Publications by authors named "Selami Demirelli"

44 Publications

Aortic propagation velocity in the prediction of coronary artery disease severity.

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021 Feb 22. Epub 2021 Feb 22.

Department of Cardiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey.

Aims: To investigate the association of the aortic propagation velocity (APV) with coronary artery disease (CAD) in patients with stable angina pectoris (SAP) through SYNTAX scores (SS).

Methods: The study population comprised 214 SAP subjects who received a coronary angiography. The APV and carotid intima-media thickness (CIMT) were examined and SS was calculated. Subjects were grouped following specific SS criteria: SS less than 22 (low) and SS greater than or equal to 22 (high).

Results: High SS subjects had lower APV compared to low SS [39.0 (32.0-51.7) vs. 55.0 (45.0-62.0) cm/s, respectively; P<0.001] and higher CIMT (0.86 ± 0.24 vs. 0.74 ± 0.21 mm, respectively; P<0.001). APV demonstrated a negative correlation with the CIMT (r=-0.239, P<0.001), age (r=-0.188, P=0.006) , and SS (r=-0.561, P <0.001) and showed a positive association with LV ejection fraction (r=0.163, P=0.017). APV, CIMT, diabetes, low-density lipoprotein cholesterol (LDL-C), and age were determined to be markers independently of a high SS.

Conclusion: APV, CIMT, diabetes, LDL-C and age are independently linked to the CAD severity of SAP subjects. Decreased APV, an indicator of subclinical atherosclerosis, may independently help determine the severity of atherosclerotic CAD in SAP patients.
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http://dx.doi.org/10.5507/bp.2021.001DOI Listing
February 2021

New onset atrial fibrilation and risk faktors in COVID-19.

J Electrocardiol 2021 Mar-Apr;65:76-81. Epub 2021 Jan 21.

Department of Cardiology, Erciyes University Faculty of Medicine, Kayseri, Turkey.

Background: There is limited data concerning the prevalence of arrhythmias, particularly atrial fibrillation (AF), which may develop as a consequence of direct myocardial injury and the inflammatory state existing in COVID-19.

Methods: This single-center study included data concerning 658 COVID-19 patients, who were hospitalized in our institute, between April 20th, 2020 and July 30th, 2020. Demographic data, findings of the imaging studies, and laboratory test results were retrieved from the institutional digital database.

Results: New onset AF (NOAF) was identified in 33 patients (5%). Patients who developed AF were older (72.42 ± 6.10 vs 53.78 ± 13.80, p < 0.001) and had higher frequencies of hypertension and heart failure compared to patients without NOAF (p < 0.001, for both). The CHA2DS2-VASc score was higher in patients, who developed NOAF, compared to those who did not during hospitalization for COVID-19 (p < 0.001). Subjects, who developed NOAF during hospitalization, had a higher leukocyte count, neutrophil / lymphocyte ratio (NLR), C-reactive protein, erythrocyte sedimentation rate, and procalcitonin levels compared to those without NOAF (p < 0.001 for all comparisons). Diffuse lung infiltration was also more frequent in COVID-19 patients, who developed NOAF, during hospitalization (p = 0.015). Multivariate logistic regression analysis demonstrated that age, CHA2DS2-VASc score, CRP, erythrocyte sedimentation rate, and presence of diffuse lung infiltration on thorax CT were predictive for NOAF.

Conclusion: The prevalence of NOAF in hospitalized COVID-19 patients is higher than the general population. Age, CHA2DS2-VASc score, C-reactive protein, erythrocyte sedimentation rate, and presence of diffuse lung infiltration on thorax CT may be used to identify patients at high risk for development of NOAF. Especially among these parameters, the presence of diffuse lung infiltration on thorax CT it was the most powerful independent predictor of NOAF development.
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http://dx.doi.org/10.1016/j.jelectrocard.2020.12.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7825910PMC
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 relationship between total atrial conduction time and left atrial global strain in patients with psoriasis vulgaris.

Arch Med Sci 2019 Jul 30;15(4):865-871. Epub 2019 Jan 30.

Department of Cardiology, Recep Tayyip Erdoğan University, Rize, Turkey.

Introduction: Psoriasis vulgaris is a chronic, multisystem disease that results in the development of atrial fibrillation (AF) over time. In this study, our goal was to assess predictors of AF in patients with psoriasis, including total atrial conduction time (TACT) and left atrial global longitudinal strain (LAGLS).

Material And Methods: A total of 80 individuals, including 40 psoriasis patients and 40 healthy controls, were enrolled in the study. A physical examination was performed, biochemical parameters were studied, and Holter electrocardiography was carried out. Conventional echocardiography, atrial tissue Doppler, and speckle tracking echocardiography were recorded.

Results: No significant difference was observed between psoriasis patients and healthy controls with regard to age, and the average duration of psoriasis was 5.7 years. High-sensitivity C reactive protein levels were higher in the patient group compared to the control group (respectively, group 1: 1 ±0.8; group 2: 0.6 ±0.3, < 0.05). Atrial arrhythmia was not detected in the Holter ECG monitoring. A significant moderate negative correlation between TACT and LAGLS ( = -0.57, < 0.05) was observed, and there was a significant moderate positive correlation between the duration of disease and TACT ( = 0.52, < 0.05).

Conclusions: In the current study, we determined that LAGLS decreased, TACT was prolonged, and P-wave dispersion increased in patients with psoriasis. The current results may improve predictions of AF risk in psoriasis patients in clinical practice.
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http://dx.doi.org/10.5114/aoms.2019.82678DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6657257PMC
July 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

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

Assessment of side branch patency using a jailed semi-inflated balloon technique with coronary bifurcation lesions.

Turk Kardiyol Dern Ars 2018 07;46(5):340-348

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

Objective: Many interventional cardiologists are concerned about the risk of side branch (SB) loss during main vessel (MV) stenting in complex bifurcation lesions. Therefore, novel techniques are required to reduce the risk of SB occlusion. The jailed semi-inflated balloon technique (JSBT) is one of these techniques. This article is a description of clinical experience with SB patency assessment using the JSBT.

Methods: A total of 64 patients with 82 distinct coronary bifurcation lesions underwent percutaneous coronary intervention (PCI) via JSBT at this institution. In the majority of patients, the SB balloon was inflated with a greater pressure (4.8±2.0 atm) than in the standard JSBT. Procedural and immediate clinical outcomes were reviewed via baseline and post-procedural quantitative coronary angiography analysis.

Results: The majority of the patients had acute coronary syndrome (60.9%) and almost one-third of the patients were Medina class 1.1.1. (32.8%). A jailed-balloon or wire was not entrapped during any PCI. SB ostial dissection was seen in only 2 patients. The minimal lumen diameter was improved in the MV and SB following PCI. There were no adverse cardiac events during in-hospital stay or at 1-month follow-up.

Conclusion: JSBT provides maximum SB protection with bifurcation lesions and requires less time than a complex technique. There was no significant SB occlusion risk even though the SB balloon was inflated with a slightly higher pressure. The immediate clinical outcomes and procedural success of this study may encourage interventional cardiologists to use this technique safely with reliable preservation of SB patency.
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http://dx.doi.org/10.5543/tkda.2018.47347DOI Listing
July 2018

The Relationship between Serum Apelin Levels and the Severity of Calcific Aortic Stenosis.

Acta Cardiol Sin 2018 05;34(3):259-266

Department of Cardiology.

Background: Apelin, an endogenous peptide, has recently gained attention due to its positive inotropic effects in heart failure physiopathology. We investigated the relationship between serum apelin levels and the severity of calcific aortic stenosis (AS).

Methods: A total of 68 consecutive patients diagnosed with calcific AS and a control group of 32 subjects were included in the study. The subjects were divided into three group as follows: the control group, the mild-moderate AS group and the severe AS group. Blood samples were obtained from all of the subjects, which were used for biochemical comparisons of apelin 36 and high-sensitive C-reactive protein (hsCRP) levels.

Results: Plasma apelin 36 levels were significantly lower in the patients with severe AS [490 (247-1074) pg/ml] compared to both the mild-moderate AS [209 (97-453) pg/ml] and control [660 (378-1200) pg/ml] groups (p < 0.001). Correlation analysis between the left ventricular mass index and apelin concentrations revealed a significant negative correlation between the two parameters (p < 0.001, r = -0.478).

Conclusions: Our study demonstrated decreased apelin levels and increased hsCRP concentrations in patients with severe calcific AS. Our findings may help to clarify the exact pathophysiologic role of apelin in cardiovascular diseases.
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http://dx.doi.org/10.6515/ACS.201805_34(3).20180207ADOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968342PMC
May 2018

Evaluation of ventricular repolarization features with novel electrocardiographic parameters (Tp-e, Tp-e/QT) in patients with psoriasis.

Anatol J Cardiol 2017 Dec;18(6):397-401

Department of Cardiology, Faculty of Medicine, Gaziosmapaþa University, Tokat-Turkey.

Objective: Psoriasis is a chronic inflammatory disorder, which affects around 1%-3% of the human population worldwide. Cardiovascular events are the leading cause of morbidity and mortality in patients with psoriasis. Some studies have reported that psoriasis is related to increased arrhythmias. The Tp-e interval and Tp-e/QT ratio have been accepted as new markers for the assessment of myocardial repolarization and ventricular arrhythmogenesis. The aim of this study was to assess ventricular repolarization in patients with psoriasis using Tp-e interval and Tp-e/QT ratio.

Methods: The study population consisted of 74 patients with psoriasis and 74 healthy volunteers. The diagnosis of psoriasis was based on a clinical or histopathological examination of all patients. QT interval, corrected QT (QTc), QT dispersion (QTd), Tp-e interval, corrected Tp-e, and Tp-e/QT ratio were measured from the 12-lead electrocardiogram. These parameters were compared between groups.

Results: According to the electrocardiographic parameters, QT and QTc intervals and QTd were significantly higher in patients with psoriasis than in control subjects (p<0.001; p<0.001; p=0.014; respectively). The Tp-e interval, corrected Tp-e, and Tp-e/QT ratio were significantly higher in patients with psoriasis than in control subjects [93±13 milliseconds (ms) vs. 98±14 ms, p=0.040; 104±17 ms vs. 111±17 ms, p=0.008; 0.23±0.03 vs. 0.25±0.03, p<0.001; respectively]. Additionally, the CRP value was an independent predictor of an increased Tp-e/QT ratio (ß=0.537, p< 0.001).

Conclusion: Our study revealed that ventricular repolarization features were impaired in patients with psoriasis. Therefore, these patients should be more closely screened for ventricular arrhythmias.
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http://dx.doi.org/10.14744/AnatolJCardiol.2017.7901DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6282903PMC
December 2017

The Comparison of Angiographic Scoring Systems With the Predictors of Atherosclerosis.

Angiology 2018 Feb 8;69(2):158-163. Epub 2017 Jun 8.

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

Syntax score (SS) and Gensini score (GS) are used to determine the complexity and severity of coronary artery disease. Although there are some studies indicating the individual relationship of these scoring systems with the carotid intima-media thickness (cIMT) and epicardial fat tissue (EFT), there was no previous study that compared the SS and GS in that respect. We aimed to assess the relationship of SS and GS with predictors of atherosclerosis. We enrolled 522 patients. There were positive correlations between GS and SS tertiles with cIMT and EFT. According to multivariate linear regression analysis for GS, EFT (β: 0.035, t: 2.63, and P = .49) and cIMT (β: 0.339, t: 2.97, and P = .053) were not independently associated. For SS, EFT (β: 0.009, t: 6.5, and P = .006) and cIMT (β: 1.2, t: 10.1, and P = .001) were independently and significantly associated. We showed that the SS is significantly associated more with surrogate markers of atherosclerosis such as EFT and cIMT than the GS.
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http://dx.doi.org/10.1177/0003319717712118DOI Listing
February 2018

The relationship of micronucleus frequency and nuclear division index with coronary artery disease SYNTAX and Gensini scores.

Anatol J Cardiol 2017 Jun 9;17(6):483-489. Epub 2017 Mar 9.

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

Objective: We aimed to evaluate the relationship of micronucleus (MN) frequency and nuclear division index (NDI) with SYNTAX and Gensini scores and thrombolysis in myocardial infarction (TIMI) frame counts of coronary arteries in patients undergoing coronary angiography.

Methods: In a single-center prospective observational study, a total of 63 individuals, 48 consecutive patients with coronary artery disease (CAD) and 15 healthy people were included. Before coronary angiography (exposure to X-ray), blood samples were collected for lymphocyte cultures, MN and NDI measurements. According to the SYNTAX and Gensini scores, patients were allocated into two groups. Group 1 and 2 included the patients with SYNTAX scores <22 and ≥22 points, respectively. Similarly, groups according to Gensini scores included the ones <23 and ≥23 points. MN test was used for in vitro studies in human peripheral lymphocytes. Binucleated lymphocytes were calculated for each patient.

Results: MN frequency was significantly higher in group 2 than group 1 and in group 1 than control group (p<0.001). NDI was significantly higher in control group than group 1 and in group 1 than group 2 (p=0.003). MN frequency had positive but moderate correlation with SYNTAX and Gensini scores and TFCs of left anterior descending (LAD), circumflex and right coronary arteries (r=0.394, p=0.003; r=0.458, p<0.001; r=0.425, p<0.001; r=0.469, p<0.001; and r=0.475, p<0.001, respectively).

Conclusion: We can conclude that as the degree of atherosclerosis increases and coronary flow worsens, MN frequency increases and NDI decreases. Our results may help to elucidate the relationship of DNA damage in pathophysiology of atherosclerosis and endothelial dysfunction in patients with stable CAD.
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http://dx.doi.org/10.14744/AnatolJCardiol.2017.7582DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5477082PMC
June 2017

Evaluation of left atrial mechanical function and atrial conduction abnormalities in patients with isolated bicuspid aortic valve.

Turk Kardiyol Dern Ars 2016 Dec;44(8):677-683

Department of Cardiology, Gaziosmapaşa University Faculty of Medicine, Tokat, Turkey.

Objective: Present study is an evaluation of left atrial (LA) mechanical and conduction function in patients with bicuspid aortic valve (BAV) without significant valve dysfunction, and an investigation of relationship between LA function and aortic elasticity.

Methods: Study population consisted of 34 isolated BAV patients (mean age: 34±13 years) and 29 healthy, age- and sex-matched volunteers (mean age: 30±10 years). LA volume was measured using biplane area-length method and LA active and passive emptying volume and fraction was calculated. Intra- and interatrial atrial conduction time (ACT) was measured with tissue Doppler imaging. Aortic elasticity parameters were calculated including aortic strain, aortic stiffness index, aortic distensibility, and aortic elastic modulus.

Results: LA diameter, LA maximum volume, LA volume before atrial systole, and LA active emptying fraction were significantly higher in patients with BAV (33.2±3.2 mm vs 34.9±2.8 mm, p=0.030; 16.2±4.6 mL/m2 vs 19.8±4.8 mL/m2, p=0.004; 10.2±3.7 mL/m2 vs 12.1±4.9 mL/m2, p=0.029; and 30.4±12.0% vs 39.9±11.8%, p=0.003, respectively). ACT was similar between groups. Aortic distensibility was significantly lower and aortic stiffness index and aortic elastic modulus were significantly higher in patients with BAV (8.1±4.6 [10-6cm2dyn-1] vs 5.1±3.6 [10-6cm2dyn-1], p=0.006; 4.1±2.8 vs 7.3±4.9, p=0.003; 3.6±2.8 [dyn.cm-2106] vs 5.9±3.9 [dyn.cm-2106], p=0.010, respectively). In correlation analysis, LA active emptying fraction was significantly correlated with aortic stiffness index and mitral A- velocity (r=0.431, p<0.001; r=0.304, p=0.016, respectively).

Conclusion: The present study demonstrated that LA mechanical functions and aortic elasticity parameters were deteriorated, while atrial conduction time was preserved in patients with isolated BAV. Furthermore, LA mechanical functions were significantly correlated with aortic elasticity parameters and mitral inflow A-wave velocity.
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http://dx.doi.org/10.5543/tkda.2016.13704DOI Listing
December 2016

The Relationship between P & QT Dispersions and Presence & Severity of Stable Coronary Artery Disease.

Korean Circ J 2016 Jul 21;46(4):522-9. Epub 2016 Jul 21.

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

Background And Objectives: The study aimed to evaluate the correlation between electrocardiographic (ECG) parameters and presence and extent of coronary artery disease (CAD) to indicate the usefulness of these parameters as predictors of severity in patients with stable CAD.

Subjects And Methods: Two hundred fifty patients, without a history of any cardiovascular event were included in the study. The ECG parameters were measured manually by a cardiologist before coronary angiography. The patients were allocated into five groups: those with normal coronary arteries (Group 1), non-critical coronary lesions (Group 2), one, two and three vessel disease (Group 3, Group 4 and Group 5, respectively.

Results: Group 1 had the lowest P wave dispersion (PWD) and P wave (Pmax), QT interval (QTmax), QT dispersion (QTd), corrected QT dispersion (QTcd) and QT dispersion ratio (QTdR), while the patients in group 5 had the highest values of these parameters. Gensini score and QTmax, QTd, QTcmax, QTcd, QTdR, Pmax, and PWD were positively correlated. QTdR was the best ECG parameter to differentiate group 1 and 2 from groups with significant stenosis (groups 3, 4, and 5) (area under curve [AUC] 0.846). QTdR was the best ECG parameter to detect coronary arterial narrowing lesser than 50% and greater than 50%, respectively (AUC 0.858).

Conclusion: Presence and severity of CAD can be determined by using ECG in patients with stable CAD and normal left ventricular function.
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http://dx.doi.org/10.4070/kcj.2016.46.4.522DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4965431PMC
July 2016

The Role of Serum Bilirubin Levels in Predicting Troponin Positivity in Non-ST-Segment Elevation Acute Coronary Syndrome.

Angiology 2017 May 18;68(5):414-418. Epub 2016 Jul 18.

4 Department of Emergency Medicine, Erzurum Education and Research Hospital, Erzurum, Turkey.

Data are scant regarding serum bilirubin levels in non-ST-segment elevation acute coronary syndrome (NSTE-ACS). In this study, we evaluated the role of serum bilirubin levels in NSTE-ACS. We enrolled 782 patients who presented to the emergency department with acute chest pain. Patients were divided into 2 groups based on the troponin positivity. Patients with NSTE-ACS who had troponin positivity were included in group 1 (n = 382), and group 2 consisted of the control patients (n = 400). Direct bilirubin (DB) levels (group 1: 0.31 ± 0.37 mg/dL, group 2: 0.20 ± 0.25 mg/dL, P < .001) and total bilirubin (TB) levels (group 1: 0.78 ± 0.56 mg/dL, group 2: 0.62 ± 0.45 mg/dL, P < .001) were significantly higher in group 1. There was a significant and moderate correlation between serum bilirubin levels and admission troponin values ( r = .34, P < .001 for TB and r = .42, P < .001 for DB). These results show that serum bilirubin levels were associated with troponin positivity in patients with NSTE-ACS.
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http://dx.doi.org/10.1177/0003319716659583DOI Listing
May 2017

The Importance of Magnesium Values in Patients With STEMI Admitted to the Emergency Department.

Clin Appl Thromb Hemost 2017 May 14;23(4):329-335. Epub 2016 Jul 14.

3 Department of Cardiology, School of Medicine, Ataturk University, Erzurum, Turkey.

Aim: The aim of this study is to examine the relationship between initial magnesium (Mg) levels, electrocardiographic no-reflow, and long-term mortality in patients who underwent primary percutaneous coronary intervention (pPCI) due to ST-segment elevation myocardial infarction (STEMI).

Methods: A total of 111 patients with pPCI participated in the study. Magnesium and high-sensitive C-reactive protein (hs-CRP) were measured. The sum of ST-segment elevation was measured immediately before and 60 minutes after the restoration of coronary flow. The difference between the 2 measurements was taken as the amount of ST-segment resolution and defined as sum of ST-segment resolution (∑STR). The ∑STR <50% was determined as electrocardiographic sign of no-reflow phenomenon. After the patients were discharged, they were followed up for major adverse cardiac events for up to 51 months after discharge.

Results: Forty patients in the no-reflow group and 71 patients in the normal-flow group were included in the study. Magnesium value ≤1.87 mg/dL initially measured had 77% sensitivity and 59% specificity in predicting no-reflow on receiver operating characteristic curve analysis. In multivariate analyses, Mg (odds ratio [OR]: 0.01, <95% confidence interval [CI]: 0.01-0.12; P = .004), hs-CRP (OR: 1.06, <95% CI: 1.00-1.14; P = .05), left anterior descending artery lesion (OR: 6.66, <95% CI: 1.45-3.05; P = .01), and reperfusion time (OR: 1.01, <95% CI: 1.00-1.01; P = .03) were still independent predictors of electrocardiographic no-reflow, and only Mg (OR: 0.08, <95% CI: 0.01-1.03; P = .05) was still an independent predictor of long-term mortality.

Conclusion: Serum Mg level is an independent predictor of electrocardiographic no-reflow and long-term mortality in patients with STEMI.
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http://dx.doi.org/10.1177/1076029616658119DOI Listing
May 2017

Echocardiographic assessment of right ventricular functions in healthy subjects who migrated from the sea level to a moderate altitude.

Anatol J Cardiol 2016 10 25;16(10):779-783. Epub 2015 Nov 25.

Department of Cardiology, Faculty of Medicine, Trakya University, Edirne-Turkey.

Objective: The aim of this study was to evaluate right ventricle (RV) functions using echocardiography in healthy subjects who migrated from the sea level to moderate altitude (1890 m).

Methods: The prospective observational in this study population consisted of 33 healthy subjects (23 men; mean age 20.4±3.2 years) who migrated from the sea level to a moderate altitude (Erzurum city centre, 1890 m above sea level) for long-term stay. Subjects underwent echocardiographic evaluation within the first 48 h of exposure to the moderate altitude and at the sixth month of arrival. Conventional echocardiographic parameters such as RV sizes and areas, systolic, and diastolic functional indices [fractional area change (FAC), tricuspid flow velocities, myocardial performance index (MPI), and tricuspid annular plane systolic excursion (TAPSE)] were obtained. Systolic (S) and diastolic (E', A') velocities were acquired from the apical fourchamber view using tissue Doppler imaging. Kolmogorov-Smirnov test, student's t-test, Wilcoxon test, and chi-square test were used in this study.

Results: There were no significant changes in RV size, FAC, MPI, TAPSE, inferior inspiratory vena cava collapse, tricuspid E velocity, and tricuspid annulus E' velocity. Compared with the baseline, there was a significant increase in mean pulmonary artery pressure (p=0.001); RV end systolic area (p=0.014); right atrial end diastolic area (p=0.021); tricuspid A velocity (p=0.013); tricuspid annulus S and A' velocity (p=0.031 and p=0.006, respectively); and RV free wall S, E', and A' velocity (p=0.007, p<0.001, and p=0.007 respectively) at the sixth month. Also, there was a significant decrease in tricuspid E/A ratio (1.61±0.3 vs. 1.45±0.2, p=0.038) and tricuspid annulus E'/A' ratio (1.52±0.5 vs. 1.23±0.4, p=0.002) at the sixth month.

Conclusion: Our study revealed that right ventricular diastolic function was altered while the systolic function was preserved in healthy subjects who migrated from the sea level to a moderate altitude.
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http://dx.doi.org/10.5152/AnatolJCardiol.2015.6622DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5324940PMC
October 2016

Assessment of right ventricular systolic and diastolic parameters in pulmonary sarcoidosis.

J Investig Med 2016 Mar 12;64(3):759-63. Epub 2016 Feb 12.

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

The clinical manifestations of cardiac involvement are seen in about 5% of patients with sarcoidosis; however, the incidence of cardiac involvement is higher in the autopsy series. About 14% of patients with pulmonary sarcoidosis (PS) without known cardiac involvement had diastolic dysfunction.We aimed to determine the role of parameters of right ventricular (RV) systolic and diastolic function in patients with PS without evidence of cardiac symptoms. Our study population consisted of 28 patients with grades 1-4 PS and 24 healthy subjects. This study was a clinical prospective cohort study. RV end-diastolic area was found to be significantly higher in the PS group (p=0.032). RV fractional area change (RVFAC) and tricuspid annular plane systolic excursion (TAPSE) were shown to be statistically lower in the PS group as compared to the control group (p<0.001). However, pulmonary arterial systolic pressure was significantly higher in the PS group (p=0.003). The tricuspid E velocity and E/A ratio were found to be significantly lower in the PS group (p=0.025 and 0.009, respectively), while the tricuspid A velocity and myocardial performance index (MPI) were found to be significantly lower in the control group (p=0.034 and 0.007, respectively). Early detection of cardiac involvement in PS is crucial because of the increased morbidity and risk of sudden cardiac death. RV diastolic Doppler parameters, tissue Doppler MPI, RVFAC and TAPSE are practical and cheap techniques in the diagnosis of cardiac involvement in patients with PS. A thorough transthorasic echocardiographic examination including RV systolic and diastolic functions and tissue Doppler MPI should constitute the mainstay of initial management and follow-up in PS.
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http://dx.doi.org/10.1136/jim-2015-000027DOI Listing
March 2016

The evaluation of myocardial function of patients in the early stage of acute ischemic stroke by two-dimensional speckle tracking echocardiography.

J Clin Ultrasound 2016 Jun 17;44(5):305-11. Epub 2016 Feb 17.

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

Purpose: To evaluate the myocardial dysfunction in the early stage of nonhemorrhagic stroke and its association with the National Institutes of Health Stroke Scale (NIHSS) score, by two-dimensional speckle tracking echocardiography.

Methods: We included 29 patients with acute ischemic stroke, in whom NIHSS scores were calculated and stroke infarct volumes recorded. Within 48 hours of admission, cardiac evaluation with speckle tracking echocardiography was performed and left ventricular global longitudinal strain (GLS) and global longitudinal systolic strain rate were obtained. These measurements were repeated on the 10th day.

Results: NIHSS score improved, but infarct volume increased (p = 0.011 and 0.065, respectively) from admission to day 10. Ejection fraction was 53.2% and 55.8%, respectively, at admission and day 10 (p = 0.482), while GLS improved from -16.41% to -18.76% (p = 0.003).

Conclusions: GLS and global longitudinal systolic strain rate showed significant improvement together with NIHSS score. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:305-311, 2016.
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http://dx.doi.org/10.1002/jcu.22332DOI Listing
June 2016

An isolated single L-II type coronary artery anomaly: A rare coronary anomaly.

Intractable Rare Dis Res 2015 Nov;4(4):203-6

Department of Radiology, School of Medicine, Ataturk University, Erzurum, Turkey.

The incidence of congenital artery anomalies is 0.2-1.4%, and most are benign. Single coronary artery (SCA) anomalies are very rare. The right coronary artery (RCA) originating from the left coronary system is one such SCA anomaly, and the risk of sudden cardiac death (SCD) increases if it courses between the pulmonary artery and aorta and coexists with other congenital heart diseases. Additionally, coursing of the RCA between the great vessels increases the risk of atherosclerosis. We herein present the case of a 57 year-old man who was admitted to our cardiology outpatient clinic and diagnosed with an SCA anomaly in which the RCA arose from the left main coronary artery (LMCA) and coursed between the pulmonary artery and aorta. However a critical stenosis was not detected in imaging techniques, and myocardial perfusion scintigraphic evidence of ischaemia was found in a small area. Therefore, he was managed with conservative medical therapy.
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http://dx.doi.org/10.5582/irdr.2015.01025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4660862PMC
November 2015

Sarcoidosis and the heart: A review of the literature.

Intractable Rare Dis Res 2015 Nov;4(4):170-80

Department of Cardiology, Aksaray State Hospital, Aksaray, Turkey.

Sarcoidosis is a chronic multisystem disorder without any defined etiology. Cardiac sarcoidosis (CS) is detected in 2-7% of patients with sarcoidosis and more than 20% of the cases of sarcoidosis are clinically silent. Cardiac involvement in systemic sarcoidosis (SS) and isolated cardiac sarcoidosis (iCS) are associated with arrhythmia and severe heart failure (HF) and have a poor prognosis. Early diagnosis of CS and prompt initiation of corticosteroid therapy with or without other immunosuppressants is crucial. Electrocardiography, Holter monitoring, and Doppler echocardiography with speckle tracking imaging can serve as the initial steps to diagnosis of CS. Cardiac magnetic resonance (CMR) imaging and positron emission tomography (PET) are promising techniques for both diagnosis and follow-up of CS. This review discusses the main aspects of cardiac involvement in sarcoidosis.
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http://dx.doi.org/10.5582/irdr.2015.01023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4660858PMC
November 2015

The importance of speckle tracking echocardiography in the early detection of left ventricular dysfunction in patients with polycystic ovary syndrome.

Bosn J Basic Med Sci 2015 Oct 19;15(4):44-9. Epub 2015 Oct 19.

Erzurum Education and Research Hospital.

Polycystic ovary syndrome (PCOS) is characterized by hormonal and metabolic abnormalities and is thought to increase a risk for cardiovascular diseases. In this study we use speckle tracking echocardiography (STE) to evaluate left ventricular (LV) dysfunction in the early period of the disease. We enrolled 31 patients with PCOS and 32 healthy volunteers as a control group. The participants' ages ranged between 18 and 40 years. PCOS was diagnosed according to the Rotterdam criteria. LV strain (LS) and strain rate (SR) were evaluated using apical two-chamber (2C), three-chamber (3C), and four-chamber (4C) imaging. Global LS and SR were calculated as average of three apical views. The waist-to-hip ratio, homeostasis model assessment-insulin resistance (HOMA-IR), and fasting insulin and triglyceride levels were higher in the PCOS group than in the controls (p=0.001, p=0.001, p=0.001, and p=0.005, respectively). In the PCOS group, the mitral A wave, deceleration time (DT), and isovolumetric relaxation time (IVRT) were significantly higher than in the controls (all p<0.05). The LV global longitudinal strain (GLS) and global longitudinal SR systolic (GLSRS) were significantly lower in the PCOS patient group (both p= 0.001). There were strong negative correlations between GLS and both fasting insulin (r=-0.64) and DT (r=-0.62) (both p<0.05). The study demonstrated that PCOS patients had decreased LV function using STE. Therefore, STE imaging appears to be useful for the early detection of subclinical LV dysfunction in patients with PCOS.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4690441PMC
http://dx.doi.org/10.17305/bjbms.2015.552DOI Listing
October 2015

Utility of γ-Glutamyl Transferase in Predicting Troponin Elevation in Emergency Departments.

Angiology 2016 09 29;67(8):737-41. Epub 2015 Oct 29.

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

Serum γ-glutamyl transferase (GGT) activity is a risk predictor for the development of coronary artery disease and is related to cardiovascular morbidity and mortality. We evaluated the clinical utility of GGT activity in predicting high troponin levels in patients with acute coronary syndrome (ACS) admitted to the emergency department with chest pain. A total of 200 troponin-positive and 203 troponin-negative patients were classified into groups 1 and 2, respectively. γ-Glutamyl transferase activity was significantly higher in group 1 (44 ± 34 U/L) compared with group 2 (31 ± 26 U/L, P = .001). A GGT activity cutoff >25.5 showed 62% sensitivity and 61% specificity in predicting troponin positivity. Logistic regression analysis demonstrated a significant predictive value of GGT for troponin positivity. Spearman rank correlation analysis showed a moderately strong relationship between GGT activity and troponin positivity. Considering the predictive value of high GGT activity for troponin positivity, GGT activity may complement other diagnostic biomarkers for predicting troponin positivity in patients having ACS admitted with chest pain.
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http://dx.doi.org/10.1177/0003319715613923DOI Listing
September 2016

Comparison of the effects of metoprolol or carvedilol on serum gamma-glutamyltransferase and uric acid levels among patients with acute coronary syndrome without ST segment elevation.

Anatol J Cardiol 2016 Jan;16(1):16-22

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

Objective: Serum gamma-glutamyltransferase (GGT) and uric acid levels measured in patients with acute coronary syndrome without ST segment elevation (NSTEMI) are important in diagnosis and in predicting the prognosis of the disease. There is a limited number of clinical studies investigating the effects of beta-blockers on GGT and uric acid levels in these patients. In our study, we aimed to investigate the effects of beta-blocker therapy on GGT and uric acid levels.

Methods: We conducted a randomized, prospective clinical study. Hundred patients with NSTEMI were included in this study, and they were divided into two groups. Fifty patients were administered metoprolol succinate treatment (1 x 50 mg), whereas the remaining 50 patients were administered carvedilol treatment (2 x 12.5 mg). Thereafter, all of the patients underwent coronary angiography. Blood samples were taken at the time of admission, at the 1st month, and 3rd month to detect GGT and uric acid levels.

Results: There was no statistically significant difference among the metoprolol or carvedilol groups in terms of the GGT levels measured at the baseline, 1st month, and 3rd month (p=0.904 and p=0.573, respectively). In addition, there was no statistically significant difference among the metoprolol or carvedilol groups in terms of uric acid levels measured at the baseline, 1st month, and 3rd month (p=0.601 and p=0.601, respectively).

Conclusion: We found that GGT and uric acid levels did not show any change compared to the baseline values, with metoprolol and carvedilol treatment initiated in the early period in patients with NSTEMI.
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http://dx.doi.org/10.5152/akd.2015.5708DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5336699PMC
January 2016

Common atrium: A rare congenital heart anomaly.

Turk Kardiyol Dern Ars 2015 Sep;43(6):579

Department of Cardiology, Aksaray State Hospital, Aksaray, Turkey.

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http://dx.doi.org/10.5543/tkda.2015.93027DOI Listing
September 2015

Bilirubin Levels and Thrombus Burden in Patients With ST-Segment Elevation Myocardial Infarction.

Angiology 2016 07 2;67(6):565-70. Epub 2015 Sep 2.

Department of Cardiology, Faculty of Medicine, Erzincan University, Erzincan, Turkey.

We investigated whether serum bilirubin level (a marker of heme oxygenase activity) is a predictor of thrombus burden in patients with acute myocardial infarction. Patients (n = 229; male 72.9%; mean age 63 ± 13.4 years) who were admitted with ST-segment elevation myocardial infarction (STEMI) were enrolled. Patients were divided into 2 groups. Group 1 was defined as low thrombus burden and group 2 was defined as high thrombus burden. Patients with high thrombus burden had higher total bilirubin levels (14.4 [4.3-22.9] vs 7.7 [2.4-20.3] µmol/L, P ≤ .001), (0.84 [0.25-1.34] vs 0.45 [0.14-1.19] mg/dL P ≤ .001) and direct bilirubin levels (3.1 [2.1-8.4] vs 1.7 [0.5-6.5] µmol/L, P ≤ .001), (0.18 [0.03-0.49] vs 0.10 [0.03-0.38] mg/dL, P ≤ .001). At multivariate analysis, total bilirubin (odds ratio: 1.05, 95% confidence interval: 1.03-1.08, P ≤ .001) was the independent predictor of high thrombus burden. In conclusion, total bilirubin level is independently associated with high thrombus burden in patients with STEMI.
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http://dx.doi.org/10.1177/0003319715603899DOI Listing
July 2016

Traumatic Coronary Artery Dissection in a Young Woman after a Kick to Her Back.

Korean J Thorac Cardiovasc Surg 2015 Aug 5;48(4):281-4. Epub 2015 Aug 5.

Department of Cardiology, Erzurum Region Training and Research Hospital.

We present the case of a 38-year-old woman admitted to our outpatient clinic with accelerating back pain and fatigue following a kick to her back by her husband. Upon arrival, we detected ST segment elevation in the D1, aVL, and V2 leads and accelerated idioventricular rhythm. She had pallor and hypotension consistent with cardiogenic shock. We immediately performed coronary angiography and found a long dissection starting from the mid-left main coronary artery and progressing into the mid-left anterior descending (LAD) and circumflex arteries. She was then transferred to the operating room for surgery. A saphenous vein was grafted to the distal LAD. Since the patient was hypotensive under noradrenaline and dopamine infusions, she was transferred to the cardiovascular surgery intensive care unit on an extracorporeal membrane oxygenator and intra-aortic balloon pump. During follow-up, her blood pressure remained low, at approximately 60/40 mmHg, despite aggressive inotropic and mechanical support. On the second postoperative day, asystole and cardiovascular arrest quickly developed, and despite aggressive cardiopulmonary resuscitation, she died.
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http://dx.doi.org/10.5090/kjtcs.2015.48.4.281DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4541055PMC
August 2015

Focal mid-ventricular anterior ballooning: An unusual pattern of Takotsubo cardiomyopathy.

Intractable Rare Dis Res 2015 May;4(2):108-10

Palandöken State Hospital, Erzurum, Turkey.

Takotsubo cardiomyopathy (TC) or left ventricular apical ballooning syndrome is typically characterized by reversible systolic dysfunction of the apical- and mid-segments of the left ventricle. Symptoms are precipitated by intense emotional or physical stress, in the absence of obstructive coronary artery lesions. The most common presentation of TC is a transient left ventricular apical ballooning. However, recent case reports have described various patterns of TC associated with distinct regional left ventricular wall motion abnormalities. One of very rare these variants, referred to as a "mid-ventricular" type, is characterized by akinesis with or without ballooning of the mid-ventricular segment, together with a hyperdynamic base and apex. Using left ventriculography we describe an atypical form of TC with transient, focal mid-ventricular ballooning of the anterior segment, followed by complete resolution of ballooning, as observed by cardiac magnetic resonance (CMR) imaging.
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http://dx.doi.org/10.5582/irdr.2015.01012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4428186PMC
May 2015

Cardiac manifestations in Behcet's disease.

Intractable Rare Dis Res 2015 May;4(2):70-5

Arif Arisoy, Department of Cardiology, M.D, Gaziosmanpasa Universty, Medical Faculty, Tokat, Turkey.

Behcet's disease (BD) is a chronic inflammatory disorder, with vasculitis underlying the pathophysiology of its multisystemic effects. Venous pathology and thrombotic complications are hallmarks of BD. However, it has been increasingly recognised that cardiac involvement and arterial complications are also important aspects of the course of the disease. Cardiac lesions include pericarditis, endocarditis, intracardiac thrombosis, myocardial infarction, endomyocardial fibrosis, and myocardial aneurysm. Treatment of cardiovascular involvement in BD is largely empirical, and is aimed towards suppressing the vasculitis. The most challenging aspect seems to be the treatment of arterial aneurysms and thromboses due to the associated risk of bleeding. When the prognosis of cardiac involvement in BD is not good, recovery can be achieved through oral anticoagulation, immunosuppressive therapy, and colchicine use. In this review, we summarise the cardiovascular involvement, different manifestations, and treatment of BD.
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http://dx.doi.org/10.5582/irdr.2015.01007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4428189PMC
May 2015