Publications by authors named "Oktay Gulcu"

29 Publications

  • Page 1 of 1

Modified model for end-stage liver disease score predicts 30-day mortality in high-risk patients with acute pulmonary embolism admitted to intensive care units.

Scand Cardiovasc J 2021 Jan 25:1-15. Epub 2021 Jan 25.

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

Objectives: The Model for End-stage Liver Disease excluding the international normalised ratio that is derived from prothrombin time which is calculated as a ratio of the patient's prothrombin time to a control prothrombin time standardized (MELD-XI) and modified MELD, which uses albumin in place of the international normalised ratio (MELD-Albumin) scores reflect liver and renal function and are predictors of mortality. However, their prognostic value in acute pulmonary embolism (APE) has not been studied.

Design: We assessed the predictive value of the MELD scores in patients diagnosed with high-risk APE admitted to the intensive care unit. The primary outcome was 30-day mortality.

Results: Of the 273 patients included in the study, 231 were survivors and 42 were non-survivors. The mortality rate was 15.3%. The mean MELD-XI and MELD-Albumin scores were significantly higher in the non-survivors than in the survivors (MELD XI, 11.8 ± 1.8 and 10.6 ± 1.43, respectively;  = .002; MELD-Albumin, 10.5 ± 1.6 and 8.7 ± 1.1, respectively;  = .001). The multiple logistic regression analysis identified the MELD-XI (hazard ratio: 3.029, confidence interval: 1.06-1.21,  = .007) and MELD-Albumin (hazard ratio: 1.13, confidence interval: 1.06-1.21,  = .002) scores as independent predictors of mortality. Receiver operating characteristic analysis revealed that the predictive power of the MELD-Albumin score (0.871 ± 0.014;  < .001) was higher than those of the MELD-XI (0.726 ± 0.022,  < .001), APACHE III (0.682 ± 0.024,  < .001), and PESI (0.624 ± 0.023,  < .001) scores.

Conclusions: The MELD-Albumin score is an easily calculable, reliable, and practical risk assessment tool and independent predictor of 30-day mortality in patients with high-risk APE.
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http://dx.doi.org/10.1080/14017431.2021.1876912DOI Listing
January 2021

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Peripartum cardiomyopathy and thrombotic complications.

North Clin Istanb 2019 20;6(1):102. Epub 2019 Jan 20.

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

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http://dx.doi.org/10.14744/nci.2018.54815DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6526991PMC
January 2019

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Endocan and Major Adverse Cardiovascular Events: Understanding Regression Methods.

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

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

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

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

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

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

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

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

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

Evaluation of ventricular repolarization parameters during migraine attacks.

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

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

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

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

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

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

Long-Term Mortality and Contrast-Induced Nephropathy.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Peripartum cardiomyopathy and ventricular thrombus: A case report and review of literature.

North Clin Istanb 2018 30;5(2):145-147. Epub 2018 Mar 30.

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

Peripartum cardiomyopathy (PPCMP) is a rare and life-threatening condition. Intracardiac thrombus is characteristically associated with increased adverse events, mortality, and a high risk of thromboembolic events, and has been associated with PPCMP. Early diagnosis and treatment play a critical role. Although echocardiography is the first-line diagnostic method, other imaging modalities may provide useful information in appropriate patients. Presently described is a case in which an apical intracardiac thrombus coexisting with PPCMP was identified and managed using multimodality imaging studies.
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http://dx.doi.org/10.14744/nci.2017.53254DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6191556PMC
March 2018

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

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

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

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

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

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

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

The association of the Syntax score II with carotid intima media thickness and epicardial fat tissue.

Indian Heart J 2017 Nov - Dec;69(6):752-756. Epub 2017 Apr 18.

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

Aim: Syntax score II (SSII) is a highly predictive scoring system, which is used to improve individualized assessment of patients with complex coronary artery disease and facilitates clinical decision making. Surrogate markers [carotid intima-media thickness (CIMT), epicardial fat tissue (EFT)] are also used for risk assessment, but their relation with SSII is not well established.

Method: We enrolled 543 consecutive patients, who underwent coronary angiography for stable angina pectoris and acute coronary syndrome, in the study. SSII was calculated for each patient and the patients were divided into two groups as low SSII group and high SSII group according to their median SSII.

Results: The average age of the patients was 61.4 years and 75% of the patients were male. The multivariate analysis indicated that only EFT (p: 0,035), CIMT (p:0,04) and Hypertension (HT) (p: 0,014) were independently associated with high SSII.

Discussion: EFT and CIMT, the surrogate markers which can be simply and non-invasively determined, are of the independent predictors of high SSII. The inclusion of these parameters in the risk classification may provide additional clinical benefit.
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http://dx.doi.org/10.1016/j.ihj.2017.04.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5717280PMC
July 2018

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

Int J Cardiol 2017 11;246:14

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

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

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

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

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

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

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

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

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

Comparison of the three conventional methods for the postoperative atrial fibrillation prediction.

Echocardiography 2017 Jun 6;34(6):831-834. Epub 2017 Apr 6.

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

Introduction: Although various risk factors have been defined for the development of postoperative atrial fibrillation (PAF), these parameters have not been adequately verified and validated. We investigated the atrial fibrillation detection capabilities of echocardiographic parameters in PAF developing and the determination of predictive values for clinical use.

Method: We enrolled 60 consecutive patients with 234 lesions who underwent CABG surgery. All patients underwent preoperative echocardiographic evaluation. Patients were divided into two groups according to PAF development status.

Results: The mean age of the patients was 67, and 73% were male and PAF occurred in 19 patients. In univariate analysis, left atrial volume index (LAVi), left ventricular global strain (LVGS) and ejection fraction were associated with PAF development. Parameters which were significant in univariate analysis were included in a logistic regression model to determine the independent predictors of PAF. LAVi was found to be an independent predictor of PAF.

Conclusion: Although several parameters have been defined for PAF development, LAVi is more advantageous than the other conventional methods in clinical decision making.
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http://dx.doi.org/10.1111/echo.13535DOI Listing
June 2017

The Risk of Atrial Fibrillation With Ivabradine Treatment: A Meta-analysis With Trial Sequential Analysis of More Than 40000 Patients.

Clin Cardiol 2016 Oct 11;39(10):615-620. Epub 2016 Aug 11.

Department of Cardiology, Kosuyolu Heart Hospital, Istanbul, Turkey.

Recent trials reported that risk of atrial fibrillation (AF) is increased in patients using ivabradine compared with controls. We performed this meta-analysis to investigate the risk of AF association with ivabradine treatment on the basis of data obtained from randomized controlled trials (RCTs). We searched PubMed, EMBASE, Scopus, and the Cochrane Library for RCTs that comprised >100 patients. The incidence of AF was assessed. We obtained data from European Medicines Agency (EMA) scientific reports for the RCTs in which the incidence of AF was not reported. We used trial sequential analysis (TSA) to provide information on when we had reached firm evidence of new AF based on a 15% relative risk increase (RRI) in ivabradine treatment. Three RCTs and 1 EMA overall oral safety set (OOSS) pooled analysis (included 5 RCTs) were included in the meta-analysis (N = 40 437). The incidence of AF was 5.34% in patients using ivabradine and 4.56% in placebo. There was significantly higher incidence of AF (24% RRI) in the ivabradine group when compared with placebo before (RR: 1.24, 95% confidence interval: 1.08-1.42, P = 0.003, I 1980 = 53%) and after excluding OOSS (RR: 1.24, 95% confidence interval: 1.06-1.44, P = 0.008). In the TSA, the cumulative z-curve crossed both the traditional boundary (P = 0.05) and the trial sequential monitoring boundary, indicating firm evidence for ≥15% increase in ivabradine treatment when compared with placebo. Study results indicate that AF is more common in the ivabradine group (24% RRI) than in controls.
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http://dx.doi.org/10.1002/clc.22578DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6490712PMC
October 2016

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

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

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

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

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

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

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

Efficacy of coronary fractional flow reserve using contrast medium compared to adenosine.

Postepy Kardiol Interwencyjnej 2016 19;12(3):212-6. Epub 2016 Aug 19.

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

Introduction: Coronary fractional flow reserve (FFR) is recommended as the gold standard method in evaluating intermediate coronary stenoses. However, there are significant debates concerning the agents and the timing of the measurement.

Aim: To compare the contrast medium induced Pd/Pa ratio (CMR) with the FFR.

Material And Methods: We enrolled 28 consecutive patients with 34 intermediate lesions who underwent coronary FFR measurement by intracoronary (i.c.) adenosine. After baseline Pd/Pa was calculated, a single contrast medium (Iomeron) injection of 6 ml (3 ml/s) was performed manually. Within 10 s after the contrast medium injection, the CMR was calculated. Bolus injection of i.c. adenosine was performed to induce maximal hyperemia (from 60 µg to 600 µg), and when it was ≤ 0.80, the intermediate lesion was considered as significant.

Results: After bolus i.c. adenosine, 12 lesions of 34 (35.3%) were identified as significant. The CMR value was 0.86 ±0.06 (range: 0.71-0.97). There were no significant differences between FFR and CMR values (p = 0.108). A substantial positive correlation between adenosine and contrast values was detected (0.886 and p < 0.001). Good agreement in Bland-Altman analysis was revealed (mean bias was 0.027, 95% confidence interval 0.038-0.092). Receiver operating characteristics curve analysis showed 90.9% sensitivity and 91.7% specificity for a cut-off value of 0.85 for the CMR compared to FFR (≤ 0.80).

Conclusions: Our study showed that measuring the CMR is a feasible method compared to FFR. The CMR may be used in situations where adenosine cannot be administered.
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http://dx.doi.org/10.5114/aic.2016.61641DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5011536PMC
September 2016

A rare life-threatening condition: metastasis to the heart.

Am J Emerg Med 2016 Sep 12;34(9):1912.e3-4. Epub 2016 Feb 12.

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

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http://dx.doi.org/10.1016/j.ajem.2016.02.023DOI Listing
September 2016

Apical hypertrophic cardiomyopathy mimicking acute coronary syndrome.

Am J Emerg Med 2016 Jul 22;34(7):1322.e1-2. Epub 2015 Nov 22.

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

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http://dx.doi.org/10.1016/j.ajem.2015.11.054DOI Listing
July 2016

Massive pulmonary embolism mimicking electrocardiographic pattern of Brugada syndrome.

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

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

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

Left atrial thrombosis due to heparin-induced thrombocytopenia.

Int J Cardiol 2015 Nov 2;198:22-3. Epub 2015 Jul 2.

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

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http://dx.doi.org/10.1016/j.ijcard.2015.06.107DOI Listing
November 2015

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

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

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

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

Pseudoaneurysm of the mitral-aortic intervalvular fibrosa and its deadly complication.

Int J Cardiol 2015 Sep 19;195:17-8. Epub 2015 May 19.

Malkara State Hospital, Department of Cardiology, Tekirdağ, Turkey.

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http://dx.doi.org/10.1016/j.ijcard.2015.05.103DOI Listing
September 2015