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    The association between serum angiogenin and osteopontin levels and coronary collateral circulation in patients with chronic total occlusion
    (TURKISH SOC CARDIOLOGY, 2019) Gürses, Kadri Murat; Yalçın, Muhammed Ulvi; Koçyiğit, Duygu; Beşler, Muhammed Said; Canpınar, Hande; Evranos, Banu; Yorgun, Hikmet; Şahiner, Mehmet Levent; Kaya, Ergün Barış; Özer, Necla; Güç, Dicle; Aytemir, Kudret; Tokgözoğlu, Lale
    Objective: A well-developed coronary collateral circulation lowers both in-hospital and long-term morbidity and mortality limiting the infarct. Angiogenin (AGN) and osteopontin (OPN) are known to be potent inducers of angiogenesis. The aim of the present study was to investigate the relationship between serum ANG and OPN levels and collateral filling grade in subjects with stable coronary artery disease (SCAD). Methods: A total of 122 age- and gender-matched consecutive patients who were found to have total occlusion (n=70) and no significant stenosis in epicardial coronary arteries (n=52) who underwent coronary angiography due to SCAD between January 2015 and July 2017 were included in the study. AGN and OPN levels were measured using enzyme-linked immunosorbent assay. Coronary collateral circulation was graded using Rentrop's classification of collateral filling. Results: A total of 52 patients (61.60 +/- 11.78 years, 61.5% male) without significant epicardial coronary artery stenosis and 70 patients (62.87 +/- 8.24 years, 65.7% male) with totally occluded coronary arteries were included in the study. Subjects with total occlusion had significantly higher levels of AGN [122.00 (79.00-623.00) pg/mL vs. 98.00 (18.00-160.00) pg/mL, p<0.0011 and OPN [1863.50 (125.00-6500.00) pg/mL vs. 451.00 (112.00-1850.00) pg/mL, p<0.0011 than those without significant stenosis. In addition, AGN [127.00 (87.00-623.00) pg/mL vs. 110.00 (79.00-188.00) pg/mL, p=0.0111 and OPN [2681.00 (126.00-6500.00) pg/mL vs. 649.00 (125.00-4255.00) pg/mL, p=0.0011 levels were significantly higher in patients with better developed collaterals. Serum AGN and OPN levels were found to be significantly associated with coronary collateral development. Conclusion: AGN and OPN are associated with better developed coronary collateral circulation and may have therapeutic implications for the promotion of coronary collateral development.
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    Impact of anatomical features of the left atrial appendage on outcomes after cryoablation for atrial fibrillation
    (ELSEVIER SCIENCE INC, 2019) Kocyigit, Duygu; Yalcin, Muhammed Ulvi; Gurses, Kadri Murat; Turk, Gamze; Ardali, Selin; Canpolat, Ugur; Evranos, Banu; Yorgun, Hikmet; Hazirolan, Tuncay; Aytemir, Kudret
    Aims: Pulmonary vein isolation (PVI) using cryoballoon has been accepted as a safe and effective method for treatment of atrial fibrillation (AF). Despite advances in catheter-based technologies, some patients still experience AF recurrence. In this study, we aimed to compare left atrial appendage (LAA) morphology in AF patients and subjects with sinus rhythm and also investigate the association between LAA morphology and success of PVI using cryoballoon in subjects with AF. Methods: In this prospective study, 359 AF patients who underwent pre-ablation computed tomographic angiography (CTA) scan between January 2013-March 2016 were included as the patient group. 100 age and gender-matched subjects in sinus rhythm who had no AF episodes in 24-h Holter monitoring that underwent CTA were included as the control group. Results: Non-chicken wing LAA morphology was more common in AF patients (p < 0.001). LAA was significantly deeper (p < 0.001) and short-axis diameter of LAA orifice and LAA orifice area were significantly larger (p < 0.001) in AF patients. Low take-off type morphology of LAA was more common in controls compared to AF patients (p = 0.006). At a median follow-up of 37 months, only longitudinal-axis left atrial diameter on CT (p = 0.003) and cauliflower-type LAA morphology (p = 0.004) were independent predictors of AF recurrence. Conclusion: This is the first study in the literature that investigates the relationship between anatomical variations of LAA and AF recurrence following cryoablation. Our findings demonstrate that cauliflower-type LAA morphology is associated with two-fold increased risk of AF recurrence.
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    Long-term outcomes of pulmonary vein isolation using second-generation cryoballoon during atrial fibrillation ablation
    (WILEY, 2019) Canpolat, Ugur; Kocyigit, Duygu; Yalcin, Muhammed Ulvi; Coteli, Cem; Sener, Yusuf Ziya; Oksul, Metin; Gurses, Kadri Murat; Evranos, Banu; Yorgun, Hikmet; Aytemir, Kudret
    Background Currently available second-generation cryoballoon (CB2) is accepted as an effective and safe tool for pulmonary vein isolation (PVI). Although much more data exist about 1-year outcomes of CB2 ablation, data on long-term outcomes are scarce. Objective We aimed to assess the long-term outcomes of PVI using CB2 in a large-scale symptomatic atrial fibrillation (AF) population at our tertiary referral center. Methods In this nonrandomized prospective observational study, a total of 486 patients with paroxysmal (71%) or persistent (29%) AF who underwent index PVI using CB2 at our hospital between January 2013 and June 2017 were enrolled. Atrial tachyarrhythmia (ATa)-free survival was defined as the absence of AF, atrial flutter, or atrial tachycardia recurrence >= 30 s following a 3 months blanking period. Predictors of recurrence were evaluated by univariate and multivariate Cox proportional hazards regression models. Results Acute procedural success rate was 99.8% (1898/1902 PVs). Mean procedural and fluoroscopy time were 64.9 +/- 9.2 and 12.1 +/- 2.6, respectively. At median 39 (interquartile range: 26-56) months follow-up, ATa-free survival was 78.6% after a single procedure (280/345 [81.2%] for paroxysmal AF vs. 102/141 [72.3%] for persistent AF, P = .019) and 84.4% after a mean 1.48 +/- 0.42 ablations. Cox regression analysis showed that left atrium diameter, duration of AF history, and early ATa recurrence were found as the independent predictors of late recurrence. Phrenic nerve palsy was observed in 17 (3.5%) patients. Conclusions CB2-based PVI is effective to maintain sinus rhythm in a significant proportion of paroxysmal and persistent AF patients with an acceptable complication rate at long-term follow-up.
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    Pulmonary vein anatomy and its variations in a Turkish atrial fibrillation cohort undergoing cryoballoon-based catheter ablation
    (TURKISH SOC CARDIOLOGY, 2017) Kocyigit, Duygu; Gurses, Kadri Murat; Yalcin, Muhammed Ulvi; Turk, Gamze; Evranos, Banu; Canpolat, Ugur; Yorgun, Hikmet
    Objective: Pulmonary vein (PV) anatomy has drawn attention since assumption that atrial fibrillation (AF) may originate from PVs and that electrical isolation of PVs may be beneficial in eliminating these triggers. The present study aims to investigate PV anatomy and its variations in a sample of Turkish patients undergoing PV isolation (PVI) for AF. Methods: 250 patients underwent multidetector computed tomography before cryoballoon-based PVI for AF. PV and left atrial (LA) anatomy were evaluated in 3-dimensional epicardial reconstructions. Results: 980 PVs were observed. All PVs drained into the LA. Mean superoinferior (SI) dimension for each vein was significantly larger than mean anteroposterior (AP) dimension. Accessory PVs were only seen on right side. Accessory veins were significantly smaller in both AP and SI diameter than other veins. Right-sided PV ostia were more round. Expected anatomy of 2 atrial ostia for right upper and lower lobe veins on each side was seen in 94.8% of patients. Remainder had other variant anatomy in right PVs. Conjoined ostium in the LA was seen in 35.6% of patients. Conclusion: PV variations were common in Turkish AF cohort undergoing PVI, which may be important to know about prior to ablation therapy for procedural success.
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    Serum galectin-3 level as a marker of thrombogenicity in atrial fibrillation
    (WILEY, 2017) Kocyigit, Duygu; Gurses, Kadri Murat; Yalcin, Muhammed Ulvi; Canpinar, Hande; Canpolat, Ugur; Evranos, Banu; Yorgun, Hikmet
    BackgroundLeft atrial appendage flow velocity (LAAFV) and presence of spontaneous echo contrast (SEC) have been reported to be predictors of thromboembolism in atrial fibrillation (AF) patients. Galectin-3 is a biomarker reflecting pro-inflammatory status, whose role in AF has recently drawn attention, particularly in persistent AF population. AimIn this study we aimed to investigate the association between serum galectin-3 levels and echocardiographic predictors of thromboembolism in persistent AF patients. MethodsWe included 65 persistent AF patients (55.5010.67years, 46.15% male). Transesophageal echocardiography (TEE) was performed to assess LAAFV and presence of left atrial (LA)/LA appendage (LAA)-located SEC and thrombus prior to direct current cardioversion or catheter ablation for AF. ResultsMedian galectin-3 level was 0.63ng/mL. Serum galectin-3 levels were significantly correlated with LAAFV (r=-.440, P<.001). Serum galectin-3 levels were associated with presence of SEC (P<.001), and LA thrombus (P=.008). Receiver operating characteristic analysis revealed that a serum galectin-3 greater or equal to the cut-off value of 0.69 predicted presence of SEC with a sensitivity and specificity of 91.00% and 79.00%, respectively (P<.001). ConclusionIn conclusion, in the setting of persistent AF, serum galectin-3 levels are associated with presence of SEC and LAAFV on TEE. Our findings suggest that serum galectin-3 level may have a place in thromboembolism risk stratification in persistent AF patients.