Publications by authors named "Nermin Bayar"

60 Publications

Supraventricular arrhythmia in mitral valve prolapse : Predictive value of P-wave dispersion and atrial conduction time.

Herz 2021 Apr 21. Epub 2021 Apr 21.

Emergency Medicine Department, SBU Kanuni Sultan Suleyman Training and Research Hospita, Istanbul, Turkey.

Background: The incidence of supraventricular arrhythmia (SVA) is high in patients with mitral valve prolapse (MVP). The purpose of our study was to determine the role of parameters showing atrial conduction heterogeneity such as P‑wave dispersion (PWD) and atrial electromechanical delay (AEMD) in predicting the development of SVA in MVP patients.

Methods: A total of 76 patients with MVP (56 female, 20 male) were included in the study. The patients were divided into two groups according to the presence or absence of SVA: 36 patients were allocated to the non-SVA group and 40 patients to the SVA group. Heart rate variability (HRV), PWD, and AEMD values were determined and compared.

Results: The PWD was found to be higher in the SVA group. Interatrial EMD was 32.00 ms (25.00-35.00) in patients with SVA while it was 18.00 ms in patients without SVA (11.00-23.75); the intra-atrial EMD was 17.0 ms (10.00-20.00) in patients with SVA whereas it was 10.00 ms (4.00-14.00) in patients without SVA. Lower HRV was found in the SVA group.

Conclusion: In the SVA group, PWD and AEMD were increased while HRV values were decreased. Noninvasive parameters may help predict the presence and incidence of SVA during the follow-up of this group of patients.
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http://dx.doi.org/10.1007/s00059-021-05034-1DOI Listing
April 2021

Transcatheter aortic valve implantation through the brachial artery.

Turk Kardiyol Dern Ars 2021 Apr;49(3):237-241

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

Summary- Transcatheter aortic valve implantation (TAVI) has been increasingly used in patients with severe aortic stenosis. The femoral artery is the most commonly used entry site for TAVI; however, other entry sites were also reported as transapical, transaortic, transaxillary/subclavian, and transcarotid in patients with occlusive peripheral arterial disease. In this report, a case of TAVI procedure through the brachial artery is presented.
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http://dx.doi.org/10.5543/tkda.2021.51892DOI Listing
April 2021

Transcatheter valve-in-valve implantation for sutureless bioprosthetic aortic paravalvular leak in the era of COVID-19.

Anatol J Cardiol 2021 03;25(3):209-211

Department of Cardiology, University of Health Sciences, Antalya Training and Research Hospital; Antalya-Turkey.

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http://dx.doi.org/10.14744/AnatolJCardiol.2020.62884DOI Listing
March 2021

Increased Intima-Media Thickness of the Ascending Aorta May Predict Neurological Complications Associated with TAVI.

J Stroke Cerebrovasc Dis 2021 May 23;30(5):105665. Epub 2021 Feb 23.

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

Objectives: Neurological complications associated with transcatheter aortic valve implantation (TAVI) are important due to its morbidity and mortality risks. The purpose of this study was to investigate the importance of the features of the aortic valve and ascending aorta to predict the neurological complications associated with TAVI.

Methods: The patients for whom the heart team decided to perform TAVI were included in the study. In order to assess possible neurological complications, cerebral diffusionweighted magnetic resonance imaging(MRI) was performed pre- and post-operatively. The diameter of the patients' aortic root and ascending aorta, aortic valve scores, intima media thickness of the ascending aorta were measured from their transesophageal echocardiography records.

Results: A total of 108 patients constituted the study population. 31 patients were found to develop a new lesion (MR+) detected on MRI after TAVI, while 76 patients did not have any new lesions (MR-). The groups did not have any significant differences in their aortic valve features and scores. However, AA-IMT was found to be higher in the MR+ group (1.8mm [1.6-2.3] vs 1.4mm [1.2-1.8] interquartile range). The multivariate logistic regression analysis conducted to detect new lesions revealed that AA-IMT led to a significantly increased risk.

Conclusion: The features of the ascending are more important than the demographic characteristics of patients and features of the native valve in predicting new lesions on MRI scans and thus neurological events after TAVI.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2021.105665DOI Listing
May 2021

Echocardiographic reference ranges for normal cardiac Doppler data in healthy Turkish population: ECHO-DOP-TR Trial.

Echocardiography 2020 09 20;37(9):1374-1381. Epub 2020 Aug 20.

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

Aim: Doppler echocardiography has become the standard imaging modality for diastolic function and provides pathophysiological insight into systolic and diastolic heart failure. In this study, we aimed to obtain normal echocardiographic Doppler parameters of healthy Turkish population.

Methods: Among 31 collaborating institutions from all regions of Turkey, 1154 healthy volunteers were enrolled in this study. Predefined protocols were used for all participants during echocardiographic examination and The American Society of Echocardiography and European Association of Cardiovascular Imaging recommendations were used for echocardiographic Doppler measurements.

Results: A total of 967 healthy participants were enrolled in this study after applying exclusion criteria. Echocardiographic examination was obtained from all subjects following predefined protocols. Mitral E wave velocity and E/A ratio were higher in females and decreased progressively in advancing ages. E wave deceleration time and A wave velocity were increased with aging. Assessment of tissue Doppler velocities showed that left ventricular lateral e', septal e', and septal s' were higher in younger subjects and in females. E/e' ratio was increased progressively with advancing decades. Right ventricular e' and s' were decreased but a' was increased with increasing age. Septal e' lower than 8 cm/s was 1.9% in the fifth decade and 13.7% in ages older than 50 years. The E/e' ratio greater than 15 (and also 13) was not found.

Conclusion: This study, for the first time, provides echocardiographic reference ranges for normal cardiac Doppler data in healthy Turkish population which will be useful in routine clinical practice as well as in future clinical trials.
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http://dx.doi.org/10.1111/echo.14827DOI Listing
September 2020

Visceral fat index: a novel predictor for coronary collateral circulation.

Arch Endocrinol Metab 2020 Apr 27;64(2):150-158. Epub 2020 Mar 27.

Departments of Cardiology, Training and Research Hospital, University of Health Sciences Antalya, Antalya, Turkey.

Objective This study was designed to investigate the role of visceral adiposity along with other clinical parameters in predicting poor coronary collateral circulation (CCC) among patients with severe obstructive coronary artery disease (CAD). Subjects and methods A total of 135 patients with severe obstructive CAD and good (n = 70) or poor (n = 65) CCC were included. Data on angiographically detected CCC, the quality criteria for CCC (Rentrop scores) and visceral fat index (VFI) obtained via bioelectrical impedance were compared between good and poor CCC groups. Independent predictors of poor CCC, the correlation between VFI and Rentrop score and the role of VFI in the identification of CCC were analyzed. Results A significant negative correlation was noted between VFI and Rentrop scores (r = -0.668, < 0.001). The presence of hypertension (OR 4.244, 95% CI 1.184 to 15.211, p = 0.026) and higher VFI (OR 1.955, 95% CI 1.342 to 2.848, p < 0.001) were shown to be independent predictors of an increased risk for poor CCC. ROC analysis revealed a VFI > 9 (AUC [area under the curve] (95% CI): 0.898 (0.834-0.943), p < 0.0001) to be a potential predictor of poor CCC with a sensitivity of 95.38% and specificity of 85.71%. Conclusion In conclusion, our findings revealed comorbid hypertension and higher VFI to significantly predict the risk of poor CCC in patients with severe obstructive CAD.
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http://dx.doi.org/10.20945/2359-3997000000218DOI Listing
April 2020

Neutrophil Count as a Predictor of Critical Coronary Artery Stenosis in Young Patients.

Iran J Public Health 2018 May;47(5):765-767

Dept. of Emergency Medicine, Antalya Training and Research Hospital, Antalya, Turkey.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005979PMC
May 2018

Unexpected complication during transcatheter aortic valve replacement: Balloon that cannot inflate!

Anatol J Cardiol 2018 May 13;19(5):351-353. Epub 2018 Mar 13.

Department of Cardiology, Antalya Training and Research Hospital; Antalya-Turkey.

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http://dx.doi.org/10.14744/AnatolJCardiol.2018.02170DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6280271PMC
May 2018

A novel biomarker for prediction of atrial fibrillation susceptibility in patients with celiac disease.

PLoS One 2018 9;13(1):e0190382. Epub 2018 Jan 9.

Department of Biophysics, Akdeniz University Faculty of Medicine, Antalya, Turkey.

Background: Celiac disease (CD), a serious autoimmune disorder that occurs in people who are genetically predisposed, is induced by dietary gluten intake and affects primarily the small intestine. Many studies have identified an increased risk of cardiovascular problems in patients with CD. Moreover, these patients are susceptible to certain liver diseases, as well as fibrosis.

Objective: The aim of this study was to assess the presence of fibrosis using the De Ritis ratio, determining its effect on the electromechanical features of the left atrium and its susceptibility to atrial fibrillation (AF) in patients with CD.

Methods: A total of 97 patients diagnosed with CD by antibody test and biopsy were included in this prospective study. Two groups were created from these patients, a fibrosis-prone (FP) group and a non-fibrosis-prone (NFP) group, according to the cut-off value, as defined in previously published reports, for the AST/ALT ratio. Electrocardiographic and echocardiographic examinations were performed as part of the study.

Results: There were no differences in the baseline characteristics and conventional echocardiographic parameters of the defined groups. However, the patients in the FP group, as compared to those in the NFP group, had significantly increased PWD (56.68±6.48 ms vs. 37.49±6.22 ms, P<0.001). Additionally, significantly higher interatrial (60.50±13.05 ms vs. 29.40±11.55 ms, P<0.001), intra-left atrial (44.18±14.12 ms vs. 21.02±11.99 ms, P<0.001), and intra-right atrial (15.61±8.91 ms vs. 8.38±4.50 ms, P<0.001) EMD was found among the patients in the FP group compared to that of the NFP group.

Conclusion: It is believed that the susceptibility to AF cited in previous studies may be related to fibrosis. Our study is the first to examine the possible effects of fibrosis on AF susceptibility in patients with CD, whereby we propose a new biomarker for prediction of AF susceptibility of these patients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0190382PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5760044PMC
February 2018

The association between apelin gene polymorphism and coronary artery disease in young patients with acute obstructive coronary syndrome.

Turk Kardiyol Dern Ars 2017 Sep;45(6):520-526

Department of Emergency Medicine, Bitlis State Hospital, Bitlis, Turkey.

Objective: The purpose of this study was to evaluate the association between V103V, 6140AG, TGA-Stop-TAA Stop, and 6016CA polymorphisms of the apelin (APLN) gene detected for the first time among young patients with acute coronary syndrome (ACS) and coronary artery disease (CAD).

Methods: This was a prospective cross-sectional study. The study population was divided into 2 groups. The first group included 132 patients who were found to have critical lesions in their coronary arteries, while the control group consisted of 41 patients who were found to have normal coronary arteries or non-critical atherosclerotic lesions.

Results: Among the gene polymorphisms, V103V was found to be more common in the critical CAD patients with the GG genotype compared with the control group (67.4% vs. 46.3%). On the other hand, the GT genotype was more common in the control group (53.7% vs. 32.6%). Univariate and multivariate logistic regression analysis revealed that the GG genotype of V103V was an independent predictor for the presence of critical CAD (odds ratio: 2.397; 95% confidence interval, 1.174-4.892; p=0.016).

Conclusion: In cases of V103V polymorphism of the APLN gene, patients with the GG genotype were at a greater risk for the presence of atherosclerotic critical lesions compared with the control group.
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http://dx.doi.org/10.5543/tkda.2017.95849DOI Listing
September 2017

Assessment of the association between the personality traits of young patients with acute coronary syndrome and the severity of coronary artery disease.

Turk Kardiyol Dern Ars 2017 Sep;45(6):514-519

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

Objective: The role of psychosocial risk factors is becoming increasingly important in the etiology of acute coronary syndrome (ACS). The purpose of this study was to assess an association between the personality types of young patients with ACS and the prevalence and severity of coronary artery disease (CAD).

Methods: Patients younger than 45 years of age who presented with ACS and who underwent coronary angiography in the period from 2012 to 2016 were included in the study. The coronary angiography records of the patients were examined and their Gensini score (GS) was calculated; GS ≥20 was considered to be severe CAD. The Eysenck Personality Questionnaire-Revised Short Form scales were used to measure psychoticism, extraversion, lying, and neuroticism.

Results: A total of 139 patients were included in the study. The median psychoticism score of patients with GS <20 was found to be significantly higher than that of patients with GS ≥20 [1.0 (25th and 75th percentile: 0.0-2.0) vs. 1.0 (25th and 75th percentile: 0.0-1.0); p=0.015]. The median psychoticism score was 1.0 (25th and 75th percentile: 1.0-2.0) in the unstable angina pectoris group, 0.5 (25th and 75th percentile: 0.0-1.0) in the ST segment elevation myocardial infarction group, and 1.0 (25th and 75th percentile: 0.0-1.0) in the non-ST segment elevation myocardial infarction group (p=0.004).

Conclusion: The presence of psychoticism characteristics in patients who present with ACS is associated with less severe CAD.
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http://dx.doi.org/10.5543/tkda.2017.32379DOI Listing
September 2017

Assessment of left ventricular function with tissue Doppler echocardiography and of B-type natriuretic peptide levels in patients undergoing transcatheter aortic valve implantation.

Rev Port Cardiol 2017 May 9;36(5):377-383. Epub 2017 May 9.

Mus State Hospital, Department of Emergency Medicine, Antalya, Turkey.

Introduction: Transcatheter aortic valve implantation (TAVI) is an emerging minimally invasive treatment modality in high surgical risk or inoperable patients.

Aim: The aim of this study was to ascertain the effect of TAVI on left ventricular (LV) systolic and diastolic function and serum B-type natriuretic peptide (BNP) levels in high surgical risk or inoperable patients with severe aortic stenosis.

Methods: Fifty-five patients were included in our retrospective study. LV systolic and diastolic function was assessed with conventional and tissue Doppler imaging (TDI) prior to and after TAVI. Additionally, BNP was measured 24 h before and three months after the procedure. Echocardiographic controls were performed at one, three and six months and one year and mean values were taken. At the end of the study, LV systolic and diastolic function, serum BNP levels and New York Heart Association functional capacity were assessed and compared to baseline parameters.

Results: The TAVI procedure was successful in all patients. In-hospital mortality was 1.8% (one patient). There was a substantial improvement in LV function and functional capacity at follow-up. In addition, a statistically significant decrease was detected in serum BNP levels post-TAVI (median 380 pg/ml [176.6-929.3] vs. 215 pg/ml [96.0-383.0], p=0.0001). Only one patient required a permanent pacemaker (1.8%) and there was no mortality after TAVI during follow-up. There were significant increases in LV ejection fraction and aortic valve area (51.0±13.1% vs. 58.4±9.1%, p<0.001, and 0.6±0.1 cm vs. 2.1±0.2 cm, p=0.0001, respectively). At the end of the study, conventional Doppler echocardiography revealed improvement in diastolic function, with an increase in mitral E wave, a decrease in mitral A wave and an increase in E/A ratio. Deceleration time and isovolumetric relaxation time were shortened and myocardial performance (Tei) index decreased. TDI showed an increase in systolic myocardial velocity (Sm) and early diastolic velocity (Em). Septal mitral annular Sm and Em were increased, whereas MPI was reduced.

Conclusion: We found that LV structural changes and diastolic dysfunction occur in patients with severe aortic stenosis and that TAVI is able to reverse these abnormalities, which we demonstrated by both conventional echocardiography and TDI. In addition, serum BNP levels were decreased after TAVI.
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http://dx.doi.org/10.1016/j.repc.2016.10.008DOI Listing
May 2017

Which Came First, the Chicken or the Egg? Paradox in Peripheral Arterial Diseases.

Angiology 2018 01 9;69(1):83-84. Epub 2017 May 9.

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

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http://dx.doi.org/10.1177/0003319717709176DOI Listing
January 2018

The Relationship between Vitamin D and Coronary Artery Ectasia in Subjects with a Normal C-Reactive Protein Level.

Korean Circ J 2017 Mar 13;47(2):231-237. Epub 2017 Mar 13.

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

Background And Objectives: Vitamin D is generally known to be closely related to inflammation. The effects of vitamin D on coronary artery disease (CAD) are not fully explained. Nowadays, coronary artery ectasia (CAE) cases are common and are regarded as being a kind of CAD. We aimed to investigate, in a case-control study, the relationship between vitamin D and CAE without an associated inflammatory process.

Subjects And Methods: This study population included 201 patients (CAE group, 121 males; mean age, 61.2±6.4 years) with isolated CAE; and 197 healthy individuals (control group, 119 males; mean age, 62.4±5.8 years), comprising the control group, who had normal coronary arteries. These participants concurrently underwent routine biochemical tests, tests for inflammatory markers, and tests for 25-OH vitamin D in whole-blood draws. These parameters were compared.

Results: There are no statistical significance differences among the groups for basic clinical characteristics (p>0.05). Inflammatory markers were recorded and compared to exclude any inflammatory process. All of them were similar, and no statistical significance difference was found. The average parathyroid hormone (PTH) level of patients was higher than the average PTH level in controls (41.8±15.1 pg/mL vs. 19.1±5.81 pg/mL; p<0.001). Also, the average 25-OH vitamin D level of patients was lower than the average 25-OH vitamin D level of controls (14.5±6.3 ng/mL vs. 24.6±9.3 ng/mL; p<0.001). In receiver operating characteristic curve analysis, the observed cut-off value for vitamin D between the control group and patients was 10.8 and 85.6% sensitivity and 75.2% specificity (area under the curve: 0.854, 95% confidence interval: 0.678-0.863).

Conclusion: We found that there is an association between vitamin D and CAE in patients who had no inflammatory processes. Our study may provide evidence for the role of vitamin D as a non-inflammatory factor in the pathophysiology of CAE.
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http://dx.doi.org/10.4070/kcj.2016.0198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5378030PMC
March 2017

Management of Left Ventricular Free Wall Rupture Associated with Acute Myocardial Infarction.

J Acute Med 2017 Mar;7(1):31-34

Antalya Education and Research Hospital Cardiology Department Antalya Turkey.

Left ventricular free wall rupture is one of the mechanical complications of acute myocardial infarction and it may result in cardiac tamponade as well as limiting itself by forming a pseudoaneurysm. In this report, a case of left ventricular free wall rupture and pseudoaneurysm that developed during the course of posterior myocardial infarction has been presented. Left ventricular free wall rupture and pseudoaneurysm were identified by three-dimensional transthoracic echocardiography and surgically repaired at a late stage.
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http://dx.doi.org/10.6705/j.jacme.2017.0701.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7517979PMC
March 2017

Vitamin D Trials and Their Limitations.

Angiology 2017 07 14;68(6):560. Epub 2016 Dec 14.

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

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http://dx.doi.org/10.1177/0003319716683494DOI Listing
July 2017

Relationship between mean platelet volume and ischemic stroke in patients with patent foramen ovale.

Turk Kardiyol Dern Ars 2017 Jan;45(1):9-15

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

Objective: Patent foramen ovale (PFO) is commonly encountered in patients with cryptogenic stroke. Mean platelet volume (MPV), an indicator of platelet reactivity, has been reported in recent trials to be higher in patients with PFO than in normal population. The aim of this study was to investigate whether there is a difference in MPV between patients with PFO and stroke or transient ischemic attack (TIA) and that of patients with asymptomatic PFO.

Methods: Patients with PFO who were younger than 55 years of age were enrolled in this retrospective study. Hemogram parameters of patients with ischemic stroke or TIA (symptomatic group) were obtained during hospitalization once they had stable clinical status.

Results: Total of 108 patients, 51 of whom were symptomatic, were included in the study. MPV was determined to be higher in symptomatic group compared with asymptomatic group (median 10.0 fl [25th-75th percentile: 9.0-11.0] vs median 8.56 fl [25th-75th percentile: 8.0-9.0], respectively; p<0.001,. Cut-off point of 9.0 fl for MPV had 70% sensitivity and 86% specificity in predicting symptomatic PFO patients.

Conclusion: MPV is higher in symptomatic than in asymptomatic PFO patients. This finding may be a subsidiary risk factor to identify patients with PFO and high risk of cardioembolic stroke.
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http://dx.doi.org/10.5543/tkda.2016.17971DOI Listing
January 2017

Successful lysis in massive pulmonary embolism with thrombus entrapped in PFO.

Am J Emerg Med 2017 Jan 25;35(1):198.e3-198.e5. Epub 2016 Jul 25.

Clinic of Cardiology, Antalya, Education and Research Hospital, Antalya, Turkey.

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http://dx.doi.org/10.1016/j.ajem.2016.07.039DOI Listing
January 2017

Short and Long-Term Effect of Carotid Artery Stenting on Arterial Blood Pressure Measured through Ambulatory Blood Pressure Monitoring.

Acta Cardiol Sin 2016 May;32(3):343-50

Clinic of Cardiology, Antalya Education and Research Hospital, Antalya;

Background: The aim of this study was to assess the short and long-term effects of carotid artery stenting (CAS) procedure on blood pressure (BP) through ambulatory BP monitoring.

Methods: One hundred fifty three patients who underwent CAS for primary or secondary protection from December 2010 to September 2013 were enrolled to our study. The BP levels of total of 123 patients were monitored for 1 year. Thereafter, the pre-procedure levels of BP were compared with BP levels at the 24-hour and the first year intervals after the procedure.

Results: Systolic and diastolic BP levels at the 24-hour and the first year intervals after CAS were significantly lower than the pre-procedure BP levels. The mean 24-hour systolic BP was 113 ± 13 mmHg and diastolic BP was 63 ± 8 mmHg, both of which were significantly lower (p < 0.001 and p < 0.001 respectively), while the pre-procedure mean systolic BP was 133 ± 10 mmHg and the mean diastolic BP was 75 ± 9 mmHg. Moreover, the mean first-year systolic BP was 125 ± 10 mmHg with a decline of 8 ± 8 mmHg and mean diastolic BP was 71 ± 8 mmHg with a decline of 4 ± 7 mmHg, both of which were again significantly lower compared to the pre-procedure levels (p < 0.001 and p < 0.001 respectively).

Conclusions: The results of our study suggested that systolic and diastolic BP levels diminished after CAS. Additionally, BP reduction continued even 1 year after the CAS.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4884763PMC
http://dx.doi.org/10.6515/acs20150604aDOI Listing
May 2016

Assessment of Aortic Elasticity in Patients with Celiac Disease.

Korean Circ J 2016 Mar 21;46(2):239-45. Epub 2016 Mar 21.

Internal Medicine Department, Antalya Education and Research Hospital, Antalya, Turkey.

Background And Objectives: Celiac disease (CD) is a chronic autoimmune disorder induced by dietary gluten intake by individuals who are genetically sensitive. Many studies report an increased risk of cardiovascular diseases in such patients. The aim of this study is to assess aortic elasticity properties in patients with CD that may be associated with an increased risk of cardiovascular disease.

Subjects And Methods: Eighty-one patients diagnosed with CD by antibody test and biopsy and 63 healthy volunteers were included in this prospective study. Electrocardiographic and echocardiographic examinations were performed.

Results: The CD group did not have any differences in the conventional echocardiographic parameters compared to the healthy individuals. However, patients in the CD group had an increased aortic stiffness beta index (4.3±2.3 vs. 3.6±1.6, p=0.010), increased pressure strain elastic modulus (33.6±17.0 kPa vs. 28.5±16.7 kPa, p=0.037), decreased aortic distensibility (7.0±3.0×10(-6) cm(2)/dyn vs. 8.2±3.6×10(-6) cm(2)/dyn, p=0.037), and similar aortic strain (17.9±7.7 vs. 16.0±5.5, p=0.070) compared to the control group. Patients with CD were found to have an elevated neutrophil/lymphocyte ratio compared to the control group (2.54±0.63 vs. 2.24±0.63, p=0.012). However, gluten-free diet and neutrophil/lymphocyte ratio were not found to be associated with aortic elasticity.

Conclusion: Patients with CD had increased aortic stiffness and decreased aortic distensibility. Gluten-free diet enabled the patients with CD to have a reduction in the inflammatory parameters whereas the absence of a significant difference in the elastic properties of the aorta may suggest that the risk of cardiovascular disease persists in this patient group despite a gluten-free diet.
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http://dx.doi.org/10.4070/kcj.2016.46.2.239DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4805569PMC
March 2016

Evaluation of the association between stroke/transient ischemic attack and atrial electromechanical delay in patients with paroxysmal atrial fibrillation.

Anatol J Cardiol 2016 Aug 25;16(8):572-578. Epub 2015 Nov 25.

Department of Cardiology, Antalya Education and Research Hospital, Antalya-Turkey.

Objective: This study aimed to evaluate the association between the history of stroke/transient ischemic attack (TIA) and inter- and intra-atrial electromechanical delay (EMD) in patients with paroxysmal atrial fibrillation (PAF).

Methods: Patients diagnosed with PAF were included in this retrospective study. Patients who had a history of stroke or TIA were defined as the symptomatic group, whereas those who did not have such a history were defined as the asymptomatic group. On the basis of the transthoracic echocardiographic records, atrial electromechanical coupling (time interval from the onset of the P wave on the surface electrocardiogram to the beginning of the A' wave interval with tissue Doppler echocardiography) and intra- and interatrial EMD were measured.

Results: In this study, 160 patients were included, 52 of whom were symptomatic. While the intra-left atrial EMD was 68.2±6.1 ms in the symptomatic group, it was found to be 50.8±6.5 ms in the asymptomatic group (p<0.001). Interatrial EMD was 91.3±5.0 ms in the symptomatic group, whereas it was 71.5±7.0 ms in the asymptomatic group (p<0.001). In multiple logistic regression analysis, intra-left atrial [odds ratio (OR): 1.417, 95% confidence interval (CI): 1.193-1.684, p<0.001] and interatrial EMDs (OR: 1.398, 95% CI: 1.177-1.661, p<0.001) were found to be independently associated with the presence of stroke/TIA.

Conclusion: Prolonged inter- and intra-left atrial EMDs in patients with PAF is associated with stroke/TIA. Evaluating this parameter in addition to the CHA2DS2-VASc score in patients with PAF may be helpful in identifying patients who are at a high risk of stroke/TIA.
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http://dx.doi.org/10.5152/AnatolJCardiol.2015.6424DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5368512PMC
August 2016

Subarachnoid hemorrhage that electrocardiographically mimics acute coronary syndrome: a case report.

Turk Kardiyol Dern Ars 2015 Dec;43(8):730-3

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

Electrocardiography alterations and cardiac enzyme elevation have been reported in patients with cerebrovascular events in various articles. This case reports a case of syncope with an electrocardiography of atrioventricular complete block and extensive ST segment elevation. However, it was finally diagnosed as subarachnoid hemorrhage. To the best of our knowledge, this patient is the first case of subarachnoid hemorrhage mimicking ST elevation myocardial infarction with atrioventricular complete block.
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http://dx.doi.org/10.5543/tkda.2015.26546DOI Listing
December 2015

Is Elevated Neutrophil-to-Lymphocyte Ratio a Predictor of Stroke in Patients with Intermediate Carotid Artery Stenosis?

J Stroke Cerebrovasc Dis 2016 Mar 17;25(3):578-84. Epub 2015 Dec 17.

Department of Cardiology, Clinic of Cardiology, Antalya Education and Research Hospital, Antalya, Turkey.

Objective: An increased neutrophil-to-lymphocyte ratio (NLR) is associated with poor clinical prognosis in patients with cardiovascular disease. In this study, we aimed to investigate if there was a correlation between NLR and the risk of stroke in patients with intermediate carotid artery stenosis.

Methods: A total of 254 patients with a 50%-70% stenosis in the carotid artery, 115 of whom were symptomatic and 139 of whom were asymptomatic, were included in the study. Patients with a history of ischemic cerebrovascular event with or without sequelae, transient ischemic attack, and amaurosis fugax in the last 1-6 months were included in the symptomatic group of the study. The symptomatic and asymptomatic groups were compared in terms of total neutrophil count, lymphocyte count, and NLR.

Results: The total white blood cell count (WBC), neutrophil count, and NLR were found to be higher and the lymphocyte count was found to be lower in the symptomatic patients than those in the asymptomatic patients (symptomatic/asymptomatic, respectively, WBC [10(3)/mm(3)]: 9.0/8.2, neutrophil count [10(3)/mm(3)]: 6.1/5.0, NLR: 3.08/2.2, lymphocyte count [10(3)/mm(3)]: 1.9/2.2) (P < .001). The cutoff value for NLR was found to be 2.6 or higher. In the multivariate regression analysis, an NLR value of 2.6 or higher was shown to be an independent variable for carotid artery stenosis to become symptomatic.

Conclusions: NLR is increased in symptomatic intermediate carotid artery stenosis. An increased NLR value is an independent variable for carotid artery plaques to become symptomatic.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2015.10.031DOI Listing
March 2016

Nebivolol-induced gynecomastia.

J Pharmacol Pharmacother 2015 Jul-Sep;6(3):166-8

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

Adverse drug reactions play a substantial role in the etiology of gynecomastia. Gynecomastia as an adverse drug reaction, related to some cardiovascular drugs, has been reported in literature. Nebivolol is a third generation beta-blocker, and gynecomastia as an adverse effect on the consumption of this drug has not been reported in any article yet. We herein present the case of a 42-year-old male, who developed bilateral gynecomastia following nebivolol use and complete regression after discontinuation of nebivolol. Other reasons causing gynecomastia were excluded. Discontinuation of the responsible drug is quite sufficient with regard to the treatment of drug-induced gynecomastia, without any pharmacological or surgical treatment.
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http://dx.doi.org/10.4103/0976-500X.162009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4544141PMC
August 2015

Is Acute Carotid Artery Stent Thrombosis an Avoidable Complication?

J Stroke Cerebrovasc Dis 2015 Oct 21;24(10):2219-22. Epub 2015 Aug 21.

Department of Cardiology, Clinic of Cardiology, Antalya Education and Research Hospital, Antalya, Turkey.

The most serious complication of carotid artery stenting (CAS) is acute carotid artery stent thrombosis (ACAST). ACAST is a very rare complication, but it may lead to dramatic and catastrophic consequences. The most important cause is inadequate or ineffective antiaggregant therapy. It is very important to identify, before CAS, those patients who might be candidates for ACAST and to start antiplatelet therapy for them. Testing patients who are candidates for CAS for acetylsalicylic acid and clopidogrel resistance may prevent this complication.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2015.05.029DOI Listing
October 2015

Right ventricle failure associated wıth trastuzumab.

Ther Adv Drug Saf 2015 Jun;6(3):98-102

Cardiology Department, Antalya Education and Research Hospital, Antalya, Turkey.

Trastuzumab (TZ), a monoclonal antibody against human epidermal growth factor receptor type 2 (HER2), is an important biological agent used for the treatment of positive breast cancer. This paper presents a 46-year-old female patient who developed right heart failure and right ventricular dysfunction while on TZ due to breast cancer, and returned to normal following the discontinuation of the drug. As far as we know, this is the first case report related to a patient presenting with right ventricular dysfunction and induced cardiotoxicity while on TZ.
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http://dx.doi.org/10.1177/2042098615582162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4519740PMC
June 2015

Usefulness of mean platelet volume for predicting stroke risk in paroxysmal atrial fibrillation patients.

Blood Coagul Fibrinolysis 2015 Sep;26(6):669-72

aAntalya Training and Research Hospital, Antalya bTürkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey.

Atrial fibrillation is the most common sustained arrhythmia in clinical practice. It is important to specify patients with a high risk of thromboembolus due to elevated procoagulant and prothrombotic state. The aim of this study is to assess the relation of stroke/transient ischaemic attack (TIA) with mean platelet volume (MPV), which is an indicator of platelet activation in patients with paroxysmal atrial fibrillation (PAF). Patients with PAF were enrolled in this study during years of 2012-2014. Patients were divided into two groups according to the presence or absence of stroke/TIA. Demographic data were registered and CHA2DS2VASc scores of patients were calculated. It was investigated whether there was a difference among groups regarding MPV levels. Ninety patients, 31 of whom had history of stroke/TIA (symptomatic group), were enrolled to study. CHA2DS2VASc score of symptomatic group was 4.77 ± 1.26, while CHA2DS2VASc score of asymptomatic group was 2.63 ± 1.41. Nevertheless, there was not any difference regarding CHA2DS2VASc score among two groups when 2 points due to stroke/TIA were subtracted in symptomatic patients. MPV was detected higher in symptomatic patients than asymptomatic patients (11.1 ± 1.3 vs. 9.1 ± 1.0 fL, P < 0.001, respectively). A value of 9.85 for the MPV ascertained with receiver operating characteristic (ROC) curve analysis to predict stroke/TIA was found to have a sensitivity of 87% and specificity of 78%. Elevated MPV levels were ascertained to be related with stroke/TIA in patients with PAF. Assessment of MPV apart from CHA2DS2VASc score in patients with PAF might be subsidiary to specify patients with an enhanced risk of stroke/TIA.
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http://dx.doi.org/10.1097/MBC.0000000000000334DOI Listing
September 2015

Clinical and morphological features of patients who underwent endovascular interventions for lower extremity arterial occlusive diseases.

Postepy Kardiol Interwencyjnej 2015 22;11(2):114-8. Epub 2015 Jun 22.

Antalya Training and Research Hospital, Antalya, Turkey.

Introduction: Patients with peripheral arterial disease (PAD) are at increased risk for all-cause mortality and cardiovascular mortality.

Aim: To present anatomical and morphological characteristics of patients who underwent endovascular stenting with laboratory and our mid-term results.

Material And Methods: One hundred fifty-three patients (mean age: 62.8, 86% male) who underwent percutaneous intervention of lower extremity arteries were included in the study. Demographic characteristics, medical history, physical examination and laboratory findings of patients were analyzed. Patients' lesions were classified according to the TransAtlantic Inter-Society Consensus (TASC). Clinical outcomes included complications and mortality, 6-minute walking distance, functional class (NYHA) and patency rates.

Results: Seventy percent of patients had hypertension, 42% were smokers, 78% had coronary artery disease, 20% had coronary artery bypass grafting, 55% had diabetes mellitus and 71% had dyslipidemia. Six patients with diabetes mellitus and poor wound healing despite medical therapy were treated with stenting leading to alleviation of pain and avoidance of amputation. The initial technical success rate of revascularization was 95.6% (153/160). Our mid-term results show that percutaneous procedures in lower extremity arterial diseases can be performed with low complication and high success rates. Patients' 6-minute walk distance, ankle/brachial index values, functional class and the status of foot ulcers were evaluated.

Conclusions: Especially in patients with distal vascular disease, poor wound healing and no chance of surgical revascularization, percutaneous endovascular revascularization may provide good blood flow and prevent amputation.
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http://dx.doi.org/10.5114/pwki.2015.52284DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4495127PMC
July 2015

Corrected balloon occlusive diameter to determine device size during percutaneous atrial septal defect closure.

Turk Kardiyol Dern Ars 2015 Jul;43(5):420-6

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

Objective: The aim of this trial was to investigate the impact of corrected balloon occlusive diameter (cBOD) on successful performance of percutaneous atrial septal defect (ASD) closure.

Methods: The trial comprised 86 patients (60 female, 26 male; mean age 36.5±14.3) on whom percutaneous ASD closure was performed. Patients were evaluated using transesophageal echocardiography (TEE). Relation of the defect to surrounding tissues and size of rims was also investigated. Balloon sizing was performed intraoperatively on all patients. Size of device was ascertained according to both durability of rims and whether or not they formed significant indentation, both of which determine cBOD.

Results: The ASD closure device was successfully implanted in 84 (97.5%) patients. Mean maximum defect size was 17.4±5.9 mm, and mean color flow diameter was 16.8±5.4 mm. Mean maximum defect size at the moment of loss of shunt flow was 18.4±5.9 mm with TEE, and 18.8±6.1 mm with fluoroscopy. Mean size of Amplatzer occluder device was 20.0±6.5 mm. Device embolization was observed in 2 patients. However, no death occurred during or after the procedure.

Conclusion: Percutaneous secundum ASD closure is a safe and effective treatment modality in experienced centers. Utilizing corrected balloon occlusive diameter may be of benefit in deciding the size of ASD occluder device.
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http://dx.doi.org/10.5543/tkda.2015.68217DOI Listing
July 2015