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  • Öğe
    Total methylated arginine load as a risk parameter in subjects with masked hypertension
    (TAYLOR & FRANCIS INC, 2020) Hoşaf, Müşerref; Abuşoğlu, Sedat; Avcı, Ahmet; Demir, Kenan; Ünlü, Ali; Eryavuz, Duygu; Abuşoğlu, Gülsüm
    Asymmetric dimethylarginine, symmetric dimethylarginine, and L-monomethylarginine are originated from the subsequent proteolytic catalysis of methylated arginine residues on different proteins and inhibit the endogenous nitric oxide generation. The changes in total methylarginine load (Asymmetric dimethylarginine plus symmetric dimethylarginine plus L-monomethylarginine) may contribute to hypertension. The aim of this study was to determine serum methylarginine concentrations in patients with masked hypertension and determine the association between these biomarkers and blood pressure measurements. Control group, masked hypertension and hypertension groups consisted of 40 subjects (11 males, 28 females, mean age 48.6 +/- 13.1), 28 subjects (14 males, 14 females, mean age 50.9 +/- 11.0) and 36 subjects (15 males, 21 females, mean age 54.4 +/- 12.3 years), respectively (P= 0.149). Serum total methylarginine load was significantly higher in hypertension group (0.63 +/- 0.23) compared to masked hypertension (0.49 +/- 0.16) and control groups (0.38 +/- 0.13) (P= 0.008 and P< 0.001). While there was no statistically significant difference between healthy control groups [0.147 (0.03-0.29)] and masked hypertension patients [0.144 (0.05-0.42)] for serum symmetric dimethylarginine levels (P= 0.970), it was markedly elevated in hypertension group [0.25 (0.07-0.54)] compared to masked hypertension group [0.14 (0.05-0.42)] (P= 0.001). Serum total methylarginine load was positively correlated with night-time SBP (r = 0.214, P= 0.029). Serum methylarginine levels might be a useful marker for determining the courses of clinical hypertension.
  • Öğe
    Author`s reply
    (Turkish Society of Cardiology, 2019) Gürses, Kadri Murat; Yalçın, Muhammet Ulvi; Koçyiğit, Duygu
    [Abstract not Available]
  • Öğe
    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.
  • Öğe
    Serum galectin-3 level predicts early recurrence following successful direct-current cardioversion in persistent atrial fibrillation patients
    (TURKISH SOC CARDIOLOGY, 2019) Gurses, Kadri Murat; Yalçın, Muhammed Ulvi; Koçyiğit, Duygu; Canpınar, Hande; Ateş, Ahmet Hakan; Canpolat, Uğur; Yorgun, Hikmet; Güç, Dicle; Aytemir, Kudret
    Objective: Atrial structural remodeling has been suggested to contribute to atrial fibrillation (AF) recurrence following direct-current cardioversion (DCCV). The role of several inflammatory and extracellular matrix turnover markers in AF recurrence following DCCV has been investigated. However, data on the impact of galectin-3, which is known to play a role in various fibrotic conditions, including cardiac fibrosis are lacking. The aim of this study was to demonstrate the predictive role of serum galectin-3 levels in AF recurrence following successful DCCV. Methods: A total of 90 persistent AF patients who were scheduled for DCCV were prospectively enrolled. Serum samples were assayed to determine pre-DCCV galectin-3 levels using the enzyme-linked immunosorbent assay method. Patients were followed up for 3 months for AF recurrence. Results: Of 90 persistent AF patients (mean age: 55.33 +/- 7.94 years; 53.33% male) who underwent successful DCCV, 28 (31.11%) experienced early AF recurrence within 3 months. Patients with AF recurrence had a greater left atrial volume index (LAVI) (33.35 +/- 2.45 mL/m(2) vs. 29.21 +/- 3.08 mL/m(2); p<0.001) and serum galectin-3 levels were higher (0.88 ng/mL [min-max: 0.52-1.32] vs. 0.60 ng/mL [min-max: 0.38-0.91]; p<0.001). In multivariate analysis, the number of DCCV attempts (hazard ratio [HR]: 1.879, 95% confidence interval [CI]: 1.052-3.355; p=0.033), LAVI (HR: 1.180, 95% CI: 1.028-1.354; p=0.018), and serum galectin-3 level (HR: 11.933, 95% CI: 1.220-116.701; p=0.033) were found to be independently associated with early AF recurrence following successful DCCV. Conclusion: Circulating levels of galectin-3 may have an association with early AF recurrence following DCCV.
  • Öğe
    Long-term prognostic significance of terminal QRS distortion on patients with stemi and its correlation with the GRACE scoring system
    (CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS, 2019) Yilmaz, Ahmet; Demir, Kenan; Karatas, Recep; Celik, Mustafa; Avci, Ahmet; Keles, Fikret; Ersecgin, Ahmet; Aygül, Nazif; Altunkeser, Bülent Behlül
    [Abstract not Available]
  • Öğe
    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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    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.
  • Öğe
    David's procedure for pulmonary artery aneurysm
    (WILEY, 2020) Circi, Renda.; Boysan, Emre.; Behlul Altunkeser, Bulent.; Aygul, Nazif.; Cagli, Kumral.; Cagli, Kerim.; Sener, Erol.
    Pulmonary artery aneurysm (PAA) is a rare entity with fatal complications. Its silent course contributes to large aneurysms with compression symptoms. We present a 39-year-old female idiopathic pulmonary arterial hypertension patient with a giant PAA causing severe pulmonary regurgitation (PR) and symptomatic left main coronary artery compression (LMCA). Since she had a failed LMCA stenting attempt, she underwent surgery. A valve-sparing David-like pulmonary trunk reconstruction and coronary artery bypass were performed. This case illustrates that David-like reconstruction procedure can be applied to the PAA with severe PR.
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    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.
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    Clinical management, psychosocial characteristics, and quality of life in patients with homozygous familial hypercholesterolemia undergoing LDL-apheresis in Turkey: Results of a nationwide survey (A-HIT1 registry)
    (ELSEVIER SCIENCE INC, 2019) Kayikcioglu, Meral.; Kuman-Tunçel, Ozlem.; Pirildar, Sebnem.; Yilmaz, Mehmet.; Kaynar, Leylagul.; Aktan, Melih.; Durmuş, Rana Berru.; Gökçe, Cumali.; Temizhan, Ahmet.; Özcebe, Osman Ilhami.; Karaagac Akyol, Tulay.; Okutan, Harika.; Sağ, Saim.; Gul, Ozen Oz.; Salcioglu, Zafer.; Yenercag, Mustafa.; Altunkeser, Bulent Behlul.; Kuku, Irfan.; Yasar, Hamiyet Yílmaz.; Kurtoğlu, Erdal.; Demir, Melis.; Demircioğlu, Sinan.; Pekkolay, Zafer.; Ílhan, Osman.; Tokgozoglu, Lale.
    BACKGROUND: Homozygous familial hypercholesterolemia (HoFH) is a rare, life-threatening inherited disease leading to early-onset atherosclerosis and associated morbidity. Because of its rarity, longitudinal data on the management of HoFH in the real world are lacking, particularly on the impact the condition has on quality of life (QoL), including the impact of the extracorporeal lipid removal procedure apheresis (LA). METHODS: The A-HIT1 study included 88 patients with HoFH aged >= 12 years receiving regular LA in 19 centers in Turkey. Demographic and disease characteristics data were obtained. For patients aged >= 18 years, additional data on psychosocial status were obtained via the SF-36 score, the Hospital Anxiety and Depression Scale, and a HoFH-specific questionnaire. RESULTS: There was no standardized approach to therapy between centers. Mean (+/-SD) frequency of LA sessions was every 19.9 (+/-14) days, with only 11.6% receiving LA weekly, and 85% of patients were not willing to increase LA frequency. The most common concerns of patients were disease prognosis (31%), and physical, aesthetic, and psychological problems (27.5%, 15.9%, and 11.6%, respectively). Lower age at diagnosis was associated with better QoL, lower anxiety, improved functioning, and greater emotional well-being compared to later diagnosis. CONCLUSIONS: These findings demonstrate that adult patients with HoFH undergoing LA, experience significant impairment of QoL with an increased risk of depression. From patients' point of view, LA is time-consuming, uncomfortable, and difficult to cope with. The speed of diagnosis and referral has a considerable impact on patient well-being. (C) 2019 National Lipid Association. All rights reserved.
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    Angiogenin and osteopontin and coronary collateral circulation: Author's Reply
    (TURKISH SOC CARDIOLOGY, 2019) Gürses, Kadri Murat.; Yalçın, Muhammed Ulvi.; Koçyiğit, Duygu.
    [Abstract not Available]
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    A rare cause of exertional dyspnea and cyanosis in an adolescent patient: Pulmonary arteriovenous malformation and successful treatment
    (TURKISH SOC CARDIOLOGY, 2019) Direk, Nevin.; Sert, Ahmet.; Koplay, Mustafa.; Erdem, Abdullah.
    [Abstract not Available]
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    Cellular Cardiomyoplasty: Arterial Cells-Stem Cells Transplantation
    (Springer Netherlands, 2012) Tokaç, Mehmet; Aktan, Tahsin Murad
    Cardiovascular disease is the leading cause of mortality and morbidity all over the world. Current treatments in cardiovascular disease do not prevent the cell loss and have no contribution to regeneration, although these therapies provided an improvement in the survival. Cardiac repair by stem cells promises regenerating damaged myocardium by reconstructing the injured heart from its component parts. Up to date, variety of stem cells including BM mononuclear, adipocyte progenitor cells, fibroblasts, smooth and strait muscle cells, circulating progenitor cells, embryonic stem cells, cord blood cells etc., have been used for cardiac repair experimentally and some at clinically. There is no consensus which cell should be use for cardiac repair. We strongly suggest that vascular wall cells seem to be a good candidate for cardiomyoplasty. © Springer Science+Business Media B.V. 2012.
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    Wolff-Parkinson-White Syndrome and Acute Pulmonary Embolism: A Case Report
    (WILEY-BLACKWELL, 2012) Gül, Enes Elvin; Soylu, Ahmet; Nikus, Kjell C.
    A 48-year-old woman admitted to the emerhency departments due to sudden onset of dyspnea. The diagnosis of pulmonary embolism (PE) was made and thrombolytic therapy was started. Baseline ECG showed signs of right ventricular overload and after thrombolysis, short PR, wide QRS, and delta wave indicating Wolf-Parkinson-White (WPW) pattern were appeared. In this case report, we discuss ECG of patient with PE mimicknig WPW.
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    Ventricular Septal Defect Developed Due to Coronary Artery Injury After Blunt Chest Trauma in Childhood
    (TURKISH ASSOC TRAUMA EMERGENCY SURGERY, 2012) Karataş, Zehra; Şap, Fatih; Altın, Hakan; Alp, Hayrullah; Baysal, Tamer; Karaaslan, Sevim
    In the literature, cardiac response associated with blunt chest trauma in children has been reported generally as case reports, and interventricular septal rupture due to trauma is quite rare. Interventricular septal rupture can develop even in the absence of visible signs of a trauma because of the flexibility of the chest structure in children. In the present case, a seven-year-old boy with interventricular septal rupture at the mid-muscular region and left ventricle pseudoaneurysm developed due to injury to the left anterior descending coronary artery after a traffic accident is reported. Patients with cardiac murmur detected on physical examination after a blunt chest trauma must be considered as cardiac injury, and in those with signs of ischemia detected on electrocardiography, it should not be forgotten that the coronary artery may be affected.
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    Usability of QTc Dispersion for the Prediction of Orthostatic Intolerance Syndromes
    (ELSEVIER SCI LTD, 2012) Karataş, Zehra; Alp, Hayrullah; Şap, Fatih; Altın, Hakan; Baysal, Tamer; Karaarslan, Sevim
    Background: Syncope is defined as transient loss of consciousness and muscle tone, usually of short duration. Noncardiac causes of syncope are classified as orthostatic intolerance syndromes (OIS). QT and QTc (corrected QT) dispersions are the measurements of myocardial instability and show predisposition to arrhythmias. In this study; clinical findings, QT and QTc dispersions of the patients who were diagnosed as OIS were evaluated retrospectively. Also, the aim of the study is to clarify the association of clinical characteristics of unexplained syncope with the outcome of the QT and QTc dispersions in children. Methods: We designed a retrospective study including 152 children and adolescents who had repeated unexplained syncope or presyncope between June 2002 and August 2010. Head-up Tilt table test (HUTT) were performed for all patients. Control group consisted of 67 healthy children. The QT and QTc dispersions were measured from the 12 ECG leads. Results: Eighty-four (55.2%) patients had positive and 68 (44.8%) had negative response to HUTT. QT and QTc dispersions were significantly higher in HUTT-positive group than in negative (p < 0.01, p < 0.001 respectively). Also, QTc dispersion was significantly higher in both vasovagal syncope and postural orthostatic tachycardia syndrome groups than in HUTT-negative group (p < 0.001, p < 0.05 respectively). Specifity and sensitivity of QTc dispersion for predicting positive HUTT are 76.5% and 59.5% respectively. The positive predictive value of the test calculated as 75.8%. Conclusions: These results revealed that we can use QTc dispersion measurement as a noninvasive electrocardiographic test to evaluate OIS for predicting positive result before performing HUTT.
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    The Relation Between Lp-PLA2 Levels with Periodic Limb Movements
    (SPRINGER HEIDELBERG, 2012) Bekçi, Taha Tahir; Kayrak, Mehmet; Kıyıcı, Aysel; Arı, Hatem; Teke, Turgut; Maden, Emin; Akıllı, Hakan
    Lipoprotein-associated phospholipase A2 (Lp-PLA2), a novel marker of vulnerable plaque to prone rupture, is a predictor of both cardiovascular event and cerebrovascular event, and highly sensitive-C-reactive protein (hs-CRP) is an acute-phase response protein implicated in a broad range of cardiovascular diseases. We aimed to examine the association between periodic limb movements in sleep (PLMs) with circulating Lp-PLA2 and hs-CRP levels in patients with PLMs. Seventy patients with newly diagnosed PLM with polysomnography were enrolled this study. Patients were divided into two groups according to PLM index (normal PLM index, < 15; elevated PLM index, a parts per thousand yen15). Lp-PLA2 and hs-CRP concentrations were measured in serum samples by turbidimetric and nephelometric methods, respectively. The concentrations of these parameters were compared between two groups and correlation analysis was performed between PLMs and Lp-PLA2 and hs-CRP levels. Lp-PLA2 levels and hs-CRP were significantly increased in elevated PLM index group compared with the control group (206.8 +/- 78.1 vs 157.8 +/- 56.7, p = 0.003, and 4.2 +/- 3.5 vs 2.4 +/- 2.1, p = 0.02, respectively). PLM index was positively correlated with Lp-PLA2 levels (r = 0.40, p = 0.001) and hs-CRP (r = 0.24, p = 0.05). In the linear regression model, Lp-PLA2 was an independent predictor of PLM index (R (2) = 0.36, p = 0.005). This study demonstrated an independent linear relation between PLM index and Lp-PLA2. In addition, it was seen increased Lp-PLA2 and hs-CRP levels in patients with elevated PLM index. Based on these results, we can suggest that risk of vascular events may be increased in patients with PLMs and with increased PLM index.
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    Soluble CD40 Ligand Levels in Acute Pulmonary Embolism: A Prospective, Randomized, Controlled Study
    (SPRINGER, 2012) Kaya, Zeynettin; Özdemir, Kurtuluş; Kayrak, Mehmet; Gül, Enes Elvin; Altunbaş, Gökhan; Duman, Çetin; Kıyıcı, Aysel
    CD40 ligand is a thromboinflammatory molecule that predicts cardiovascular events. Platelets constitute the major source of soluble CD40 ligands (sCD40L), which has been shown to influence platelet activation. The main aim of this study was to evaluate sCD40L levels in patients with acute pulmonary embolism (PE). Sixty-five PE patients (32 males, mean age 58 +/- A 12 years) and 29 healthy controls (15 males, mean age 56 +/- A 14 years) were enrolled in the study. sCD40L levels were evaluated at the enrollment by ELISA method. Multislice detected pulmonary computed tomography was performed on all patients with a suspected diagnosis of PE. In addition, echocardiography was performed to evaluate right ventricular (RV) dysfunction. There was no statistically significant difference between the two groups regarding demographic features. sCD40L levels were significantly higher in acute PE group compared to healthy controls (5.3 ng/ml and 1.4 ng/ml, respectively; < 0.001). sCD40L levels of patients with and without RV dysfunction were similar. Correlation analysis between echocardiographic findings and sCD40L levels did not show significant difference. The present study demonstrated a role of sCD40L in pathogenesis of PE for the first time. Further studies are needed to clarify a predictive and prognostic value of sCD40L levels in acute PE patients.
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    Mobile right heart thrombus as a manifestation of homozygous mutation of MTHFR 1298 A > C
    (Turkish Soc Cardiology, 2012) Gül, Enes Elvin; Erdoğan, Halil İbrahim; Bayram, Ufuk Tan; Özdemir, Kurtuluş; Taşçı, İlker
    Mobile right heart thrombus (MRHT) is uncommon pathology but the true prevalence is still unknown. Previous studies reported that MRHT occurs in 7% to 18% of patients with pulmonary embolism with high mortality rate (44.7%) (1). The main manifestations of venous thromboembolism (VTE) are deep venous thrombosis (DVT) and pulmonary embolism. In addition, genetic factors play an important role in pathogenesis of VTE. The relationship between common genetic mutations such as factor V Leiden, prothrombin factor II G 20210A, methylenetetrahydrofolate reductase (MTHFR), deficiencies of protein C, protein S, and antithrombin III, and VTE have been reported (2).
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    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, Mehmet
    Background: 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)