Publications by authors named "Muhammet Rasit Sayin"

40 Publications

Be aware of misdiagnosis tied to COVID-19 focusing: a case report of abciximab-induced alveolar haemorrhage thought to be SARS-CoV-2 in a patient with ST-segment elevation myocardial infarction.

Eur Heart J Case Rep 2020 Dec 12;4(6):1-6. Epub 2020 Dec 12.

Department of Cardiology, University of Health Sciences Trabzon Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Vatan St., Ortahisar/Trabzon 61000, Turkey.

Background: Early diagnosis of diffuse alveolar haemorrhage (DAH) can be extremely difficult, as the common clinical picture is often attributed to more common clinical conditions. High degree of suspicion is key to diagnosis which can be much more difficult during the coronavirus disease 2019 (COVID-19) pandemic.

Case Summary: A 61-year-old man with inferolateral ST-segment elevation myocardial infarction treated by a stent to the left circumflex artery and intravenous abciximab treatment was started for the high thrombus burden. Two hours later, the patient developed dyspnoea and hypoxaemia. Chest examination revealed diffuse rales over both lung fields. Chest X-ray revealed bilateral diffuse alveolar infiltrates, while the echocardiography was normal. Chest computed tomography (CT) was performed and the 'crazy paving appearance', which is the typical radiological finding of COVID-19, was reported. The patient was considered to be suspected of COVID-19 and was transferred to a quarantine unit. Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) test was obtained and azithromycin and hydroxychloroquine were initiated. 48 h later, 2.6 mmol/L reduction was observed in haemoglobin levels and haemoptysis was developed. After the second negative RT-PCR with an interval of 24 h, CT was repeated and the patient was diagnosed to have abciximab-induced DAH. The patient was later followed up conventionally and discharged after two weeks without additional complications.

Discussion: DAH and COVID-19 might share common clinical and radiological findings during examination. The physicians must be aware of the high motivation of the COVID-19 pandemic which can lead to misdiagnosis by overlooking other important clinical conditions.
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http://dx.doi.org/10.1093/ehjcr/ytaa505DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7799284PMC
December 2020

Efficacy of uniportal video-assisted thoracoscopic pericardial window creation using two lung ventilation in chronic large pericardial effusions.

J Pak Med Assoc 2020 Oct;70(10):1742-11747

Department of Pathology, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey.

Objective: To demonstrate that two lung ventilation under general anaesthesia may also be safely performed to create pericardial window with uniportal video-assisted thoracoscopic surgery.

Method: The single-centre, retrospective, comparative study was conducted at Bulent Ecevit University, Zonguldak, Turkey, comprised data from March 2011 to March 2018 of patients with recurrent and/or with chronic large pericardial effusions unresponsive to medical therapy and/or to pericardiocentesis and who underwent pericardial window creation with uniportal video-assisted thoracoscopic surgery. Group 1 had data of patients in whom pericardial windows were created under general anaesthesia, while group 2 had patients with two lung ventilation. Parameters compared between the groups were gender, age, operation side, operation time amount of drainage, complication, recurrences and survival. Data was analysed using SPSS 19.

Results: Of the 20 patients, 9(45%) were males and 11(55%) were females. Group 1 had 14(70%) patients, while group 2 had 6(30%). The age of patients in group 2 was significantly higher than those in group 1 (p=0.041). There was no significant difference between the groups with respect to gender, amount of drainage, operation time and post-operative complications (p>0.05). There was no recurrence or mortality in either of the two groups.

Conclusions: Pericardial window could be created safely with video-assisted thoracoscopic surgery under two lung ventilation for patients carrying high risk for one lung ventilation.
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http://dx.doi.org/10.5455/JPMA.28968DOI Listing
October 2020

Persistent left superior vena cava accompanying repaired tetralogy of Fallot: Does it pose a challenge for device implantation?

Cardiol Young 2020 Aug 29;30(8):1186-1187. Epub 2020 Jun 29.

Kocaeli Universitesi Tip Fakultesi - Cardiology, Kocaeli, Turkey.

Persistent left superior vena cava is a thoracic venous return anomaly. Tetralogy of Fallot is one of the most common congenital anomalies seen with persistent left superior vena cava. We are presenting a successful cardiac resynchronisation therapy device implantation in a patient with repaired tetralogy of Fallot and persistent left superior vena cava combination which has not been previously reported in the literature.
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http://dx.doi.org/10.1017/S1047951120001584DOI Listing
August 2020

Presystolic Wave is Associated with Subclinical Left Ventricular Dysfunction Assessed by Myocardial Performance Index in Type 2 Diabetes Mellitus.

Arq Bras Cardiol 2019 07 29;113(2):207-215. Epub 2019 Jul 29.

Trabzon Ahi Evren Gogus Kalp Ve Damar Cerrahisi Egitim Ve Arastirma Hastanesi - Cardiology, Trabzon - Turkey.

Background: Myocardial performance index (MPI), demonstrates both systolic and diastolic functions of the left ventricle. Presystolic wave (PSW) is frequently detected on Doppler examination of the left ventricular outflow tract and possible mechanism of PSW is impaired LV compliance and left ventricular stiffness.

Objective: To investigate the relationship between PSW and MPI in type 2 diabetic patients.

Method: A total of 129 type 2 diabetic patients were included in this study. Patients were divided into two groups according to the presence of PSW on Doppler echocardiography. There were 90 patients (38 male, mean age 57.77 ± 10.91 years) in the PSW-positive group and 39 patients (13 male; mean age: 55.31 ± 11.29 years) in the PSW-negative group. The p values of < 0.05 were considered statistically significant.

Results: MPI was higher in PSW- positive group (0.63 ± 0.17vs 0.52 ± 0.13, p < 0.001). In addition, subclinical left ventricle dysfunction (LVD) was higher in the PSW- positive group (p = 0.029). Univariate analysis showed that the presence of PSW associated with abnormal MPI (p = 0.031). Pearson correlation analysis showed that PSW velocity correlated with MPI (r: 0.286, p = 0.006).

Conclusion: Presence of the PSW on Doppler examination was associated with subclinical LV dysfunction in patients with DM type 2. This easy-to-perform echocardiographic parameter may be related to subclinical LVD among patients with type 2 DM.
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http://dx.doi.org/10.5935/abc.20190134DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6777877PMC
July 2019

Association of Aortic Valve Sclerosis and Clinical Factors in Patients With Acute Myocardial Infarction.

Am J Med Sci 2019 06 22;357(6):474-482. Epub 2019 Mar 22.

Department of Cardiology, Saglik Bilimleri University, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turkey.

Background: Since aortic valve sclerosis (AVS) and coronary artery disease (CAD) share similar cardiovascular risk factors, we hypothesized that the clinical profile of patients with acute myocardial infarction (AMI) would be worse in the presence of AVS. The aim of this study was to investigate the association between AVS and clinical factors in patients with AMI.

Methods: Three hundred and fifteen patients with AMI were consecutively enrolled in the study. Echocardiography was used to assess the aortic valve morphology and left ventricular function. The extent and severity of CAD were assessed by Gensini score and the number of obstructed vessels. The patients were divided into 2 groups according to presence or absence of AVS.

Results: The overall number of patients with AVS was 132 (41.9%). Patients with AVS were older (69.5 ± 11 vs. 59.5 ± 12 years, P < 0.00001). They also had a higher prevalence of hypertension (61% vs. 45%, P = 0.006), prior CAD (33% vs. 23%, P = 0.041), prior AMI (20% vs. 11%, P = 0.019) and a higher percentage were female (32% vs. 19%, P = 0.007) compared with AMI patients without AVS. There was no significant difference between the 2 groups with respect to the Gensini score (P = 0.372). Prior AMI was associated with AVS on age-adjusted logistic regression analyses. A multivariate analysis showed an independent association between the AVS and prior AMI and age (P < 0.0000001, P = 0.022, respectively).

Conclusions: Our results showed that the presence of AVS is associated with AMI recurrence.
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http://dx.doi.org/10.1016/j.amjms.2019.03.007DOI Listing
June 2019

Non-Alcoholic Fatty Pancreas Disease is Associated with Increased Epicardial Adipose Tissue and Aortic Intima-Media Thickness.

Acta Cardiol Sin 2019 Mar;35(2):118-125

Department of Cardiology, Saglik Bilimleri Universitesi (University of Health Sciences), Samsun Education and Research Hospital, Samsun 55000 61040, Turkey.

Background: We aimed to investigate whether non-alcoholic fatty pancreas disease (NAFPD) is associated with epicardial adipose tissue (EAT), which is a kind of ectopic fat accumulation, and aortic intima-media thickness (aIMT), which is associated with subclinical atherosclerosis.

Methods: Fifty-four patients with NAFPD (22 men; mean age: 52 ± 10 years) and 49 without NAFPD (16 men; mean age: 49 ± 8 years) were included in this study. NAFPD and aIMT were evaluated using transabdominal ultrasonography (TUS). EAT was evaluated with transthoracic echocardiography.

Results: EAT (6.09 ± 1.52 mm and 3.87 ± 1.31 mm, p < 0.001) and aIMT [1.12 (0.60-1.90) mm vs. 0.93 (0.50-1.44) mm, p < 0.001] were significantly higher in the NAFPD positive subjects, compared to the NAFPD negative subjects. Multivariate analysis showed that age (p = 0.016), body mass index (p = 0.004), and presence of NAFPD (p = 0.024) were associated with increased aIMT. In addition, multivariate analysis demonstrated that the presence of NAFPD (p < 0.001) was associated with increased EAT.

Conclusions: The presence of NAFPD on TUS is associated with increased aIMT and EAT. Our study results may suggest that NAFPD may reflect subclinical atherosclerosis and may be a simple warning sign for physicians.
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http://dx.doi.org/10.6515/ACS.201903_35(2).20181009ADOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6434412PMC
March 2019

The value of syntax score to predict new-onset atrial fibrillation in patients with acute coronary syndrome.

Ann Noninvasive Electrocardiol 2019 07 7;24(4):e12622. Epub 2019 Jan 7.

Department of Cardiology, Trabzon Ahi Evren Training and Research Hospital, University of Health Science, Trabzon, Turkey.

Background And Aim: New-onset atrial fibrillation (NOAF) has been associated with poor outcome in patients with acute coronary syndromes (ACS). Also, Syntax score (SS) is a scoring system that is derived from angiographic images and is associated with long-term mortality and major adverse cardiac events. In this study, we aimed to assess the relationship between SS and NOAF with known predictors of atrial fibrillation.

Methods: In a prospective, single-center, cross-sectional study, 692 patients who were diagnosed with coronary artery disease for the first time were enrolled consecutively. NOAF was defined as atrial fibrillation, which was documented after hospital admission. SS was calculated by a computer software. Multivariable logistic regression analyzes were used to detect the relationship between variables and NOAF.

Results: New-onset atrial fibrillation was detected in 82 patients (11.8%). Patients with NOAF had higher SS (22, interquartile range 18.3-25.1, vs. 12, interquartile range 7-19.5, p < 0.001). According to multivariable logistic regression analysis for NOAF, SS were independently and significantly associated (OR, 1.103; 95% confidence interval, 1.047-1.163; p < 0.001). Other independent predictors of NOAF were TIMI flow <3, C reactive protein, left ventricular ejection fraction, left atrial volume index and E/E' ratio. The optimal cut-off value for SS was 18 for the development of NOAF with 82% sensitivity and 68% specificity (area under the curve: 0.795, 95% confidence interval 0.749-0.841, p < 0.001).

Conclusion: Syntax score may be helpful to identify for patients who would develop atrial fibrillation in the setting of ACS.
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http://dx.doi.org/10.1111/anec.12622DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6931656PMC
July 2019

Successful Use of Ranolazine in a Patient With Vasospastic Angina.

Can J Cardiol 2019 01 26;35(1):104.e13-104.e14. Epub 2018 Oct 26.

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http://dx.doi.org/10.1016/j.cjca.2018.10.013DOI Listing
January 2019

Presystolic wave is associated with carotid intima media thickness.

Echocardiography 2019 02 5;36(2):237-242. Epub 2018 Dec 5.

Department of Cardiology, Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Saglik Bilimleri Universitesi (University of Health Sciences), Trabzon, Turkey.

Introduction: Carotid intima media thickness (CIMT), a direct marker of atherosclerosis, has emerged as a promising means for cardiovascular risk evaluation. Presystolic wave (PSW) is commonly detected by the Doppler interrogation of the left ventricular outflow tract (LVOT). It is thought to be a result of a stiff left ventricle and impaired LV compliance. Herein, we aimed to investigate a possible association between carotid intima media thickness, an atherosclerotic marker, and PSW.

Method: We prospectively enrolled 282 patients divided into two groups based on the presence of PSW: 221 (89F; mean age: 49.3 ± 11.5 years) had PSW on Doppler examination while 61 patients (32F; mean age: 46.4 ± 10.3 years) did not. Both groups were compared with respect to demographic, clinical properties, and CIMT.

Results: Both groups had comparable age, body mass index, and diabetes mellitus, hypertension, dyslipidemia, smoking, and family history for coronary heart disease. PSW-positive group had significantly higher CIMT (PSW-positive: 0.59 ± 0.22 mm vs PSW-negative: 0.42 ± 0.11 mm; P < 0.001) than PSW-negative group. Multivariate analysis showed that the independent predictors of increased CIMT were age (95% CI; 1.044-1.101, P < 0.001), dyslipidemia (95% CI; 0.147-0.664, P = 0.002), and the presence of PSW (95% CI; 2.168-7.836, P < 0.001).Correlation analysis showed that PSW velocity is correlated with increased CIMT in PSW-positive group (r: 0.418, P < 0.001).

Conclusion: Assessment of PSW on TTE is easy and feasible method. Presence of PSW and increased PSW velocity on TTE might provide information that we should be careful in terms of subclinical atherosclerosis.
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http://dx.doi.org/10.1111/echo.14217DOI Listing
February 2019

Atrioventricular conduction defect associated with severe hyponatremia.

Clujul Med 2018 Jul 31;91(3):342-345. Epub 2018 Jul 31.

Department of Cardiology, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey.

Hyponatremia is the most common electrolyte disorder among hospitalized patients and in the clinical setting. Patients with hyponatremia may develop a variety of symptoms, primarily neurological and gastrointestinal. Hyponatremia is more frequently encountered in patients with an underlying heart disease, particularly in the elderly. We hereby present a case of complete atrioventricular block in an elderly patient who had undergone aortic valve replacement and had been using thiazide. Complete atrioventricular block improved after sodium replacement therapy and no other cause of electrolyte disorder was documented.
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http://dx.doi.org/10.15386/cjmed-846DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6082612PMC
July 2018

An extremely rare clinical entity: congenitally corrected transposition with situs ınversus and single coronary artery presented with complete atrioventricular block in a young man.

Cardiol Young 2018 May 12;28(5):759-761. Epub 2018 Feb 12.

Department of Cardiology,Trabzon Ahi Evren Training and Research Hospital,University of Health Science,Trabzon,Turkey.

Congenitally corrected transposition of the great arteries is a rare form of CHD. Situs inversus is a much less common variant of a congenitally corrected transposition of the great arteries. In rare cases, transposition events may be accompanied by various cardiac anomalies. However, situs inversus patients with congenitally corrected transposition, single coronary artery anomaly, and atrioventricular block together have not been reported previously. This combination of abnormalities is presented as a first in the literature.
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http://dx.doi.org/10.1017/S1047951118000069DOI Listing
May 2018

Bilateral subconjunctival hemorrhage secondary to abciximab use: case report.

Sao Paulo Med J 2019 Mar-Apr;137(2):209-211. Epub 2017 Dec 18.

MD. Associate Professor, Saglik Bilimleri University, Department of Cardiology, Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Saglik Bilimleri University, Trabzon, Turkey.

Context: There are no reports on cases of subconjunctival hemorrhage due to use of glycoprotein IIb/IIIa inhibitors. In this report, we present the case of a patient with bilateral subconjunctival hemorrhage after receiving abciximab.

Case Report: A 40-year-old male patient underwent coronary angiography after acute anterior myocardial infarction and a coronary stent was placed. Abciximab was added to the therapy because of stent thrombosis. Bilateral subconjunctival hemorrhage was observed after the administration of the abciximab treatment. We treated our patient by stopping abciximab and administering artificial tears.

Conclusİon: For the first time in the literature, we presented the case of a patient with bilateral subconjunctival hemorrhage after receiving abciximab, which was managed conservatively.
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http://dx.doi.org/10.1590/1516-3180.2017.0182150717DOI Listing
December 2019

Atrial conduction times and left atrial mechanical functions and their relation with diastolic function in prediabetic patients.

Korean J Intern Med 2017 Mar 6;32(2):286-294. Epub 2016 Dec 6.

Department of Cardiology, Bulent Ecevit University, School of Medicine, Zonguldak, Turkey.

Background/aims: The aim of this study was to investigate atrial conduction times and left atrial mechanical functions, the noninvasive predictors of atrial fibrillation, in prediabetic patients with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT).

Methods: Study included 59 patients (23 males, 36 females; mean age 52.5 ± 10.6 years) diagnosed with IFG or IGT by the American Diabetes Association criteria, and 43 healthy adults (22 males, 21 females; mean age 48.5 ± 12.1 years). Conventional and tissue Doppler echocardiography were performed. The electromechanical delay parameters were measured from the onset of the P wave on the surface electrocardiogram to the onset of the atrial systolic wave on tissue Doppler imaging from septum, lateral, and right ventricular annuli. The left atrial volumes were calculated by the disk method. Left atrial mechanical functions were calculated.

Results: The mitral E/A and E'/A' ratios measured from the lateral and septal annuli were significantly lower in the prediabetics compared to the controls. The interatrial and left atrial electromechanical delay were significantly longer in prediabetic group compared to the controls. Left atrial active emptying volume (LAAEV) and fraction (LAAEF) were significantly higher in the prediabetics than the controls. LAAEV and LAAEF were significantly correlated with E/A, lateral and septal E'/A'.

Conclusions: In the prediabetic patients, the atrial conduction times and P wave dispersion on surface electrocardiographic were longer before the development of overt diabetes. In addition, the left atrial mechanical functions were impaired secondary to a deterioration in the diastolic functions in the prediabetic patients.
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http://dx.doi.org/10.3904/kjim.2014.380DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5339456PMC
March 2017

Renal artery stenosis and mean platelet volume.

Anatol J Cardiol 2016 Mar 18;16(3):197-201. Epub 2015 Jun 18.

Department of Cardiology, Faculty of Medicine, Bülent Ecevit University; Zonguldak-Turkey.

Objective: Increased mean platelet volume (MPV) has been reported in various atherosclerotic diseases. The aim of our study was to investigate the relationship between the atherosclerotic renal artery stenosis (ARAS) and various hematological parameters including MPV.

Methods: This study was performed with a retrospective review of the angiographic images of patients who underwent renal angiography at Bülent Ecevit University catheter laboratory between January 2004 and December 2009. The patients were trichotomized into three groups based on the presence and severity of renal artery stenosis (RAS). Group 1 included patients with a critical RAS (33 patients; 18 female (F), 15 male (M); mean age 61.6 ± 11.5 years), group 2 consisted of patients with non-critical RAS (26 patients; 15 F, 11 M; mean age 58. 1 ± 11.3 years), and group 3 was composed of patients without RAS (69 patients; 38 F, 31 M; mean age 53.5 ± 11.9 years). Demographic data, complete blood count, and biochemical parameters were compared between the groups.

Results: Comparison of the hematological parameters revealed that MPV and platelet distribution width were significantly higher in group 1 than in group 2 and 3 (8.96 ± 0.99 fL versus 8.35 ± 0.76 fL, 8.31 ± 0.79 fL, respectively; p=0.001; 16.53 ± 0.58% versus 16.19 ± 0.56%, 16.29 ± 0.53%, respectively; p=0.04).

Conclusion: MPV levels are higher in patients with ARAS. Considering both the effect of platelets on atherosclerosis and their close association with other risk factors, MPV level may be an important factor in pathogenesis of ARAS.
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http://dx.doi.org/10.5152/AnatolJCardiol.2015.6102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5336806PMC
March 2016

Presence of Fragmented QRS Complexes in Patients with Obstructive Sleep Apnea Syndrome.

Chin Med J (Engl) 2015 Aug;128(16):2141-6

Department of Cardiology, School of Medicine, Bulent Ecevit University, Zonguldak, Turkey.

Background: Obstructive sleep apnea syndrome (OSAS) is a disease with increasing prevalence, which is mainly characterized by increased cardiopulmonary mortality and morbidity. It is well-known that OSAS patients have increased prevalence of cardiovascular diseases including coronary heart disease, heart failure, and arrhythmias. The aim of this study was to evaluate the presence of prolonged and fragmented QRS complexes, which have previously been associated with cardiovascular mortality, in OSAS patients.

Methods: Our study included 51 patients (mean age 41.6 ± 10.1 years) who were recently diagnosed with OSAS (apnea-hypopnea index [AHI] ≥5 events/h) and never received therapy. The control group consisted of 34 volunteers (mean age 43.1 ± 11.6 years) in whom OSAS was excluded (AHI <5 events/h). The longest QRS complexes was measured in the 12-lead electrocardiogram (ECG) and the presence of fragmentation in QRS complexes was investigated.

Results: Fragmented QRS frequency was significantly higher in patients with OSAS (n = 31 [61%] vs. n = 12 [35%], P = 0.021). QRS and QTc durations were also significantly longer in OSAS patients than controls (99.8 ± 13.9 ms vs. 84.7 ± 14.3 ms, P < 0.001; 411.4 ± 26.9 ms vs. 390.1 ± 32.2 ms, P = 0.001, respectively). Analysis of the patient and controls groups combined revealed a weak-moderate correlation between AHI and QRS duration (r = 0.292, P = 0.070). OSAS group had no correlation between AHI and QRS duration (r = -0.231, P = 0.203).

Conclusions: In our study fragmented QRS frequency and QRS duration were found to increase in OSAS patients. Both parameters are related with increased cardiovascular mortality. Considering the prognostic importance of ECG parameters, it may be reasonable to recommend more detailed evaluation of OSAS patients with fragmented or prolonged QRS complexes with respect to presence of cardiovascular diseases.
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http://dx.doi.org/10.4103/0366-6999.162503DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4717978PMC
August 2015

Temporary pacemaker with left bundle branch block image in ECG: left ventricle via right common carotid artery.

Anatol J Cardiol 2015 Jan 25;15(1):76, 92. Epub 2014 Dec 25.

Department of Cardiology, Faculty of Medicine, Bülent Ecevit University; Zonguldak-Turkey.

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http://dx.doi.org/10.5152/akd.2014.5818DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5336907PMC
January 2015

Right ventricular isovolumic acceleration in acute pulmonary embolism.

Echocardiography 2014 Nov 25;31(10):1253-8. Epub 2014 Mar 25.

Cardiology Department, Karadeniz Eregli State Hospital, Zonguldak, Turkey.

Objective: In this study, we examined the role of isovolumic acceleration (IVA) measured with right ventricle (RV) tissue Doppler imaging (TDI) to predict the presence of acute pulmonary embolism (APE) in hemodynamically stable patients with clinical suspicion of APE.

Materials And Method: This study included 25 hemodynamically stable (systolic blood pressure >90 mmHg) patients diagnosed with APE for the first time. Twenty-five subjects with similar demographic characteristics in whom APE was excluded due to preexisting clinical suspicion were also enrolled as the control group. All control group subjects were enrolled after proved to have no evidence of APE on imaging. Both groups were compared with respect to RV-IVA measured with TDI in addition to conventional echocardiographic parameters.

Results: Among the echocardiography parameters, only RV-IVA was impaired in patients with hemodynamically stable APE compared to controls (2.85 [1.37-6.42] m/sec(2) vs. 3.32 [2.24-6.52] m/sec(2) , respectively; P = 0.02). A receiver operating characteristic (ROC) analysis was performed to determine the RV-IVA value to predict clinically suspected APE. A cutoff level of 3.22 m/sec(2) had a sensitivity of 64% and a specificity of 60%; a cutoff level of 3.17 m/sec(2) had a sensitivity of 64% and a specificity of 64%; and a cutoff level of 3.10 m/sec(2) had a sensitivity of 60% and specificity of 64% (ROC area under curve: 0.691, 95% CI: 0.543-0.839, P = 0.02).

Conclusion: Results of our study suggest that RV-IVA may be a useful parameter to detect subtle alterations in RV and may predict the presence of APE in hemodynamically stable patients.
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http://dx.doi.org/10.1111/echo.12579DOI Listing
November 2014

Authors' response to the comments on automated platelet analyses by Dr Beyan.

J Cardiol 2014 Mar 19;63(3):244-5. Epub 2013 Oct 19.

Hacettepe University School of Medicine, Department of Hematology, Ankara 06100, Turkey.

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http://dx.doi.org/10.1016/j.jjcc.2013.09.001DOI Listing
March 2014

Diffuse coronary ectasia and acute coronary syndrome in a young man. Who is guilty? Cannabis, smoking or dyslipidemia?

Anadolu Kardiyol Derg 2013 Sep 10;13(6):616-8. Epub 2013 Sep 10.

Department of Cardiology, Faculty of Medicine, Bülent Ecevit University, Zonguldak-Turkey.

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http://dx.doi.org/10.5152/akd.2013.212DOI Listing
September 2013

Plateletcrit and red cell distribution width are independent predictors of the slow coronary flow phenomenon.

J Cardiol 2014 Feb 4;63(2):112-8. Epub 2013 Sep 4.

Hacettepe University School of Medicine, Department of Hematology, Ankara, 06100, Turkey.

Background And Purpose: Endothelial dysfunction may play a role in the pathogenesis of the slow coronary flow (SCF) phenomenon. A detailed examination of blood cellular components has not been performed for this condition. We investigated the relationship between SCF and whole blood cell counts.

Method: Records of 17,315 patients who underwent coronary angiography between January 2006 and December 2012 were evaluated retrospectively. A total of 146 patients with SCF were compared with 148 patients with normal coronary arteries according to demographic data, complete blood count, and biochemical parameters.

Results: The following parameters were significantly higher in SCF patients than in patients with normal coronary arteries: percentage of smokers (36.3% vs. 25%, p=0.036), body mass index (26.69 ± 2.84 vs. 26.07 ± 3.15, p=0.049), white blood cells (WBCs) (7.52 ± 1.43 × 10(3)mm(-3) vs. 7.01 ± 1.42 × 10(3)mm(-3), p=0.002), red cell distribution width (RDW) (13.68 ± 1.42% vs. 13.15 ± 1.13%, p<0.001), platelets (250.29 ± 50.96 × 10(3)mm(-3) vs. 226.10 ± 38.02 × 10(3)mm(-3), p<0.001), plateletcrit (PCT) (0.214 ± 0.40% vs. 0.184 ±0.29%, p<0.001), mean platelet volume (8.63 ± 1.10fL vs. 8.22 ± 0.83 fL, p<0.001), platelet distribution width (PDW) (16.58 ± 0.76% vs. 16.45 ± 0.57%, p=0.028), and neutrophils (4.44 ± 1.25 × 10(3)mm(-3) vs. 4.12 ± 1.24 × 10(3)mm(-3), p=0.029). Positive PCT values [odds ratio (OR), 4.165; 95% confidence interval (CI), 2.493-6.959; p<0.001) and RDW (OR, 1.304; 95% CI, 1.034-1.645; p=0.025) were independent predictors of SCF.

Conclusion: Although within the normal range, the increased numbers of WBCs and neutrophils in patients with SCF suggest that SCF may be a subclinical inflammatory condition. Furthermore, increased RDW and PDW in SCF patients may cause microvascular blood flow resistance due to impaired cell deformability. The PCT provides reliable data regarding total platelet mass and may be a useful predictor of SCF.
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http://dx.doi.org/10.1016/j.jjcc.2013.07.010DOI Listing
February 2014

The effects of strict salt control on blood pressure and cardiac condition in end-stage renal disease: prospective-study.

Ren Fail 2013 2;35(10):1344-7. Epub 2013 Sep 2.

Department of Nephrology, Bulent Ecevit University , Zonguldak , Turkey .

Introduction: Overhydration is the main contributory factor of left ventricular hypertrophy and closely associated with cardiovascular events in end stage renal disease (ESRD) patients. The aim of this prospective-study was to investigate the impact of strict salt and volume control on hypertension and cardiac condition in ESRD patients.

Methods: A total of 12 peritoneal dialysis (PD) and 15 prevalent hemodialysis (HD) patients were enrolled. All patients either PD or HD were allocated to intervention of strict salt restriction according to basal hydration state of empty abdomen in PD and midweek predialysis HD which were estimated by body composition monitor (BCM) and echocardiography.

Results: Mean ages were 48.3 ± 16.7 years for PD, and 48.8 ± 18 for HD patients. Extracellular water/height was 10.04 ± 2.70 and 10.39 ± 1.53 L/m in PD and HD groups. Systolic blood pressures decreased in PD and HD from 133.1 ± 28 and 147.3 ± 28.5 to 114.8 ± 16.5 and 119.3 ± 12.1 mmHg, respectively, (p < 0.00). IDKA/DW were decreased from 3.26 ± 1.6 to 2.97 ± 1.63 % in HD group (p > 0.05). LVMI and LAI were not increased in both groups.

Conclusion: Strict salt and volume control in ESRD patients after assessment of hydration status with either using BCM or echocardiography provides better management of volume control leading to more precise cardiovascular protection.
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http://dx.doi.org/10.3109/0886022X.2013.828259DOI Listing
June 2014

Atypical type of dual left anterior descending coronary artery.

J Cardiol Cases 2013 Jul 15;8(1):e39-e41. Epub 2013 Apr 15.

Department of Cardiology, School of Medicine, Bulent Ecevit University, Kozlu 67600, Zonguldak, Turkey.

Dual left anterior descending coronary artery (LAD) is a rare coronary anomaly and is divided into six subgroups in the literature according to the origin and course of the short and long branches of the anomalous artery. We present two distinct cases of dual LAD which are distinguished by two branches of equal length from their counterparts in the literature. < In our cases a novel dual LAD variant is presented with two main branches of equal length and reaches the cardiac apex. Cardiologists and cardiovascular surgeons should be aware of these variants to avoid misinterpretation of coronary angiography and intraoperative complications.>.
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http://dx.doi.org/10.1016/j.jccase.2013.03.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6281501PMC
July 2013

Left main coronary artery thrombus resulting from combined protein C and S deficiency.

Intern Med 2013 15;52(6):697. Epub 2013 Mar 15.

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http://dx.doi.org/10.2169/internalmedicine.52.9357DOI Listing
August 2013

Large caseous mitral annular calcification with mitral stenosis, dynamic left ventricular outflow obstruction, and syncope.

Tex Heart Inst J 2012 ;39(6):910-2

Department of Cardiology, Faculty of Medicine, Zonguldak Karaelmas University, Zonguldak 67600, Turkey.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3528210PMC
June 2013

An unusual defect and a rare combination: Gerbode defect and subaortic membrane.

Anadolu Kardiyol Derg 2013 Mar 28;13(2):E7-8. Epub 2013 Mar 28.

Department of Cardiology, Faculty of Medicine, Bülent Ecevit University, Zonguldak, Turkey.

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http://dx.doi.org/10.5152/akd.2013.056DOI Listing
March 2013

[The association of eccentricity indexes with cardiac biomarkers in normotensive acute pulmonary embolism patients: an observational study].

Anadolu Kardiyol Derg 2013 Mar 7;13(2):108-14. Epub 2012 Dec 7.

Zonguldak Karadeniz Ereğli Devlet Hastanesi, Kardiyoloji Kliniği, Zonguldak, Turkey.

Objective: The present study aims at investigating the association of systolic and diastolic eccentricity indexes with cardiac biomarkers in hemodynamically stable patients with acute pulmonary embolism (APE).

Methods: Thirty hemodynamically stable (systolic blood pressure >90 mmHg) patients with APE (17M, mean age 61.67±17.6 years) were included in this cross-sectional observational study. The associations of serum troponin I, D-dimer, brain natriuretic peptide (BNP) and heart type fatty acid binding protein (hFABP) levels with systolic and diastolic eccentricity indices, tricuspid annular plane systolic excursion (TAPSE), myocardial performance index (MPI), systolic pulmonary artery pressure and the index of the inferior vena cava were investigated. The relationships between parameters were evaluated by Pearson and Spearman correlation analysis according to the distribution of data.

Results: Correlation analysis revealed that the most significant relationship between cardiac biomarkers and echocardiographic measurements was in the BNP value. Meanwhile, systolic and diastolic eccentricity indexes were found to have significant correlation with serum troponin I (respectively r=0.470, p=0.009/r=0.310, p=0.095) and BNP (respectively r=0.402, p=0.028/r=0.384, p=0.036) values. On the other hand, elevated D-dimer levels led to statistical significance in none of the echocardiographic parameters.

Conclusion: According to our results, hFABP was rarely positive in normotensive patients with APE. An elevated D-dimer alone was not significant in predicting RVD. Eccentricity indexes revealed significant relationship with BNP and troponin I values. The results obtained indicate that early echocardiographic evaluation is important in patients with abnormal cardiac biomarkers.
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http://dx.doi.org/10.5152/akd.2013.033DOI Listing
March 2013

Severe main coronary artery disease in a young woman with ankylosing spondylitis.

Intern Med 2012 15;51(18):2635-7. Epub 2012 Sep 15.

Department of Cardiology, Faculty of Medicine, Zonguldak Karaelmas University, Turkey.

Patients with ankylosing spondylitis (AS) have an approximately two-fold increased death rate compared to the general population, which is predominately caused by increased cardiovascular risk. The prevalence rate for myocardial infarction is approximately 2-3 fold increased as compared with the general population. The inflammatory process appears to have an important role in causing this excess cardiovascular risk. In this paper, we present a case of severe coronary artery disease which could be demonstrated clearly by computer tomography in a 27-year-old woman who is being followed with AS.
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http://dx.doi.org/10.2169/internalmedicine.51.7829DOI Listing
April 2013

An asymptomatic needle in the left ventricular anterolateral wall: a prison inmate's strange radio antenna.

Echocardiography 2012 Sep 5;29(8):E179-81. Epub 2012 Jun 5.

Department of Cardiology, Faculty of Medicine, Zonguldak Karaelmas University, Zonguldak, Turkey.

A foreign body such as a needle in the heart can be life-threatening. While this may occur accidentally, needles may be inserted into the body by psychiatric patients or in cases involving domestic violence. A needle can migrate through the thorax toward the heart. In drug users, needles may also reach the right ventricle via the peripheral veins. Cardiac injury can occur via the esophagus after swallowing a needle. The clinical outcome may vary from an asymptomatic situation to tamponade or shock, depending on how severely the cardiac structures are affected. In injuries involving the thorax, pneumothorax may cause sudden shortness of breath. Here, we report the case of a 34-year-old male prison inmate who accidentally lodged a pin in his left ventricle while asleep. As he has refused surgery, it was decided to follow the patient carefully.
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http://dx.doi.org/10.1111/j.1540-8175.2012.01756.xDOI Listing
September 2012

Echocardiographic dilemma: misleading thrombus appearance due to cavitation with intravascular hemolysis on a mechanical prosthetic valve.

Can J Cardiol 2013 Mar 26;29(3):403.e1-2. Epub 2012 May 26.

Zonguldak Karaelmas University, Faculty of Medicine, Department of Cardiology, Zonguldak, Turkey.

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http://dx.doi.org/10.1016/j.cjca.2012.03.022DOI Listing
March 2013

A case of acute myocardial infarction due to the use of cayenne pepper pills.

Wien Klin Wochenschr 2012 Apr 20;124(7-8):285-7. Epub 2012 Apr 20.

Department of Cardiology, School of Medicine, Zonguldak Karaelmas University, 67600, Kozlu, Zonguldak, Turkey.

The use of weight loss pills containing cayenne pepper has ever been increasing. The main component of cayenne pepper pills is capsaicin. There are conflicting data about the effects of capsaicin on the cardiovascular system. In this paper, we present the case of a 41 year old male patient with no cardiovascular risk factors who took cayenne pepper pills to lose weight and developed acute myocardial infarction.
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http://dx.doi.org/10.1007/s00508-012-0163-8DOI Listing
April 2012