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Tigen K, Dogan Z, Sunbul M, Gurel E, Cincin A, Kanar B, Sayar N, Ozben B. "Main Vessel-Oriented" Treatment Strategy Versus "Open Side Branch" Treatment Strategy in Acute Coronary Syndrome Patients With Culprit Bifurcation Lesions. Am J Cardiol 2023; 204:339-344. [PMID: 37573612 DOI: 10.1016/j.amjcard.2023.07.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/19/2023] [Accepted: 07/26/2023] [Indexed: 08/15/2023]
Abstract
Percutaneous coronary intervention of bifurcation lesions is associated with an increased risk of complications in patients with acute coronary syndrome (ACS). The study aimed to evaluate the in-hospital outcomes of patients with ACS with culprit bifurcation lesions who were treated with either a "main vessel-oriented" (MVO) treatment strategy or an "open side branch" (OSB) treatment strategy. This retrospective study included 575 consecutive patients with ACS. "MVO" and "OSB" treatment strategies were defined as primary/urgent percutaneous coronary intervention procedures performed by either totally ignoring the side branch (SB) or trying to maintain both main vessel and SB open with thrombolysis in myocardial infarction 3 flow. Procedural success and major cardiac/cerebrovascular events during hospitalization were noted. MVO and OSB treatment strategies were performed on 384 and 191 patients, respectively. The procedural success rate was significantly higher in the OSB treatment strategy whereas major cardiac/cerebrovascular events rates were similar except for the contrast-induced nephropathy rate being slightly higher in OSB treatment strategy. Subgroup analysis revealed a significantly higher procedural success rate in OSB treatment strategy if the SB was located within the bifurcation core, especially in those where the diameter of SB was ≥2 mm. In conclusion, our results suggest a better procedural result with SB protection attempts in patients with ACS with a culprit bifurcation lesion if the SB is originating within the bifurcation core and its diameter is ≥2 mm. MVO treatment strategy may be preferred in most cases with minor SBs located distant to the bifurcation core because of the similar procedural success.
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Affiliation(s)
- Kursat Tigen
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Zekeriya Dogan
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Murat Sunbul
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Emre Gurel
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Altug Cincin
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Batur Kanar
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Nurten Sayar
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Beste Ozben
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey.
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Mirioglu S, Çinar S, Uludag O, Gurel E, Varelci S, Ozluk Y, Kilicaslan I, Yalçinkaya Y, Yazici H, Gül A, Inanc M, Artim-Esen B. AB0495 SERUM AND URINE GALECTIN-9, IP-10 AND SIGLEC-1 AS BIOMARKERS OF DISEASE ACTIVITY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundGalectin-9, interferon-inducible protein-10 (IP-10) and sialoadhesin (SIGLEC-1) are proteins associated with interferon signature, and considered as potential biomarkers reflecting disease activity in patients with systemic lupus erythematosus (SLE).ObjectivesIn this study, we aimed to investigate the association of serum and urine levels of galectin-9, IP-10 and SIGLEC-1 with disease activity in patients with SLE.MethodsSixty-three patients with active SLE (31 renal and 32 extrarenal) were included in the study. Thirty inactive patients with SLE (15 renal and 15 extrarenal) and 32 healthy volunteers were selected as control groups. Serum (s) and urine (u) levels of galectin-9, IP-10 and SIGLEC-1 were tested using ELISA. Urine levels of biomarkers were normalized by urine creatinine.ResultsGroups were comparable with regard to sex and age distribution. Of 125 participants, 102 (81.6%) were female and median age was 33 (28-44.5) years. Proliferative lupus nephritis (LN) (class III/III+V and IV/IV+V) were found in 22 patients with active renal SLE (70.9%), while 6 patients (19.3%) had pure class V and 3 (9.7%) had class II LN. Levels of sIP-10, uIP-10, sGalectin-9 and uSIGLEC-1 were significantly higher in the active SLE group compared to the inactive SLE group (sIP-10 p=0.046, uIP-10 p<0.001, sGalectin-9 p=0.031 and uSIGLEC-1 p=0.006); however, no differences were detected in the comparison of uGalectin-9 and sSIGLEC-1 between the groups (uGalectin-9 p=0.180 and sSIGLEC-1 p=0.699) (Table 1). Serum and urine levels of galectin-9, IP-10 and SIGLEC-1 did not differ between patients with active renal and extrarenal SLE. Levels of sIP-10, uIP-10 and uSIGLEC-1 were correlated with SLE Disease Activity Index (SLEDAI). Serum and urine levels of all biomarkers were re-tested in 41 of 63 patients (65%) with active SLE after a median treatment of 8 (5-22.5) months. At the time of the second tests, there was a significant decrease in disease activity as measured by SLEDAI [2 (0-4)] compared to the time of the first tests [10 (6-15.5)]. Comparison of sGalectin-9 levels between the serum at the time of active disease and remission showed a very significant decline (p<0.001) as shown in Figure 1. uGalectin-9, sIP-10 and uSIGLEC-1 also decreased after treatment; however, the difference was not statistically significant.Table 1.Serum and urine levels of biomarkers across study groups.BiomarkerActive SLE(n=63)Inactive SLE(n=30)Healthy Control(n=32)sGalectin-9 (ng/ml)11.73 (7.52-14.15)8.66 (7.51-10.02)5.61 (4.56-6.6)sIP-10 (pg/ml)279.4 (147.5-430.3)173.4 (142.2-247.9)74.3 (58.8-103)sSIGLEC-1 (pg/ml)181.2 (157.8-213.9)182.5 (169.9-203.1)258.3 (179-602)uGalectin-9 (ng/ml)8.83 (4.07-18.11)11.54 (7.03-15.07)10.63 (5.55-17.4)uIP-10 (pg/ml)34.4 (15.9-73,9)20.8 (9.9-53.3)12.2 (1.8-25.7)uSIGLEC-1 (pg/ml)321 (236.3-370.9)297.6 (247.7-371)290 (205.1-323.5)uGalectin-9 (ng/mgCre)15.50 (9.60-32.05)11.41 (8.78-19.54)13.57 (11.27-22.08)uIP-10 (pg/mgCre)73.4 (40.9-136.9)26.1 (18.1-55.1)16.4 (5-32.5)uSIGLEC-1 (pg/mgCre)619.6 (389.4-1056.5)393.2 (248.6-715.8)425.6 (264.7-925.9)Figure 1.Serum levels of galectin-9 before and after the treatment in 41 patients with active SLE.ConclusionsIP-10, uIP-10, sGalectin-9 and uSIGLEC-1 are associated with disease activity in SLE. None is able to discriminate active renal from active extrarenal disease. sGalectin-9 may be a valuable biomarker to monitor response after treatment for active disease (Funded by Scientific Research Projects Coordination Unit of Istanbul University. Project number: TSA-2019-34218).Disclosure of InterestsNone declared
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Uludag O, Gurel E, Cetin C, Cene E, Yalçinkaya Y, Gül A, Inanc M, Artim-Esen B. POS0766 CLUSTER ANALYSIS AND COMPARISON OF CUMULATIVE DAMAGE BY DIAPS IN A SINGLE CENTER COHORT OF APS PATIENTS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Antiphospholipid syndrome (APS) is a chronic autoimmune disease with significant morbidity and mortality. The recently developed damage index for APS (DIAPS) considers thrombotic APS specific damage.Objectives:Herein we aimed to identify disease clusters based on clinical characteristics and compare DIAPS between these clusters in a single center cohort of patients with APS ± systemic lupus erythematosus (SLE).Methods:This retrospective study included 237 consecutive patients with APS [114 primary APS (PAPS) and 123 SLE+APS]. Data regarding demographics, clinical and laboratory characteristics and cardiovascular risk factors were retrieved from the existing database and revised. Two-step cluster analysis was performed. Cumulative damage was calculated for all patients by applying DIAPS as described previously.Results:237 patients were classified into 4 subgroups by cluster analysis. Cluster 1 (n=74) consisted of older patients with arterial-predominant VT, livedo reticularis and increased cardiovascular risk, cluster 2 (n=70) of SLE+APS patients with thrombocytopenia and heart valve disease, cluster 3 (n=59) of patients with venous-predominant VT, less extra-criteria manifestations and cluster 4 (n=34) of patients with only PM with a lower frequency of extra-criteria features and cardiovascular risk (table 1).Table 1.Demographic, clinical and laboratory characteristics of clustersAll (n=237)Cluster 1 (n=74)Cluster 2 (n=70)Cluster 3(n=59)Cluster 4 (n=34)PAge (years), median (range)43 (20-81)51 (20-81)40 (27-72)42 (24-69)40.5 (26-65)<0.001Duration of disease (years), median (range)9.5 (1-37.7)13.1 (1-37.7)10.4 (1-28.7)8.5 (1-32.8)7 (1-22.4)0.028Female, n (%)198 (83.5)56 (75.7)61 (87.1)47 (79.7)34 (100)<0.05SLE, n (%)123 (51.9)31 (41.9)46 (65.7)32 (54.2)14 (41.2)<0.05Vascular thrombosis, n (%)191 (80.6)73 (98.6)59 (84.3)59 (100)0 (0)<0.001Arterial thrombosis, n (%)109 (46)50 (67.6)31 (44.3)28 (47.5)0 (0)<0.001Venous thrombosis, n (%)112 (47.3)36 (48.6)37 (52.9)39 (66.1)0 (0)<0.001Pregnancy morbidity, n (%)117 (49.4)22 (29.7)46 (65.7)15 (25.4)34 (100)<0.001Livedo reticularis, n (%)38 (16)21 (28.4)10 (14.3)5 (8.5)2 (5.9)<0.01Thrombocytopenia, n (%)81 (34.2)4 (5.4)65 (92.9)4 (6.8)8 (23.5)<0.001Heart valve disease, n (%)92 (38.8)32 (43.2)46 (65.7)8 (13.6)6 (17.6)<0.001Arterial hypertension, n (%)101 (42.6)49 (66.2)34 (48.6)18 (30.5)0 (0)<0.001Hyperlipidemia, n (%)103 (43.5)69 (93.2)26 (37.1)0 (0)8 (23.5)<0.001Smoking, n (%)58 (24.5)31 (41.9)7 (10)17 (28.8)3 (8.8)<0.001Lupus anticoagulant, n (%)156 (65.8)53 (71.6)48 (68.6)35 (59.3)20 (58.8)0.36Anticardiolipin IgG/IgM, n (%)155 (65.4)46 (62.2)46 (65.7)38 (64.4)25 (73.5)0.71Anti-β2-glycoprotein I IgG/IgM, n (%)93 (39.2)25 (33.8)33 (47.1)26 (44.1)9 (26.5)0.13Triple aPL positivity, n (%)45 (19)12 (16.2)16 (22.9)13 (22)4 (11.8)0.46Cluster 2 had the highest cumulative damage (mean DIAPS 2.48 ± 1.67) followed by cluster 1 (2.24 ± 1.44), cluster 3 (1.69 ± 1.27) and cluster 4 (0.32 ± 0.68). Comparison of DIAPS (total and major domains) between the clusters is shown in figure 1.Patients with SLE+APS had a higher mean DIAPS compared to those with PAPS (2.10 ± 1.61 vs 1.69 ± 1.47, P=0.046). Cardiovascular domain was the most frequently affected DIAPS domain in both groups. Proteinuria and avascular necrosis were significantly more frequent in SLE+APS (9.8% vs 2.2%, P=0.02 and 5.7% vs 0%, P=0.009, respectively). DIAPS was positively correlated with disease duration (r=0.192, P=0.003).Conclusion:Elder APS patients with arterial thrombosis and increased cardiovascular risk and SLE+APS patients with extra-criteria manifestations had higher cumulative DIAPS. Longer disease duration, higher frequency of major organ involvement and higher immunosuppressive usage may have contributed to this difference. Therefore, control of cardiovascular risk factors, prevention and effective treatment of SLE flares may help to reduce damage in these subgroups.Figure 1.Comparison of mean DIAPS (total and major domains) between the clustersDisclosure of Interests:None declared
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Cincin A, Ozben B, Tukenmez Tigen E, Sunbul M, Sayar N, Gurel E, Tigen K, Korten V. Ventricular and atrial functions assessed by speckle-tracking echocardiography in patients with human immunodeficiency virus. J Clin Ultrasound 2021; 49:341-350. [PMID: 32954546 DOI: 10.1002/jcu.22921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/29/2020] [Accepted: 09/01/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Antiretroviral therapy (ART) has dramatically changed the clinical manifestation of human immunodeficiency virus (HIV) associated cardiomyopathy from severe left ventricular (LV) systolic dysfunction to a pattern of subclinical cardiac dysfunction. The aim of this study was to evaluate by speckle tracking echocardiography (STE) LV, right ventricular (RV), and biatrial functions in HIV-infected patients under different ART combinations. METHODS We consecutively included 128 HIV-infected patients (mean age 44.2 ± 10.1 years, 110 males) and 100 controls (mean age 42.1 ± 9.4 years, 83 males). Ventricular and atrial functions were assessed by both conventional and STE. RESULTS Although there was not any significant difference in conventional echocardiographic variables, HIV-infected patients had significantly lower LV global longitudinal strain (GLS), RV GLS, left atrial (LA) reservoir and conduit strain, and right atrial conduit strain. HIV patients receiving integrase strand transfer inhibitors and protease inhibitors (PI) had significantly lower LV GLS and LA conduit strain, while patients receiving non-nucleoside reverse transcriptase inhibitors and PI had significantly lower RV GLS than controls. CD4 count at the time of echocardiography was strongly correlated with LV GLS (r = .619, P < .001) and RV GLS (r = .606, P < .001). CONCLUSION Biventricular and atrial functions are subclinically impaired in HIV-infected patients. ART regimen may also affect myocardial functions.
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Affiliation(s)
- Altug Cincin
- Marmara University School of Medicine Department of Cardiology, Istanbul, Turkey
| | - Beste Ozben
- Marmara University School of Medicine Department of Cardiology, Istanbul, Turkey
| | - Elif Tukenmez Tigen
- Marmara University School of Medicine Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Murat Sunbul
- Marmara University School of Medicine Department of Cardiology, Istanbul, Turkey
| | - Nurten Sayar
- Marmara University School of Medicine Department of Cardiology, Istanbul, Turkey
| | - Emre Gurel
- Marmara University School of Medicine Department of Cardiology, Istanbul, Turkey
| | - Kursat Tigen
- Marmara University School of Medicine Department of Cardiology, Istanbul, Turkey
| | - Volkan Korten
- Marmara University School of Medicine Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
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Sahin AA, Ozben B, Sunbul M, Yagci I, Sayar N, Cincin A, Gurel E, Tigen K, Basaran Y. The effect of cardiac rehabilitation on blood pressure, and on left atrial and ventricular functions in hypertensive patients. J Clin Ultrasound 2020; 49:e22956. [PMID: 33289108 DOI: 10.1002/jcu.22956] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/15/2020] [Accepted: 11/20/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE Hypertension is associated with left ventricular (LV) hypertrophy, impaired LV relaxation, and left atrial (LA) enlargement. Cardiac rehabilitation (CR) improves clinical outcomes in a broad spectrum of cardiac disease. The aim of our study was to determine the effect of CR on blood pressure (BP), and on LA and LV functions in hypertensive patients. METHODS Thirty consecutive hypertensive patients who would undergo CR program, and 38 hypertensive patients who refused to undergo CR program were included. All patients underwent ambulatory BP monitoring and transthoracic echocardiography, which were repeated after completion of the CR program, or 12 weeks later in the control group. LA and LV functions were assessed by both speckle tracking and 3-dimensional echocardiography. N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were assessed before and after CR. RESULTS Although initial ambulatory BP values and NT-proBNP levels were similar between the groups, daily, day-time, and night-time BP and NT-proBNP were significantly lower in the CR group after rehabilitation. LA reservoir strain and LV global longitudinal strain of the CR group significantly increased after CR while no significant increase was observed in controls. CONCLUSION CR improves LA and LV strain while lowering BP and should be encouraged in routine management of hypertensive patients.
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Affiliation(s)
- Ahmet Anil Sahin
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Beste Ozben
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Murat Sunbul
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Ilker Yagci
- Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Nurten Sayar
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Altug Cincin
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Emre Gurel
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Kursat Tigen
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Yelda Basaran
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
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Kanar BG, Tigen MK, Sunbul M, Cincin AA, Gurel E, Sayar N, Kepez A, Sadıc BO. Evaluation of right ventricular dyssynchrony in patients with acute inferior myocardial infarction and its relation with mortality. Echocardiography 2020; 37:1610-1616. [PMID: 32986898 DOI: 10.1111/echo.14865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/22/2020] [Accepted: 08/31/2020] [Indexed: 12/01/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate right ventricle (RV) dyssynchrony and its relation with mortality using speckle-tracking echocardiography (STE) in patients with acute inferior myocardial infarction (IMI). METHODS One hundred and fifty-eight consecutive patients with acute IMI treated with primary percutaneous coronary intervention, and 44 healthy subjects were included. RV myocardial involvement (RVMI) was defined as an elevation >1 mm in V1 or V4R and/or the presence of a culprit lesion at the proximal portion of the first RV marginal branch after reviewing coronary angiography. Patients were followed for 3 years to determine the cardiovascular mortality. RESULTS Overall, 70 patients with IMI had RVMI. IMI patients had significantly higher RV peak systolic longitudinal strain dyssynchrony (PLSSD) index, lower peak longitudinal systolic strain (PLSS), longer time to PLSS, and time to PLSS differences compared to healthy controls while the patients with RVMI had significantly worse values compared to patients without RVMI and healthy controls. Twenty-seven patients (17.1%) died within 2 years. RVMI was more prevalent in mortality group, and they had significantly higher RV PSSD index, whereas they had lower RV free wall PLSS and longer time to PLSS differences. Receiver operating characteristics (ROC) analysis revealed that a RV PLSSD index > 65 ms predicted mortality with a sensitivity of 88.9% and specificity of 71.8% in IMI patients. CONCLUSIONS Intra- and inter-ventricular dyssynhcrony may develop in patients with acute IMI, especially in those with RV involvement, which might have a negative effect on the prognosis of these patients.
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Affiliation(s)
- Batur Gonenc Kanar
- Department of Cardiology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Mustafa Kursat Tigen
- Department of Cardiology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Murat Sunbul
- Department of Cardiology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Ahmet Altug Cincin
- Department of Cardiology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Emre Gurel
- Department of Cardiology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Nurten Sayar
- Department of Cardiology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Alper Kepez
- Department of Cardiology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Beste Ozben Sadıc
- Department of Cardiology, Faculty of Medicine, Marmara University, Istanbul, Turkey
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Paudel A, Tigen K, Yoldemir T, Guclu M, Yildiz I, Cincin A, Sunbul M, Gurel E, Sayar N, Ozben B. The evaluation of ventricular functions by speckle tracking echocardiography in preeclamptic patients. Int J Cardiovasc Imaging 2020; 36:1689-1694. [PMID: 32388817 DOI: 10.1007/s10554-020-01872-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/29/2020] [Indexed: 12/16/2022]
Abstract
Preeclampsia is a maternal disorder of pregnancy characterized by concomitant increase in preload and afterload with end organ dysfunction. The aim of our study is to evaluate left ventricular (LV) and right ventricular (RV) functions with speckle tracking echocardiography in preeclamptic patients. Fifty-five preeclamptic (mean age: 30.7 ± 5.9 years) and 35 healthy pregnant women (mean age: 28.8 ± 5.7 years) of the same race, similar age and gestational week were consecutively included. The diagnosis of preeclampsia was based on the criteria proposed by the American College of Obstetricians and Gynecologists. LV and RV functions were assessed by both conventional and speckle tracking echocardiography after the 30th gestational week and at the postpartum 6th months. The preeclamptic patients had significantly larger left atrium, thicker interventricular septum, higher systolic pulmonary artery pressure and mitral E/e' ratio compared to controls during pregnancy while LV ejection fraction was similar. Preeclamptic patients had significantly lower LV and RV global longitudinal strain (GLS) during pregnancy compared to controls (- 18.0 ± 2.6% vs. - 19.8 ± 2.1% p = 0.001 and - 26.7 ± 3.3% vs. 28.9 ± 3.3% p = 0.002, respectively). In the postpartum period, while LVGLS values of preeclamptic patients increased significantly (- 18.0 ± 2.6% vs. - 20.4 ± 2.4% p < 0.001) and became similar to those of controls at the sixth month, the RVGLS decreased significantly (- 26.7 ± 3.3% vs. - 25.8 ± 2.7% p = 0.003) making the difference in RVGLS between the preeclamptic patients and controls more prominent. Preeclampsia may impair LV and RV function. Long-term follow up with larger sample is needed to determine the clinical relevance of the observed changes in strain.
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Affiliation(s)
- Ashok Paudel
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Kursat Tigen
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Tevfik Yoldemir
- Department of Obstetrics and Gynecology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Guclu
- Department of Obstetrics and Gynecology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Ipek Yildiz
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Altug Cincin
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Murat Sunbul
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Emre Gurel
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Nurten Sayar
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Beste Ozben
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey.
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Atas H, Tigen K, Ozben B, Kartal F, Gurel E, Atas DB, Sari İ, Basaran Y. Short and Long Term Mortality Predictors in Octogenarians with Acute Coronary Syndromes. CLIN INVEST MED 2018; 41:E43-E50. [PMID: 29959882 DOI: 10.25011/cim.v41i2.29914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Indexed: 11/03/2022]
Abstract
PURPOSE Octogenarians with acute coronary syndromes have higher mortality and morbidity due to higher prevalence of comorbidities and frailty. The aim of this study was to explore the predictors of short and long term mortality in octogenarians with ACS. METHODS Ninety-eight consecutive octogenarians presenting with acute coronary syndrome (mean age:84±3 years, 56 male) were included. All patients underwent coronary angiography and were given optimal medical treatment. The primary end point was cardiovascular mortality in hospital and at one year. RESULTS Fifteen patients died during hospitalization and 20 patients died after discharge within the first year. ST-segment-elevation myocardial infarction and hypotension were significantly more prevalent in the in-hospital mortality group while atrial fibrillation and hyponatremia were more prevalent in the long-term mortality group. All deceased patients had significantly lower left ventricular ejection fraction and glomerular filtration rate. Cox analysis revealed ST-segment-elevation myocardial infarction, hypotension and left ventricular ejection fraction as independent predictors of in-hospital mortality while hyponatremia, atrial fibrillation and renal dysfunction as independent predictors of long term mortality. CONCLUSION It would be reasonable to pay further attention to octogenarians with acute coronary syndrome if they are presenting with ST-segment-elevation myocardial infarction, and have hypotension, impaired left ventricular function, hyponatremia, atrial fibrillation or renal dysfunction, which are associated with increased mortality.
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Affiliation(s)
- Halil Atas
- Marmara University School of Medicine Department of Cardiology, Istanbul, Turkey.
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Kanar B, Tigen K, Ozben Sadic B, Sunbul M, Cincin A, Atas H, Gurel E, Kepez A, Sari I, Basaran Y. P1432Right ventricular global longitudinal strain as a predictor of in-hospital mortality in patients with acute inferior myocardial infarction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tigen K, Karaahmet T, Dundar C, Cincin A, Ozben B, Guler A, Gurel E, Sunbul M, Basaran Y. Right ventricular and atrial functions in patients with nonischemic dilated cardiomyopathy. Wien Klin Wochenschr 2015; 127:877-883. [DOI: 10.1007/s00508-015-0852-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 08/12/2015] [Indexed: 12/15/2022]
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Sahin G, Verma SK, Gurel E. Calcium and magnesium elimination enhances accumulation of cardenolides in callus cultures of endemic Digitalis species of Turkey. Plant Physiol Biochem 2013; 73:139-143. [PMID: 24095920 DOI: 10.1016/j.plaphy.2013.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 09/10/2013] [Indexed: 06/02/2023]
Abstract
Elimination of calcium (Ca), magnesium (Mg) or both from the medium of callus cultures of Digitalis davisiana Heywood, Digitalis lamarckii Ivanina, Digitalis trojana Ivanina and Digitalis cariensis Boiss. ex Jaub. et Spach increased cardenolides production. Callus was induced from hypocotyl segments from one-month old seedlings were cultured on MS medium containing 0.5 μg ml(-1) thidiazuron (TDZ) and 0.25 μg ml(-1) indole acetic acid (IAA). After 30 days of culture, callus was transferred in hormone-free MS medium (MSO) as well as Ca or Mg or both were completely eliminated from same medium. The amount of five cardenolides from D. davisiana Heywood, D. lamarckii Ivanina, D. trojana Ivanina and D. cariensis Boiss. ex Jaub. et Spach were compared. Higher amounts of five cardenolides and total cardenolides were obtained when callus of four Digitalis species were incubated on MS medium lacking both Ca and Mg. The mean contents of total cardenolides obtained were in the order of D. lamarckii (2017.97 μg g(-1))>D. trojana (1385.75 μg g(-1))>D. cariensis (1038.65 μg g(-1))>D. davisiana (899.86 μg g(-1)) when both Ca and Mg were eliminated from the medium, respectively. This protocol is useful for development of new strategies for the large-scale production of cardenolides.
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Affiliation(s)
- G Sahin
- Abant Izzet Baysal University, Department of Biology, 14280 Bolu, Turkey.
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Vijayan S, Khanji M, Ionescu A, Vijayan S, Ionescu A, Podoleanu C, Frigy A, Ugri A, Varga A, Podoleanu D, Incze A, Carasca E, Dobreanu D, Mjolstad O, Dalen H, Graven T, Kleinau J, Hagen B, Fu H, Liu T, Li J, Liu C, Zhou C, Li G, Bordese R, Capriolo M, Brero D, Salvetti I, Cannillo M, Antolini M, Grosso Marra W, Frea S, Morello M, Gaita F, Maffessanti F, Caiani E, Muraru D, Tuveri F, Dal Bianco L, Badano L, Majid A, Soesanto A, Ario Suryo Kuncoro B, Sukmawan R, Ganesja MH, Benedek T, Chitu M, Beata J, Suciu Z, Kovacs I, Bucur O, Benedek I, Hrynkiewicz-Szymanska A, Szymanski F, Karpinski G, Filipiak K, Radunovic Z, Lande Wekre L, Steine K, Bech-Hanssen O, Rundqvist B, Lindgren F, Selimovic N, Jedrzychowska-Baraniak J, Jozwa R, Larysz B, Kasprzak J, Ripp T, Mordovin V, Ripp E, Ciobanu A, Dulgheru R, Dragoi R, Magda S, Florescu M, Mihaila S, Rimbas R, Cinteza M, Vinereanu D, Benavides-Vallve C, Pelacho B, Iglesias O, Castano S, Munoz-Barrutia A, Prosper F, Ortiz De Solorzano C, Manouras A, Sahlen A, Winter R, Vardas P, Brodin L, Sarvari SI, Haugaa KH, Zahid W, Bendz B, Aaberge L, Edvardsen T, Di Bella G, Pedri S, Donato R, Madaffari A, Zito C, Stapf D, Schreckenberg M, Carerj S, Yoshikawa H, Suzuki M, Kusunose Y, Hashimoto G, Otsuka T, Nakamura M, Sugi K, Grapsa J, Dawson D, Gin-Sing W, Howard L, Gibbs J, Nihoyannopoulos P, Smith B, Grapsa J, Dawson D, Coulter T, Rendon A, Gorissen W, Nihoyannopoulos P, Shiran A, Asmer I, Adawi S, Ganaeem M, Shehadeh J, Cameli M, Lisi M, Righini F, Maccherini M, Sani G, Galderisi M, Mondillo S, Kalimanovska-Ostric D, Nastasovic T, Jovanovic I, Milakovic B, Dostanic M, Stosic M, Sasic I, Sveen K, Nerdrum T, Hanssen K, Dahl-Jorgensen K, Steine K, Holte E, Vegsundvaag J, Hole T, Hegbom K, Wiseth R, Ikonomidis I, Lekakis J, Tritakis V, Papadakis I, Kadoglou N, Tzortzis S, Trivilou P, Koukoulis C, Paraskevaidis I, Anastasiou-Nana M, Smedsrud MK, Sarvari S, Haugaa KH, Gjesdal O, Aaberge L, Edvardsen T, Muraru D, Beraldo M, Solda' E, Cucchini U, Peluso D, Tuveri M, Al Mamary A, Badano L, Iliceto S, Dores H, Abecasis J, Carvalho M, Santos M, Andrade M, Ribeiras R, Reis C, Horta E, Gouveia R, Mendes M, Zaliaduonyte-Peksiene D, Mizariene V, Cesnaite G, Tamuleviciute E, Jurkevicius R, Vaskelyte J, Zaliunas R, Smarz K, Zaborska B, Jaxa-Chamiec T, Maciejewski P, Budaj A, Trifunovic D, Sobic-Saranovic D, Stankovic S, Ostojic M, Vujisic-Tesic B, Petrovic M, Nedeljkovic I, Banovic M, Tesic M, Petrovic I, Peovska I, Srbinovska E, Maksimovic J, Andova V, Arnaudova F, Hristova E, Otljanska M, Vavlukis M, Jovanova S, Tamborini G, Fusini L, Gripari P, Muratori M, Pontone G, Andreini D, Bertella E, Ghulam Ali S, Bartorelli A, Pepi M, Zito C, Cusma-Piccione M, Salvia J, Antonini-Canterin F, Lentini S, Di Bella G, Donato D, Miceli M, Oreto G, Carerj S, Shiran A, Adawi S, Sachner R, Asmer I, Ganaeem M, Rubinshtein R, Shnapp M, Gaspar T, Marchese A, Deste W, Sanfilippo A, Aruta P, Patane M, Millan G, Ussia G, Tamburino C, Banovic M, Vujisic-Tesic B, Kujacic V, Obradovic S, Nedeljkovic I, Trifunovic D, Petrovic M, Crkvenac Z, Ostojic M, Bernard A, Piquemal M, Muller G, Arbeille P, Charbonnier B, Broyd C, Davies J, Mikhail G, Mayet J, Francis D, Rosca M, Magne J, Szymanski C, Popescu B, Ginghina C, Pierard L, Lancellotti P, Gonzalez-Mansilla A, Solis J, Angulo R, Perez-David E, Madrid G, Garcia-Robles J, Yotti R, Prieto R, Bermejo J, Fernandez-Aviles F, Otsuka T, Suzuki M, Yoshikawa H, Ishikawa Y, Ishida T, Osaki T, Matsuyama M, Yamashita H, Ozaki S, Sugi K, Stevanella M, Votta E, Fusini L, Veronesi F, Tamborini G, Pepi M, Maffessanti F, Alamanni F, Redaelli A, Caiani E, Park SD, Lee J, Shin S, Woo S, Kim D, Park K, Kwan J, Tsang W, Chandra S, Weinert L, Gayat E, Djelassi M, Balbach T, Mor-Avi V, Lang R, De Meester P, Van De Bruaene A, Delcroix M, Budts W, Abid L, Frikha Z, Makni K, Rekik H, Znazen A, Mourad H, Kammoun S, Sargento L, Satendra M, Sousa C, Lopes S, Longo S, Lousada N, Palma Reis R, Fouad D, Shams Eldeen R, Rosca M, Popescu B, Beladan C, Calin A, Voinea F, Enache R, Jurcut R, Coman I, Ghionea M, Ginghina C, Tesic M, Djordjevic-Dikic A, Trifunovic D, Petrovic O, Nedeljkovic I, Petrovic M, Boricic M, Giga V, Ostojic M, Vujisic-Tesic B, Pisciella L, Lanzillo C, Minati M, Caselli S, Di Roma M, Fratini S, Romano S, Calo' L, Lioy E, Penco M, Finocchiaro G, Pinamonti B, Merlo M, Barbati G, Sinagra G, Finocchiaro G, Pinamonti B, Merlo M, Barbati G, Dilenarda A, Sinagra G, Comenale Pinto S, Ancona R, Caso P, Cavallaro C, Vecchione F, D'onofrio A, Fero' M, Calabro' R, Gustafsson S, Ihse E, Henein M, Westermark P, Suhr O, Lindqvist P, Oliva Sandoval M, Gonzalez Carrillo M, Garcia Navarro M, Garcia-Molina Saez E, Sabater Molina M, Saura Espin D, Lacunza Ruiz J, Gimeno Blanes J, De La Morena Valenzuela G, Valdes Chavarri M, Prinz C, Faber L, Horstkotte D, Hoetz H, Voigt J, Dores H, Gandara F, Correia M, Abecasis J, Rosario I, Fonseca C, Arroja I, Aleixo A, Martins A, Mendes M, Radulescu L, Dan Radulescu D, Parv Andreea P, Duncea Caius D, Ciuleanu T C, Mitrea Paulina M, Frea S, Capriolo M, Grosso Marra W, Cali Quaglia F, Bordese R, Ribezzo M, Boffini M, Rinaldi M, Gaita F, Morello M, Maceira Gonzalez AM, Cosin-Sales J, Dalli E, Diago J, Aguilar J, Ruvira J, Sousa C, Goncalves S, Gomes A, Pinto F, Tsai WC, Liu YW, Shih JY, Huang YY, Chen JY, Tsai LM, Chen JH, Sargento L, Satendra M, Longo S, Lousada N, Palma Reis R, Ribeiro S, Doroteia D, Goncalves S, Santos L, David C, Vinhas De Sousa G, Almeida A, Iwase M, Itou Y, Yasukochi S, Shiino K, Inuzuka H, Sugimoto K, Ozaki Y, Gieszczyk-Strozik K, Sikora-Puz A, Mizia M, Lasota B, Chmiel A, Lis-Swiety A, Michna J, Brzezinska-Wcislo L, Mizia-Stec K, Gasior Z, Luijendijk P, De Bruin-Bon H, Zwiers C, Vriend J, Van Den Brink R, Mulder B, Bouma B, Brigido S, Gianfagna P, Proclemer A, Plicht B, Kahlert P, Kaelsch H, Buck T, Erbel R, Konorza T, Yoon H, Kim K, Ahn Y, Jeong M, Cho J, Park J, Kang J, Rha W, Jansen Klomp WW, Brandon Bravo Bruinsma G, Van 'T Hof A, Spanjersberg S, Nierich A, Bombardini T, Gherardi S, Picano E, Ciarka A, Herbots L, Eroglu E, Van Cleemput J, Droogne W, Jasityte R, Meyns B, Voigt J, D'hooge J, Vanhaecke J, Al Barjas M, Iskreva R, Morris R, Davar J, Zhao Y, Lindqvist P, Holmgren A, Morner S, Henein M, Nedeljkovic I, Ostojic M, Giga V, Stepanovic J, Djordjevic-Dikic A, Beleslin B, Nedeljkovic M, Banovic M, Mazic S, Stojanov V, Piatkowski R, Kochanowski J, Scislo P, Grabowski M, Marchel M, Roik M, Kosior D, Opolski G, Tomaszewski A, Kutarski A, Tomaszewski M, Eibel S, Hasheminejad E, Mukherjee C, Tschernich H, Ender J, Delithanasis I, Celutkiene J, Kenny C, Monaghan M, Van Den Oord S, Ten Kate G, Akkus Z, Renaud G, Sijbrands E, Ten Cate F, De Jong N, Bosch J, Van Der Steen A, Schinkel A, Lisowska A, Knapp M, Tycinska A, Sawicki R, Kralisz P, Sobkowicz B, Chang SA, Lee SC, Kim EY, Hahm SH, Ahn GT, Sohn MK, Park SJ, Choi JO, Park SW, Oh JK, Gursoy MO, Gokdeniz T, Astarcioglu M, Bayram Z, Cakal B, Karakoyun S, Kalcik M, Kahveci G, Yildiz M, Ozkan M, Muraru D, Dal Bianco L, Solda' E, Cucchini U, Peluso D, Tuveri M, Al Mamary A, Badano L, Iliceto S, Skidan V, Borowski A, Park M, Thomas J, Ranjbar S, Hassantash S, Karvandi M, Foroughi M, Davidsen ES, Cramariuc D, Bleie O, Gerdts E, Matre K, Cusma' Piccione M, Zito C, Bagnato G, Di Bella G, Mohammed M, Piluso S, Oreto L, Oreto G, Bagnato G, Carerj S, Prinz C, Bitter T, Faber L, Horstkotte D, Dores H, Abecasis J, Carvalho S, Santos M, Andrade M, Ribeiras R, Canada M, Reis C, Gouveia R, Mendes M, Santisteban Sanchez De Puerta M, Mesa Rubio MD, Ruiz Ortiz M, Delgado Ortega M, Pena Pena ML, Puentes Chiachio M, Suarez De Lezo Cruz-Conde J, Pan Alvarez-Ossorio M, Mazuelos Bellido F, Suarez De Lezo Herreros De Tejada J, Altekin E, Yanikoglu A, Karakas S, Oncel C, Akdemir B, Belgi Yildirim A, Cilli A, Yilmaz H, Lenartowska L, Furdal M, Knysz B, Konieczny A, Lewczuk J, Comenale Pinto S, Ancona R, Caso P, Severino S, Cavallaro M, Coppola M, Calabro' R, Motoki H, To A, Bhargava M, Wazni O, Marwick T, Klein A, Sinkovskaya E, Horton S, Abuhamad A, Mingo Santos S, Monivas Palomero V, Beltran Correas B, Mitroi C, Gutierrez Landaluce C, Garcia Lunar I, Gonzalez Mirelis J, Cavero M, Segovia Cubero J, Alonso Pulpon L, Gurel E, Karaahmet T, Tigen K, Kirma C, Dundar C, Pala S, Isiklar I, Cevik C, Kilicgedik A, Basaran Y, Brambatti M, Romandini A, Barbarossa A, Molini S, Urbinati A, Giovagnoli A, Cipolletta L, Capucci A, Park S, Choi E, Ahn C, Hong S, Kim M, Lim D, Shim W, Xie J, Fang F, Zhang Q, Chan J, Yip G, Sanderson J, Lam Y, Yan B, Yu C, Jorge Perez P, De La Rosa Hernandez A, Hernandez Garcia C, Duque Garcia A, Barragan Acea A, Arroyo Ucar E, Jimenez Rivera J, Lacalzada Almeida J, Laynez Cerdena I, Maffessanti F, Gripari P, Pontone G, Andreini D, Tamborini G, Carminati C, Pepi M, Caiani E, Capoulade R, Larose E, Clavel M, Dumesnil J, Arsenault M, Bedard E, Mathieu P, Pibarot P, Gargani L, Baldi G, Forfori F, Caramella D, D'errico L, Abramo A, Sicari R, Picano E, Giunta F, Lee WN, Larrat B, Messas E, Pernot M, Tanter M, Velagic V, Cikes M, Matasic R, Skorak I, Skorak I, Samardzic J, Puljevic D, Lovric Bencic M, Biocina B, Milicic D, Roosens B, Bala G, Droogmans S, Hostens J, Somja J, Delvenne E, Schiettecatte J, Lahoutte T, Van Camp G, Cosyns B, Ghosh A, Hardy R, Chaturvedi N, Francis D, Deanfield J, Pellerin D, Kuh D, Hughes A, Malmgren A, Dencker M, Stagmo M, Gudmundsson P, Seo Y, Ishizu T, Aonuma K, Schuuring MJ, Vis J, Bouma B, Van Dijk A, Van Melle J, Pieper P, Vliegen H, Sieswerda G, Mulder B, Foukarakis E, Pitarokilis A, Kafarakis P, Kiritsi A, Klironomos E, Manousakis A, Fragiadaki X, Papadakis E, Dermitzakis A. Poster Session 1: Thursday 8 December 2011, 08:30-12:30 * Location: Poster Area. European Journal of Echocardiography 2011. [DOI: 10.1093/ejechocard/jer206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Sonne C, Bott-Fluegel L, Hauck S, Michalk F, Lesevic H, Demetz G, Braun D, Hausleiter J, Schoemig A, Kolb C, Hirayama Y, Tsukamoto M, Hotta D, Yokoyama H, Kikuchi K, Ohori K, Sato N, Kawamura Y, Hasebe N, Kaladaridis A, Bramos D, Skaltsiotis I, Kottis G, Antoniou A, Matthaios I, Agrios I, Vasiladiotis N, Pamboucas C, Toumanidis S, Minati M, Cavarretta E, De Ruvo E, Rebecchi M, Sciarra L, Matera S, Fratini S, Zuccaro L, Lioy E, Calo' L, Esposito C, Chinali M, D' Asaro M, Toscano A, Iacobelli R, Del Pasqua A, Di Clemente S, Parisi F, Pongiglione G, Rinelli G, Djordjevic-Dikic A, Nikcevic G, Raspopovic S, Jovanovic V, Tesic M, Djordjevic S, Milasinovic G, Gurel E, Tigen K, Karaahmet T, Dundar C, Guler A, Fotbolcu H, Basaran Y, Risum N, Williams E, Khouri M, Jackson K, Olsen N, Jons C, Storm K, Velazquez EJ, Kisslo J, Sogaard P, Separovic Hanzevacki J, Baricevic Z, Pezo Nikolic B, Lovric D, Ivanac Vranesic I, Ernst A, Milicic D, Jurin H, Esmaeilzadeh M, Salehi Omran M, Maleki M, Haghjoo M, Noohi F, Ojaghi Haghighi Z, Sadeghpour A, Nakhostin Davari P, Bakhshandeh Abkenar H. Moderated Poster Sessions 4: Velocity and deformation imaging in electrophysiology * Friday 9 December 2011, 14:00-18:00 * Location: Moderated Poster Area. European Journal of Echocardiography 2011. [DOI: 10.1093/ejechocard/jer215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mutlu B, Tigen K, Gurel E, Ozben B, Karaahmet T, Basaran Y. The predictive value of flow-mediated dilation and carotid artery intima-media thickness for occult coronary artery disease. Echocardiography 2011; 28:1141-7. [PMID: 21854440 DOI: 10.1111/j.1540-8175.2011.01492.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Multidetector row computed tomography (MDCT) is an attractive noninvasive alternative to assess overall coronary artery disease (CAD) burden and may reveal coronary plaques, which may be underestimated by conventional coronary angiography. The aim of this study was to determine whether brachial artery flow-mediated dilation (FMD) and carotid artery intima-media thickness (CIMT) might accurately predict patients with occult coronary plaques whose conventional coronary angiographies revealed normal coronary arteries (NCA). METHODS Thirty-five patients with angiographically NCA were consecutively recruited into the study. They underwent MDCT and were divided into NCA group (18 patients; 8 male; 47 ± 9 years) and occult CAD group (17 patients; 11 male; 50 ± 10 years) according to presence of coronary plaque. Nineteen consecutive patients with evident CAD (16 male; 54 ± 7 years) and 19 healthy subjects (10 male; 50 ± 6 years) were included as control groups. FMD and CIMT were measured by brachial and carotid artery ultrasonography. RESULTS Occult CAD group had significantly lower FMD and insignificantly higher CIMT than NCA group whereas they had significantly higher FMD and insignificantly lower CIMT than evident CAD group. NCA group had significantly lower CIMT than evident CAD group. Receiver operating characteristic curve analysis demonstrated FMD < 8% (sensitivity: 94.4%; specificity: 73.0%; PPV: 77.3%; NPV: 93.1%) and CIMT ≥ 0.65 cm (sensitivity: 72.2%; specificity: 62.2%; PPV: 65.0%; NPV: 69.7%) could predict patients with CAD. FMD and CIMT were independent predictors of CAD (P < 0.001; OR: 45.630; 95%CI: 5.38-386.983 and P = 0.015; OR: 14.226; 95%CI: 1.666-121.467, respectively). CONCLUSION FMD and CIMT might predict patients with occult CAD and be helpful in selecting patients for MDCT.
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Affiliation(s)
- Bulent Mutlu
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
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Karaahmet T, Tigen K, Dundar C, Cevik C, Guler A, Gurel E, Kirma C. Intraventricular and papillary muscle dyssynchrony is related to the diastolic phase of functional mitral regurgitation in patients with non-ischemic dilated cardiomyopathy. J Heart Valve Dis 2011; 20:136-145. [PMID: 21560811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Functional mitral regurgitation (FMR) is commonly encountered in patients with heart failure, and is associated with an adverse prognosis. It is hypothesized that left ventricular (LV) and papillary muscle systolic dyssynchrony causes diastolic mitral regurgitation (DMR) in non-ischemic dilated cardiomyopathy (DC) patients. METHODS A total of 77 patients with non-ischemic DC was enrolled, of whom 25 were without DMR (group I) and 52 with DMR (group II). Mitral valve apparatus measurements were calculated using two-dimensional echocardiography, while LV/papillary muscle (Pap-index) systolic dyssynchrony parameters were calculated using tissue Doppler echocardiography. RESULTS The FMR volumes were similar between the two groups (19.4 +/- 10.6 and 22.4 +/- 11.1 ml/beat in groups I and II, respectively). Both groups had similar mitral valves, as assessed by the geometry of the mitral valve apparatus parameters, including tent area, mitral annulus diameter, and tethering distance. However, the maximal intraventricular mechanical delay (MIMD; p < 0.001), peak (+/- SD) myocardial sustained systolic velocity (Ts-SD; p < 0.001) and Pap-index (p < 0.001) were each significantly increased in group II. Strong correlations were apparent between DMR and dyssynchrony parameters [(Ts-SD; r = 0.74, p < 0.001), MIMD (r = 0.78, p < 0.001) and Pap-index (r = 0.78, p < 0.001)]. Linear regression analysis revealed the MIMD (OR 2.94, 95% CI 2.7-6.6, p < 0.001), Ts-SD (OR 3.6, 95% CI 1.2-3.5, p < 0.001) and Pap-index (OR 2.2, 95% CI 1.27-1.35, p = 0.001) to be independent predictors of DMR. CONCLUSION In patients with non-ischemic DC, DMR may serve as a useful indicator of mechanical LV/papillary muscle dyssynchrony, especially when used in combination with the other echocardiographic parameters.
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Affiliation(s)
- Tansu Karaahmet
- Cardiology Division, Acibadem University School of Medicine, Istanbul, Turkey
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Basaran Y, Tigen K, Karaahmet T, Isiklar I, Cevik C, Gurel E, Dundar C, Pala S, Mahmutyazicioglu K, Basaran O. Fragmented QRS Complexes Are Associated with Cardiac Fibrosis and Significant Intraventricular Systolic Dyssynchrony in Nonischemic Dilated Cardiomyopathy Patients with a Narrow QRS Interval. Echocardiography 2011; 28:62-8. [PMID: 20618390 DOI: 10.1111/j.1540-8175.2010.01242.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Yelda Basaran
- Cardiology Department, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey.
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Kuznetsov VA, Kozhurina AO, Plusnin AV, Szulik M, Sredniawa B, Streb W, Lenarczyk R, Stabryla-Deska J, Sedkowska A, Kowalski O, Kalarus Z, Kukulski T, Katova TM, Nesheva A, Simova I, Hristova K, Kostova V, Boiadjiev L, Dimitrov N, Papamichalis Michalis MP, Sitafidis George SG, Dimopoulos Basilios BD, Kelepesis Glafkos GK, Economou Dimitrios DE, Skoularigis John JS, Triposkiadis Filippos FT, Attenhofer Jost CH, Pfyffer M, Naegeli B, Levis P, Faeh-Gunz A, Brunner-Larocca HP, Velasco Del Castillo MS, Cacicedo A, Onaindia JJ, Gonzalez Ruiz J, Subinas A, Alarcon JA, Quintana O, Rodriguez I, Laraudogoitia E, Lam YY, Henein MY, Mazzone A, Vianello A, Perlini S, Corciu AI, Cappelli S, Cerillo A, Chiappino D, Berti S, Glauber M, Herrmann S, Niemann M, Stoerk S, Strotmann J, Voelker W, Ertl G, Weidemann F, Yong ZY, Boerlage - Van Dijk K, Koch KT, Vis MM, Bouma BJ, Henriques JPS, Cocchieri R, De Mol BAJM, Piek JJ, Baan J, Keenan NGJ, Cueff C, Cimadevilla C, Brochet E, Lepage L, Detaint D, Iung B, Vahanian A, Messika-Zeitoun D, Otsuka T, Suzuki M, Yoshikawa H, Hashimoto G, Osaki T, Tsuchida T, Matsuyama M, Yamashita H, Ozaki S, Sugi K, Garcia Alonso CJ, Vallejo Camazon N, Ferrer Sistach E, Camara ML, Lopez Ayerbe J, Bosch Carabante C, Espriu Simon M, Gual Capllonch F, Bayes Genis A, Deswarte G, Vanesson C, Polge AS, Huchette D, Modine T, Marboeuf P, Lamblin N, Bauters C, Deklunder G, Le Tourneau T, Agricola A, Gullace M, Stella S, D'amato R, Slavich M, Oppizzi M, Ancona M, Margonato A, Le Ven F, Etienne Y, Jobic Y, Frachon I, Castellant P, Fatemi M, Blanc JJ, Muratori M, Montorsi P, Maffessanti F, Gripari P, Teruzzi G, Ghulam Ali S, Fusini L, Celeste F, Pepi M, Goebel B, Haugaa K, Meyer K, Otto S, Lauten A, Jung C, Edvardsen T, Figulla HR, Poerner TC, Aksoy H, Okutucu S, Evranos B, Aytemir K, Kaya EB, Kabakci G, Tokgozoglu L, Ozkutlu H, Oto A, Valeur N, Pedersen HH, Videbaek R, Hassager C, Svendsen JH, Kober L, Tigen MK, Karaahmet T, Gurel E, Pala S, Dundar C, Basaran Y, Caldararu CI, Ene E, Dorobantu M, Vatasescu RG, Tigen MK, Karaahmet T, Gurel E, Dundar C, Basaran Y, Tigen MK, Karaahmet T, Gurel E, Dundar C, Pala S, Basaran Y, Tigen MK, Pala S, Karaahmet T, Dundar C, Gurel E, Basaran Y, Cikes M, Bijnens B, Gasparovic H, Siric F, Velagic V, Lovric D, Samardzic J, Ferek-Petric B, Milicic D, Biocina B, Kjaergaard J, Ghio S, St John Sutton M, Hassager C, Moreau O, Kervio G, Thebault C, Leclercq C, Donal E, Mornos C, Rusinaru D, Petrescu L, Cozma D, Ionac A, Pescariu S, Dragulescu SI, Petrovic MZ, Vujisic-Tesic B, Milasinovic G, Petrovic MT, Nedeljkovic I, Zamaklar-Trifunovic D, Calovic Z, Jelic V, Boricic M, Petrovic I, Kuchynka P, Palecek T, Simek S, Nemecek E, Horak J, Hulinska D, Schramlova J, Vitkova I, Aster V, Linhart A, Paluszkiewicz L, Guersoy D, Ozegowski S, Spiliopoulos S, Koerfer R, Tenderich G, Gaggl M, Heinze G, Sunder-Plassmann G, Graf S, Zehetmayer M, Voigtlaender T, Mannhalter C, Paschke E, Fauler G, Mundigler G, Tesic M, Trifunovic D, Djordjevic-Dikic A, Petrovic O, Nedeljkovic I, Petrovic M, Boricic M, Beleslin B, Vujisic-Tesic B, Ostojic M, Trifunovic D, Tesic M, Vujisic-Tesic B, Petrovic O, Petrovic M, Nedeljkovic I, Boricic M, Draganic G, Ostojic M, Correia CE, Rodrigues B, Santos LF, Moreira D, Gama P, Nunes L, Nascimento C, Dionisio O, Santos O, Prinz C, Oldenburg O, Bitter T, Piper C, Horstkotte D, Faber L, Nemes A, Gavaller H, Csanady M, Forster T, Calcagnino M, O'mahony C, Tsovolas K, Lambiase PD, Elliott P, Olezac AS, Bensaid A, Nahum J, Teiger E, Dubois-Rande JL, Gueret P, Lim P, Prinz C, Langer C, Oldenburg O, Horstkotte D, Faber L, Kansal M, Surapaneni P, Sengupta PP, Lester SJ, Ommen SR, Ressler SW, Hurst RT, Monivas Palomero V, Mingo Santos S, Mitroi C, Garcia Lunar I, Garcia Pavia P, Gonzalez Mirelis J, Ruiz Bautista L, Castro Urda V, Toquero Ramos J, Fernandez Lozano I, Sommer A, Poulsen SH, Mogensen J, Thuesen L, Egeblad H, Montisci R, Ruscazio M, Vacca A, Garau P, Tuveri F, Soro C, Matthieu A, Meloni L, Kosmala W, Przewlocka-Kosmala M, Wojnalowicz A, Mysiak A, Marwick TH, Yotti R, Ripoll C, Bermejo J, Benito Y, Mombiela T, Rincon D, Barrio A, Banares R, Fernandez-Aviles F, Tomaszewski A, Kutarski A, Tomaszewski M, Ticulescu R, Vriz O, Sparacino L, Popescu BA, Ginghina C, Nicolosi GL, Carerj S, Antonini-Canterin F, Agricola E, Slavich M, Stella S, Ancona M, Oppizzi M, Bertoglio L, Melissano G, Margonato A, Chiesa R, Garcia Blas S, Iglesias Del Valle D, Lopez Fernandez T, Gomez De Diego JJ, Monedero Martin MC, Dominguez FJ, Moreno Yanguela M, Lopez Sendon JL, Adhya S, Murgatroyd FD, Monaghan M, Spinarova L, Meluzin J, Hude P, Krejci J, Podrouzkova H, Pesl M, Panovsky R, Dusek L, Orban M, Korinek J, Hammerstingl C, Schwiekendik M, Nickenig G, Momcilovic D, Lickfett L, Beladan CC, Calin A, Rosca M, Popescu BA, Muraru D, Voinea F, Popa E, Matei F, Curea F, Ginghina C, Di Salvo G, Pacileo G, Gala S, Castaldi B, D'aiello AF, Mormile A, Baldini L, Russo MG, Calabro R, Halvorsen PS, Dahle G, Bugge JF, Bendz B, Aaberge L, Rein KA, Fiane A, Bergsland J, Fosse E, Aakhus S, Koopman LP, Chahal N, Slorach C, Hui W, Sarkola T, Manlhiot C, Bradley TJ, Jaeggi ET, Mccrindle BW, Mertens L, Di Salvo G, Pacileo G, Castaldi B, Gala S, Baldini L, D'aiello FA, Mormilw A, Rea A, Russo MG, Calabro R, Calin A, Rosca M, O'Connor K, Romano G, Magne J, Beladan CC, Ginghina C, Pierard L, Lancellotti P, Popescu BA, Arita T, Ando K, Isotani A, Soga Y, Iwabuchi M, Nobuyoshi M, Hammerstingl C, Momcilovic D, Wiesen M, Nickenig G, Skowasch D, Mornos C, Cozma D, Rusinaru D, Ionac A, Pescariu S, Dragulescu SI, Niemann M, Breunig F, Beer M, Herrmann S, Strotmann J, Hu K, Voelker W, Ertl G, Wanner C, Weidemann F, Morel MA, Bernard YF, Descotes-Genon V, Meneveau N, Schiele F, Vitarelli A, Bernardi M, Scarno A, Caranci F, Padella V, Dettori O, Capotosto L, Vitarelli M, De Cicco V, Bruno P, Bajraktari G, Lindqvist P, Gustafsson U, Holmgren A, Henein MY, Hassan M, Said K, Baligh E, Farouk H, Osama D, Elmahdy MF, Elfaramawy A, Sorour K, Luckie M, Zaidi A, Fitzpatrick A, Khattar RS, Schwartz J, Huttin O, Popovic B, Zinzius PY, Christophe C, Marcon O, Groben L, Juilliere Y, Chabot F, Selton-Suty C, Krastev B, Kinova ETK, Zlatareva NIZ, Goudev ARG, Teske AJ, De Boeck BW, Mohames Hoesein FA, Van Driel V, Loh P, Cramer MJ, Doevendans PA, Dillenburg F, Mertens L, Abd El Salam KM, Ho EMM, Hall M, Hemeryck L, Bennett K, Scott K, King G, Murphy RT, Mahmud A, Brown AS, Dalen H, Thorstensen A, Romundstad PR, Aase SA, Stoylen A, Vatten L, Bochenek T, Wita K, Tabor Z, Doruchowska A, Lelek M, Trusz-Gluza M, Hamodraka E, Paraskevaidis I, Karamanou A, Michalakeas C, Vrettou H, Kapsali E, Tsiapras D, Lekakis I, Anastasiou-Nana M, Kremastinos D, Sirugo L, Bottari VE, Licciardi S, Blundo A, Atanasio A, Monte IP, Park CS, Kim JH, Cho JS, Kim MJ, Cho EJ, Ihm SH, Jung HO, Jeon HK, Youn HJ, Kim KS, Fontana A, Taravella L, Zambon A, Trocino G, Giannattasio C, Kalinin A, Alekhin M, Bahs G, Lejnieks A, Kalvelis A, Kalnins A, Shipachovs P, Zakharova E, Blumentale G, Trukshina M, Biering-Sorensen T, Mogelvang R, Haahr-Pedersen S, Schnohr P, Sogaard P, Skov Jensen J, Gargani L, Agoston G, Capati E, Badano L, Moreo A, Costantino MF, Caputo ML, Mondillo S, Sicari R, Picano E, Malev EG, Timofeev EV, Reeva SV, Zemtsovsky EV, Piazza R, Enache R, Roman-Pognuz A, Muraru D, Popescu BA, Leiballi E, Pecoraro R, Antonini-Canterin F, Ginghina C, Nicolosi GL, Sadeghian H, Lotfi_Tokaldany M, Rezvanfard M, Kasemisaeid A, Majidi S, Montazeri M, Saber-Ayad M, Nassar YS, Farhan A, Moussa A, El-Sherif A, Cooper RM, Somauroo JD, Shave RE, Williams KL, Forster J, George C, Bett T, Gaze DC, George KP, Mansencal N, Dupland A, Caille V, Perrot S, Bouferrache K, Vieillard-Baron A, Jouffroy R, Cioroiu SG, Alexe OS, Bobescu E, Rus H, Schiano Lomoriello V, Esposito R, Santoro A, Raia R, Farina F, Ippolito R, Galderisi M, Aburawi EH, Malcus P, Thuring A, Maxedius A, Pesonen E, Nair SV, Joyce E, Lee L, Shrimpton J, Newman E, James PR, Jurcut C, Caraiola S, Jurcut RO, Giusca S, Nitescu D, Amzulescu MS, Copaci I, Popescu BA, Tanasescu C, Ginghina C, Silva Marques J, Silva D, Ferreira F, Ferreira PC, Almeida AG, Martim Martins J, Lopes MG, Bergenzaun L, Chew M, Ersson A, Gudmundsson P, Ohlin H, Borowiec A, Dabrowski R, Wozniak J, Jasek S, Chwyczko T, Kowalik I, Musiej-Nowakowska E, Szwed H, Wen YL, Tian J, Yan L, Cheng H, Yang H, Luo B, Wang J, Kozman H, Villarreal D, Liu K, Karavidas A, Tsiachris D, Lazaros G, Matzaraki V, Xylomenos G, Levendopoulos G, Arapi S, Perpinia A, Matsakas E, Pyrgakis V, Liu YW, Su CT, Tsai WC, Huang JW, Hung KY, Chen JH, Larsson M, Kremer F, Kouznetsova T, Bjallmark A, Lind B, Brodin LA, D'hooge J, Santoro A, Caputo M, Antonelli G, Lisi M, Giacomin E, Mondillo S, Moustafa S, Alharthi M, Kansal M, Deng Y, Chandrasekaran K, Mookadam F, Hayashi SY, Bjallmark A, Larsson M, Nascimento MM, Lindholm B, Lind B, Seeberger A, Nowak J, Riella MC, Brodin LA, Theodosis A, Fousteris E, Tsiaousis G, Krommydas A, Margetis P, Katidis Z, Beldekos D, Argirakis S, Melidonis A, Foussas S, Khaleva O, Onyshchenko O, Lukaschuk E, Sherwi N, Nikitin N, Cleland JGF, Risum N, Jons C, Olsen NT, Valeur N, Kronborg MB, Jensen MT, Fritz-Hansen T, Bruun NE, Hojgaard MV, Sogaard P, Petrini J, Yousry M, Rickenlund A, Liska J, Franco-Cereceda A, Hamsten A, Eriksson P, Caidahl K, Eriksson MJ, Elmstedt N, Lind B, Ferm-Widlund K, Westgren M, Brodin LA, Szymczyk E, Kasprzak JD, Wozniakowski B, Rotkiewicz A, Szymczyk K, Stefanczyk L, Michalski B, Lipiec P, Ring L, Eller T, Deegan P, Rusk R, Urbano Moral JA, Arias JA, Kuvin JT, Patel AR, Pandian NG, Bellsham-Revell H, Bell AJ, Miller O, Greil GF, Simpson J, Moustafa S, Kansal M, Alharthi M, Deng Y, Chandrasekaran K, Mookadam F, Ancona R, Comenale Pinto S, Caso P, Severino S, Nunziata L, Roselli T, Calabro R, Dussault C, Donal E, Lafitte S, Habib G, Reant P, Derumeaux G, Thibault H, Gueret P, Lim P, Kaladaridis A, Agrios IA, Pamboucas CP, Mesogitis SM, Vasiladiotis NV, Bramos DB, Toumanidis STT, Martiniello AR, Santangelo G, Caso P, Pedrizzetti G, Tonti G, Cioppa C, Cavallaro M, Calvi V, Chianese R, Calabro R. Poster session I * Thursday 9 December 2010, 08:30-12:30. European Journal of Echocardiography 2010. [DOI: 10.1093/ejechocard/jeq136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Tigen K, Karaahmet T, Cevik C, Gurel E, Pala S, Mutlu B, Basaran Y. Prognostic utility of right ventricular systolic functions assessed by tissue doppler imaging in dilated cardiomyopathy and its correlation with plasma NT-pro-BNP levels. ACTA ACUST UNITED AC 2010; 15:234-9. [PMID: 19751425 DOI: 10.1111/j.1751-7133.2009.00095.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors invesitgated the impact of right ventricular systolic function measured by tissue Doppler imaging on clinical end points and its correlation with plasma NT-pro-BNP levels in 75 patients with nonischemic dilated cardiomyopathy. Echocardiographic peak systolic velocities of tricuspid lateral annulus by tissue Doppler imaging and plasma pro-B-type natriuretic peptide (NT-pro-BNP) levels were measured. Forty patients had clinical end points in 29+/-16 months. They were found to have higher plasma NT-pro-BNP levels and lower tricuspid lateral annulus and interventricular septum tissue Doppler peak systolic velocities than patients without clinical end points. Cut-off level of plasma NT-pro-BNP levels for predicting clinical end points was 1700 pg/mL (sensitivity and specificity, 82% and 75%, respectively). Cut-off level of tricuspid lateral annulus tissue Doppler peak systolic velocities for predicting clinical end points was 6.25 cm/sec (sensitivity and specificity, 80% and 57%, respectively). In conclusion, plasma NT-pro-BNP levels and tissue Doppler-derived right ventricular systolic functional parameters are helpful in determining prognosis in dilated cardiomyopathy.
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Affiliation(s)
- Kursat Tigen
- Cardiology Department, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
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Karaahmet T, Tigen K, Gurel E, Cevik C, Dundar C, Fotbolcu H, Pala S, Basaran Y. Grading Functional Mitral Regurgitation by Tissue Doppler-Derived Isovolumic Acceleration Parameters in Patients with Nonischemic Dilated Cardiomyopathy. Echocardiography 2010; 27:815-22. [DOI: 10.1111/j.1540-8175.2009.01135.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Tigen K, Karaahmet T, Zencirkiran H, Cevik C, Gurel E, Fotbolcu H, Dundar C, Sasmazel A, Basaran Y. Utilidad de la aceleración isovolumétrica y los parámetros de ecocardiografía Doppler tisular en la predicción de la recuperación funcional postoperatoria tras cirugía valvular cardiaca. Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70064-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Tigen K, Karaahmet T, Zencirkiran H, Cevik C, Gurel E, Fotbolcu H, Dundar C, Sasmazel A, Basaran Y. [Usefulness of isovolumic acceleration and tissue Doppler echocardiographic parameters for predicting postoperative functional recovery after heart valve surgery]. Rev Esp Cardiol 2010; 63:430-438. [PMID: 20334809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION AND OBJECTIVES Postoperative right ventricular (RV) systolic dysfunction is associated with perioperative myocardial ischemia, hypothermic cardiac arrest, cardiopulmonary bypass and pericardial injury. As myocardial acceleration during isovolumic contraction (IVA) and myocardial velocity during isovolumic contraction (IVV) are little affected by loading conditions, they can predict myocardial function better than conventional parameters. We investigated the usefulness of these parameters for predicting postoperative RV systolic function after isolated heart valve surgery. METHODS Overall, 63 patients who underwent isolated heart valve surgery were evaluated by tissue Doppler echocardiography preoperatively, and immediately and 6 months postoperatively. RESULTS By the 6-month follow-up, patients' New York Heart Association functional class had improved significantly (P< .026). At that time, functional recovery was observed in 38 of the 63 patients. Logistic regression analysis demonstrated that RV IVA (odds ratio [OR]=3.1; 95% confidence interval [CI], 1.01-9.64; P=.047) and pulmonary artery systolic pressure (OR=1.07; 95% CI, 0.99-1.15; P=.07) were independent predictors of functional recovery 6 months postoperatively. The RV IVA value had recovered by the 6-month follow-up in 39 patients. A positive correlation was observed between functional recovery and IVA recovery (Spearman's correlation, r=0.499; P< .001). The RV IVA was observed to recover in all patient groups regardless of surgical method or atrial rhythm. CONCLUSIONS Preoperative RV IVA and pulmonary artery systolic pressure were independent predictors of functional recovery 6 months after isolated heart valve surgery. Given its association with functional recovery, postoperative improvement in these parameters may be a useful clinical indicator after heart valve surgery.
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Affiliation(s)
- Kursat Tigen
- Departamento de Cardiología. Kartal Kosuyolu Heart Education and Research Hospital. Estambul. Turquía
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Tigen K, Karaahmet T, Kirma C, Kilicgedik A, Dundar C, Pala S, Cevik C, Guler A, Gurel E, Basaran Y. The association of functional mitral regurgitation and anemia in patients with non-ischemic dilated cardiomyopathy. Cardiol J 2010; 17:274-280. [PMID: 20535718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND We investigated the association between anemia and functional mitral regurgitation (MR) in non-ischemic dilated cardiomyopathy (DCM) patients with sinus rhythm and normal renal function. METHODS Sixty non-ischemic DCM patients with sinus rhythm and left ventricular ejection fraction < 40% were recruited. Functional MR was quantified with the proximal isovelocity surface area method. MR was graded according to the mitral regurgitant volume (Reg Vol) or effective regurgitant orifice (ERO) area. The clinical, biochemical and echocardiographic correlates of functional MR severity were investigated in patients with DCM. RESULTS Hemoglobin degrees were significantly different between various MR levels (mild MR 13.9 +/- 1.7 mg/dL, moderate MR 12.3 +/- 1.5 mg/dL, moderate to severe MR 10.8 +/- 0.9 mg/dL). Receiver operating characteristic (ROC) analysis was performed to assess the utility of hemoglobin levels to predict moderate or severe functional MR. A hemoglobin level less than 12.5 mg/dL predicted moderate or high MR with 80% sensitivity and 58% specificity (AUC: 0.789, 95% CI: 0.676-0.901, p < 0.0001). Logistic regression analysis was performed to determine the independent predictors of moderate or severe levels of MR. The left atrium diameter (OR: 19.3, 95% CI: 1.4-27.1, p = 0.028) and presence of anemia (OR: 11.9, 95% CI: 1.22-42.5, p = 0.0045) were independent predictors of moderate or severe functional MR. CONCLUSIONS The presence of anemia and enlarged left atrium are independent predictors of moderate or severe functional MR in non-ischemic DCM patients with normal renal function. Hemoglobin levels less than 12.5 mg/dL should alert the physician for the presence of moderate or severe MR in patients with DCM.
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Affiliation(s)
- Kursat Tigen
- Kartal Kosuyolu Heart, Education, and Research Hospital, Cardiology Division, Istanbul, Turkey.
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Tigen K, Karaahmet T, Gurel E, Durmus HI, Kirma C. Spontaneous dissection of left anterior descending coronary artery in a young man. Tex Heart Inst J 2010; 37:131-133. [PMID: 20200650 PMCID: PMC2829786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Kursat Tigen
- Department of Cardiology, Kartal Kosuyolu Heart & Research Hospital, 34846 Istanbul, Turkey
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Tigen K, Karaahmet T, Gurel E, Cevik C, Nugent K, Pala S, Tanalp AC, Mutlu B, Basaran Y. The utility of fragmented QRS complexes to predict significant intraventricular dyssynchrony in nonischemic dilated cardiomyopathy patients with a narrow QRS interval. Can J Cardiol 2009; 25:517-22. [PMID: 19746241 DOI: 10.1016/s0828-282x(09)70137-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Fragmented QRS complexes in the electrocardiograms (ECGs) of patients with coronary artery disease are associated with adverse cardiac events. However, there are limited data on its predictive usefulness in patients with nonischemic dilated cardiomyopathy. Left ventricular dyssynchrony is common in heart failure patients who have wide QRS intervals, but its frequency in patients with narrow QRS intervals is uncertain. OBJECTIVES To investigate the relationship between fragmented QRS complexes and intraventricular dyssynchrony in patients with nonischemic dilated cardiomyopathy in sinus rhythm. METHODS Sixty nonischemic dilated cardiomyopathy patients with sinus rhythm and narrow QRS intervals were recruited. Forty patients had a fragmented QRS in their basal ECG, and 20 patients did not have a fragmented QRS. Patients were analyzed for correlation between fragmented QRS complexes and intraventricular dyssynchrony. RESULTS The maximal difference in time to the peak myocardial systolic velocity between any two left ventricular segments (Max-ASE Sys), and maximal difference between Max-ASE Sys and the mean value of all segments (Max-ASE to Mean Sys) were significantly higher in patients with fragmented QRS complexes (P=0.001 and P=0.003, respectively). Seventy-two per cent of the patients with fragmented QRS complexes had significant left ventricular dyssynchrony; 15% of patients without fragmented QRS complexes had significant left ventricular dyssynchrony (P<0.0001). The presence of fragmented QRS complexes in leads corresponding to the specific ventricular segment in basal ECG was found to detect intraventricular dyssynchrony with 90.6% sensitivity (negative predictive value of 85%). CONCLUSION Fragmentation in the resting ECG is associated with significant intraventricular dyssynchrony in patients with nonischemic cardiomyopathy, narrow QRS and sinus rhythm. Fragmentation in ECG might be useful in identifying patients who could benefit from cardiac resynchronization therapy.
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Affiliation(s)
- Kursat Tigen
- Cardiology Department, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Kartal, Turkey
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Abstract
Pathologic calcium deposition may be observed in the valve leaflets, valvular annulus, pericardial scar areas in chronic constructive pericarditis, and myocardial tissue. A direct x-ray may reveal the area of calcification in any of these tissues. The most common cause of myocardial calcification is myocardial infarction (MI) in which calcium accumulates in the infarcted tissue during myocardial healing process. The authors present a case of diffuse myocardial calcification located in the left ventricular apical aneurysm in a patient who had an MI 24 years ago, together with a diagnostic and therapeutic approach.
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Affiliation(s)
- Tansu Karaahmet
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
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Abstract
Myocardial noncompaction is an extremely uncommon cardiomyopathy. It can present as an isolated cardiac malformation or in association with other congenital anomalies. The left ventricle is usually affected, but a biventricular involvement rarely occurs. A predominant right ventricular involvement has not been reported. Here, we report an 18-year-old woman with biventricular noncompaction that predominantly involves the right ventricle.
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Affiliation(s)
- Kursat Tigen
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
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Gurel E, Ozdemir N, Cevik C, Kaymaz C. Acute anterior myocardial infarction secondary to a myocardial muscular bridge. J Invasive Cardiol 2009; 21:E12-E15. [PMID: 19126927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Emre Gurel
- Tervuursestraat 117/12, B-3000, Leuven, Belgium.
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Tigen K, Gurel E, Karaahmet T, Cevik C, Mutlu B, Basaran Y. A Complex Case of Congenital Cardiac Anomaly: Pulmonary Atresia and Ventricular Septal Defect Associated with Major Aortopulmonary Collaterals. Heart Surg Forum 2008; 11:E252-4. [DOI: 10.1532/hsf98.20081010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Tigen K, Karaahmet T, Tanalp AC, Gurel E, Cevik C, Mutlu B, Basaran Y. Value of clinical, electrocardiographic, echocardiographic and neurohumoral parameters in non-ischaemic dilated cardiomyopathy. Acta Cardiol 2008; 63:207-12. [PMID: 18468202 DOI: 10.2143/ac.63.2.2029530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM The aim of this study was to assess the predictive value of electrocardiographic, echocardiographic and neurohumoral parameters for adverse outcomes in non-ischaemic dilated cardiomyopathy patients with sinus rhythm. METHODS Seventy-eight patients with non-ischaemic dilated cardiomyopathy (LVEF < 40%) and sinus rhythm were enrolled. All patients underwent electrocardiographic, echocardiographic examination and coronary angiography. Blood samples for plasma NT pro-BNP levels were obtained at rest, following echocardiographic examination. Patients were followed up for clinical end points of death from worsening heart failure, sudden cardiac death and heart transplantation. RESULTS The study population consisted of 24 (30.8%) women and 54 (69.2%) men. Forty-four patients (65.4%) suffered from clinical end points during a mean of 1278 +/- 188 days follow-up; cardiac transplantation was performed in 5 (11%), sudden cardiac death occurred in 10 (23%) and death due to worsening heart failure in 29 (66%) patients. The patients were grouped according to the presence (group 1, 44 patients) or absence (group 2, 34 patients) of clinical end points. The patients in group 1 had lower systolic blood pressures (P = 0.006) and higher NYHA functional classes (P < 0.0001). When echocardiographic parameters and NT pro-BNP values were compared, the patients in group 1 had lower left ventricular ejection fractions (P < 0.0001), higher E/A ratios (P < 0.0001), shorter E wave deceleration times (P = 0.004), pulmonary acceleration times (P < 0.0001) and isovolumetric relaxation times (P = 0.03), increased mitral regurgitant volumes (P = 0.033) and higher plasma NT pro-BNP levels (P < 0.0001). There was no significant difference between the two groups regarding electrocardiographic parameters. In univariate analysis, the prognostic predictors of life expectancy were identified as plasma NT pro-BNP, NYHA functional class, left ventricular ejection fraction, E/A ratio and E wave deceleration time. However, in multivariate analysis by logistic regression only plasma NT pro-BNP was determined as independent predictor of life expectancy (P = 0.04, HR (95% CI) = 1.0003 (1.0000-1.0007), chi2 = 3.9). CONCLUSION Electrocardiographic parameters failed to predict clinical end points in this group of patients. Plasma NT pro-BNP is a useful biochemical marker to define the high-risk group that warrants closer follow-up in dilated cardiomyopathy patients with sinus rhythm.
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Affiliation(s)
- Kursat Tigen
- Kartal Kosuyolu Heart Education and Research Hospital, Cardiology Department, Istanbul Turkey;
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Gurel E, Karaahmet T, Tanalp AC, Mutlu B, Basaran Y. Discrete membranous subaortic stenosis complicated by infective endocarditis: a case report. Heart Surg Forum 2007; 10:E317-9. [PMID: 17599883 DOI: 10.1532/hsf98.20071020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Discrete membraneous subaortic stenosis is an uncommon cause of left ventricular outflow tract obstruction. Although its relationship to infective endocarditis is well defined, the expected site of vegetation is over the aortic valve. We report on a 46-year-old man who had a discrete membranous subaortic stenosis, complicated with infective endocarditis, in which the vegetation was over the subaortic membrane and the aortic valve was spared. To our knowledge, this is the first reported case of that entity.
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Affiliation(s)
- Emre Gurel
- Department of Cardiology, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey.
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Abstract
Acute coronary syndromes may be associated with a systemic acute pro-thrombotic condition, possibly involving inflammatory mechanisms as well, which are not confined to a single spot in the coronary circulation. Multivessel coronary thrombosis appears to be an exceptionally rare clinical finding. Here we present a case of anterior MI complicated by thrombi in circumflex and right coronary arteries.
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Affiliation(s)
- Bilal Boztosun
- Merkez Mah Cobancesme Cad., Selale Evleri A-8 blok Daire:3 Kagithane, Istanbul, Turkey.
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Bitigen A, Gurel E, Tanalp AC, Aung SM, Başaran Y. Acute anterior myocardial infarction due to aortosaphenous vein graft occlusion with very large thrombus burden. Exp Clin Cardiol 2007; 12:203-205. [PMID: 18651005 PMCID: PMC2359607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Accepted: 08/13/2007] [Indexed: 05/26/2023]
Abstract
A 75-year-old man, with a previous history of myocardial infarction and three-vessel coronary artery bypass grafting, presented with an acute anterior ST-elevation myocardial infarction. The vein graft to the left anterior descending artery was occluded with heavy thrombus burden, and the other grafts were patent. After administering a bolus dose of tirofiban and then undergoing percutaneous coronary intervention without stenting to the left anterior descending artery saphenous vein graft, intracoronary thrombolytic infusion was performed to maintain the patency of the vein graft. The patient was asymptomatic after medical follow-up. This may be an effective treatment option in patients with large thrombus burden and requires further investigation through large-scale trials.
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Affiliation(s)
- Atilla Bitigen
- Department of Cardiology, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul
| | - Emre Gurel
- Department of Cardiology, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul
| | | | - Soe Moe Aung
- Department of Cardiology, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul
| | - Yelda Başaran
- Department of Cardiology, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul
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