 0.19309 vs 0.54193 ± 0.31046; P=.20).

Conclusion: Radiation doses, contrast use, and fluoroscopy times are lower in fluoroscopic LFH angiography vs cine angiography. Interclass variability of visual stenosis estimation between three operators was not different between cine and LFH groups. Fluoroscopic LFH images conventionally have inferior diagnostic quality when compared with cine coronary angiography, but with new angiographic systems with improved LFH image quality, these images may be adequate for diagnostic coronary angiography.
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April 2015

Left atrial expansion index is an independent predictor of diastolic dysfunction in patients with preserved left ventricular systolic function: a three dimensional echocardiography study.

Int J Cardiovasc Imaging 2014 Oct 24;30(7):1315-23. Epub 2014 Jun 24.

Department of Cardiology, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey,

In the absence of mitral valve disease left atrial (LA) volume is a marker of diastolic dysfunction and its severity. This study investigated the relationship between left ventricular (LV) end diastolic pressure (LVEDP) and LA volumes and phasic atrial functions detected by real-time full volume three-dimensional echocardiography (RT3DE), in a patient population with preserved LV systolic function. Seventy-two (39 female and 33 male; mean age 56.1 ± 9.0 years) stable patients with normal LV ejection fraction (EF) undergoing cardiac catheterization were studied. All patients underwent comprehensive echocardiographic examination just before catheterization and LVEDP was obtained. In addition to conventional echocardiographic measurements and Doppler indices; by using RT3DE LA maximum, minimum and pre-a-wave volumes were measured; LA total, passive and active emptying volumes and fractions were calculated. LV systolic function was assessed by EF and global longitudinal strain by speckle tracking. RT3DE minimum LA volume index, RT3DE active LAEF and LA expansion index (EI) were statistically significant univariate predictors of LVEDP ≥ 16 mmHg. When age and hypertension adjusted multivariate analysis was performed EI [β = -1.741, p = 0.015; OR 0.175; 95 % CI (0.043-0.717)] was an independent predictor of elevated LVEDP. RT3DE evaluation of LA function during entire cardiac cycle has incremental value for the diagnosis of diastolic dysfunction in patients with preserved EF. We suggest that RT3DE evaluation of LA may find clinical application in this field.
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http://dx.doi.org/10.1007/s10554-014-0476-yDOI Listing
October 2014

Type of anesthesia affects neonatal wellbeing and frequency of transient tachypnea in elective cesarean sections.

J Matern Fetal Neonatal Med 2015 Mar 12;28(5):568-72. Epub 2014 Jun 12.

Department of Anesthesiology, Yedikule Pulmonary Diseases and Thoracic Surgery Research Hospital , Istanbul , Turkey .

Objective: We aimed to assess whether the type of anesthesia in cesarean section (C/S) (spinal anesthesia, SA versus general anesthesia, GA) has an effect or not on umblical vein blood gas analysis and APGAR scores of term neonates and development of transient tachypnea of the newborn (TTN).

Methods: The data of 172 procedure (85, GA versus 87, SA) were collected retrospectively. Results of umblical vein blood gas analysis, APGAR scores at first and fifth minutes and presence of TTN from in-hospital files' of neonates were examined.

Results: Neonates in the SA group had significantly higher first and fifth minute APGAR scores (8, 7 versus 9, 2, p < 0.001 and 9, 3 versus 10, 2, p = 0.017, respectively). The pH value of umblical vein samples were higher (7.30 ± 0.05 versus 7.32 ± 0.05, p = 0.029) and pO2 and SaO2 levels were significantly lower in the SA group (34.8 ± 13.8 mmHg versus 27.6 ± 14.5 mmHg; p = 0.001 and 56.6% ± 18.7 versus 49.8% ± 21.4; p = 0.029, respectively) as compared to the GA group. Thirteen neonates in the GA group (15.3%) and five in the SA group (5.7%) were diagnosed as TTN (p = 0.048).

Conclusion: In our study, considerable determinants of fetal wellbeing was stated to be higher in C/S performed under SA in comparison to GA. Furthermore, our findings favor SA for avoidance of TTN.
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http://dx.doi.org/10.3109/14767058.2014.926328DOI Listing
March 2015

Relation of left atrial peak systolic strain with left ventricular diastolic dysfunction and brain natriuretic peptide level in patients presenting with ST-elevation myocardial infarction.

Cardiovasc Ultrasound 2013 Jul 5;11:24. Epub 2013 Jul 5.

Background: In patients presenting with ST-elevation myocardial infarction (STEMI), we investigated the relation of left atrial (LA) deformational parameters evaluated by two-dimensional speckle tracking imaging (2D-STI) with conventional echocardiographic diastolic dysfunction parameters and B-type natriuretic peptide (BNP) level.

Methods: Ninety STEMI patients who were treated with primary percutaneous coronary intervention (PCI) and 22 healthy control subjects were enrolled. STEMI patients had echocardiographic examination 48 hours after the PCI procedure and venous blood samples were drawn simultaneously. In addition to conventional echocardiographic parameters, LA strain curves were obtained for each patient. Average peak LA strain values during left ventricular (LV) systole (LAs-strain) were measured.

Results: BNP values were higher in MI patients compared to controls. Mean LAs-strain in control group was higher than MI group (30.6 ± 5.6% vs. 21.6 ± 6.6%; p = 0.001). LAs-strain had significant correlation with LVEF (r = 0.51, p = 0.001), also significant inverse correlations between LAs-strain and BNP level (r = -0.41, p = 0.001), E/Em (r = -0.30, p = 0.001), LA maximal volume (r = -0.41, p = 0.001), LA minimal volume (r = -0.50, p = 0.001) and LV end systolic volume (r = -0.37, p = 0.001) were detected. The cut off value of LAs-strain to predict BNP > 100 pg/ml was determined as 19.9% with 55.3% sensitivity and 77.2% specificity (p < 0.05 AUC:0.7).

Conclusion: Our study showed that LAs-strain values decreased consistently with deteriorating systolic and diastolic function in STEMI patients treated with primary PCI. LA-s strain measurements may be helpful as a complimentary method to evaluate diastolic function in this patient population.
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http://dx.doi.org/10.1186/1476-7120-11-24DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3708795PMC
July 2013

Determinants of high sensitivity troponin T concentration in chronic stable patients with heart failure: Ischemic heart failure versus non-ischemic dilated cardiomyopathy.

Cardiol J 2014 25;21(1):67-75. Epub 2013 Jun 25.

Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey.

Background: Cardiac troponin T is a marker of myocardial injury, especially when measured by means of the high-sensitivity assay (hs-cTnT). The echocardiographic and clinical predictors of hs-cTnT may be different in ischemic heart failure (IHF) and non-ischemic dilated cardiomyopathy (DCM).

Methods: Sixty consecutive patients (19 female, 41 male; mean age 56.3 ± 13.9 years) with stable congestive heart failure (33 patient with IHF and 27 patients with DCM), with New York Heart Association functional class I-II symptoms, and left ventricular ejection fraction < 40% were included.

Results: In patients with IHF peak early mitral inflow velocity (E), E/peak early diastolic mitral annular tissue Doppler velocity (Em) lateral, peak systolic mitral annular tissue Doppler velocity (Sm) lateral and logBNP were univariate predictors of hs-cTnT above median. But only E/Em lateral was an independent predictor of hs-cTnT above median (p = 0.04, HR: 1.2,CI: 1-1.4). In patients with DCM; left atrial volume index, male sex, Sm lateral and global longitudinal strain (LV-GLS) were included in multivariate model and LV-GLS was detected to be an independent predictor for hs-cTnT above median (p < 0.05, HR: 0.7, CI: 0.4-1.0).

Conclusions: While LV-GLS is an independent predictor of hs-cTnT concentrations in patients with DCM, E/Em lateral predicted hs-TnT concentrations in patients with IHF.
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http://dx.doi.org/10.5603/CJ.a2013.0061DOI Listing
January 2016

Extent of left ventricular hypertrophy is related to interatrial conduction delay in hypertensive patients.

Clin Exp Hypertens 2013 29;35(6):454-8. Epub 2012 Nov 29.

Kartal Kosuyolu Heart and Research Hospital , Istanbul , Turkey.

The aim of this study was to investigate the relationship between left ventricular mass (LVM) and interatrial conduction delay (CD) measured by tissue Doppler echocardiography. In enrolled 66 hypertensive patients, positive correlation between interatrial CD and LVM index (r = 0.32) was detected. Meanwhile, intra-atrial CD was correlated to early diastolic tissue Doppler mitral annular velocity measured from septum (r = 0.34), tricuspid annular velocity (r = 0.29), and left atrial volume index (r = 0.26). By using stepwise linear regression analysis, LVM index was determined as an independent predictor of interatrial CD.
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http://dx.doi.org/10.3109/10641963.2012.746356DOI Listing
April 2014

Relationship between the tissue Doppler-derived Tei index and plasma brain natriuretic peptide levels in patients with mitral regurgitation.

J Heart Valve Dis 2010 Jan;19(1):35-42

Kartal Kofluyolu Yüksek Ihtisas Education and Research Hospital, Istanbul, Turkey.

Background And Aim Of The Study: The Tei index, obtained from tissue Doppler echocardiography (TDE-Tei index), has emerged as a new parameter that incorporates both systolic and diastolic time intervals to express global ventricular performance. The study aim was to evaluate whether the TDE-Tei index also correlates with left ventricular (LV) systolic and diastolic function and plasma brain natriuretic peptide (BNP) levels and echocardiographic parameters in patients with symptoms of mitral regurgitation (MR).

Methods: Thirty-three patients (17 males, 16 females; mean age 57 +/- 17 years) with isolated organic MR underwent transthoracic echocardiography and tissue Doppler echocardiography, and were also assessed for symptoms. Plasma BNP levels were also monitored. The patients were allocated to two groups, based on a TDE-Tei index cut-off level of 0.51.

Results: Correlations were identified between the TDE-Tei index and LV ejection fraction (LVEF) (r = -0.54), plasma BNP level (r = 0.5), MR index (r = 0.48), MR jet area (r = 0.38), MR effective regurgitant orifice area (r = 0.37), LV end-systolic diameter (r = 0.43), E/Ea (r = 0.41) and NYHA functional class (r = 0.38). However, no correlations were identified with the left atrial area, MR vena contracta width, MR regurgitant volume, MR regurgitant fraction, systolic pulmonary artery pressure, LV end-diastolic dimensions and LV diastolic dysfunction. The mean values of the TDE-Tei index were 0.40 +/- 11, 0.44 +/- 11 and 0.53 +/- 16 in MR patients in NYHA classes I, II and III, respectively.

Conclusion: In patients with isolated organic MR, the TDE Tei index was found to correlate well with LVEF and plasma BNP levels, and thus may be considered as a new echocardiographic parameter for the assessment of global ventricular function during patient follow up.
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January 2010
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