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Balaban Kocas B, Cetinkal G, Ser OS, Yildiz SS, Kilickesmez K. Comparative Analysis of Neutr ophil -to-l ympho cyte Ratio, Systemic Immune-Inflammation Index, and Prognostic Nutritional Index in Acute Myocardial Infarction Patients Treated with Percutaneous Coronary Intervention. Turk Kardiyol Dern Ars 2022; 50:505-511. [DOI: 10.5543/tkda.2022.22513] [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: 01/07/2023] Open
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2
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Ergene O, Aras D, Kaymaz C, Arsava EM, Gonen C, Gurkas E, Arslan U, Cagirici G, Cay S, Kilickap M, Kanat S, Ozpelit E, Vatansever F, Kilickesmez K. The Role of Non-Vitamin K Antagonist Oral Anticoagulants (NOACs) in Atrial Fibrillation: Treatment Management Based on Patient and Drug Characteristics. Turk Kardiyol Dern Ars 2022; 50:356-370. [DOI: 10.5543/tkda.2022.21191] [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: 11/04/2022] Open
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3
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Kocas B, Kilickesmez K. Catheter-directed thrombolysis in a COVID-19 patient complicated with pulmonary embolism. Turk J Emerg Med 2022; 22:54-57. [PMID: 35284696 PMCID: PMC8862799 DOI: 10.4103/2452-2473.336102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/14/2021] [Accepted: 09/20/2021] [Indexed: 11/05/2022] Open
Abstract
Since December 2019, the novel coronavirus (COVID-19) outbreak has become an important public health problem and one of the most common causes of morbidity and mortality worldwide. COVID-19 is highly associated with thromboembolic events, like deep venous thrombosis and pulmonary embolism (PE). Catheter-directed thrombolysis (CDT) provides effective reperfusion for the treatment of PE. We report a patient who was presented with intermediate-risk PE and had a saccular aneurysm of the anterior cerebral artery. The patient was suffered from recent COVID-19 infection and ischemic stroke. As the patient had high bleeding risk for full-dose systemic thrombolytic therapy, CDT was the preferred method for reperfusion. Finally, the patient was discharged from the hospital uneventfully 4 days later. In the setting of high bleeding risk, CDT seems to be an effective and safe approach in patients with intermediate-risk PE.
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Cetinkal G, Balaban Kocas B, Keskin K, Kilci H, Ser O, Yildiz SS, Sigirci S, Gurdal A, Sumerkan MC, Kilickesmez K. Comparative analysis of sequential pot-side-pot and kissing balloon techniques in patients with coronary bifurcation lesions treated with single stent strategy: propensity score analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2132] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
It is unknown whether the novel re-POT technique is more effective than commonly preferred kissing balloon inflation (KBI) in patients with non-complex coronary bifurcation lesions (CBL) treated with single-stent strategy. Our aim was to compare the efficacy of re-POT and KBI techniques in one-stent strategy of non-complex CBL.
Methods
283 patients were retrospectively analyzed (re-POT group, n=149; KBI group, n=134). Primary end-points of the study were defined as; in-hospital and 30-day mortality, contrast induced acute kidney injury (CI-AKI), stent thrombosis (ST), side branch (SB) dissection and need for SB stenting. Characteristics of patients at baseline were balanced by using propensity score inverse probability weighting (IPW).
Results
Procedure time (minute, 30.6±8.5 vs 34.3±11.6; p=0.003) and contrast volume (mL, 153.7±42.4 vs 171.1±58.2; p=0.004) were significantly lower in re-POT group. Besides, SB residual stenosis and number of patients with >50% SB residual stenosis remained significantly higher in re-POT group both in general and true bifurcation subgroup analysis (20.3±19.8% vs 16.5±16.4%, p=0.02; 11.9% vs 5.7%, p=0.01 and 24.1±23.2% vs 18.8±18.7%, p=0.03; 17.6% vs 6.6%, p=0.005; respectively). Combined clinical adverse outcomes were similar between groups. (Figure 1) SB dissection (10.2% vs 20.1%, p=0.001) and need for SB stenting (12.6% vs 19%, p=0.04) were reached statistically significance in KBI group after adjustment. (Figure 2)
Conclusions
Re-POT may be a simple and safe technique with a shorter procedure time and lower incidence of adverse events in non-complex CBL treated with single-stent strategy.
Funding Acknowledgement
Type of funding sources: None. Adverse clinical outcomes; weighted
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Affiliation(s)
- G Cetinkal
- Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - B Balaban Kocas
- Okmeydani Training and Research Hospital, Cardiology, Istanbul, Turkey
| | - K Keskin
- Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - H Kilci
- Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - O Ser
- Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - S S Yildiz
- Okmeydani Training and Research Hospital, Cardiology, Istanbul, Turkey
| | - S Sigirci
- Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - A Gurdal
- Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - M C Sumerkan
- Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - K Kilickesmez
- Okmeydani Training and Research Hospital, Cardiology, Istanbul, Turkey
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Sevinc M, Hasbal NB, Basturk T, Ozcafer PN, Kocas BB, Kilickesmez K, Ozel A, Sakaci T, Ahbap E, Unsal A, Koc Y. Comparison of lung ultrasound and other volumetric methods in peritoneal dialysis patients. Medicine (Baltimore) 2021; 100:e23856. [PMID: 33545952 PMCID: PMC7837871 DOI: 10.1097/md.0000000000023856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/23/2020] [Indexed: 12/24/2022] Open
Abstract
Although many alternative methods are present, maintaining ideal volume status in peritoneal dialysis (PD) patients still rely on clinical evaluation due to lack of an evidence-based method. Lung ultrasound (LUS) is a new method for evaluation of hidden congestion in this group.LUS findings and its relationship with other volumetric methods are investigated in this observational cross-sectional study.In this observational cross sectional study, LUS was performed to all PD patients and compared with symptoms of hypervolemia, physical examination, vascular endothelial growth factor-C (VEGF-C), and N-terminal pro-brain natriuretic peptide levels, chest radiography, echocardiography, bioelectrical impedance analysis.Data of 21 PD patients were evaluated. There was correlation between number of B lines and VEGF-C levels (r = 0.447, P = .042), daily urine output (r = 0.582, P = .007) and left ventricle mass index (r = -0.456, P = .038). Correlations with all other parameters were not significant. Daily urine output and VEGF-C levels were significantly different when B lines were grouped into 2 according to the median level (P < .05 for all).This is the widest spectrum study looking for LUS findings and other volumetric parameters in a small PD cohort. LUS might be useful to evaluate hidden hypervolemia. Its correlation with VEGF-C level is a novel finding.
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Affiliation(s)
- Mustafa Sevinc
- Nephrology Department, Sisli Hamidiye Etfal Training and Research Hospital
| | | | - Taner Basturk
- Department of Internal Medicine, Clinic of Nephrology, Health Sciences University, Sisli Hamidiye Etfal Training and Research Hospital
| | | | | | | | - Alper Ozel
- Clinic of Radiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul
| | - Tamer Sakaci
- Nephrology Department, Sisli Hamidiye Etfal Training and Research Hospital
| | - Elbis Ahbap
- Nephrology Department, Sisli Hamidiye Etfal Training and Research Hospital
| | - Abdulkadir Unsal
- Department of Internal Medicine, Clinic of Nephrology, Health Sciences University, Sisli Hamidiye Etfal Training and Research Hospital
| | - Yener Koc
- Nephrology Department, Medical Faculty, Cumhuriyet University, Sivas, Turkey
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Balaban Kocas B, Cetinkal G, Ser OS, Kilci H, Keskin K, Ozcan SN, Verdi Y, Zeren MI, Kilickesmez K. The relation between left ventricular global longitudinal strain and troponin levels in patients hospitalized with COVID-19 pneumonia. Int J Cardiovasc Imaging 2020; 37:125-133. [PMID: 33206248 PMCID: PMC7673246 DOI: 10.1007/s10554-020-02102-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/08/2020] [Indexed: 12/17/2022]
Abstract
Left ventricular global longitudinal strain (LVGLS) from two-dimensional speckle-tracking echocardiography (2D-STE) provides a more accurate estimation of subclinical myocardial dysfunction. In patients with COVID-19, elevated high sensitive troponin (hs-TnI) levels are frequent independent from the underlying cardiovascular disease. However, the relationship between high troponin levels and LVGLS in such patients remains unknown. We aimed to investigate the relation between troponin levels and LVGLS values in patients with COVID-19. A total of thirty-eight patients diagnosed with COVID-19 pneumonia who underwent echocardiography examination within the first week of hospital admission were enrolled in our study. Patients were divided into two groups according to their hs-TnI levels. Conventional left venticular (LV) function parameters, including ejection fraction, LV diastolic and systolic volumes were obtained and LVGLS was determined using 2D-STE. Frequency of hypertension, diabetes mellitus and current smoking were similar among groups. Compared with the patients in the negative troponin group, those in the positive troponin group were more likely to have a higher age; higher levels of D-dimer, C-reactive protein and ferritin; higher need for high-flow oxygen, invasive mechanical ventilation therapy or both; and a higher number of intensive care unit admissions. There was no statistically significant difference in LVGLS and ejection fraction values between the two groups.(− 18.5 ± 2.9, − 19.8 ± 2.8, p = 0.19; 55.2 ± 9.9, 59.5 ± 5.9, p = 0.11 respectively). Despite troponin increase is highly related to in-hospital adverse events; no relevance was found between troponin increase and LVGLS values of COVID-19 patients.
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Affiliation(s)
- Betul Balaban Kocas
- Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Sisli, Mecidiyekoy, 34360, Istanbul, Turkey.
| | - Gokhan Cetinkal
- Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Sisli, Mecidiyekoy, 34360, Istanbul, Turkey
| | - Ozgur Selim Ser
- Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Sisli, Mecidiyekoy, 34360, Istanbul, Turkey
| | - Hakan Kilci
- Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Sisli, Mecidiyekoy, 34360, Istanbul, Turkey
| | - Kudret Keskin
- Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Sisli, Mecidiyekoy, 34360, Istanbul, Turkey
| | - Safiye Nur Ozcan
- Department of Infectious Disease and Microbiology, Sisli Hamidiye Etfal Education and Research Hospital, Sisli, Istanbul, Turkey
| | - Yildiz Verdi
- Department of Infectious Disease and Microbiology, Sisli Hamidiye Etfal Education and Research Hospital, Sisli, Istanbul, Turkey
| | - Mustafa Ismet Zeren
- Department of Infectious Disease and Microbiology, Sisli Hamidiye Etfal Education and Research Hospital, Sisli, Istanbul, Turkey
| | - Kadriye Kilickesmez
- Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Sisli, Mecidiyekoy, 34360, Istanbul, Turkey
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Cetinkal G, Kocas BB, Ser OS, Kilci H, Keskin K, Ozcan SN, Verdi Y, Zeren MI, Demir T, Kilickesmez K. Assessment of the Modified CHA2DS2VASc Risk Score in Predicting Mortality in Patients Hospitalized With COVID-19. Am J Cardiol 2020; 135:143-149. [PMID: 32861734 PMCID: PMC7453224 DOI: 10.1016/j.amjcard.2020.08.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/12/2020] [Accepted: 08/17/2020] [Indexed: 01/10/2023]
Abstract
Since the modified CHA2DS2VASC (M-CHA2DS2VASc) risk score includes the prognostic risk factors for COVID-19; we assumed that it might predict in-hospital mortality and identify high-risk patients at an earlier stage compared with troponin increase and neutrophil-lymphocyte ratio (NLR). We aimed to investigate whether M-CHA2DS2VASC RS is an independent predictor of mortality in patients hospitalized with COVID-19 and to compare its discriminative ability with troponin increase and NLR in terms of predicting mortality. A total of 694 patients were retrospectively analyzed and divided into 3 groups according to M-CHA2DS2VASC RS which was simply created by changing gender criteria of the CHA2DS2VASC RS from female to male (Group 1, score 0-1 (n = 289); group 2, score 2-3 (n = 231) and group 3, score ≥4 (n = 174)). Adverse clinical events were defined as in-hospital mortality, admission to intensive care unit, need for high-flow oxygen and/or intubation. As the M-CHA2DS2VASC RS increased, adverse clinical outcomes were also significantly increased (Group 1, 3.8%; group 2, 12.6%; group 3, 20.8%; p <0.001 for in-hospital mortality). The multivariate logistic regression analysis showed that M-CHA2DS2VASC RS, troponin increase and neutrophil-lymphocyte ratio were independent predictors of in-hospital mortality (p = 0.005, odds ratio 1.29 per scale for M-CHA2DS2VASC RS). In receiver operating characteristic analysis, comparative discriminative ability of M-CHA2DS2VASC RS was superior to CHA2DS2VASC RS score. Area under the curve (AUC) values for in-hospital mortality was 0.70 and 0.64, respectively. (AUCM-CHA2DS2-VASc vs. AUCCHA2DS2-VASc z test = 3.56, p 0.0004) In conclusion, admission M-CHA2DS2VASc RS may be a useful tool to predict in-hospital mortality in patients with COVID-19.
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Affiliation(s)
- Gokhan Cetinkal
- Sisli Hamidiye Etfal Education and Research Hospital, Department of Cardiology, Istanbul, Turkey.
| | - Betul Balaban Kocas
- Sisli Hamidiye Etfal Education and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Ozgur Selim Ser
- Sisli Hamidiye Etfal Education and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Hakan Kilci
- Sisli Hamidiye Etfal Education and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Kudret Keskin
- Sisli Hamidiye Etfal Education and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Safiye Nur Ozcan
- Sisli Hamidiye Etfal Education and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Yildiz Verdi
- Sisli Hamidiye Etfal Education and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Mustafa Ismet Zeren
- Sisli Hamidiye Etfal Education and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Tolga Demir
- Sisli Hamidiye Etfal Education and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey
| | - Kadriye Kilickesmez
- Sisli Hamidiye Etfal Education and Research Hospital, Department of Cardiology, Istanbul, Turkey
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Yildiz SS, Sutasir N, Sigirci S, Topcu H, Kilickesmez K. P2544Acute effects of synthetic cannabinoids on ventricular repolarization parameters. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0872] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Bacground
The association between ventricular repolarization parameters (VRP) and ventricular arrhythmias has been shown in previous studies. However, there are limited data on the association between synthetic cannabinoids (SCs) and VRP.
Purpose
To analysis the acute effects of SCs on VRP by using T-peak to T-end (Tp-e) interval, Tp-e/QT ratio and Tp-e/QTc ratio.
Methods
The present study included 58 patients who admitted to the emergency department and who used of SC (SC+) during the years 2014–2016, and 50 healthy control subjects (SC−). QT and QTc intervals, Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were measured from the 12-lead electrocardiogram in all subjects. Then, this parameters were compared between the groups and were performed correlation analysis.
Results
The Tp-e and QTc intervals were significantly higher in SC+ when compared to SC- (92.2±10.0, 77.4±9.3, p<0.001; 434.5±30.8, 410.9±27.3, p<0.001, respectively). Tp-e/QT and Tp-e/QTc ratios were increased in SC+ in comparison to SC− (0.26±0.02, 0.22±0.02, p<0.001; 0.21±0.02, 0.18±0.02, p<0.001, respectively). Significant correlations were found between use of SC and Tp-e interval (r=0.610, p<0.001), Tp-e/QT (r=0.655, p<0.001) and Tp-e/QTc ratios (r=0.437, p<0.001).
Table 1. Electrocardiographic findings in between SC+ group and SC− group. SC+ group (n=58) SC− group (n=55) p value QRS duration (ms) 92.6±8.2 90.1±7.9 0.492 QT (ms) 348.4±29.0 353.4±30.7 0.301 QTc (ms) 434.5±30.8 410.9±27.3 <0.001 Tp-e (ms) 92.2±10.0 77.4±9.3 <0.001 TPe/QT ratio (ms) 0.26±0.02 0.22±0.02 <0.001 TPe/QTc ratio (ms) 0.21±0.02 0.18±0.02 <0.001
Conclusion
The present study revealed that Tp-e interval, Tp-e/QT and Tp-e/QTc ratios increased in subjects who used SC. Therefore, SC users might have an increased risk of ventricular arrhythmia.
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Affiliation(s)
- S S Yildiz
- Sisli Hamidiye Etfal Education and Research Hospital, cardiology, Istanbul, Turkey
| | - N Sutasir
- Sisli Hamidiye Etfal Education and Research Hospital, Emergency medicine, Istanbul, Turkey
| | - S Sigirci
- Sisli Hamidiye Etfal Education and Research Hospital, cardiology, Istanbul, Turkey
| | - H Topcu
- Sisli Hamidiye Etfal Education and Research Hospital, Emergency medicine, Istanbul, Turkey
| | - K Kilickesmez
- Sisli Hamidiye Etfal Education and Research Hospital, cardiology, Istanbul, Turkey
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Cetinkal G, Kilickesmez K, Balaban Kocas B, Keskin K, Yildiz SS, Kilci H, Sigirci S, Gurdal A, Er A, Dogan GM. P968Comparison of re-proximal optimizing technique with kissing balloon technique in provisional stenting during primary percutaneous coronary intervention. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0562] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Re-proximal optimizing technique (rePOT) (POT, side branch inflation and final POT) is a new provisional coronary bifurcation stenting technique which has better results in bench tests in comparison with kissing balloon inflation (KBI) techique. A clinical study showed that rePOT had beneficial effects in terms of strut malapposition, side branch obstruction and stent geometry. But it has not been compared with KBI technique especially in patients with ST segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (p-PCI).
Purpose
The aim of our study is to compare the new rePOT technique with a known and widely used provisional stenting technique in a real-world special patient population in terms of clinical and technical aspects
Methods
51 patients with STEMI who underwent p-PCI and needed provisional side branch stenting were enrolled in a tertiary center. Patients who needed “two stent strategy” at the beginning of procedure were deferred.
Results
Results were shown in Table 1. In-hospital death, contrast induced acute kidney injury, side branch dissection, need for side branch stenting and acute stent thrombosis were lower in rePOT group but there was no statistically significance.
Table 1 rePOT group (n=23) KBI group (n=28) p value Age 51.6±11.7 51.2±9.4 0.87 Male gender 18 (78.3%) 24 (85.7%) 0.16 Diabetes Mellitus 3 (13%) 6 (21.4%) 0.43 Hypertension 5 (21.7%) 5 (17.9%) 0.73 Ejection fraction 46.8±10.6 44.8±8.4 0.43 Killip class>2 1 (4.3%) 4 (14.3%) 0.47 Stent type (DES) 21 (91.3%) 23 (82.1%) 0.34 Side branch dissection 3 (13%) 8 (28.6) 0.18 Side branch stenting 3 (13%) 6 (21.4%) 0.43 In-hospital death 2 (8.7%) 3 (10.7%) 0.81 CI-AKI 3 (13%) 6 (21.4%) 0.43 Acute stent thrombosis 0 2 (7.1%) 0.19 DES: Drug eluting stent; CI-AKI: contrast induced acute kidney injury.
Conclusion
To the best of our knowledge this is the first study which compares the new rePOT technique with KBI in patients with STEMI who underwent p-PCI and needed provisional coronary bifurcation stenting. Although results are similiar in terms of clinical and technical aspects, rePOT may be a useful and user-friendly technique in such a complex and emergent procedure.
Acknowledgement/Funding
None
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Affiliation(s)
- G Cetinkal
- Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - K Kilickesmez
- Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - B Balaban Kocas
- Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - K Keskin
- Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - S S Yildiz
- Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - H Kilci
- Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - S Sigirci
- Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - A Gurdal
- Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - A Er
- Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - G M Dogan
- Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
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Yildiz SS, Keskin K, Cetinkal G, Aksan G, Okuyan E, Avsar M, Sigirci S, Cetin S, Kilickesmez K. P4639Electrocardiographic diagnosis of atrial infarction in patients with acute inferior ST-segment elevation myocardial infarction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S S Yildiz
- Sisli Hamidiye Etfal Education and Research Hospital, Cardiology, Istanbul, Turkey
| | - K Keskin
- Sisli Hamidiye Etfal Education and Research Hospital, Cardiology, Istanbul, Turkey
| | - G Cetinkal
- Sisli Hamidiye Etfal Education and Research Hospital, Cardiology, Istanbul, Turkey
| | - G Aksan
- Sisli Hamidiye Etfal Education and Research Hospital, Cardiology, Istanbul, Turkey
| | - E Okuyan
- Bagcilar University Hospital, Cardiology, Istanbul, Turkey
| | - M Avsar
- Bagcilar University Hospital, Cardiology, Istanbul, Turkey
| | - S Sigirci
- Sisli Hamidiye Etfal Education and Research Hospital, Cardiology, Istanbul, Turkey
| | - S Cetin
- Sisli Hamidiye Etfal Education and Research Hospital, Cardiology, Istanbul, Turkey
| | - K Kilickesmez
- Sisli Hamidiye Etfal Education and Research Hospital, Cardiology, Istanbul, Turkey
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Polat Canbolat I, Belen E, Bayyigit A, Helvaci A, Kilickesmez K. Evaluation of Daily Blood Pressure Alteration in Subclinical Hypothyroidism. Acta Cardiol Sin 2017; 33:489-494. [PMID: 28959101 PMCID: PMC5611345 DOI: 10.6515/acs20170220b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 02/20/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Subclinical hypothyroidism is the most common thyroid dysfunction in the general population. The relationship between overt thyroid dysfunction and hypertension is generally understood. Besides high blood pressure, non-dipper hypertension is known to increase cardiovascular risk. Our aim is to investigate daily blood pressure changes and the frequency of non-dipping patterns in patients with subclinical hypothyroidism. METHODS Forty-nine patients without hypertension with subclinical hypothyroidism were compared with 50 healthy sex- and age-matched controls using ambulatory blood pressure monitoring. RESULTS Thyroid-stimulating hormone (TSH) levels were significantly higher in the subclinic hypothyroidism group, and there was no difference between free triiodothyronine (FT3) and free thyroxine (FT4) levels which could be predicted as a result of the study design. Levels of mean diastolic, daytime diastolic, nighttime diastolic and nighttime systolic blood pressure were significantly higher in the subclinic hypothyroidism group (p = 0.001 for mean, daytime and nighttime diastolic and p = 0.01 for nighttime systolic). Diastolic non-dipping occurred more frequently in the subclinic hypothyroidism group [subclinical hypothyroidism group 24 patients (49%), control group 13 patients (26%), p = 0.01]. On multivariate analysis, subclinical hypothyroidism was independently associated with diastolic non-dipping (95% confidence interval 1.162-8.053, odds ratio 1.182, p = 0.024). CONCLUSIONS Our study found that both the frequency of diastolic non-dipping pattern and diastolic blood pressure increase with subclinical hypothyroidism. Therfore, it would appear that searching for non-dipping pattern can add valuable information for patients with subclinical hypothyroidism.
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Affiliation(s)
| | | | - Akif Bayyigit
- Department of Internal Medicine, Okmeydani Training and Research Hospital
| | | | - Kadriye Kilickesmez
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Secco GG, Ghione M, Mattesini A, Dall’Ara G, Ghilencea L, Kilickesmez K, De Luca G, Fattori R, Parisi R, Marino PN, Lupi A, Foin N, Di Mario C. Very high-pressure dilatation for undilatable coronary lesions: indications and results with a new dedicated balloon. EUROINTERVENTION 2016; 12:359-65. [DOI: 10.4244/eijy15m06_04] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Yildiz SS, Aksan G, Sigirci S, Keskin K, Kilickesmez K. Thrombosis of the left internal mammary artery graft causing acute coronary syndrome after 4 years of coronary bypass surgery. Anatol J Cardiol 2015; 15:1031-2. [DOI: 10.5152/anatoljcardiol.2015.6614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Zivelonghi C, Ghione M, Kilickesmez K, Loureiro RE, Foin N, Lindsay A, de Silva R, Ribichini F, Vassanelli C, Di Mario C. Intracoronary optical coherence tomography: a review of clinical applications. J Cardiovasc Med (Hagerstown) 2015; 15:543-53. [PMID: 24922045 DOI: 10.2459/jcm.0000000000000032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Optical coherence tomography (OCT) is a light-based technology that provides very high spatial resolution images. OCT has been initially employed as a research tool to investigate plaque morphology and stent strut coverage. The introduction of frequency domain OCT allowing fast image acquisition during a prolonged contrast injection via the guiding catheter has made OCT applicable for guidance of coronary interventions. In this manuscript, the various applications of OCT are reviewed, from assessment of plaque vulnerability and severity to characteristics of unstable lesions and thrombus burden to stent optimization and evaluation of late results.
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Affiliation(s)
- Carlo Zivelonghi
- aCardiovascular Biomedical Research Unit, Royal Brompton Hospital bImperial College, London, UK cDepartment of Medicine, University of Verona, Verona, Italy
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Estevez-Loureiro R, Ghione M, Kilickesmez K, Agudo P, Lindsay A, Di Mario C. The role for adjunctive image in pre-procedural assessment and peri-procedural management in chronic total occlusion recanalisation. Curr Cardiol Rev 2014; 10:120-6. [PMID: 24694101 PMCID: PMC4021282 DOI: 10.2174/1573403x10666140331143731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 12/15/2013] [Accepted: 01/20/2014] [Indexed: 11/28/2022] Open
Abstract
Non invasive coronary angiography with multislice computed tomography has exquisite sensitivity to detect
calcium and even the faintest late contrast filling of the distal vessel. Calcium burden and occlusion length are still valuable
markers of duration, complexity and success of the recanalisation procedure. The ability to visualise the vessel also in
the occluded segment, especially if calcified, can also help the operator to understand where to pierce the proximal cap in
stumpless occlusions and to predict unusual courses, especially in very tortuous arteries. Imaging side by side CT images
and angiography during the recanalisation procedure is an established practice in many active CTO laboratories and algorithms
for co-registration are designed to overcome the challenges of systo-diastolic and respiratory motion. Intravascular
ultrasound is used in almost all cases by the experienced Japanese CTO operators but most of the times its main use is a
better identification of the diseased segment after predilatation to ensure complete stent cover and appropriate stent expansion,
an application similar to other complex non occlusive lesions. The specificity of IVUS during CTO recanalisation is
the identification of the vessel path in stumpless occlusions and the guidance of wire reentry especially during reverse
Controlled Retrograde Anterograde Tracking. Optical coherence tomography has limitations in the setting of CTO recanalisation
because of the need of forceful contrast flushing to clear blood, contraindicated in the presence of anterograde
dissections, and the limited penetration. The variability in the use of both non-invasive and invasive imaging during CTO
recanalisation is immense, going from more than 90% in Japan to less than 20% in Europe and intermediate penetration in
the USA. Probably the explanation is almost only in availability and cost because all countries see a progressive increase
of use suggesting that these methods are becoming an established tool for guidance of CTO recanalisation.
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Affiliation(s)
| | | | | | | | | | - Carlo Di Mario
- Royal Brompton Hospital, Sydney Street, London, Greater London SW3 6NP, UK.
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Kilickesmez K, Dall'Ara G, Rama-Merchan JC, Ghione M, Mattesini A, Vinues CM, Konstantinidis N, Pighi M, Estevez-Loureiro R, Zivelonghi C, Lindsay AC, Secco GG, Foin N, De Silva R, Di Mario C. Optical coherence tomography characteristics of in-stent restenosis are different between first and second generation drug eluting stents. Int J Cardiol Heart Vessel 2014; 3:68-74. [PMID: 29450174 PMCID: PMC5801271 DOI: 10.1016/j.ijchv.2014.03.003] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 03/10/2014] [Indexed: 11/26/2022]
Abstract
Aims Characterization of neointimal tissue is essential to understand the pathophysiology of in-stent restenosis (ISR) after drug eluting stent (DES) implantation. Using optical coherence tomography (OCT), we compared the morphologic characteristics of ISR between first and second generation DES. Methods and Results OCT was performed in 66 DES-ISR, defined as > 50% angiographic diameter stenosis within the stented segment. Patients with ISR of first generation sirolimus-eluting stents (SES), paclitaxel eluting stents (PES) and second generation zotarolimus-eluting stents (ZES), everolimus-eluting stents (EES) and biolimus-eluting stents (BES) were enrolled. Quantitative and qualitative ISR tissue analysis was performed at 1-mm intervals along the entire stent, and categorised as homogeneous, heterogeneous and neo-atherosclerosis. The presence of microvessels and peri-strut low intensity area (PSLIA) was determined in all ISR. Neoatherosclerosis was identified by lipid, calcium and thin-cap fibro-atheroma (TCFA) like lesions. We compared the two DES generations at both early (< 1 year) and late (> 1 year) follow-ups. In second generation DES a heterogeneous pattern was prevalent both before and after 1 year (57.1% and 58.6% respectively). Neo-atherosclerosis was more common in the early period in first generation DES (19.4% vs 11.7%, p < 0.01), but after one year was more prevalent in second generation DES (7.0% vs 19.3%, p < 0.01). Similar prevalence of TCFAs was observed in both groups in all comparisons. Conclusions When ISR restenosis occurs in second generation DES, the current data suggest a different time course and different morphological characteristics from first generation. Future prospective studies should evaluate the relationship between ISR morphology, time course and clinical events.
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Affiliation(s)
- Kadriye Kilickesmez
- NIHR Biomedical Research Unit, Royal Brompton Hospital & Harefield NHS Foundation Trust, London, UK
| | - Gianni Dall'Ara
- NIHR Biomedical Research Unit, Royal Brompton Hospital & Harefield NHS Foundation Trust, London, UK
| | - Juan Carlos Rama-Merchan
- NIHR Biomedical Research Unit, Royal Brompton Hospital & Harefield NHS Foundation Trust, London, UK
| | - Matteo Ghione
- NIHR Biomedical Research Unit, Royal Brompton Hospital & Harefield NHS Foundation Trust, London, UK
| | - Alessio Mattesini
- NIHR Biomedical Research Unit, Royal Brompton Hospital & Harefield NHS Foundation Trust, London, UK
| | - Carlos Moreno Vinues
- NIHR Biomedical Research Unit, Royal Brompton Hospital & Harefield NHS Foundation Trust, London, UK
| | - Nikolaos Konstantinidis
- NIHR Biomedical Research Unit, Royal Brompton Hospital & Harefield NHS Foundation Trust, London, UK
| | - Michele Pighi
- NIHR Biomedical Research Unit, Royal Brompton Hospital & Harefield NHS Foundation Trust, London, UK
| | - Rodrigo Estevez-Loureiro
- NIHR Biomedical Research Unit, Royal Brompton Hospital & Harefield NHS Foundation Trust, London, UK
| | - Carlo Zivelonghi
- NIHR Biomedical Research Unit, Royal Brompton Hospital & Harefield NHS Foundation Trust, London, UK
| | - Alistair C Lindsay
- NIHR Biomedical Research Unit, Royal Brompton Hospital & Harefield NHS Foundation Trust, London, UK
| | - Gioel G Secco
- NIHR Biomedical Research Unit, Royal Brompton Hospital & Harefield NHS Foundation Trust, London, UK.,Department of Clinical and Experimental Medicine, University of Eastern Piedmont, Novara, Italy
| | - Nicolas Foin
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Ranil De Silva
- NIHR Biomedical Research Unit, Royal Brompton Hospital & Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Carlo Di Mario
- NIHR Biomedical Research Unit, Royal Brompton Hospital & Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
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Ghione M, Agudo P, Kilickesmez K, Estevez-Loureiro R, Zivelonghi C, Lindsay A, Foin N, Secco GG, Di Mario C. Tools and Techniques - Clinical: Catheter compatibility in CTO recanalisation. EUROINTERVENTION 2013; 9:290-1. [DOI: 10.4244/eijv9i2a46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ghione M, Kilickesmez K, Di Mario C. Sealing old plaques, seeding new plaques. Eur Heart J Cardiovasc Imaging 2013; 14:203-4. [DOI: 10.1093/ehjci/jes219] [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: 11/13/2022] Open
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Syrseloudis D, Secco GG, Barrero EA, Lindsay AC, Ghione M, Kilickesmez K, Foin N, Martos R, Di Mario C. Increase in J-CTO lesion complexity score explains the disparity between recanalisation success and evolution of chronic total occlusion strategies: insights from a single-centre 10-year experience. Heart 2013; 99:474-9. [PMID: 23376946 DOI: 10.1136/heartjnl-2012-303205] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate whether treatment of lesions of greater complexity is now undertaken and to assess the rates of procedural success per class of lesion complexity. DESIGN Observational study. SETTING Despite impressive progress in treatment strategies and equipment, the success rate of percutaneous coronary intervention for chronic total occlusion (CTO) has remained relatively stable. PARTICIPANTS 483 patients consecutively treated with CTO from 2003 to 2012. MAIN OUTCOME MEASURES The Multicenter CTO Registry of Japan (J-CTO) score was used to classify lesion complexity. The study population was subdivided into an early (period 1, n=288) and a late (period 2, n=195) period according to the routine implementation of novel techniques and advanced equipment. RESULTS Period 2 was marked by more 'difficult' and 'very difficult' lesions (J-CTO grades 2 and 3) being attempted, with procedural success increasing from 68.4% to 88.1% (p<0.001) and from 42.0% to 78.9% (p<0.001), respectively. 'Easy' and 'intermediate' lesions (J-CTO grades 0 and 1) were less common, but with similarly high success rates (89.1% vs 96.6% (p=0.45) for easy, and 86.3% vs 86.1% (p=0.99) for intermediate). Period 2 was characterised by a trend for more successful procedures overall (by 6.1%, p=0.09). Procedural complications were similarly low in both periods. J-CTO score and technical era were identified as independent correlates of success in the total population by logistic regression analysis. CONCLUSIONS Advanced CTO techniques and equipment have resulted in an increase in the successful treatment of highly complex lesions. Total success rate did not substantially improve, as it was counterbalanced by the increased rate at which complex lesions were attempted.
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Baydar O, Kilickesmez K, Canbolat I, Dursun M, Okan A, Giirmen A. PP-252 CORONARY INTERVENTION FOR ACUTE MYOCARDIAL INFARCTION IN A PATIENT WITH LEFT MAIN CORONARY ARTERY ARISING FROM THE RIGHT AORTIC SINUS. Int J Cardiol 2012. [DOI: 10.1016/s0167-5273(12)70452-7] [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: 11/24/2022]
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Kansiz E, Hatemi AC, Tongut A, Cohcen S, Yildiz A, Kilickesmez K, Celiker C. Surgical treatment of a giant postero-inferior left ventricular pseudoaneurysm causing severe mitral insufficiency and congestive heart failure. Ann Thorac Cardiovasc Surg 2011; 18:151-5. [PMID: 22001213 DOI: 10.5761/atcs.cr.11.01674] [Citation(s) in RCA: 6] [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: 11/16/2022] Open
Abstract
INTRODUCTION Left ventricular pseudoaneurysm caused by a transmural myocardial infarction is a fatal complication. Reliable diagnosis and on-time surgical intervention are significant for the patient's survival. METHODS/RESULTS A 70-year-old diabetic man with a two-month earlier history of successful stent implantation on the proximal right coronary artery because of total occlusion was admitted to our institution with symptoms of congestive heart failure. Transthoracic echocardiogram showed severely decreased overall LV systolic function and a large aneurismal sac attached to the inferior surface of the left ventricle, moderate tricuspid regurgitation and severe mitral insufficiency. On transesophageal echocardiography examination and cardiac magnetic resonance imaging, the aneurismal cavity appeared to be entirely surrounded by thrombi. During the operation, a left ventricular postero-inferior pseudoaneurysm was observed to extend to the mitral annulus. Purse string suturing was used to reduce left ventricular volume, and the hole was closed with a Dacron patch. The patient was weaned from the CPB without any difficulty. The patient's postoperative period was uneventful, and his physical condition appeared to be very healthy (NYHA class I-II) after the first year. CONCLUSION Following a myocardial infarction, a careful preoperative examination and proper way to diagnose are essential on patients with nonspecific complains or asymptomatic. Despite the risk of high mortality, patients may survive when they are diagnosed and undergo surgery at the right time.
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Affiliation(s)
- Erhan Kansiz
- Department of Cardiovascular Surgery, Institute of Cardiology, Istanbul University, Istanbul, Turkey
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Başkurt M, Aktürk F, Keskin K, Canbolat P, Karadag B, Kaya A, Yildiz A, Coskun U, Kilickesmez K, Esen O, Muniboglu SK. Serum high-sensitivity C-reactive protein, amyloid associated protein and N-terminal proBNP levels do not predict reversible myocardial ischaemia. Cardiovasc J Afr 2011; 22:85-9. [PMID: 21556451 PMCID: PMC3721907 DOI: 10.5830/cvja-2010-041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 04/22/2010] [Indexed: 11/06/2022] Open
Abstract
AIM The aim of this study was to detect any relationship between serum high-sensitivity C-reactive protein (hs-CRP), serum amyloid-associated protein (SAA) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, and reversible myocardial ischaemia during cardiovascular exercise tests and to determine whether these biomarkers could predict transient myocardial ischaemia. METHODS Ninety-six patients (36 women, 60 men, mean age 57 ± 8.5 years) were included in the study. Venous blood samples were taken from patients before and 15 minutes after exercise testing. SAA and hs-CRP were analysed using immunonephelometric assays (Dade-Behring, BN II, Marburg, Germany). NT-proBNP (pg/ml) was determined using the immulite 1 000 chemiluminescence immunoassay system (Siemens Medical Solution Diagnostics, Deerfiled, USA). Forty-eight patients (18 women, 30 men) with positive exercise tests were allocated to the exercise-positive group and 48 (18 women, 30 men) with negative exercise tests were put in the exercise-negative group. Coronary angiography was performed on all patients in the exercise-positive group. RESULTS There was no difference between the levels of hs-CRP, SAA and NT-pro-BNP before and after exercise testing in both of the exercise groups. CONCLUSION Serum levels of hs-CRP, SAA and NT-proBNP could not predict the occurrence of reversible myocardial ischaemia during exercise. Large-scale clinical studies are needed to clarify the status of hs-CRP, SAA and NT-proBNP with exercise.
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Affiliation(s)
- M Başkurt
- Cardiology Department, Institute of Cardiology, Istanbul University, Haseki, Istanbul.
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Kilickesmez K, Kucukoglu MS. Phosphodiesterase type 5 inhibitors in the treatment of pulmonary arterial hypertension. ACTA ACUST UNITED AC 2010; 10 Suppl 2:16-8. [DOI: 10.5152/akd.2010.125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Baskurt M, Okcun B, Abaci O, Dogan GM, Kilickesmez K, Ozkan AA, Ersanli M, Gurmen T. N-acetylcysteine versus N-acetylcysteine + theophylline for the prevention of contrast nephropathy. Eur J Clin Invest 2009; 39:793-9. [PMID: 19500141 DOI: 10.1111/j.1365-2362.2009.02173.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND The use of N-acetylcysteine or theophylline in specific subgroups of patients has been suggested to reduce the incidence of contrast-induced nephropathy (CIN) in patients undergoing angiographic procedures. Our purpose was to compare the use of N-acetylcysteine versus N-acetylcysteine + theophylline for the prevention of CIN. MATERIALS AND METHODS We randomized 217 patients with estimated glomerular filtration rate (eGFR) (calculated by Modification of Diet in Renal Disease formula) between 30 and 60 mL min(-1) 1.73 m(-2) who were undergoing coronary angiography to three prophylactic treatment groups: Group 1: Intravenous hydration with isotonic saline (1 mL kg(-1) h(-1) for 12 h before and after contrast, n = 72). Group 2: Intravenous hydration with isotonic saline (1 mL kg(-1) h(-1) for 12 h before and after contrast)+ N-acetylcysteine (600 mg p.o. twice daily the preceding day and the day of angiography, n = 73). Group 3: Intravenous hydration with isotonic saline (1 mL kg(-1) h(-1) for 12 h before and after contrast)+ N-acetylcysteine + theophylline (600 mg N-acetylcysteine p.o. and 200 mg theophylline p.o. twice daily for the preceding day and the day of angiography, n = 72). The incidence of CIN (0.5 mg dL(-1) increase in serum creatinine from the baseline value 48 h after intravascular injection of contrast) was compared in three groups. RESULTS Of the 217 patients, 12 patients (5.5%) experienced CIN. Five patients (6.9%) in group 1, seven patients (9.6%) in group 2 and zero (0%) patients in group 3 experienced CIN (P < 0.033). CONCLUSION Among patients with eGFR between 30 and 60 mL min(-1) 1.73 m(-2) undergoing coronary angiography, oral administration of N-acetylcysteine + theophylline in addition to saline hydration has a beneficial effect in the prevention of CIN.
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Affiliation(s)
- M Baskurt
- Institute of Cardiology, Istanbul University, Istanbul, Turkey.
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