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The accordion phenomenon of the left anterior descending (LAD) artery
(2013) Avcı, Ahmet; Demir, Kenan
Akordiyon fenomeni rutin anjioplasti sırasında sert klavuz telin kıvrımlı damarlara yaptığı mekanik etki sonrasında şekil ve geometrisinin değişimiyle damar duvarının kısalması ve iç içe geçmesiyle oluşur. Bütün koroner arterler ve sol internal mammarial arter greftinde görülebilmesine rağmen left sol ön inen arterde oldukça nadirdir. Trombüs, spasm, diseksiyon gibi olası ciddi alternatif teşhislerin yanında akordiyon fenomeninin de düşünülmesi hastaya yapılabilecek gereksiz müdahaleleri önleyebilir.
Aktif atriyum elektrodu yerleştirilmesi sonrası sağ atriyum delinmesi
(2013) Avcı, Ahmet; Demir, Kenan; Altunkeser, Bülent Behlül
Yirmi dört yaşında kadın hastaya kardiyoinhibitör senkop nedeniyle sağ taraftan çift odacıklı kalıcı kalp pili yerleştirildi. İşlemden beş gün sonra hastada göğüs ağrısı ve nefes darlığı gelişti. Minimal perikart sıvısı ve sağda hemopnömotoraks tespit edildi. Aktif atriyum elektrodunun sağ atriyum duvarını, perikardı ve plevrayı delerek sağ atriyum apendiksinin hemen üzerindeki sağ akciğer orta bölgesine girdiği görüldü. Elektrot başarılı bir şekilde çıkarılarak aynı seansta pasif bipolar atriyum elektrodu sorunsuz olarak yerleştirildi.
Aneroid sfigmomanometreyle ölçülen brakiyal arter basıncının santral aortik basınçla karşılaştırılması ve farka etki eden faktörler
(2008) Kayrak, Mehmet; Ülgen, Mehmet S.; Yazıcı, Mehmet; Demir, Kenan; Doğan, Yıldız; Koç, Fatih; Zengin, Kadriye
Amaç: Aneroid sfigmomanometreyle alınan brakiyal arter kan basıncı (KB) ölçümleri ile çıkan aorttan alınan KB ölçümleri karşılaştırılarak iki ölçüm yöntemi arasındaki sapmaya etki eden temel faktörler araştırıldı. Ça lış ma pla nı: Çalışmaya, rutin koroner anjiyografi işlemine alınan 463 hasta (177 kadın, 286 erkek, ort. yaş 6011) alındı. Tüm hastalarda çıkan aorttan pigtail kateter aracılığıyla yapılan invaziv KB ölçümleriyle eşzamanlı olarak, sağ koldan aneroid sfigmomanometre ile brakiyal arter KB ölçümleri yapıldı. Sistolik ve diyastolik KB değerlerinden, nabız basıncı (NB), fraksiyone NB ve pulsatilite indeksleri hesaplandı. Bul gu lar: Brakiyal sistolik ve diyastolik KB değerleri, çıkan aorttan alınan ölçümlerden sırasıyla -3.110 mmHg ve 3.07.1 mmHg farklılık gösterdi (p0.001). İki yöntemle ölçülen sistolik KB değerleri kadınlar ve erkekler arasında anlamlı farklılık göstermedi; ancak, brakiyal diyastolik KB kadınlarda anlamlı sapma gösterdi (4.8 mmHg, p0.0001). Sfigmomanometre ile yapılan ölçümde diyastolik KB düzeyindeki sapma 60 yaş ve üzerindeki hastalarda daha fazlaydı (sırasıyla 4.5 mmHg ve 1.1 mmHg, p0.0001). Hipertansiflerde sistolik KB için belirlenen sapma, normotansiflerdekinden fazlaydı (-4 mmHg ve -2.0 mmHg, p0.04). Sistolik KB düzeylerindeki sapma, çıkan aorttan ölçülen sistolik KB düzeyiyle birlikte artmaktaydı (p0.0001). Diyabet ve hipertansiyonun birlikte görüldüğü hastalarda, iki yöntem arasındaki sapma sistolik KB için -5.8 mmHg (p0.01), diyastolik KB için 4.2 mmHg (p0.03) bulundu. Beden kütle indeksi ve kol çevresi ile iki yöntem arasındaki sapma ilişkili değildi. So nuç: İki yöntemle elde edilen KB değerleri arasındaki anlamlı farkları etkilediği bulunan temel faktörler (cinsiyet, yaş, KB yüksekliği ve diyabet varlığı) klinik pratikte dikkate alınmalıdır.
Arterial Stiffness and Carotid Intima-Media Thickness in Diabetic Peripheral Neuropathy
(INT SCIENTIFIC LITERATURE, INC, 2014) Avci, Ahmet; Demir, Kenan; Kaya, Zeynettin; Marakoglu, Kamile; Ceylan, Esra; Ekmekci, Ahmet Hakan; Yilmaz, Ahmet
Background: We investigated the relationship between peripheral neuropathy and parameters of arterial stiffness and carotid intima media thickness (CIMT) in patients with type 2 diabetes mellitus (T2DM). Material/Methods: The study included 161 patients (80 females and 81 males), 69 of whom had peripheral neuropathy. All patients underwent 24-h blood pressure monitoring, and arterial stiffness parameters were measured. The CIMT was measured using B- mode ultrasonography and patients also underwent transthoracic echocardiographic examination. Results: Patients with peripheral neuropathy, compared with those without it, were older (54.68 +/- 8.35 years vs. 51.04 +/- 7.89 years; p= 0.005) and had T2DM for longer periods (60 vs. 36 months; p= 0.004). Glycated hemoglobin (HbA1c) values (8.55 +/- 1.85 mg/dL vs. 7.30 +/- 1.51 mg/dL; p<0.001), pulse wave velocity (PWV) (7.74 +/- 1.14 m/s vs. 7.15 +/- 1.10 m/s; p= 0.001), CIMT (anterior 0.74 +/- 0.15 mm vs. 0.67 +/- 0.13 mm; p= 0.01), and left ventricular mass (LVM) index (98.68 +/- 26.28 g/m(2) vs. 89.71 +/- 19.70 g/m(2); p= 0.02) were all significantly increased in the group with peripheral neuropathy compared to the group without peripheral neuropathy. We determined that duration of diabetes, HbA1c, and LVM index were predictors of peripheral neuropathy. Conclusions: A significant relationship was found between diabetic neuropathy and increased PWV, a parameter of arterial stiffness, as well as CIMT, a marker of systemic atherosclerosis. Diabetic peripheral neuropathy may be a determinant of subclinical atherosclerosis in T2DM.
Assessment of atrial electromechanical delay and P-wave dispersion in patients with type 2 diabetes mellitus
(ELSEVIER, 2016) Demir, Kenan; Avci, Ahmet; Kaya, Zeynettin; Marakoglu, Kamile; Ceylan, Esra; Yilmaz, Ahmet; Ersecgin, Ahmet
Objectives: Diabetes mellitus is an independent and strong risk factor for development of atrial fibrillation (AF). Electrophysiologic and electromechanical abnormalities are associated with a higher risk of AF. In this study we aimed to determine the correlation of atrial conduction abnormalities between the surface electrocardiographic and tissue Doppler echocardiographic measurements in type 2 diabetes mellitus (T2DM) patients. Methods: A total of 88 consecutive T2DM patients and 49 age-, gender-, and body mass index-matched healthy volunteers were included in the present study. Baseline characteristics were recorded and 24 hour ambulatory blood pressure monitoring, transthoracic echocardiography, and 12-lead surface electrocardiography were performed for all study participants. Atrial electromechanical delay (EMD) intervals were measured. Results: Maximum P-wave duration and P-wave dispersion (Pd) were significantly higher in patients with T2DM (105.7 +/- 10.2 ms vs. 102.2 +/- 7.5 ms, p = 0.02; 40.6 +/- 7.6 ms vs. 33.6 +/- 5.9 ms, p < 0.001, respectively). Interatrial, intraatrial, and intraleft atrial EMD were significantly higher in the T2DM patients when compared with the controls (16.5 +/- 7.8 ms vs.11.2 +/- 4.4 ms, p < 0.001; 9.0 +/- 7.3 ms vs. 6.0 +/- 3.8 ms, p = 0.002, and 7.4 +/- 5.2 ms vs. 5.1 +/- 3.2 ms, p = 0.002 respectively). Correlation analysis showed a positive correlation between interatrial EMD and Pd (r = 0.429, p < 0.001) and left atrial volume (r = 0.428,p < 0.001). Conclusions: In this study, there was significant EMD and Pd in patients with T2DM as compared with healthy volunteers. Additionally, interatrial EMD was correlated with Pd and left atrial volume index. (C) 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
Assessment of Inhomogeneities of Repolarization in Patients with Systemic Lupus Erythematosus
(WILEY, 2014) Avcı, Ahmet; Demir, Kenan; Altunkeser, Bülent Behlül; Yılmaz, Sema; Yılmaz, Ahmet; Erseçgin, Ahmet; Demir, Tarık
Objectives: Systemic lupus erythematosus (SLE) is a chronic disease that affects many organ systems and manifests a broad spectrum of laboratory and clinical features. SLE patients have an increased risk of developing cardiovascular disease. The aim of this study was to evaluate inhomogeneities of repolarization by using T-peak-T-end (Tp-e) interval and Tp-e/QT ratio were measured from the 12-lead surface electrocardiogram (ECG) in patients with SLE. Material and method: This study included 69 SLE patients (69 females; mean age 35.8 +/- 10.2) and 57 control subjects (57 females; mean age 34.5 +/- 8.9). Transthoracic echocardiographic examination was done in all participants. QT parameters, Tp-e intervals and Tp-e/QT ratio were measured from the 12-lead ECG. These parameters were compared between groups. Results: No statistically significant difference was found between two groups in terms of basic characteristics. Diastolic function parameters were similar between the two groups (P > 0.05). In electrocardiographic parameters analysis, QT dispersion (QTd) and corrected QT dispersion (cQTd) were significantly increased in SLE patients compared the control group (49.5 +/- 16.4 ms vs. 32.8 +/- 11.7 ms and 56.7 +/- 19.5 ms vs. 36.4 +/- 13.1 ms, all P value < 0.001). Tp-e interval and Tp-e/QT ratio were also significantly higher in SLE patients (82.8 +/- 18.9 vs. 72.4 +/- 17.6 and 0.22 +/- 0.05 vs. 0.19 +/- 0.05, P = 0.002 and P = 0.001, respectively). Tp-e interval and Tp-e/QT were positively correlated with disease duration (r = 0.29, P = 0.01 and r = 0.24, P = 0.04, respectively). Conclusion: Our study revealed that QTd, cQTd, Tp-e interval and Tp-e/QT ratio increased in patients with SLE. Also, Tp-e interval and Tp-e/QT were positively correlated with disease duration.
Atorvastatin did not prevent recurrence of atrial fibrillation in addition to antiarrhythmic therapy after electrical cardioversion
(OXFORD UNIV PRESS, 2007) Can, İlknur; Demir, Kenan; Özdemir, Kurtuluş; Altunkeser, Bülent Behlül; Tokaç, M.; Gök, Hasan
[Abstract not Available]
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, Alpay
Objective: 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, Basel
Brugada syndrome with atypical characteristics: Case report
(2013) Arı, Hatem; Koyuncu, Ferudun; Avcı, Ahmet; Demir, Kenan; Altunkeser, Bülent Behlül
The Brugada Syndrome (BrS) is a heterogeneous genetic disease characterized by persistent or transient ST-segment elevation in the right precordial electrocardiography (ECG) leads and a high incidence of sudden death and life-threatening ventricular tachyarrhythmias in patients with structurally normal hearts. The syndrome generally manifests in men during adulthood. The ECG manifestations can be overt or concealed. We report a case of BrS whose type 1 ECG pattern during febrile state converted to type 2 ECG after alleviation of fever with atypical characteristics (78-year-old woman with monomorphic ventricular tachycardia on holter monitoring, a history of the sudden infant death of her child, and without inducible ventricular arrhythmia by programed ventricular stimulation [PVS]). © 2012 Egyptian Society of Cardiology. Production and hosting by Elsevier B.V.
Can neutrophil/lymphocyte ratio predict recurrence of non-valvular atrial fibrillation after cardioversion?
(TURKISH SOC CARDIOLOGY, 2013) Arıbaş, Alpay; Akıllı, Hakan; Gül, Enes Elvin; Kayrak, Mehmet; Demir, Kenan; Duman, Çetin; Alibaşiç, Hayruddin
Objective: High neutrophil/lymphocyte ratio (NLR) has been associated with post-operative AF development in patients who underwent cardiac surgery. In this study, effectiveness of NLR for prediction of recurrence after electrical cardioversion (CV) in non-valvular AF was investigated. Methods: A total of 149 patients who underwent a successful CV were included in this prospective cohort study. Baseline complete blood cell count, routine biochemical tests, high sensitive C-reactive protein (hs-CRP), and echocardiographic measurements were examined. After CV, patients were monitored over six months for recurrence. Baseline characteristics of recurrence group were compared with sinus rhythm group by using Student's t -test. Logistic regression analysis was used to determine predictors of recurrence. Results: Recurrence occurred in a total of 46 patients (30.9%). Median AF duration [16 (IQR:14.25) vs. 12 (IQR: 11) months, p=0.01], baseline hs-CRP [9.80 (IQR:8.50) mg/dL vs. 4.28 (IQR:5.65) mg/dL, p=0.002] and left atrium (LA) diameter (4.5 +/- 0.4 cm, 4.3 +/- 0.5 cm, p=0.023) were significantly higher in the recurrence group than sinus rhythm group. Median NLR was comparable in recurrence and sinus groups [2.38 (IQR:2.09) vs. 2.23, (IQR: 1.23) p=0.96, respectively]. There was a weak correlation between NLR and hs-CRP (r=0.22, p=0.05) and age (r=0.24, p=0.02). In multiple logistic regression analysis, hs-CRP [OR: 1.34 (1.09-1.65 95% CI) p=0.006], LA diameter [OR: 11.92 (1.84-77.07 95% CI) p=0.01], spontaneous echo contrast positivity, [OR: 5.40 (1.04-12.02 95% CI) p=0.045] and systolic blood pressure [OR: 1.05 (1.01-1.10 95% CI) p=0.03] were independent predictors of AF recurrence. Conclusion: NLR failed to predict AF recurrence after a successful electrical CV, but hs-CRP remained an inflammatory marker of AF recurrence. (Anadolu Kardiyol Derg 2013; 13: 123-30)
Carbon Monoxide Poisoning Presenting with Atrial Fibrillation
(MODESTUM LTD, 2015) Avci, Ahmet; Yilmaz, Ahmet; Demir, Kenan; Celik, Mustafa; Karatas, Recep
Carbon monoxide intoxication is one of the most common types of poisoning and it is the leading cause of death by poisoning in the world. We report a carbon monoxide intoxication case presenting with atrial fibrillation on 17 years old healthy boy. 17 years old boy admitted to emergency service after exposuring carbon monoxide gas approximately 3 hours. His first electrocardiography (ECG) showed atrial fibrillation with rapidly ventricular response. After oxygen supply sinus rhythm was achieved spontaneously. Emergency physicians should be aware of the clinical presentation of carbon monooxide intoxication. Every patient that arrived emergency service with acute or chronically carbon monoxide poisoning should undergo cardiovascular investigation, including ECG and measurement of cardiac enzymes.
Circadian Rhythm of Infarct Size and Left Ventricular Function Evaluated with Tissue Doppler Echocardiography in ST Elevation Myocardial Infarction
(ELSEVIER SCIENCE INC, 2016) Arı, Hatem; Sönmez, Osman; Koç, Fatih; Demir, Kenan; Alihanoğlu, Yusuf İzzettin; Özdemir, Kurtuluş; Vatankulu, Mehmet Akif
Background We aimed to investigate the circadian rhythm on left ventricular (LV) function and infarct size, according to the onset of ST elevation myocardial infarction (STEMI), with echocardiography in patients with first STEMI successfully revascularised with primary percutaneous coronary intervention (PCI). Methods We conducted a retrospective analysis of 252 STEMI patients. Patients were divided into the four, six-hour periods of the day. Conventional and tissue Doppler imaging (TDI) echocardiography were performed within 48 hours after onset of chest pain. The average of peak systolic myocardial velocities (Sm) in each of the four myocardial segments and LV ejection fraction (LVEF) were calculated. Results A negative linear correlation was shown between CK-MB levels and Sm (r= -0.209, p = 0.001). There was an oscillation between time of day and average of Sm. The lowest Sm and largest infarct size were in the period of 06: 00-noon compared with period of noon-18: 00 and 18: 00-midnight (p = 0.029 and p = 0.031, respectively). A secondary analysis showed that both LVEF and Sm were lower in the midnight-noon group compared with the noon-midnight group (44.9 +/- 7.3% versus 47.3 +/- 7.9%, p = 0.018, and 7.6 +/- 1.4 cm/s versus 8.2 +/- 1.6 cm/s, p= 0.003, respectively). Conclusions This study has shown that there was a circadian rhythm of infarct size and LV function evaluated by echocardiography according to time of STEMI onset. The largest infarct size and poor LV function occurred in the midnight-noon period, in particular in the 06: 00-noon period.
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, Fikret
Objective: 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.
Comparison Between Prospectively Electrocardiogram-Gated High-Pitch Mode and Retrospectively Electrocardiogram- Gated Mode for Dual-Source CT Coronary Angiography
(INT SCIENTIFIC INFORMATION INC, 2015) Koplay, Mustafa; Celik, Mahmut; Avci, Ahmet; Erdogana, Hasan; Demir, Kenan; Sivri, Mesut; Nayman, Alaaddin
Background: We aimed to report the image quality, relationship between heart rate and image quality, amount of contrast agent given to the patients and radiation doses in coronary CT angiography (CTA) obtained by using high-pitch prospectively ECG-gated "Flash Spiral" technique (method A) or retrospectively ECG-gated technique (method B) using 128x2-slice dual-source CT. Material/Methods: A total of 110 patients who were evaluated with method A and method B technique with a 128x2-detector dual-source CT device were included in the study. Patients were divided into three groups based on their heart rates during the procedure, and a relationship between heart rate and image quality were evaluated. The relationship between heart rate, gender and radiation dose received by the patients was compared. Results: A total of 1760 segments were evaluated in terms of image quality. Comparison of the relationship between heart rate and image quality revealed a significant difference between heart rate <60 beats/min group and >75 beats/min group whereas <60 beats/min and 60-75 beats/min groups did not differ significantly. The average effective dose for coronary CTA was calculated as 1.11 mSv (0.47-2.01 mSv) for method A and 8.22 mSv (2.19-12.88 mSv) for method B. Conclusions: Method A provided high quality images with doses as low as <1 mSv in selected patients who have low heart rates with a high negative predictive value to rule out coronary artery disease. Although method B increases the amount of effective dose, it provides high diagnostic quality images for patients who have a high heart rate and arrhythmia which makes it is difficult to obtain images.
A Comparison of Blood Pressure and Pulse Pressure Values Obtained by Oscillometric and Central Measurements in Hypertensive Patients
(Taylor & Francis Ltd, 2010) Kayrak, Mehmet; Ülgen, Mehmet Sıddık; Yazıcı, Mehmet; Yılmaz, Remzi; Demir, Kenan; Doğan, Yıldız; Özhan, Hakan; Alihanoğlu, Yusuf İzzettin; Koç, Fatih; Bodur, Sait
Objective. Wide pulse pressure (PP) affects the accuracy of oscillometric blood pressure measurements (OBPM): however, the degree of this impact on different patient groups with wide PPs is unclear. This study will investigate the accuracy of OBPM in achieving target BP and PP in isolated systolic hypertension (ISH) group compared with mixed hypertension (MHT) group. Method. A total of 115 patients (70 with ISH and 45 with MHT) were enrolled in the study. Upper arm and wrist OBPM, obtained by OmronM3 and OmronR6 devices respectively, were compared with the simultaneously measured values from the ascending aorta. The ISH was defined as a systolic blood pressure (SBP) >= 140 mmHg and a diastolic blood pressure (DBP) < 90 mmHg. MHT was defined as a SBP >= 140 mmHg and a DBP >= 90 mmHg. Results. The mean central arterial blood pressure (BP) and central PP were higher in the ISH group than those in the MHT group. The upper arm OBPM underestimated the central SBP in two groups (-5 mmHg, -3 mmHg, p=0.5, respectively), but overestimated DBP in the ISH group compared with MHT patients (6.8 mmHg, 1 mmHg, p=0.04, respectively). Wrist OBPM similarly underestimated to the central SBP in each group (-16 mmHg, -19 mmHg, p=0.15), whereas the sum of overestimation of DBP was significantly higher in the ISH than in the MHT group (+6 mmHg, - 1 mmHg, p=0.001, respectively). Also, each of the devices underestimated the central PP in the ISH group (about 10 mmHg) as being higher than that of the MHT group. Conclusion. Oscillometric devices may be used for self-BP measurement in patients with ISH without clinically important disadvantages compared with the patients with MHT. For PP measurement in patients with ISH, there were substantial differences between intra-arterial and indirect arm BP measurements.
Determination of Physical Activity Levels of Men and Women in the 20- 30 Age Range: The Case of Batman Province
(Selçuk Üniversitesi, 2020 Nisan) Boz, Hilal Kılınç; Bayrakdar, Akan; Demir, Kenan
The aim of this study is to determine the Physical Activity Levels of Men and Women between the ages of 20-30. The universe of the study included men and women living in the province of Batman; The sample included the voluntary men and women aged 20-30 who were living in the province of Batman. There are a total of 1524 people, 762 men and 762 women. A questionnaire consisting of two parts as socio-demographic characteristics and international physical activity questionnaire. SPSS package program is used in the calculation of the obtained filtering. In the 1524 computers for the study, 732 of them are between the ages of 20-25 and 792 of them are between 26-30 years of age. According to the findings of our study, both women and men had high levels of physical activity. There was a significant difference at the level of p <0.001 between the physical activity levels of women and men. In addition, although there was no statistical relationship between age and physical activity level, it was determined that the physical activity level decreased as the age progressed. As a result, it can be said that the level of physical activity decreases in both women and men as the age progresses.
Diagnostic accuracy and effective radiation dose of high pitch dual source multidetector computed tomography in evaluation of coronary artery bypass graft patency
(SPRINGER WIEN, 2016) Koplay, Mustafa; Guneyli, Serkan; Akbayrak, Hakan; Demir, Kenan; Sivri, Mesut; Avci, Ahmet; Erdogan, Hasan
The aim of the study was to evaluate the diagnostic accuracy and effective radiation dose (ERD) of high pitch dual source multidetector computed tomography (MDCT) for coronary artery bypass graft (CABG) patency. Fourty-five patients who underwent 128 x 2aEuroslice MDCT angiography with a prospective electrocardiogram-triggering, low-dose, high pitch, dual source, flash spiral acquisition mode after CABG surgery were included in the study. The interobserver agreement of the image quality was evaluated with Cohen kappa value. The image quality was compared to the heart rates (HRs) using Mann-Whitney U test and to the graft segments using chi(2) test. The findings for the CABG patency on MDCT were compared to those determined on catheter coronary angiography. Dose-length product (DLP) and ERD were compared to the gender, HRs, and body mass index (BMI) of the patients using Kruskall Wallis and Mann-Whitney U tests. A total of 110 grafts and 330 vessel segments were evaluated with a good interobserver agreement (kappa = 0.80). The image quality was better in proximal and middle graft segments (p < 0.05), as well as in the patients with low HRs (p < 0.05). High pitch MDCT had the following sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for evaluation of graft patency: 92.8, 99.3, 92.8, 99.3 and 98.8 %, respectively. ERD was correlated to the HRs and BMI. High pitch 128 x 2aEuroslice dual source CT angiography is a noninvasive imaging modality, and it can be safely and effectively used in evaluation of CABG patency with lower radiation dose.
Does Spironolactone Have a Dose-Dependent Effect on Left Ventricular Remodeling in Patients with Preserved Left Ventricular Function After an Acute Myocardial Infarction?
(WILEY-HINDAWI, 2013) Vatankulu, Mehmet Akif; Bacaksız, Ahmet; Sönmez, Osman; Alihanoğlu, Yusuf İzzettin; Koç, Fatih; Demir, Kenan; Gül, Enes Elvin
Aims The aim of this study was to investigate the effects of spironolactone on left ventricular (LV) remodeling in patients with preserved LV function following acute myocardial infarction (AMI). Methods and Results Successfully revascularized patients (n=186) with acute ST elevation MI (STEMI) were included in the study. Patients were randomly divided into three groups, each of which was administered a different dose of spironolactone (12.5, 25mg, or none). Echocardiography was performed within the first 3days and at 6months after MI. Echocardiography control was performed on 160 patients at a 6-month follow-up. The median left ventricular ejection fraction (LVEF) increased significantly in all groups, but no significant difference was observed between groups (P=0.13). At the end of the sixth month, the myocardial performance index (MPI) had improved in each of the three groups, but no significant difference was found between groups (F=2.00, P=0.15). The mean LV peak systolic velocities (S-m) increased only in the control group during the follow-up period, but there is no significant difference between groups (F=1.79, P=0.18). The left ventricular end-systolic volume index (LVESVI) and the left ventricular end-diastolic volume index (LVEDVI) did not change significantly compared with the basal values between groups (F=0.05, P=0.81 and F=1.03, P=0.31, respectively). Conclusion In conclusion, spironolactone dosages of up to 25mg do not augment optimal medical treatment for LV remodeling in patients with preserved cardiac functions after AMI.
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, Alpay
Amaç: 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.
Fragmented QRS in patients with systemic lupus erythematosus
(TAYLOR & FRANCIS LTD, 2014) Demir, Kenan; Avcı, Ahmet; Yılmaz, Sema; Demir, Tarık; Erseçgin, Ahmet; Altunkeser, Bülent Behlül
Introduction. Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with a variety of clinical features. Cardiac involvement is present in more than half of the patients with SLE. Fragmentation of QRS (fQRS) is presumed marker of cardiovascular risk and has not been previously evaluated in SLE. Methods. A total of 56 women previously diagnosed with SLE were recruited. In addition, a control group consisting of 51 healthy people was formed. QRS complexes were also evaluated in terms of fragmentations. All patients with SLE and control subjects underwent transthoracic echocardiographic examination. Erythrocyte sedimentation rate and C-reactive protein levels were also obtained. Results. Frequency of fQRS was higher in patients with SLE (41% vs. 21%, p = 0.03). Left ventricular posterior wall thickness and mass index were higher in the patients with SLE. CRP levels and age were significantly higher, and disease duration was significantly longer in the fQRS(+) group (p = 0.02, 0.01, and 0.006, respectively). Conclusion. A careful cardiovascular evaluation and follow-up is essential to continuously improve survival in SLE. For this purpose, fQRS may be used for the early detection in patients with SLE.

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