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Öğe Acute Occlusion of the Left Main Trunk Presenting as ST-Elevation Acute Coronary Syndrome(Churchill Livingstone Inc Medical Publishers, 2010) Aygül, Nazif; Salamov, Elvin; Doğan, Umuttan; Tokaç, MehmetAcute obstruction of the left main coronary artery (LMCA) is not frequently encountered Electrocardiographic findings are important to early diagnosis in determining an acute obstruction of the LMCA, which requires immediate aggressive treatment, in this extremely unstable condition However, there is no single typical electrocardiographic pattern representing acute occlusion of the LMCA We describe a rare electrocardiographic finding that suggested ST-elevation acute coronary syndrome of the anterior zone due to left main trunk total occlusion.Öğe Association of Fragmented QRS Complex with Myocardial Reperfusion in Acute ST-Elevated Myocardial Infarction(WILEY-BLACKWELL, 2013) Erdem, Fatma Hızal; Tavil, Yusuf; Yazıcı, Hüseyin; Aygül, Nazif; Abacı, Adnan; Boyacı, BülentIn this study, we aimed to evaluate the relationship between TIMI myocardial perfusion (TMP) grade, as an indicator of myocardial reperfusion, and fragmented QRS (fQRS) in standard 12-lead electrocardiogram. Also, we evaluate fQRS is an additional indicator of myocardial reperfusion. One hundred patients admitted with first STEMI to Coronary Intensive Care Unit and who were used thrombolytic therapy was included in this retrospective study. Standard 12-lead electrocardiogram records of patients simultaneous with coronary angiography (second day) were assessed and analysed for the presence of fQRS. Also, coronary angiography images were analyzed to identify the infarct related artery, TIMI grade of infarct related artery and TMP grade of infarct related artery. The patients with fQRS demonstrated a significantly lower TMP grade, TIMI grade and ejection fraction compared with the non-fQRS patients (P = 0.004, P = 0.003, P = 0.02 respectively). The patients with inadequate myocardial reperfusion demonstrated a significantly higher fQRS compared with the adequate myocardial reperfusion patients. (56.9% versus 23.5%, P = 0.002 respectively). On correlation analysis, there was a significant negative correlation between fQRS and left ventricular ejection fraction (r = -232, P = 0.02) TMP grade and adequate myocardial reperfusion (TMP 3) showed significant negative correlation with fQRS (r = -0.370, P = 0.000; r = -0.318, P = 0.001 respectively). Presence of fragmented QRS in STEMI patients was associated with inadequate myocardial reperfusion and it can be used as a simple, noninvasive parameter to evaluate myocardial reperfusion. Ann Noninvasive Electrocardiol 2013;18(1):69-74Öğe Autologous Transplantation of Arterial Cells Improves Cardiac Function in a Rabbit Model of Infarcted Myocardium(Mary Ann Liebert, Inc, 2010) Tokaç, Mehmet; Aktan, Murad; Ak, Ahmet; Duman, Selçuk; Tokgözoğlu, Lale; Aygül, Nazif; Paksoy, Yahya; Porat, YaelCellular cardiomyoplasty is a promising approach for the treatment of severe heart failure. However, the question which cell line is the best to use is still a matter of debate. In this study, we aimed to evaluate the efficacy of arterial media-intima cell suspension (AMICS) transplantation in rabbit myocardial infarct model. The study was divided into 2 groups: group A (the cell-treated group, n = 9) and group B (the medium injection group, n = 8). Group A was further divided into 2 subgroups as branch-1 (treated with unlabeled cells) and branch-2 (treated with iron-labeled cells). The experimental myocardial infarction (MI) was induced by ligation of left anterior descending coronary artery with a combination of cryoinjury. Ten days after the MI, cells obtained from autologous femoral arteries were injected into the injured myocardium of group A, while group B received an injection of only DMEM medium. Clinical, echocardiographic, and histopathologic evaluations were done. As compared to the ninth day values, echocardiography showed a significant improvement in systolic functions and left ventricular (LV) dimensions of the cell-treated group on the 30th day. In the heart biopsy sections of branch-1, the immunostained injected cells were observed to exist closely, suggesting an organization. Cells existing separately and lumen-like structure organizations stained positive with both smooth muscle cell (SMC) a-actin and Prussian Blue were also showed in the histological observation of branch-2. Autologous AMICS transplantation seems to be a feasible and efficacious method for cellular cardiomyoplasty in our rabbit model.Öğe Brugada sendromu: İki olgu sunumu ve ailenin gözden geçirilmesi(2004) Altunkeser, Bülent Behlül; Atar, İlyas; Özdemir, Kurtuluş; Aygül, Nazif; Yazıcı, Mehmet; Düzenli, Mehmet Akif; Ertan, ÇağatayBrugada sendromu, EKG'de sağ dal bloğu paterni ve sağ prekordiyal derivasyonlarda ST yükselmesi ile karakterize, ani ölüm riskinin yüksek olduğu bir genetik durumdur. Tüm dünyada yapılan epidemiyolojik çalışmalarda, özellikle gençlerde gözlenen, ani, beklenmedik kalp ölümlerinin önemli bir kısmından sorumludur. Tipik EKG değişiklikleri, hastalarda zaman zaman ortaya çıkıp zaman zaman kaybolabilmektedir. Sodyum kanallarını bloke eden bazı antiaritmik ajanların bu EKG değişikliklerini ortaya çıkarmada etkili oldukları bilinmektedir. Bu yazıda Brugada sendromlu bir ailenin klinik ve elektrokardiyografik özellikleri incelenmektedir.Öğe A Case Report of an Unusual Complication of Amanita Phalloides Poisoning: Development of Cardiogenic Shock and Its Successful Treatment with Intra-Aortic Balloon Counterpulsation(Pergamon-Elsevier Science Ltd, 2010) Aygül, Nazif; Düzenli, Mehmet Akif; Özdemir, Kurtuluş; Altunkeser, Bülent BehlülAmanita phalloides is responsible for the majority of the fatalities caused by mushroom poisoning. It causes damage in liver, kidneys and rarely pancreas, causing encephalopathic coma, disseminated intravascular coagulation, hemorrhage and hypovolemic shock. However, its effect on cardiac functions has not been established yet. In this case report, we aimed to present a female patient poisoned by A. phalloides mushroom complicated with multi-organ failure and cardiogenic shock due to advanced left ventricular systolic dysfunction. This case report was the first to show a successful treatment of cardiogenic shock due to mushroom poisoning with intra-aortic balloon counterpulsation, whereas she did not respond to other therapies.Öğe Comparative effects of atorvastatin 80 mg and rosuvastatin 40 mg on the levels of serum endocan, chemerin, and galectin-3 in patients with acute myocardial infarction(TURKISH SOC CARDIOLOGY, 2019) Tunçez, Abdullah; Altunkeser, Bülent Behlül; Öztürk, Bahadır; Ateş, Muhammed Salih; Tezcan, Hüseyin; Aydoğan, Canan; Kırık, Emre Can; Yalçın, Ulvi; Aygül, Nazif; Demir, Kenan; Akyürek, FikretObjective: Endocan, chemerin, and galectin-3 are discrete biomarkers associated with cardiovascular diseases and acting through different pathophysiological pathways. The aim of this study is to investigate and compare the effects of high doses of atorvastatin and rosuvastatin on serum endocan, chemerin, and galectin-3 levels in patients with acute myocardial infarction (AMI). Methods: Sixty-three patients with AMI were randomized to receive atorvastatin (80 mg/day) or rosuvastatin (40 mg/day) after percutaneous revascularization. Serum levels of endocan, chemerin, and galectin-3 were evaluated at baseline and after 4-week therapy. Results: Endocan levels were not decreased statistically significantly with atorvastatin 80 mg, but rosuvastatin 40 mg markedly decreased the levels of endocan according to baseline [from 110.27 (86.03-143.69) pg/mL to 99.22 (78.30-122.87) pg/mL with atorvastatin 80 mg and from 110.73 (77.28-165.22) pg/mL to 93.40 (70.48-115.13) pg/mL with rosuvastatin 40 mg, p=0.242 for atorvastatin 80 mg and p=0.014 for rosuvastatin 40 mg]. Chemerin levels significantly decreased in both groups according to baseline [from 264.90 (196.00-525.95) ng/mL to 135.00 (105.95-225.65) ng/mL with atorvastatin 80 mg and from 309.95 (168.87-701.27) ng/mL to 121.25 (86.60-212.65) ng/mL with rosuvastatin 40 mg, p<0.001, respectively, for both groups]. Galectin-3 levels did not change markedly with atorvastatin 80 mg, but they decreased with rosuvastatin 40 mg [from 17.00 (13.10-22.25) ng/mL to 19.30 (15.25-23.45) ng/mL with atorvastatin 80 mg, p=0.721, and from 18.25 (12.82-23.82) ng/mL to 16.60 (10.60-20.15) ng/mL with rosuvastatin 40 mg, p=0.074]. There were no significant between-group differences in terms of absolute and percentage changes of endocan, chemerin, and galectin-3 at 4 weeks. Conclusion: We reported that both statins similarly decreased the endocan levels, whereas rosuvastatin seems to have more prominent effects on the reduction of the chemerin and galectin-3 levels in patients with AMI.Öğe Comparative effects of high-dose atorvastatin versus moderate-dose rosuvastatin on lipid parameters, oxidized-LDL and inflammatory markers in ST elevation myocardial infarction(ELSEVIER IRELAND LTD, 2015) Aydın, Meryem Ülkü; Aygül, Nazif; Altunkeser, Bülent Behlül; Ünlü, Ali; Taner, AlpaslanBackground: The important role of oxidized low density lipoprotein (oxidized-LDL) in preclinic atherosclerosis and pathophysiology of acute coronary syndromes studies have reported. Oxidation of LDL activates many inflammatory and atherogenic pathways and plays a pivotal role in atherosclerosis. Our aim in this study is to compare the effects of 80 mg daily dose of atorvastatin and 20 mg daily dose of rosuvastatin on lipid profiles and the levels of oxidized-LDL and inflammatory markers in ST elevation myocardial infarction (STEMI). Methods: One hundred and twenty patients with STEMI were enrolled in this study. The patients were randomly assigned to receive atorvastatin (80 mg/day) or rosuvastatin (20 mg/day) by using a ratio of 1: 1 after revascularization. The levels of total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), LDL-C, apolipoprotein B and apolipoprotein A were compared between groups after 4-week therapy. The values of oxidized-LDL, tumor necrosis factor receptor 1 and 2, Interleukin-6 and hs-CRP were also compared between groups. The Student's t test was used to detect absolute and percent changes between groups, and p < 0.05 was considered as statistically significant for all tests. Results: After treatment in both treatment groups LDL-C, oxidized-LDL, hs-CRP, tumor necrosis factor receptor 1 and 2, Interleukin-6 values significantly decreased according to baseline. The only difference was in HDL-C levels. HDL-C slightly decreased in atorvastatin group while it increased in the rosuvastatin group compared baseline ( 1.4 +/- 8.9 mg/dl vs 2.0 +/- 9.4 mg/dl, p = 0.04). Conclusion: We reported that both statin treatment regiments have comparable effects on LDL-C, oxidized-LDL and inflammatory markers. Moreover, it was observed that rosuvastatin was more effective in terms of ability to increase HDL-C level. Based on these findings, 20 mg daily dose of rosuvastatin may be an alternative to 80 mg daily dose of atorvastatin in patients with acute coronary syndrome. (C) 2015 Elsevier Ireland Ltd. All rights reserved.Öğe A Comparison of Artificial Intelligence Methods on Determining Coronary Artery Disease(Springer-Verlag Berlin, 2010) Babaoğlu, İsmail; Baykan, Ömer Kaan; Aygül, Nazif; Özdemir, Kurtuluş; Bayrak, MehmetThe aim of this study is to show a comparison of multi-layered perceptron neural network (MLPNN) and support vector machine (SVM) on determination of coronary artery disease existence upon exercise stress testing (EST) data. EST and coronary angiography were performed on 480 patients with acquiring 23 verifying features from each. The robustness of the proposed methods is examined using classification accuracy, k-fold cross-validation method and Cohen's kappa coefficient. The obtained classification accuracies are approximately 78% and 79% for MLPNN and SVM respectively. Both MLPNN and SVM methods are rather satisfactory than human-based method looking to Cohen's kappa coefficients. Besides, SVM is slightly better than MLPNN when looking to the diagnostic accuracy, average of sensitivity and specificity, and also Cohen's kappa coefficient.Öğe Comparison of traditional risk factors, angiographic findings, and in-hospital mortality between smoking and nonsmoking turkish men and women with acute myocardial infarction(2010) Aygül, Nazif; Özdemir, Kurtuluş; Abacı, Adnan; Aygül, Meryem Ülkü; Düzenli, Mehmet Akif; Yazıcı, Hüseyin Uğur; Özdoğru, İbrahim; Karakaya, EkremBackground: The prevalence of smoking is high in Turkey. However, there are no data available evaluating the differences between smokers and nonsmokers according to their sex in patients with acute myocardial infarction (AMI) in Turkey. Hypothesis: The aim of the study was to determine the prevalence of smoking and its relationship to age, localization, and extension of coronary heart disease (CHD), and other risk factors in Turkish men and women with first AMI. Methods: This study included, 1502 patients with first AMI from 3 different cities in Turkey. The baseline characteristics and traditional risk factors for CHD, Coronary angiographic results, and in-hospital outcome were recorded. Results: The proportion ofmale smokers was significantly higher than that ofwomen (68%vs 18%, P < 0.001). Smokers were younger by almost a decade than nonsmokers (P < 0.001). Male nonsmokers were younger than females; however, the mean age of first AMI was similar in male and female smokers. In both genders, prevalence of hypertension and diabetes mellitus was significantly lower in smokers than in nonsmokers (P < 0.001). Smokers had lessmultivessel disease andless comorbidity as compared to nonsmokers. Although the in-hospital mortality rate was lower in smokers, smoking status was not an independent predictor of mortality. Conclusions: Smoking, by decreasing the age of first AMI in women, offsets the age difference in first AMI betweenmen and women. The mean age of first AMI is lower in Turkey than most European countries due to a high percentage of smoking. © 2010 Wiley Periodicals, Inc.Öğe Öğe Effect of preload and heart rate on the Doppler and tissue Doppler-derived myocardial performance index(WILEY, 2007) Özdemir, Kurtuluş; Balcı, Sibel; Düzenli, Mehmet Akif; Can, İlknur; Yazıcı, Mehmet; Aygül, Nazif; Altunkeser, Bülent BehlülDoppler-derived myocardial performance index (MPI) has been described as a noninvasive measurement of LV function. Our aim was to investigate the effect of hemodialysis related volume reduction and heart rate changes on the Doppler-derived LV MPI, and Doppler tissue imaging (DTI) derived left and right ventricular MPI. Method: The study group comprised 32 consecutive patients (mean age: 43 18 yrs) undergoing hemodialysis. Patients underwent echocardiography before and immediately after hemodialysis session. Left and right ventricular MPI derived from conventional pulsed-wave Doppler and DTI was calculated. The difference in MPI, heart rate and body weight was calculated before and after hemodialysis. Results: Doppler-derived LV MPI, and right ventricular MPI obtained by DTI were increased (p = 0.05) but the LV MPI obtained by DTI was unchanged after hemodialysis. There is a significant positive correlation between the Doppler-derived LV MPI difference and volume reduction (r = 0.38, p = 0.032). The heart rate difference was correlated with Doppler-derived LV MPI difference, and DTI derived right ventricular MPI difference (r = 0.38, p = 0.034; r = 0.48, p = 0.006, respectively). Whereas, DTI derived LV MPI difference was not correlated with heart rate difference. By the multivariate analysis, there was no correlation between Doppler-derived LV MPI difference with heart rate difference, and volume reduction. Right ventricular MPI difference correlated with heart rate difference (r = 0.41, p = 0.021) but not with volume reduction. Doppler-derived MPI is partially influenced by preload and heart rate changes. However, DTI derived LV MPI is not influenced by preload and heart rate changes.Öğe Emergency revascularization procedures in patients with acute ST-elevation myocardial infarction due to acute total occlusion of unprotected left main coronary artery: A report of five cases(Turkish Anaesthesiology and Intensive Care Society, 2010) Aygül, Nazif; Aygül, Meryem Ülkü; Özdemir, Kurtuluş; Altunkeser, Bülent BehlülSeveral studies have compared the efficacy of elective coronary artery stenting and coronary artery bypass grafting (CABG) in patients with unprotected left main coronary artery (ULMCA) disease. However, a definite reperfusion modality has yet to be established in ST-elevation myocardial infarction (STEMI) due to acute total occlusion of ULMCA, which has catastrophic clinical results. We presented five patients (3 males, 2 females; mean age 59 years; range 53 to 67 years) with acute anterior STEMI and angiographically documented acute total occlusion of ULMCA. On presentation, all the patients had chest pain and four patients were in cardiogenic shock. All the patients were taken to the catheterization room with minimum delay. Intra-aortic balloon counterpulsation was used during coronary angiography in all the patients. Three patients underwent PCI and, after balloon predilatation, bare-metal stents were implanted and TIMI III flow was achieved. One patient who had atrial fibrillation on admission died on the 14th day of hospitalization after PCI due to pump failure. After diagnostic coronary angiography, two patients were submitted to surgery for emergency CABG. They both died, one within two hours of admission during preparation of the surgical team, and the other on the third postoperative day. Both were in cardiogenic shock on admission.Öğe Evre I-II hipertansif bireylerde kan basıncı düzenlemesinin arteryel sertlik üzerine etkisi(2013) Arıbaş, Füsun Zeynep; Altunkeser, Bülent Behlül; Avcı, Ahmet; Demir, Kenan; Aygül, Nazif; Arıbaş, AlpayAmaç: Hipertansif hastalarda sub-klinik organ hasarı göstergelerinden biri de arteryel sertliktir. Çalışmamızda Evre I-II hipertansiflerde kan basıncı düzenlemesinin arteryel sertlik üzerine etkilerini değerlendirdik. Gereç ve Yöntem: 18-65 yaş Evre I-II hipertansif 60 (34 Evre I, 26 Evre II) hastaya tedavi öncesi ve en az bir ay sonrası olmak üzere 24 saatlik ayaktan kan basıncı izlemi yapıldı. Hastaların tedavileri, arteryel sertlik parametrelerine kör olan hastanın kendi doktorunca verildi. Kan basıncı kontrol altına alınan (Grup 1, n30) ve alınamayan (Grup 2, n30) olarak iki grup oluşturuldu. 24 saatlik holter izleminden hesaplanan aortik sertlik parametrelerinin her iki grupta tedavi öncesi ve sonrası değerleri karşılaştırıldı. Bulgular: Tedavi sonrası; grup 1 hastaların kan basınçları ve arteryel sertlik parametrelerinde [Augmentasyon basıncı (13,46, 10.75.6, p0.001), Augmentasyon indeksi (29,68,2, 26,08,0, p0.001), nabız basıncı (479, 416, p0,001), nabız dalga hızı (7.70.9, 7.10.9, p0.001)] anlamlı düşme izlendi (p0,05). Grup 2 hastaların ortalama diyastolik kan basıncı (948, 918, p0,01) ile kalp hızında (788, 748, p0,03) anlamlı düşme, Augmentasyon basıncında (12,05,1, 14,05,9, p.03) anlamlı yükselme (p0,05) izlenirken, diğer parametrelerde anlamlı değişim görülmedi. Sonuç: Evre I ve Evre II hipertansif hastalarda kan basıncı kontrolü, arteryel sertlik parametrelerinde anlamlı düzelme sağlamaktadır. Yeterli kan basıncı kontrolünün sağlanamadığı durumda ise antihipertansiflere rağmen arteryel sertlik parametreleri düzelmemektedir.Öğe Investigation of Plant Sterols, Oxidized Low Density Lipoproteins (LDL) and Homocysteine Levels in Patients with Coronary Arthery Disease and Healthy Controls(Nobel Ilac, 2010) Sivrikaya, Abdullah; Mehmetoğlu, İdris; Kurban, Sevil; Aygül, Nazif; Yerlikaya, F. HümeyraAmaç: Bu çalışma serum bitki sterollerinin (B- sitosterol, stigmasterol) koroner arter hastalığının gelişi- mindeki rolünü ve diğer potansiyel risk faktörleriyle korelasyonunu göstermek için yapıldı. Materyal ve Metod: Anjiografisi yapılan toplam 166 kişi koroner anjiografi sonuçlarına göre kontrol ve hasta olarak gruplandırıldı. Anjiografisi normal olan 60 kışı kontrol grubunu, üç majör koroner arterlerinin en az birinde > %50 stenozu olan 106 kişi hasta grubunu oluşturdu. Vakaların serum ß-sitosterol, stigmasterol, okside LDL ve homosistein düzeyleri analiz edildi Bulgular: Hastalarım serum ß-sitosterol, stigmasterol ve bunların kolesterole oranları, okside LDL ve homosistein düzeyleri kontrollere göre biraz yüksek (istatistiksel açıdan önemsiz) bulundu. Üç hastanın serum bitki sterol seviyelen diğerlerine göre çok yüksekti. Hasta grubunda ẞ-sitosterol ile kolesterol düzeyleri arasında, kontrol grubunda stigmasterol ile kolesterol düzeyleri arasında önemli pozitif korelasyon vardı. Serum bitki sterolleri ile bunların okside LDL, homo- sistein ve koroner oklüzyon seviyeleri arasında ise korelasyon yoktu. • Sonuç: Bulgularımız serum bitki sterollerinin koroner arter hastalarında bağımsız risk faktörü olmadığım göstermektedir. Aynca bu hastalarda diğer risk faktörlerinin yanında serum bitki sterollerinin de rutin olarak ölçülmesmin hastaların daha iyi değerlendirilmesinde çok önemli olacağı kanaatindeyiz.Öğe Kalp yetersizliği olan hastalarda fonksiyonel kapasitenin değerlendirilmesinde doku Doppler ekokardiyografinin rolü(2008) Düzenli, Mehmet Akif; Özdemir, Kurtuluş; Aygül, Nazif; Zengin, Kadriye; Gök, HasanAmaç: Kalp yetersizliği (KY) olan hastalarda, fonksiyonel kapasitenin değerlendirilmesinde yaygın olarak kullanılan New York Kalp Derneği (NYHA) fonksiyonel sınıflandırma sistemi ile klasik ekokardiyografi ve doku Doppler ekokardiyografi (DDE) parametreleri arasındaki ilişki değerlendirildi. Çalışma planı: Çalışmaya, sol ventrikül (SV) ejeksiyon fraksiyonu (EF) %50’nin altında olan KY’li 122 hasta (31 kadın, 91 erkek; ort. yaş 5911) alındı. Hastalar NYHA fonksiyonel sınıf I-II (n79; ort. yaş 58) ve III-IV (n43; ort. yaş 61) olmak üzere iki grupta değerlendirildi. Standart ikiboyutlu ekokardiyografi ve DDE parametreleri ile NYHA fonksiyonel kapasite arasındaki ilişkiler araştırıldı. Bulgular: NYHA fonksiyonel sınıf, klasik ekokardiyografi parametrelerinden SV EF, SV atım hacmi, mitral erken doluş deselerasyon zamanı ve ileri akım hızı (Vp) ile negatif ilişki gösterdi. Fonksiyonel sınıf ile mitral erken (E) ve geç (A) diyastolik zirve hızları ve E/A oranı arasında ilişki bulunmazken, sistol ve diyastol sonu çaplar ve hacimler, pulmoner arter basıncı, E/Vp oranı ile pozitif ilişki vardı. NYHA fonksiyonel sınıf DDE parametrelerinden sistolik miyokardiyal (Sm), erken (Em) ve geç (Am) diyastolik miyokardiyal hızlar ile negatif, E/Em oranı ile pozitif ilişki gösterdi; Em/Am oranı ile anlamlı ilişki bulunmadı. Çoklu lineer regresyon analizinde, Sm, EF ve pulmoner arter basıncının NYHA fonksiyonel sınıfı ile ilişkisi anlamlı ve bağımsız bulundu (sırasıyla -0.33, p0.005; -0.26, p0.05; 0.23, p0.05). Sonuç: Miyokardiyal hızlar fonksiyonel kapasite ile ilişki göstermektedir. Özellikle Sm, konvansiyonel ekokardiyografi ve diğer DDE parametrelerine göre fonksiyonel kapasiteyle daha güçlü ilişki içindedir.Öğe Long-term prognostic significance of terminal QRS distortion on patients with stemi and its correlation with the GRACE scoring system(CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS, 2019) Yilmaz, Ahmet; Demir, Kenan; Karatas, Recep; Celik, Mustafa; Avci, Ahmet; Keles, Fikret; Ersecgin, Ahmet; Aygül, Nazif; Altunkeser, Bülent Behlül[Abstract not Available]Öğe Percutaneous Coronary Intervention of a Single Coronary Artery Originating From Right Sinüs of Valsalva in a Patient With Inferior Myocardial Infarction(2010) Aygül, Nazif; Aygül, Meryem Ülkü; Altunkeser, Bülent BehlülSol ana koroner arterin tek koroner arter olarak sağ Valsalva sinüsünden çıkması oldukça nadir görülen bir koroner arter çıkış anomalisidir. Literatürde insidansı genel popülasyonda %0.017, koroner arter anomalileri içerisinde ise %1.3 olarak bildirilmektedir. Bu anomali sıklıkla çocukluk veya genç erişkinlik döneminde miyokardiyal iskemi veya ani ölümle karakterizedir. Biz bu yazıda, sağ Valsalva sinüsünden çıkan tek koroner artere sahip, inferiyor duvar miyokard infarktüsü ile kliniğe başvuran 75 yaşında bir olguyu takdim etmeyi amaçladık.Öğe Prevalence of risk factors of ST segment elevation myocardial infarction in Turkish patients living in Central Anatolia(TURKISH SOC CARDIOLOGY, 2009) Aygül, Nazif; Özdemir, Kurtuluş; Abacı, Adnan; Aygül, Meryem Ülkü; Düzenli, Mehmet Akif; Vatankulu, Mehmet Akif; Yazıcı, Hüseyin UğurObjective: There is not enough available data in our country about the prevalence of risk factors for ST-elevation myocardial infarction (STEMI), which has the highest in-hospital mortality rate within subtypes of acute coronary syndromes. Therefore, in this study, we aimed to evaluate the prevalence of risk factors for STEMI in Central Anatolia, one of the regions with high risk for coronary heart disease (CHD). Methods: This cross-sectional observational study included 1210 patients (962 men, 248 women) with the diagnosis of STEMI in 3 tertiary-medical centers in 3 cities in Central-Anatolia (Ankara, Konya, and Kayseri). Demographic characteristics (age, gender) and risk factors known to be traditional risk factors for CHD (history of hypertension (HT), diabetes mellitus (DM), smoking, and family history) were inquired and fasting blood samples within 24 hours from onset of STEMI were taken to analyze lipid levels. Patients were divided into 3 groups based on their ages: Group A - age <= 44 years; Group B - age 45-64 years; and Group C - age >= 65 years. Prevalence of risk factors and differences within age-groups and genders were evaluated. Results: The mean age was 58+/-11 years (range 24-96 years). Although the percentage of female patients increased in relation to increasing age, 80% of the total patients were male. While prevalence of smoking and family history was observed to decrease with aging, there was a statistically significant increase in prevalence of HT and DIM (p<0.001). Prevalence of smoking was the highest in young patients and males (p<0.001). Prevalence of HT and DM, on the other hand, was significantly higher in women than in men (p<0.001). Although the number of modifiable risk factors was found to be significantly smaller in men, male patients with STEMI were 8 years younger than females on average. Conclusions: The results of our study, in which modifiable risk factors and especially smoking were found to have a high prevalence in patients with STEMI living in Central Anatolia, suggested that most STEMI cases especially at younger ages might be prevented by the modification of these risk factors. (Anadolu Kardiyol Derg 2009; 9: 3-8)Öğe The Relationship Between Admission Hemoglobin Level and and Left Ventricular Systolic Functions in Patients With First ST-segment Elevated Myocardial Infarction(2010) Şen, Nihat; Yazıcı, Hüseyin Uğur; Tavil, Yusuf; Poyraz, Fatih; Turfan, Murat; Aygül, Nazif; Vatankulu, Mehmet Akif; Özdoğru, İbrahim; Abacı, AdnanObjectives: The goal of this study was to evaluate the relationship between admission hemoglobin levels and left ventricular systolic functions in patients admitted with first ST-segment elevated myocardial infarction (STEMI). Study design: The study was conducted prospectively in three centers in 483 consecutive patients (402 men, 81 women; mean age 56.5±11.2 years; range 24 to 74 years) with first STEMI. All patients were evaluated by echocardiography after a mean of 2.4 days of admission. Evaluation of left ventricular systolic functions included measurements of ejection fraction (EF), wall motion score index (WMSI), and tissue Doppler S wave velocities at four different localizations (anterior, inferior, lateral, posterior septum). Hemoglobin levels were measured within one hour of admission. Anemia was defined according to the World Health Organization criteria (hemoglobin <13.0 g/dl in men and <12.0 g/dl in women). Echocardiographic characteristics of the patients with and without anemia were compared. Results: Anemia was detected in 67 patients (13.9%). There were no significant differences between patients with and without anemia with respect to left ventricular end-systolic and end-diastolic diameters, wall thickness, WMSI, and EF. The mean EF in the anemic group (47.5%) was lower than that of the patients without anemia (48.5%), but this difference was not significant. All Sm velocities were lower in the anemic group, but only septal mitral annular Sm velocity reached statistical significance (p0.048). There was no correlation between hemoglobin levels and EF (r0.027, p0.55). Conclusion: Our findings suggest that mild to moderate anemia has no deleterious effect on systolic function in patients with first STEMI.Öğe Relationship between systolic myocardial velocity obtained by tissue Doppler imaging and left ventricular ejection fraction: Systolic myocardial velocity predicts the degree of left ventricular dysfunction in heart failure(BLACKWELL PUBLISHING, 2008) Düzenli, Mehmet Akif; Özdemir, Kurtuluş; Aygül, Nazif; Altunkeser, Bülent Behlül; Zengin, Kadriye; Sizer, MuratThis study was planned to research the relationship between systolic myocardial velocity (Sm) obtained by tissue Doppler imaging (TDI) and left ventricular ejection fraction (LVEF) measured according to conventional Simpson's method in healthy subjects and patients with heart failure (HF). Two hundred eight patients with HF whose LVEF < 50% (mean age 59 +/- 11 years) and 187 healthy subjects (mean age 57 +/- 11 years) were enrolled in this study. LVEF was measured and TDI recordings were obtained at the septal, lateral, inferior, and anterior of the mitral annulus, and Sm was measured. LV mean Sm was calculated. In patients with HF, a significant correlation was detected between LVEF and Sm (r = 0.71, P < 0.0001), while no relationship was found between these parameters in healthy subjects (r = 0.16, not significant). The cutoff value of Sm < 8 cm/s for identifying patients with LVEF between 30% and 49% had a sensitivity of 86%, a specificity of 93%, and a negative predictive value of 92%, and the cutoff value of Sm < 6.0 cm/s for identifying patients with LVEF < 30% had a sensitivity of 92%, a specificity of 84%, and a negative predictive value of 97%. The time required to calculate the LVEF was significantly longer than that of LV mean Sm (327 +/- 98 sec vs. 110 +/- 29 sec, P < 0.0001), and LVEF had higher inter- and intraobserver variability. LV mean Sm obtained by TDI, a parameter that is reproducible, easily obtained, reliable, and practical, can be used to evaluate LV systolic function in patients with HF.
