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Öğe Association Between Exaggerated Blood Pressure Response to Exercise and Serum Asymmetric Dimethylarginine Levels(Japanese Circulation Soc, 2010) Kayrak, Mehmet; Bacaksız, Ahmet; Vatankulu, Mehmet Akif; Ayhan, Selim S.; Taner, Alparslan; Ünlü, Ali; Yazıcı, Mehmet; Ülgen, Mehmet S.Background: The exaggerated blood pressure response to exercise (EBPR) is an independent predictor of hypertension. Asymmetric dimethylarginine (ADMA) is an endogenous nitric oxide inhibitor and higher plasma levels of ADMA are related to increased cardiovascular risk. The aim of this study is to identify the relationship between ADMA and EBPR. Methods and Results: A total of 66 patients (36 with EBPR and 30 as controls) were enrolled in the study. EBPR is defined as blood pressure (BP) measurements >= 200/100 mmHg during the treadmill test. All the subjects underwent 24-h ambulatory BP monitoring. L-arginine and ADMA levels were measured using a high performance lipid chromatography technique. The serum ADMA levels were increased in the EBPR group compared to the healthy controls (4.0 +/- 1.4 vs 2.6 +/- 1.1 mu mol/L respectively, P=0.001), but L-arginine levels were similar in the 2 groups (P=0.19). The serum ADMA levels were detected as an independent predictor of EBPR (odds ratio 2.28; 95% confidence interval 1.22-4.24; P=0.002). Conclusions: Serum ADMA levels might play a role in EBPR to exercise.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 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 AkifBackground 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.Öğe 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 ElvinAims 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.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 The Effect of Smoking on Myocardial Performance Index in Middle-Aged Males after First Acute Myocardial Infarction(WILEY, 2013) Bacaksız, Ahmet; Kayrak, Mehmet; Vatankulu, Mehmet Akif; Ayhan, Selim S.; Sönmez, Osman; Akıllı, Hakan; Arıbaş, AlpayBackground: Cigarette smoking is associated with increased rates of coronary artery disease and acute myocardial infarction (MI). Paradoxically, smokers had lower mortality after MI. The purpose of this study was to evaluate the effect of chronic smoking on myocardial performance index (MPI) in middle-aged men after an acute MI. Material and methods: A total of 429 patients (325 smokers vs. 104 nonsmokers) presenting with acute ST elevation MI were enrolled in this study. Thrombolysis in myocardial infarction (TIMI) flow of the infarct related artery was measured before and after the primary percutaneous coronary intervention (PCI), and Gensini score was also calculated. Conventional echocardiography and tissue Doppler echocardiography (TDI) were performed within 4872hours after onset of chest pain. Peak early (Em) and late (Am) diastolic velocities, peak systolic (Sm) mitral annular velocities and time intervals were recorded with TDI. The MPI, ratio of Em/Am, and E/Em were calculated. Results: Baseline demographic and angiographic characteristics such as Gensini score, pre and, post PCI TIMI flow were similar in 2 groups. In contrast, LV MPI was preserved among smokers (0.59 +/- 0.15 vs. 0.66 +/- 0.14, P=0.01), and Em/Am values were also higher in smokers (0.84 +/- 0.28 vs. 0.75 +/- 0.31, P=0.01). Independent predictors of impaired MPI (0.60) were determined as nonsmoking status (odds ratio 2.940, 95% CI 0.985.83, P=0.05), left anterior descending artery stenosis (odds ratio 3.196, 95% CI 1.735.91 P=0.001), and, age (odds ratio 1.12, 95% CI 1.031.22, P=0.01). Conclusions: Despite similar demographic and angiographic characteristics, smoker males had a paradoxically better MPI after acute MI.Öğe Exaggerated Blood Pressure Response to Exercise - A New Portent of Masked Hypertension(Taylor & Francis Inc, 2010) Kayrak, Mehmet; Bacaksız, Ahmet; Vatankulu, Mehmet Akif; Ayhan, Selim S.; Kaya, Zeynettin; Ari, Hatem; Sönmez, Osman; Gök, HasanMasked hypertension (MHT) is a popular entity with increased risk of developing sustained hypertension, heart attack, stroke, and death. Subjects have normal blood pressure (BP) at office but elevated values at night so it is difficult to diagnose. Exaggerated blood pressure response to exercise (EBPR) is also a predictor of future hypertension. To investigate the relationship between these two entities, we evaluated 61 normotensive subjects with EBPR. The subjects underwent 24-h ambulatory blood pressure monitoring (ABPM). The prevalence of masked hypertension among subjects with EBPR was 41%. Body mass index (BMI), non-high density lipoprotein (HDL) cholesterol, diastolic blood pressure (DBP) at peak exercise and recovery, nondipping DBP pattern, and elevated early morning average BPs were associated with masked hypertension. In multivariate logistic regression analysis, the DBP measured at peak exercise was detected as an independent predictor of MHT in subjects with EBPR. Subjects with abnormally elevated BP during exercise are prone to MHT, necessitate medical assessment and close follow-up for hypertension.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 Is diastolic dysfunction associated with atrial electrocardiographic parameters in Behcet's disease?(TAYLOR & FRANCIS LTD, 2011) Koc, Fatih; Koc, Sema; Yuksek, Jale; Vatankulu, Mehmet Akif; Ozbek, Kerem; Gul, Enes Elvin; Celik, AtacBackground The impact of Behcet's disease (BD) on the vascular bed is highly important, as this condition may lead to heart failure from asymptomatic systolic and diastolic dysfunction. Our aim was to evaluate diastolic functions using new echocardiographic parameters and the correlation of these parameters with atrial electrocardiographic (ECG) indices in patients with BD. Methods 31 patients with BD and 31 healthy control subjects were enrolled to this study. Left ventricular (LV) diastolic functions were examined with conventional and tissue Doppler echocardiography. P-wave dispersion (PD) was calculated by measuring minimum and maximum P-wave duration values on the 12-lead surface ECG, The relationship between PD and echocardiographic parameters of diastolic dysfunction were investigated. Results The mitral inflow E/A ratio and diastolic myocardial velocity ratio (Em/Am) were lower in the BD group (P < 0.001 and P < 0.001, respectively). The E/Em ratio and left atrial volume index (LAVi) were higher in the BD group (P < 0.001 and P = 0.014, respectively) compared to healthy control subjects. P max and PD were significantly higher in the BD group (P < 0.001 and P < 0.001). PD correlated positively with the duration of BD. Also, PD correlated positively with LAVi and E/Em ratio, but negatively with E/A and Em/Am ratios. Conclusion In this study, we demonstrated that LV diastolic functions are impaired in BD patients. Furthermore, P-wave abnormalities were demonstrated in BD patients and there was a significant correlation between PD and diastolic dysfunction.Öğe Isolated mitral valve prolapsus does not affect left ventricular function ınsights from tissue-doppler echocardiography(2011) Demir, Kenan; Koc, Fatih; Can, İlknur; Vatankulu, Mehmet Akif; Yazıcı, Mehmet; Ülgen, Mehmet SıddıkAmaç: İdiopatik Mitral Kapak Prolapsusu (MVP), mitral kapağın miksomatöz dejenerasyonuyla karakterizedir. MVPli hastalarda kardiyovasküler mortalitenin en önemli belirleyicisi Sol Ventrikül (LV) disfonksiyonudur. Bu yüzden biz izole MVP hastalarında doku doppler ekokardiyografi (TDE) ile LV fonksiyonunu değerlendirmeyi amaçladık. Metod: MVPli 25 hasta (ortalama yaş, 3112) çalışmaya MVP grubu olarak dahil edildi. Kontrol grubu ise yaş ve cinsiyet eşleştirilmiş 20 hastadan oluşturuldu (ortalama yaş, 349). LV fonksiyonları konvansiyonel ekokardiyografi ve TDE ile incelendi. Miyokardiyal zirve sistolik (Sm), erken (Em) ve geç (Am) diastolik dolum hızları, Em/Am, isovolumetrik kontraksiyon zamanı (ICT), isovolu- metrik relaksasyon zamanı (IRT) ve ejeksiyon zamanı (ET) ölçümleri inferior-septal ve lateral duvarın bazal segmentlerinden ölçüldü. Miyokardial performans indeksi (MPI) hesaplandı. Bulgular: MVPli hastaların 10unda (%40) hafif derecede mitral yetmezlik, 2sinde (%8) orta derecede mitral yetmezlik vardı. Diastolik parametreler açısından 2 grup arasında fark bulunamadı. TDEden hesaplanan MPI değerleri iki grupta tüm segmentlerde benzerdi. Sol ventrikül ortalama Sm ve lateral duvar Smde iki grup arasında anlamlı fark vardı (11.62.8 vs. 9.41.0, p0.001; 13.03.9 vs. 9.22.3, p0.001 sırasıyla). Sonuç: Belirgin mitral yetmezliği olmayan izole MVP sol ventrikül diastolik fonksiyonunu ve MPIyi etkilemez. Fakat, MVPli hastaların lateral duvar Sm ve LV ortalama Smsi MVPsi olmayanlara göre daha yüksekti.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.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 A Rare but Serious Complication of Percutaneous Coronary Intervention: Spinal Cord Embolism(Taylor & Francis Ltd, 2010) Vatankulu, Mehmet Akif; Kayrak, Mehmet; Alihanoğlu, Yusuf İzzettin; Sallı, Ali; Ülgen, Mehmet SıddıkBackground/Objective: Many atherothrombotic complications are associated with coronary angiography. Spinal cord embolism with high morbidity and mortality is one of these complications. Methods: Case report. Results: A 65-year-old woman was admitted to the hospital with acute myocardial infarction. Immediately after coronary angiography, she complained of paresthesia and paraparesis of her legs. Magnetic resonance imaging (MRI) detected hyperintensity at the level of the conus medullaris. Antiaggregant therapy and a physiotherapy program continued. After 2 months, clinical and MRI findings had improved. Conclusions: Invasive procedures such as coronary angiography can lead to serious atherothrombotic complications.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 The Relationship between Coronary Sinus and Impaired Right Ventricular Myocardial Performance Index in Mitral Stenosis(WILEY-BLACKWELL, 2013) Vatankulu, Mehmet Akif; Koç, Fatih; Gül, Enes Elvin; Bacaksız, Ahmet; Sönmez, Osman; Demir, Kenan; Alihanoğlu, Yusuf İzzettinObjectives: We aimed to investigate whether coronary sinus (CS) dilatation develops in patients with mitral stenosis (MS) and to demonstrate its relationship with the global myocardial performance of the right ventricle (RV). Methods: We enrolled 34 patients with MS who underwent echocardiography after exhibiting typical symptoms (31 female; mean age 41 +/- 12 years) and 20 age-and sex-matched controls without MS who underwent echocardiography (16 female; mean age 38 +/- 13 years). The RV myocardial performance index (MPI) was detected using tissue Doppler echocardiography (TDE), and maximum CS diameter was measured from the posterior atrioventricular groove in the apical fourchamber view during the ventricular systole. Results: The RV MPI was significantly higher in the MS group compared to the control group (0.60 +/- 0.11 vs. 0.41 +/- 0.08, P < 0.001). Moreover, the maximum CS dimension was higher in the MS group compared to the control group (8.5 +/- 1.1 mm vs. 6.5 +/- 1.4 mm, P < 0.001). The maximum CS dilatation was positively correlated with the RV MPI (r = 0.691; P < 0.001). Conclusion: The RV MPI, which represents both systolic and diastolic functions, is increased in patients with MS and correlates with CS dilatation.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.Öğe Sol ön inen arter proksimal lezyonlarının saptanmasında aVR derivasyonunun değeri(2006) Aygül, Nazif; Özdemir, Kurtuluş; Tokaç, Mehmet; Aydın, Meryem Ülkü; Vatankulu, Mehmet AkifAmaç: Bu çalışmada son zamanlarda elektrokardiyografinin (EKG) değerlendirilmesinde kullanımı gündeme gelen aVR derivasyonun, sol ön inen arter (SİA) proksimal lezyonlarını belirlemedeki değeri araştırıldı. Çalışma planı: Çalışmaya, tipik göğüs ağrısı nedeniyle hastaneye başvuran ve EKG’de tipik ST yükselmesi görülen akut miyokard infarktüslü (AMİ) 361 hasta (293 erkek, 68 kadın; ort. yaş 5810; dağılım 24-84) alındı. Hastaların hepsine koroner anjiyografi (KAG) yapılarak infarktüsten sorumlu arter (İSA) ve segmenti saptandı. Elektrokardiyografi değerlendirmesinde her bir derivasyonda ve aVR’de meydana gelen ST yükseklikleri ve çökmeleri kaydedildi. Hastalar aVR’de 0.5 mm ST yüksekliği varlığına göre aVR pozitif () ve negatif (-) olmak üzere iki gruba ayrıldı. Bulgular: Elektrokardiyografi değerlendirmesinde, aVR () grupta hastaların %54’ünde infarktüsten sorumlu arter SİA proksimali iken, aVR (-) grupta bu oran %9 idi (p0.001). Çokdamar hastalığı da aVR () grupta daha fazla görüldü (p0.001). aVR derivasyonunda ST segment yüksekliği Gensini skoru ile pozitif, fakat zayıf bir korelasyon göstermekteydi (r0.21, p0.002). Anterior AMİ’li hastalarda, aVR pozitifliğinin İSA’nın SİA proksimalinde olmasını göstermedeki duyarlılığı %47, özgüllüğü %91, negatif öngörü değeri %81, pozitif öngörü değeri %68 ve tanısal doğruluğu %78 olarak hesaplandı. Sonuç: Anterior AMİ’li bir hastada aVR derivasyonunun değerlendirilmesi, İSA’nın SİA proksimalinde olduğunu ve tehdit altındaki miyokard dokusunun daha fazla olduğunu öngörmede yol gösterici olabilir.Öğe The thrombus image in the huge left atrial appendage(VIA MEDICA, 2010) Vatankulu, Mehmet Akif; Gul, Enes Elvin; Kayrak, Mehmet[Abstract not Available]Öğe Ventriküler pacemaker ritmi ve atipik semptomları olan bir olguda akut miyokard infarktüsü tanısı ve başarılı takibi(2008) Kayrak, Mehmet; Sönmez, Osman; Vatankulu, Mehmet Akif; Güleç, Hakan; Gök, HasanAkut miyokard infarküsü vakaları kardiyologların karışlaştıkları en önemli hasta grubunu oluşturmaktadır. Hızlı tanı ve uygun revaskülarizasyon yönteminin belirlenmesi hastanın mortalitesi ve morbiditesi için oldukça önemlidir. Ancak bazı olgularda tanısal gecikmelere yol açan ve hekimi zorlayan çeşitli durumlarla karşılaşılmaktadır. Bu yazıda servisimizde pacemaker cep enfeksiyonu nedeniyle yatmakta olan bir olguda epigastrik huzursukluk gelişmesi sonrası çekilen elektrokardiyografide pace ritmi morfolojisinde belirgin bir değişiklik olamamasına karşın ekokardiyografide yeni gelişen duvar hareket bozukluğu ile tespit edilen akut miyokard infarktüsü vakası sunulmuştur. Hasta koroner anjiyografi laboratuarına alındı ve total oklüzyona yol açan trombüse başarılı primer perkutan girişim uygulandı.
