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Öğe Adult cyanotic congenital heart disease: an unusual cause of stroke(PAKISTAN MEDICAL ASSOC, 2013) Bacaksiz, Ahmet; Sonmez, Osman; Akif, Mehmet; Kayrak, MehmetA 33-year-old male patient with uncorrected tetralogy of Fallot was hospitalised for multiple peripheral arterial emboli. Bilateral above-knee amputation had been done after unsuccessful femoral embolectomy. A large thrombus was detected in the apical portion of the left ventricle which was the source of the embolus. The patient complained of mild frontal headache and progressive right-sided weakness shortly after an echocardiographic examination. A computed tomography (CT) scan revealed a left middle cerebral artery territory infarct. Patients with grown-up cyanotic congenital heart disease are at increased risk of thromboembolic cerebrovascular events. This report highlights the necessity for physicians to be alert for uncommon causes of acute stroke.Öğe 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 The effects of spironolactone on atrial remodeling in patients with preserved left ventricular function after an acute myocardial infarction: a randomized follow-up study(LIPPINCOTT WILLIAMS & WILKINS, 2010) Kayrak, Mehmet; Bacaksiz, Ahmet; Vatankulu, Mehmet A.; Ayhan, Selim S.; Ari, Hatem; Kaya, Zeynettin; Ozdemir, KurtulusObjectives Atrial remodeling is an important part of cardiac remodeling after acute myocardial infarction (AMI). The aim of this study was to evaluate the effect of spironolactone on atria in patients with preserved left ventricular (LV) functions after AMI by using two-dimensional and tissue Doppler imaging techniques (TDI). Methods The study consisted of 110 patients with AMI, successfully revascularized with percutaneous coronary intervention, ejection fraction greater than or equal to 40%, and Killip class I-II. Patients were randomized into two groups: conventional therapy (n=55) and additional spironolactone of 25 mg/day with standard conventional therapy (n=55). Echocardiography was performed in the first 48-72 h of AMI and during 6 months of follow-up. Left atrial volume index and emptying fraction were obtained. The peak regional atrial contraction velocity, the time between the onset of p-wave on the monitor ECG and the onset, peak, and the end (TE) of the atrial contraction wave on the tissue Doppler technique curve were measured. Results The left atrial volume index and left atrium (LA) dimensions did not significantly change in either group. In the spironolactone group, left atrial emptying fraction increased compared with both baseline value ( from 53.0 +/- 0.16 to 57.0 +/- 0.13 P = 0.011) and conventional therapy group (from 50.0 +/- 0.17 to 47.0 +/- 0.16, P = 0.013). The atrial contraction velocity did not change but the LA-TE, interatrial septum-TE, and right atrium-TE were prolonged in the conventional therapy group. Conclusion Additional spironolactone therapy provided a little benefit on LA remodeling and atrial electromechanic properties in patients with AMI and preserved LV functions. Coron Artery Dis 21:477-485 (C) 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.Öğe Endocarditis of Mitral Annuloplasty Ring due to Coagulase-Negative Staphylococci(I C R PUBLISHERS, 2009) Kayrak, Mehmet; Bacaksiz, Ahmet; Narin, Cueneyt[Abstract not Available]Öğe The evaluation of doxorubicin-induced cardiotoxicity: Comparison of Doppler and tissue Doppler-derived myocardial performance index(VIA MEDICA, 2012) Ayhan, S. Selim; Ozdemir, Kurtulus; Kayrak, Mehmet; Bacaksiz, Ahmet; Vatankulu, M. Akif; Eren, Onder; Koc, FatihBackground: Doxorubicin is a chemotherapeutic agent used in a wide spectrum of cancers. However, cardiotoxic effects have limited its clinical use. The early detection of doxorubicin-induced cardiotoxicity is crucial. The purpose of our study was to assess values of Doppler and tissue Doppler imaging (TDI) -derived myocardial performance index (MPI) in adult cancer patients receiving doxorubicin treatment. Methods: A total of 45 patients underwent echocardiographic examinations before any doxorubicin had been administered and then after doxorubicin. Doppler and TDI-derived MPI of left ventricular (LV) were determined in the evaluation of cardiotoxicity. Additionally, TDI-derived MPI of right ventricular (RV) was determined. Results: All patients underwent control echocardiographic examination after mean 5 +/- 1.7 months. The LV MPI obtained by both Doppler and TDI were increased after doxorubicin treatment (0.56 +/- 0.11, 0.61 +/- 0.10, p = 0,005 vs 0.51 +/- 0.09, 0.59 +/- 0.09, p = 0.001, respectively). There was no correlation between Doppler-derived MPI and cumulative doxorubicin dose (coefficient of correlation 0.11, p = 0.6). TDI-derived MPI was correlated with cumulative doxorubicin dose (coefficient of correlation 0.35, p = 0.015), but this correlation is weak (r = 0.38). The study population was divided into two groups according to doxorubicin dose (below and above 300 mg level). There was a moderate correlation between TDI-derived MPI and less than 300 mg of doxorubicin dose (coefficient of correlation 0.51, p = 0.028). However, Doppler-derived MPI was not correlated with less than 300 mg of doxorubicin dose (coefficient of correlation 0.38, p = 0.123). Also, there was no significant change in the TDI-derived RV-MPI (0.49 +/- 0.14, 0.50 +/- 0.12, p = 0.56). Conclusions: TDI-derived MPI is a useful parameter and an early indicator compared with Doppler-derived MPI in the detection of cardiotoxicity during the early stages. Also, doxorubicin administration does not affect RV function. (Cardiol J 2012; 19,4: 363-368)Öğe Is enoxaparin injection from the abdominal wall safe in elderly people? A fatal case of rectus sheath hematoma(COLL FAMILY PHYSICIANS CANADA, 2008) Kayrak, Mehmet; Bacaksiz, Ahmet; Yazici, Mehmet[Abstract not Available]Öğe Long-Term Immunesuppressive Treatment of Pemphigus Vulgaris as a Predisposing Factor for Native Valve Endocarditis: Report of Two Cases(I C R PUBLISHERS, 2011) Kayrak, Mehmet; Bacaksiz, Ahmet; Gul, Enes E.; Sonmez, Osman[Abstract not Available]Öğe Plasma concentrations of soluble CD40 ligand in smokers with acute myocardial infarction: a pilot study(SPRINGER, 2011) Kayrak, Mehmet; Bacaksiz, Ahmet; Ulgen, Mehmet S.; Vatankulu, Mehmet Akif; Zengin, Kadriye; Ayhan, Selim S.; Basarali, Mustafa KemalCoronary artery disease (CAD) is believed to be the single leading cause of death in both men and women in the world. Smoking is the most important risk factor for CAD. Smoking increases platelet aggregation and thrombus formation. CD40 ligand (CD40L) is a transmembrane glycoprotein derived from activated platelets. It participates in thrombus formation during the acute phase of acute myocardial infarction (MI). Elevation of CD40L identifies the patients who are at highest risk for cardiac events and who are likely to benefit from treatment with the glycoprotein IIb/IIIa (GPIIb/IIIa) receptor antagonists. The purpose of this study was to evaluate levels of CD40L in smokers with acute MI. Fifty-seven patients with acute MI were enrolled in this study. Thirty-one smokers were compared with 26 non-smokers. Soluble CD40L level in the plasma was determined by a standard enzyme-linked immunosorbent assay. Circulating levels of CD40L were higher in the smokers' group. Smokers with acute MI may have increased risk for thrombotic complications during acute MI, and optimal antiaggregant therapy should be administered.
