Publications by authors named "Zehra Erkal"

19 Publications

  • Page 1 of 1

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

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

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

Mitral valve repair facilitated with transapical beating heart NeoChord implantation in a non-Hodgkin's lymphoma patient.

J Anesth 2016 12 19;30(6):1056-1059. Epub 2016 Sep 19.

Department of Cardiovascular Surgery, Antalya Training and Research Hospital, Antalya, Turkey.

Elderly patients with severe hematological malignancies may require cardiac surgery. The combined impact of cardiopulmonary bypass (CPB) and surgical trauma is a potent inflammatory activator and is increased by intraoperative and postoperative complications. To avoid the adverse effects of CPB, minimally invasive off-pump techniques may be used in these patients. The transapical off-pump mitral valve intervention with NeoChord implantation (TOP-MINI) is a minimally invasive technique for mitral valve repair, which makes it possible to avoid the risks of CPB in selected patients, such as elderly, cancer or immunosuppressive patients. We report here the case of a 78-year-old male with B-cell non-Hodgkin's lymphoma, who presented with severe mitral regurgitation. The patient was successfully treated with the TOP-MINI procedure.
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http://dx.doi.org/10.1007/s00540-016-2251-9DOI Listing
December 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

An unusual thrombolytic therapy decision in prosthetic valve thrombosis during early pregnancy.

Turk Kardiyol Dern Ars 2015 Sep;43(6):554-7

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

Pregnancy is among the risk factors for mechanical valve thrombosis, and even though thrombolytic therapy is contraindicated during pregnancy, it may be used in the treatment of this life-threatening complication. This case report describes a pregnant patient, whose echocardiogram showed evident gradient increase on her mechanical prosthetic mitral valve, and who was treated successfully with tissue plasminogen activator for mechanical valve thrombosis.
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http://dx.doi.org/10.5543/tkda.2015.68327DOI Listing
September 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

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

Effects of Carotid Stenting on Nocturnal Nondipping Phenomenon.

J Stroke Cerebrovasc Dis 2015 Sep 13;24(9):2102-9. Epub 2015 Jun 13.

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

Background: It is well known that nondipper blood pressure (BP) pattern is associated with an increased cardiovascular risk in hypertensive patients. The aim of this study is to observe whether carotid artery stent (CAS) procedure returns nondipper BP pattern to dipper pattern in hypertensive patients.

Methods: Ambulatory BP monitorization (ABPM) was performed in 152 hypertensive patients who underwent CAS procedure 1 day before, and 1 day and 1 year after the procedure. BP monitorization of patients was classified as dipper and nondipper. BP parameters 1 year after CAS procedure were compared with preprocedure parameters.

Results: According to baseline ambulatory BP follow-ups, a total of 152 hypertensive patients with 122 (80%) nondippers and 30 (20%) dippers were enrolled in this study. According to ABPM results 1 year after CAS procedure, 78 patients (64%) who had nondipper pattern at first transformed into dipper pattern and 44 patients (36%) remained to be nondippers. Moreover, 1 year after CAS procedure, 18 patients (60%) who had dipper pattern at first transformed into nondipper pattern and 12 patients (40%) remained as dippers. When BP follow-up values at 1 year after CAS procedure were compared with BP readings before the procedure, 78 patients (51%) who were nondipper before the procedure transformed into dipper pattern (P ≤ .01), whereas 44 patients (29%) with nondipper pattern remained to be nondippers (P = .01). Twelve patients (7.9%) who had dipper pattern remained to have dipper pattern (P = .768). Eighteen patients who had dipper pattern (12%) transformed into nondipper pattern after the procedure (P < .01). The total number of nondipper pattern patients before CAS procedure was 80.3% (122 patients), whereas this percentage dropped to 40.8% (62 patients) after the CAS procedure (P < .01).

Conclusions: During 1-year follow-up after CAS procedure, nondipper BP pattern transforms into dipper pattern. This result might be attributed to the contributory effect of CAS procedure to long-term cardiovascular protection.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2015.05.018DOI Listing
September 2015

Assessment of Left Atrial Function in Patients with Celiac Disease.

Echocardiography 2015 Dec 28;32(12):1802-8. Epub 2015 Apr 28.

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

Background: There is some evidence suggesting increased risk of atrial fibrillation (AF) in patients with celiac disease (CD). Impaired left atrial function plays a significant role in the development of AF. This study aimed at assessing the electrical and mechanical functions of the left atrium in patients with CD.

Methods: A total of 71 patients with biopsy-proven, antibody-positive CD and 52 age-matched healthy controls were included in this prospective study. P-wave dispersion (PWD) was measured to assess the electrical functions of the left atrium through the use of surface electrocardiography. A tissue Doppler echocardiography was performed to determine the atrial conduction and electromechanical delay (EMD) time. To evaluate the mechanical functions of the left atrium, maximum, minimum, and presystolic atrial volumes were estimated to calculate the contractile, conduit, and reservoir functions.

Results: In terms of transthoracic echocardiographic parameters, CD and control subjects were not significantly different. However, as compared to controls, patients with CD had significantly increased PWD (median 52 ms [interquartile range 46-58 ms] vs. 38 [36-40], P < 0.001). Also, significantly higher interatrial (49 ms [32-60] vs. 26 ms [22-28], P < 0.001), intra-left atrial (26 ms [17-44] vs. 14 ms [12-18], P < 0.001), and intra-right atrial (15 ms [8-22] vs. 10 ms [8-14], P < 0.001) EMD was found among CD subjects than controls. Despite an increase in the left atrial volume in patients with CD, conduit and reservoir functions were comparable.

Conclusions: Although atrial mechanical functions are preserved in patients with CD, a slower electrical conduction was found, suggesting an increased risk of AF in this group of patients.
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http://dx.doi.org/10.1111/echo.12963DOI Listing
December 2015

Assessment of morphology of patent foramen ovale with transesophageal echocardiography in symptomatic and asymptomatic patients.

J Stroke Cerebrovasc Dis 2015 Jun 20;24(6):1282-6. Epub 2015 Apr 20.

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

Background: The frequency of patent foramen ovale (PFO) is greater in patients who have had a stroke and transient ischemic attack (TIA) than that in the general population. However, it is not well defined, which PFO would cause stroke or TIA. In this trial, we aimed to evaluate whether there was a difference regarding morphologic features of PFO in patients who were symptomatic (cryptogenic stroke or history of TIA) or asymptomatic according to the neurologic findings.

Methods: Symptomatic patients with PFO and cryptogenic stroke or TIA and asymptomatic patients with PFO who were symptomatic in terms of neurologic findings as well as patients without any neurologic symptoms in whom PFO was diagnosed incidentally by transesophageal echocardiography were enrolled to this retrospective study on the condition that they were aged younger than 55 years. Not only the clinical and demographic characteristics of 2 groups were compared but also their morphological features were assessed. The morphologic features of PFO that were assessed included the length and height of tunnel, atrial septal excursion distance, thickness of septum primum, and thickness of septum secundum.

Results: One hundred fifty-six patients, 64 of whom were symptomatic, were enrolled to this study. The height of PFO (median, 3.0 [interquartile range, 2.0-3.8]mm versus 2.0 [2.0-2.0]mm, P < .001), thickness of septum secundum (5.0 [5.0-7.0] versus 3.0 [2.0-3.0], P < .001), and septal excursion distance (7.0 [6.0-10.5] versus 4.0 [4.0-5.0], P < .001) were found to be greater in the symptomatic group than those in the asymptomatic group. There was no significant difference regarding the length of tunnel and thickness of septum primum. The ratio of length to height of PFO tunnel was less in the symptomatic group (3.0 [3.0-3.23] versus 5.0 [4.0-6.25], P < .001).

Conclusions: Our findings appear to indicate that a higher PFO tunnel, relatively greater interatrial septal mobility, thicker septum pellucidum, and the presence of an atrial septal aneurysm may help identifying the subjects at the age of or younger than 55 years with PFO who are at greater risk for cryptogenic stroke or TIA.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2015.01.036DOI Listing
June 2015

The importance of electrocardiographic findings in the diagnosis of atrial septal defect.

Kardiol Pol 2015 7;73(5):331-6. Epub 2015 Jan 7.

Antalya Education and Research Hospital, Antalya, Turkey.

Background: Atrial septal defect (ASD) is the most frequent heart defect observed in adulthood. Although it is usually non-symptomatic, it may result in heart failure, arrhythmic complications, and paradoxical embolism-related morbidity or mortality if the diagnosis is late.

Aim: This study was planned in order to investigate the importance of electrocardiographic findings in the diagnosis of ASD.

Methods: Sixty-one patients with a diagnosis of ASD and 66 healthy volunteers without cardiac disease were enrolled in the study. Electrocardiographs (ECG) were performed on all patients to investigate the presence of right bundle branch block (RBBB), incomplete RBBB, defective T wave (DTW), and notch finding in the R wave of inferior derivations (crochetage R wave). ASD types and diameters were determined via transthoracic and transoesophageal echocardiography.

Results: It was determined that incomplete RBBB (56% vs. 5%), DTW (48% vs. 3%), and R wave crochetage (57% vs. 8%) in inferior derivations were more frequent in ASD patients compared to the control group patients. The specificity of the defined ECG findings in the diagnosis of ASD were 95%, 97%, and 92%, respectively. No correlation was detected between the ASD diameter and incomplete RBBB, whereas significant correlation was observed between the ASD diameter and the presence of crochetage R wave (17.5 ± 4.0 mm in patients with crochetage R wave, and 20.9 ± 8.2 mm in patients without crochetage R wave, p = 0.057).

Conclusions: Detection of RBBB, DTW, and crochetage R wave in superficial ECG may contribute to early detection in patients with ASD.
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http://dx.doi.org/10.5603/KP.a2014.0240DOI Listing
February 2017

The importance of fragmented QRS in the early detection of cardiac involvement in patients with systemic sclerosis.

Anatol J Cardiol 2015 Mar 8;15(3):209-12. Epub 2014 Apr 8.

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

Objective: Systemic sclerosis (SSc) is an autoimmune connective tissue disorder characterized by fibrosis. The prognosis of the disease is bad when clinically symptomatic cardiac dysfunction is occurred, therefore early detection of cardiac dysfunction is important in patients with SSc. The aim of this study was to investigate the frequency of fQRS in superficial electrocardiography in cardiacally asymptomatic patients with SSc and its relation to the systolic pulmonary artery pressure (sPAP).

Methods: This study included 31 cardiacally asymptomatic patients with SSc (23 females, 40.4±9.2 years) and 41 healthy volunteers as the control (31 females, 38.2±11.8 years). The ECGs with 12 derivations and transthoracic echocardiographies of the patients were evaluated. The presence of fQRS in the superficial ECG, and its relation to systolic pulmonary artery pressure (sPAP) were investigated.

Results: The mean sPAP value in the SSc group was observed to be higher than that of the control group (26 mm Hg and 20 mm Hg, respectively, p<0.001). The presence of fQRS in the SSc group was more frequent than the control group (55% and 10%, respectively, p<0.001). In SSc patients presence of fQRS become relevant with ≥24 mm Hg sPAP by 88% sensitivity and 79% specificity.

Conclusion: In our study, the presence of fQRS in SSc patients, were more frequent than in the normal population. Since pulmonary hypertension is the primary cause of mortality in patients with SSc, the correlation of fQRS with sPAP should also be considered.
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http://dx.doi.org/10.5152/akd.2014.5191DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5337056PMC
March 2015

Assessment of the relationship between fragmented QRS and cardiac iron overload in patients with beta-thalassemia major.

Anatol J Cardiol 2015 Feb 2;15(2):132-6. Epub 2014 Apr 2.

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

Objective: Beta-thalassemia major (TM) is a genetic hemoglobin disorder causing chronic hemolytic anemia. Since cardiac insufficiency and arrhythmias are the primary causes of mortality in such patients, monitoring of cardiac iron load is important in management of the disorder. The purpose of this study was to investigate the importance of fragmented QRS (fQRS) and its relation to the cardiac T2* value for the evaluation of cardiac iron load in TM patients.

Methods: This retrospective study included 103 TM patients. The patients' T2* values, measured by cardiac MRI and 12-lead surface ECGs, were interpreted. The cardiac T2* values under 20 were considered as cardiac iron overload. The relationship between the cardiac T2* value and fQRS in ECG was investigated.

Results: The median age of the patients was 22.6 ± 6.6 years. All patients were on regular blood transfusions and iron chelators. The patients had no risk factors for coronary artery disease. In 50 (48%) patients fQRS was detected, and in 37 (74%) of these the T2* values were low. 86% of patients with cardiac involvement (37) had fQRS, but 22% of patients with non-involvement (13) had fQRS (p < 0.001).

Conclusion: Since cardiac involvement is the primary cause of mortality in TM patients, the early diagnosis of cardiac dysfunction is of vital importance. The search for fQRS in the ECGs of these patients, particularly when cardiac T2* values cannot be determined and followed, is a non-expensive and easy-to-attain method for therapy management.
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http://dx.doi.org/10.5152/akd.2014.5188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5336998PMC
February 2015

Sustained ventricular tachycardia in a patient with thalassemia major.

Ann Noninvasive Electrocardiol 2014 Mar 9;19(2):193-7. Epub 2013 Sep 9.

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

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http://dx.doi.org/10.1111/anec.12085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4544285PMC
March 2014

[Recurrent myocardial infarction in a young patient with PAI-1 4G/4G mutation].

Anadolu Kardiyol Derg 2013 Sep 10;13(6):599-600. Epub 2013 Sep 10.

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

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http://dx.doi.org/10.5152/akd.2013.201DOI Listing
September 2013

[A case of myopericarditis following butane gas inhalation].

Anadolu Kardiyol Derg 2013 Aug 29;13(5):505-6. Epub 2013 May 29.

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

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http://dx.doi.org/10.5152/akd.2013.156DOI Listing
August 2013