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Öğe Atorvastatin Given prior to Electrical Cardioversion Does Not Affect the Recurrence of Atrial Fibrillation in Patients with Persistent Atrial Fibrillation Who Are on Antiarrhythmic Therapy(KARGER, 2011) Demir, Kenan; Can, İlknur; Koç, Fatih; Vatankulu, Mehmet Akif; Ayhan, Selim; Akıllı, Hakan; Arıbaş, AlpayObjective: In this study, our aim was to evaluate the effect of a higher dose of atorvastatin on the recurrence rate of atrial fibrillation (AF) after electrical cardioversion (EC) in addition to antiarrhythmic therapy. Subjects and Methods: 48 patients with persistent AF were included in this study. The patients were randomized to an atorvastatin 40-mg treatment group and a control group. Atorvastatin was started 3 weeks before EC and was continued for 2 months after EC. EC was performed using biphasic shocks after 3 weeks of treatment with the orally administered anticoagulant warfarin. Lipid and inflammatory parameters (high-sensitivity C-reactive protein, white blood cell count and fibrinogen level) were evaluated at the baseline and before EC. The endpoint of this study was electrocardiographically confirmed recurrence of AF of >10 min. Results: There were no significant differences in baseline characteristics and lipid and inflammatory marker levels between the treatment and control groups. Total cholesterol and low-density lipoprotein levels were significantly decreased in patients taking atorvastatin for 2 months compared with baseline values (174 +/- 31 vs. 129 +/- 25 mg/dl, p = 0.001, and 112 +/- 23 vs. 62 +/- 20 mg/dl, p = 0.001, respectively), while no significant change occurred in control patients (168 +/- 26 vs. 182 +/- 29 mg/dl, p = 0.07, and 99 +/- 18 vs. 108 +/- 26 mg/dl, p = 0.1, respectively). At the end of the 2-month follow-up period, 9 patients (20.5%) experienced AF recurrence, and there was no significant difference in AF recurrence rate between the treatment and control groups (26 vs. 13%; p = 0.2). Conclusion: Atorvastatin therapy prior to EC does not prevent the recurrence of arrhythmia in patients with persistent AF who are receiving antiarrhythmic therapy. Copyright (C) 2011 S. Karger AG, BaselÖğe Does Estimated Glomerular Filtration Rate Have an Effect on Left Ventricular Function after ST-Elevation Myocardial Infarction?(WILEY, 2014) Sonmez, Osman; Vatankulu, Mehmet A.; Tasal, Abdurrahman; Bacaksiz, Ahmet; Ayhan, Selim; Yazici, Huseyin U.; Karakaya, EkremObjectivesLittle is known about whether estimated glomerular filtration rates (eGFR) affect left ventricular (LV) function and gain benefit with antiremodeling treatment in patients with ST-elevation myocardial infarction (STEMI). We investigated the effect of eGFR on LV function using tissue Doppler imaging (TDI) parameters. In addition, we sought to evaluate the antiremodeling effect of standard treatment at follow-up in patients with renal insufficiency (RI) after STEMI. Methods and ResultsA retrospective analysis of 579 patients with STEMI was performed. Patients were divided into 3 groups according to eGFR (Group 1: eGFR>90mL/min per 1.73m(2); Group 2: eGFR=60-89mL/min per 1.73m(2); Group 3: eGFR<60mL/min per 1.73m(2)). Conventional echocardiography and TDI were performed within 48-72hours after STEMI and at 6-month follow-up. The mean left ventricular ejection fraction (LVEF) was significantly lower in Group 3 than in Group 1 (P=0.021). The mean peak systolic velocity (Sm) was significantly lower in Group 3 than in Group 1 and Group 2 (P=0.002 and 0.006, respectively). The estimated GFR had a linear association with Sm and LVEF (P=0.001, r=0.161; P=0.005, r=0.132, respectively). Multivariate analysis showed that an eGFR<60mL/min per 1.73m(2) was an independent predictor of lower Sm and in-hospital mortality. In addition, an antiremodeling effect of standard treatment was seen in all groups at 6-month follow-up. ConclusionsEstimated glomerular filtration rate of <60mL/min per 1.73m(2) was associated with lower LV function after STEMI, and may gain an antiremodeling effect with standard treatment at follow-up.Öğe Effect of Long-Term Resynchronization Therapy on Left Ventricular Remodeling in Pacemaker Patients Upgraded to Biventricular Devices(EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC, 2009) Vatankulu, Mehmet Akif; Goktekin, Omer; Kaya, Mehmet Gurkan; Ayhan, Selim; Kucukdurmaz, Zekeriya; Sutton, Richard; Henein, MichaelRight ventricular pacing resulted in abnormal ventricular depolarization and an activation pattern similar to left branch bundle block. In some circumstances, it may exacerbate symptoms of heart failure and increase hospital admission rates. The objective of this study was to assess the effects of long-term ventricular resynchronization therapy on echocardiographic parameters of left ventricular (LV) remodeling in patients with moderate to severe heart failure who were upgraded from single- to biventricular pacing. Twenty-six consecutive pacemaker-dependent patients (20 men; mean age 61 +/- 20 years) who underwent placement of an LV lead to upgrade their conventional pacing system to biventricular pacing were included in the study. All patients had heart failure symptoms, received the maximum tolerated medical therapy, and were stable for >= month before the upgrade. Echocardiography and electrocardiography were performed before the pacemaker upgrade and at follow-up (mean duration 15 +/- 9 months). QRS duration decreased significantly from 176 +/- 23 to 154 +/- 19 ms (p <0.001). LV end-diastolic volume (p = 0.006) and LV end-systolic volume (p = 0.004) decreased at follow-up compared with baseline: The decrease in LV volumes observed during follow-up was accompanied by a significant increase in ejection fraction (39 +/- 11% to 46 +/- 10%; p = 0.001) and decrease in LV myocardial performance index (0.84 +/- 0.18 to 0.68 +/- 0.14; p = 0.001). The upgrade of conventional pacing to biventricular pacing resulted in significant prolongation of normalized LV filling time (p = 0.01) and shortening of isovolumic contraction time (p 0.002). In addition, biventricular pacing significantly (V-V interval 0) reduced intra- (44 +/- 11 vs 18 +/- 12 ms; p <0.001) and interventricular dyssynchrony (78 +/- 33 vs 49 +/- 22 ms; p <0.001). In conclusion, these findings suggested that in patients with advanced heart failure and continuous right ventricular pacing, upgrading to biventricular system resulted in significant reverse LV remodeling in the long-term follow-up and improvement in overall synchronicity of ventricular function. (C) 2009 Elsevier Inc. All rights reserved. (Am J Cardiol 2009;103:1280-1284)Öğe Intravenous N-acetylcysteine Plus High-dose Hydration Versus High-dose Hydration and Standard Hydration for the Prevention of Contrast-induced Nephropathy: CASİS-A Multicenter Prospective Controlled Trial(Elsevier Ireland Ltd, 2012) Koç, Fatih; Özdemir, Kurtuluş; Kaya, Mehmet Güngör; Doğdu, Orhan; Vatankulu, Mehmet Akif; Ayhan, Selim; Erkorkmaz, Ünal; Sönmez, Osman; Aygül, Meryem Ülkü; Kalay, Nihat; Kayrak, Mehmet; Karabağ, Turgut; Alihanoğlu, Yusuf İzzettin; Günebakmaz, ÖzgürBackground: Contrast-induced nephropathy (CIN) is a leading cause of acute renal failure and affects mortality and morbidity. We investigated the efficacy of prophylactic intravenous (IV) N-acetylcysteine (NAC) and hydration for the prevention of CIN in patients with mild to moderate renal dysfunction who are undergoing coronary angiography and/or percutaneous coronary intervention (PCI). Methods: A total of 220 patients who had mild to moderate renal dysfunction with serum creatinine (SCr) >= 1.1 mg/dL or creatinine clearance <= 60 mL/min were randomized in 3 groups: 80 patients were assigned to IV NAC plus high-dose hydration with normal saline, 80 patients to only high-dose hydration with normal saline and 60 patients to standard hydration with normal saline (control group). The primary end point was the alteration of SCr level. The secondary end point was the development of CIN after the procedure. Results: SCr levels changed the least in the NAC plus high-hydration group (P=0.004). The rate of the CIN in the NAC plus high-dose hydration group was also lower than the high-dose hydration group (P=0.006). No significant differences in the primary and secondary end points were found between high-dose hydration and control group. Conclusion: The results of this study suggest that NAC plus high-dose hydration was superior to high-dose hydration alone as well as standard hydration for the protection of renal functions in patients with mild to moderate renal dysfunction who are undergoing coronary angiography and/or PCI. High-dose hydration without NAC was not better than standard hydration alone.Öğe Long Term Effects of Bosentan Therapy on Echocardiographic Parameters in Patients With Eisenmenger Syndrome(LIPPINCOTT WILLIAMS & WILKINS, 2009) Kaya, Mehmet; Lam, Yat Yin; Erer, Betul; Ayhan, Selim; Vatankulu, Mehmet A.; Nurkalem, Zekeriya; Eren, Mehmet[Abstract not Available]Öğe Long-term Effect of Bosentan Therapy on Cardiac Function and Symptomatic Benefits in Adult Patients with Eisenmenger Syndrome(Churchill Livingstone Inc Medical Publishers, 2012) Kaya, Mehmet G.; Lam, Y-Y.; Erer, Betül; Ayhan, Selim; Vatankulu, Mehmet A.; Nurkalem, Zekeriya; Meric, Murat; Eryol, Namık K.; Eren, MehmetBackground: Bosentan improves symptoms in patients with Eisenmenger syndrome (ES). This study evaluated the effect of long-term bosentan therapy on cardiac function and its relation to symptomatic benefits in ES patients. Methods and Results: Twenty-three consecutive adult ES patients (15 with ventricular septal defect, 6 with atrial septal defect, and 2 with patent ductus arteriosus) underwent standard and tissue Doppler echocardiography before and 24 +/- 9 months after bosentan therapy. Echocardiographic measurements included pulmonary arterial systolic pressure (PASP), myocardial performance index (MPI), tricuspid and lateral mitral annular pulsed-wave tissue Doppler systolic (Sa) and early diastolic (Ea) long-axis motions. Patients' World Health Organization (WHO) functional class, 6-minute walk distance (6MWD), and systemic arterial oxygen saturations (SaO(2)) were also recorded. The PASP, WHO functional class, 6MWD, and SaO(2) all improved (118 +/- 22 to 111 +/- 19 mm Hg, 3.2 +/- 0.4 to 2.4 +/- 0.5, 286 +/- 129 m to 395 +/- 120 m, and 84.6 +/- 6.5% to 88.8 +/- 3.9%, respectively; all P < .01) after therapy. There was also significant improvement in right ventricular (RV) MPI (by 23.9%: 0.46 +/- 0.15 to 0.35 +/- 0.09) and biventricular long-axis function (tricuspid Sa and Ea: 6.7 +/- 1.5 to 8.8 +/- 1.7 cm/s and 5.7 +/- 1.3 to 7.0 +/- 1.2 cm/s, respectively; lateral Sa and Ea: 6.8 +/- 1.3 to 8.4 +/- 1.5 cm/s and 7.6 +/- 2.0 to 8.5 +/- 2.1 cm/s, respectively; all P < .05). Posttherapy RV MPI was moderately correlated with PASP and 6MWD. Conclusions: Sustained improvement of pulmonary arterial hypertension and RV function in ES patients was evident 2 years after bosentan therapy, and this may provide insights on the symptomatic benefits gained in these patients. (J Cardiac Fail 2012;18:379-384)Öğe Serum Asymmetric Dimethylarginine Levels in Normotensive Obese Individuals(Int Scientific Information, Inc, 2010) Koç, Fatih; Tokaç, Mehmet; Erdem, Sami; Kaya, Coşkun; Ünlü, Ali; Karabağ, Turgut; Vatankulu, Mehmet Akif; Demir, Kenan; Ayhan, Selim; Kaya, AhmetBackground: Obesity is associated with an increased risk of developing insulin resistance, hyperinsulinemia, glucose intolerance, dyslipidemia, hypertension, premature atherosclerosis, and coronary artery disease. This study is designed to compare serum asymmetric dimethylarginine (ADMA) levels between obese individuals and controls. Material/Methods: Fifty volunteers, 30 obese (13 men; mean age, 40 +/- 11 years) and 20 healthy controls (13 men; mean age, 44 +/- 10 years) were enrolled to this study. Measurement of ADMA was accomplished by high performance liquid chromatography. Results: The mean body mass index of the obese group was significantly higher than that of the control group (35 +/- 4 vs 26 +/- 3 kg/m(2); P=.001). The mean waist circumference of the obese subjects was also significantly higher compared with controls (111 +/- 11 vs 93 +/- 10 cm; P=.001). No significant difference was found concerning age, sex, blood pressures, and biochemistry parameters. Serum ADMA levels were significantly higher in obese individuals compared with healthy controls (5.4 +/- 3.3 vs 3.1 +/- 1.8 mu mol/L; P=.006). A weak but significant correlation was identified between serum ADMA concentration and the waist circumference (r=0.282, P=.047). Conclusions: The results of the present study demonstrated that serum ADMA levels of normotensive obese individuals were significantly higher than healthy controls. Increased ADMA concentrations observed only in the obese group were deemed to be important regarding the development future of cardiovascular disease in the future.
