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Kalender E, Dogan GM, Keskin K, Sigirci S, Sumerkan MC, Ser OS, Alyan O. Microvascular Dysfunction in COVID-19 Patients with Acute Coronary Syndrome. Sisli Etfal Hastan Tip Bul 2023; 57:367-373. [PMID: 37900331 PMCID: PMC10600601 DOI: 10.14744/semb.2023.92074] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/05/2023] [Accepted: 04/27/2023] [Indexed: 10/31/2023]
Abstract
Objective Coronavirus disease 2019 (COVID-19) is considered to deteriorate endothelial function through hyperinflammation. We aimed to investigate microvascular dysfunction using the angiographic parameters thrombolysis in myocardial infarction frame count (TFC) and myocardial blush grade (MBG), in COVID-19 patients with acute coronary syndrome (ACS). Methods One hundred and sixty-five patients presented with ACS (62.4% ST elevated myocardial infarction) and underwent percutaneous coronary intervention between March 1 and June 30, 2020, were enrolled in the study. The polymerase chain reaction test was performed in case of suggestive symptoms or typical computerized tomography findings. Results Twenty-six patients (15.7%) were tested positive for COVID-19. Significantly higher values were observed in TFC in patients with COVID-19 (p<0.001), whereas COVID-19 patients had significantly lower MBGs (Grade 0 and 1) (p<0.001). Peak troponin-I value was also higher in the COVID-19 group (27335 vs. 15959 ng/dL, p=0.006). Mortality risk was higher in COVID-19 patients (38.4% vs. 7.2%, p<0.001). TFC and ejection fraction may predict in-hospital mortality among COVID-19 patients with ACS according to logistic regression results. In correlation analysis, TFC correlated positively with C-reactive protein (r=0.340, p<0.001) and peak troponin-I value (r=0.369, p<0.001). Conclusion COVID-19 is associated with slow coronary flow and microvascular impairment in ACS.
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Affiliation(s)
- Erol Kalender
- Department of Cardiology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Gunes Melike Dogan
- Department of Cardiology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Kudret Keskin
- Department of Cardiology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Serhat Sigirci
- Department of Cardiology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Mutlu Cagan Sumerkan
- Department of Cardiology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Ozgur Selim Ser
- Department of Cardiology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Omer Alyan
- Department of Cardiology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
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Hayiroglu M, Cinar T, Cinier G, Yuksel G, Pay L, Keskin K, Coskun C, Ayan G, Cicek V, Tekkesin AI. Can left ventricle mass index predict pacemaker-induced cardiomyopathy in patients with dual chamber permanent pacemakers implanted due to complete atrioventricular block? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.857] [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
Background
Pacing induced cardiomyopathy (PICM) occurs due to high-burden right ventricular pacing. In patients with complete atrioventricular (AV) block, it is presumed to have a higher burden of right ventricular pacing. There is a lack of data regarding the relationship between PICM and pre-implantation left ventricular mass index (LVMI).
Purpose
This study aims to investigate the effect of LVMI on PICM in patients with implanted dual chamber permanent pacemakers (PPM) due to complete AV block.
Methods
PPM implanted 577 patients were divided into three groups according to admission LVMI. Mean duration of follow-up was 57±38 months. The baseline characteristics, laboratory and echocardiographic variables were compared between the groups. The independent predictors of PICM incidence and the effect LVMI on PICM were evaluated.
Results
Age, post-implantation QRS duration, left atrium anteroposterior diameter and LVMI were determined to predict long-term PICM. After adjustment for confounding baseline variables, tertile with highest LVMI had 1.9 times higher rates of long-term PICM compared to tertile with lowest LVMI, which was used as the reference group. A ROC analysis showed that the optimal cut-off value of the LVMI to predict long-term PICM was 109.8 mg/m2 with 71% sensitivity and 62% specificity (AUC: 0.68; 95% CI: 0.60–0.76; p<0.001),
Conclusion
Pre-implantation LVMI plays an important prognostic role in predicting PICM in patients with implanted dual chamber PPM due to complete AV block.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Hayiroglu
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Cardiology , Istanbul , Turkey
| | - T Cinar
- Haydarpasa Sultan Abdulhamid Han Training and Research Hospital, Cardiology , Istanbul , Turkey
| | - G Cinier
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Cardiology , Istanbul , Turkey
| | - G Yuksel
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Cardiology , Istanbul , Turkey
| | - L Pay
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Cardiology , Istanbul , Turkey
| | - K Keskin
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Cardiology , Istanbul , Turkey
| | - C Coskun
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Cardiology , Istanbul , Turkey
| | - G Ayan
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Cardiology , Istanbul , Turkey
| | - V Cicek
- Haydarpasa Sultan Abdulhamid Han Training and Research Hospital, Cardiology , Istanbul , Turkey
| | - A I Tekkesin
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Cardiology , Istanbul , Turkey
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Aktürk İF, Yıldız C, Karabulut D, Oflar E, Şahin A, Ertuğrul AS, Koyuncu A, Polat V, Karahan A, Koşar F, Alp İB, Keskin K, Çağlar FNT. Is the revascularisation strategy and outcome different in patients with acute coronary syndrome in COVID-19 pandemic era: a tertiary centre experience. Acta Cardiol 2022; 77:720-728. [PMID: 34427169 DOI: 10.1080/00015385.2021.1967614] [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] [Indexed: 01/08/2023]
Abstract
BACKGROUND In this study, we aimed to compare the management and clinical outcomes of patients with acute coronary syndrome (ACS) before and during pandemic. METHODS A total of 239 patients with ACS were enrolled into the study. Patients who were admitted during pandemic were compared with pre-pandemic patients according to their demographic, biochemical, angiographic features, revascularisation strategies and clinical outcomes. RESULTS During the pandemic period, we observed an increase in total number of patient with ST elevation myocardial infarction patients compared to the pre-pandemic period. Initial high sensitive troponin and CK-MB levels were statistically higher in the pandemic group patients (1953 pg/ml versus 259 pg/ml for troponin I and 14 ng/ml versus 6 ng/ml for CK-MB p < 0.0001, p = 0.02, respectively). Type 4a myocardial infarction due to stent thrombosis was more frequent in pandemic group relative to the pre-pandemic group (10 versus 0, p = 0.003). Post-procedural TIMI flow grade was lower in the pandemic group and distal embolisation and TIMI thrombus score were significantly higher in the pandemic group compared to the pre-pandemic group (p = 0.001, p = 0.02, and p = 0.002, respectively). The number of patients who underwent bypass surgery was much lower compared to pre-pandemic period (27 versus 8, p < 0.0001). There was no statistically significant difference in hospital mortality and short-term all-cause mortality among groups (p > 0.05). CONCLUSION Although clinical, laboratory, and angiographic features were worse in ACS patients during pandemic, the mortality rate of ACS was similar in both pre-pandemic and pandemic era. It is important to keep coronary intensive care units and catheter labs open and fully-functioning during the pandemic.
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Affiliation(s)
- İbrahim Faruk Aktürk
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Bakırköy, Istanbul, Turkey
| | - Cennet Yıldız
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Bakırköy, Istanbul, Turkey
| | - Dilay Karabulut
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Bakırköy, Istanbul, Turkey
| | - Ersan Oflar
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Bakırköy, Istanbul, Turkey
| | - Alparslan Şahin
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Bakırköy, Istanbul, Turkey
| | - Abdulcelil Sait Ertuğrul
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Bakırköy, Istanbul, Turkey
| | - Atilla Koyuncu
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Bakırköy, Istanbul, Turkey
| | - Veli Polat
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Bakırköy, Istanbul, Turkey
| | - Aysun Karahan
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Bakırköy, Istanbul, Turkey
| | - Feridun Koşar
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Bakırköy, Istanbul, Turkey
| | - İlayda Bostancı Alp
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Bakırköy, Istanbul, Turkey
| | - Kudret Keskin
- Department of Cardiology, Şişli Hamidiye Etfal Education and Research Hospital, Bakırköy, Istanbul, Turkey
| | - Fatma Nihan Turhan Çağlar
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Bakırköy, Istanbul, Turkey
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Sumerkan MC, Kalender E, Korkut S, Simsek EE, Keskin K, Gurdal A, Sigirci S, Gunaydin YK, Ozhan H, Mayda AS, Oksuz S, Agirbasli M, Alyan O. Clinical Presentation, Electrocardiographic Findings, and Factors Related to the Hospitalization In Mad-Honey Intoxication. Sisli Etfal Hastan Tip Bul 2022; 56:365-374. [PMID: 36304212 PMCID: PMC9580964 DOI: 10.14744/semb.2022.45144] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/07/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Mad-honey intoxication (MHI) often presents with all kinds of bradyarrhythmias. Despite numerous publications focused on clinical findings, we aim to evaluate poor prognostic implications, ischemia likely electrocardiography (ECG) changes, and detailed ECG findings of MHI in the largest series. METHODS This is a retrospective single-center study of 117 MHI patients admitted to emergency service. RESULTS The study had 26 (22.2%) females (median 52.5 years) and 91 (77.8%) males (median 51.0 years). Fifty-six (47.9%) patients had ischemia likely changes on ECG. Multivariate model demonstrated that beta-blocker usage (odds ratio (OR): 52.871; 95% confidence interval (CI): 3.618-772.554 (p=0.004)), atrioventricular junctional rhythm (AVJR) (OR: 5.319; 95%CI: 1.090-25.949 (p=0.039)), and quantity of mad-honey consumption (OR: 1.035; 95% CI: 1.008-1.063 (p=0.011)) are predictors of hospitalization. ROC curve analysis showed cutoff value of mad-honey consumption quantity 24.79 g had 57% sensitivity and 68% specificity for predicting hospitalization (AUC: 0.7, 95% CI: 0.55-0.816, p=0.027). In addition, all hospitalized cases were male. CONCLUSION Our study has shown that male gender, AVJR, the quantity of mad-honey consumption, and beta-blocker usage are high-risk criteria for hospitalization in MHI patients. Furthermore, ischemia likely ECG changes is often observed with MHI even independently from hypotension or bradycardia.
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Affiliation(s)
- Mutlu Cagan Sumerkan
- Department of Cardiology, University of Health Sciences Turkey, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Erol Kalender
- Department of Cardiology, University of Health Sciences Turkey, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Semih Korkut
- Department of Emergency Service, Duzce University Faculty of Medicine, Duzce, Türkiye
| | - Engin Ersin Simsek
- Department of Family Medicine, Düzce Ataturk State Hospital, Duzce, Türkiye
| | - Kudret Keskin
- Department of Cardiology, University of Health Sciences Turkey, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Ahmet Gurdal
- Department of Cardiology, University of Health Sciences Turkey, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Serhat Sigirci
- Department of Cardiology, University of Health Sciences Turkey, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Yahya Kemal Gunaydin
- Department of Emergency Service, University of Health Sciences Turkey, Ankara Training and Research Hospital, Ankara, Türkiye
| | - Hakan Ozhan
- Department of Cardiology, Duzce University Faculty of Medicine, Duzce, Türkiye
| | - Atilla Senih Mayda
- Department of Family Medicine, Duzce University Faculty of Medicine, Duzce, Türkiye
| | - Sukru Oksuz
- Department of Medical Microbiology, Duzce University Faculty of Medicine, Duzce, Türkiye
| | - Mehmet Agirbasli
- Department of Cardiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye
| | - Omer Alyan
- Department of Cardiology, University of Health Sciences Turkey, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
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Çetinkal G, Balaban Koçaş B, Keskin K, Kilci H, Selim Ser Ö, Kılıçkesmez K. Comparison of Sequential POT-Side-POT and Kissing Balloon Techniquesin Patientswith Coronary Bifurcation Lesions Treatedwith Single-Stent Strategy; Which One is Simple and Safe? Propensity Score Analysis. The Anatolian Journal of Cardiology 2022; 26:559-566. [PMID: 35791712 PMCID: PMC9361205 DOI: 10.5152/anatoljcardiol.2022.1136] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: It is unknown whether the novel POT-side-POT technique is more useful than the commonly preferred kissing balloon inflation in patients with non-complex coronary bifurcation lesions treated with a single-stent strategy. The aim of this study was to compare the efficacy of POT-side-POT and kissing balloon inflation techniques in one-stent strategy for non-complex coronary bifurcation lesions. Methods: In this study, 283 patients were retrospectively analyzed (POT-side-POT group, n = 149; KBI group, n = 134). Primary endpoints of the study were defined as follows: in-hospital and 30-day mortality, contrast-induced acute kidney injury, stent thrombosis, side branch dissection, and need for side-branch stenting. Characteristics of patients at baseline were balanced by using propensity score inverse probability weighting. Results: Procedure time (minute, 30.6 ± 8.5 vs. 34.3 ± 11.6; P = .003) and contrast volume (milliliter, 153.7 ± 42.4 vs. 171.1 ± 58.2; P = .004) were significantly lower in POT-side-POT group. Besides, side branch residual stenosis and number of patients with >50% side branch residual stenosis remained significantly higher in POT-side-POT group both in general and true bifurcation subgroup analysis (20.3 ± 19.8% vs. 16.5 ± 16.4%, P = .022; 11.9% vs. 5.7%, P = .013 and 24.1 ± 23.2% vs. 18.8 ± 18.7%, P = .033; 17.6% vs. 6.6%, P = .005; respectively). Combined clinical adverse outcomes were similar between groups. Side branch dissection (10.2% vs. 20.1%, P = .001) and need for side branch stenting (12.6% vs. 19%, P = .040) reached statistically significance in kissing balloon inflation group after adjustment. Conclusion: POT-side-POT may be a simple and safe technique with a shorter procedure time and lower incidence of adverse clinical events in non-complex coronary bifurcation lesions treated with single-stent strategy.
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Affiliation(s)
- Gökhan Çetinkal
- Department of Cardiology, Prof. Dr. Cemil Taşçıoğlu City Hospital, İstanbul, Turkey
- Corresponding author:Gökhan Çetinkal ✉
| | - Betül Balaban Koçaş
- Department of Cardiology, Prof. Dr. Cemil Taşçıoğlu City Hospital, İstanbul, Turkey
| | - Kudret Keskin
- Department of Cardiology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Hakan Kilci
- Department of Cardiology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Özgür Selim Ser
- Department of Cardiology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Kadriye Kılıçkesmez
- Department of Cardiology, Prof. Dr. Cemil Taşçıoğlu City Hospital, İstanbul, Turkey
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Karabulut U, Yılmaz Can Y, Duygu E, Karabulut D, Keskin K, Okay T. Periprocedural, Short-Term, and Long-Term Outcomes of Alcohol Septal Ablation in Patients with Hypertrophic Obstructive Cardiomyopathy: A 20-Year Single-Center Experience. Anatol J Cardiol 2022; 26:316-324. [PMID: 35435843 PMCID: PMC9366452 DOI: 10.5152/anatoljcardiol.2022.852] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background : Alcohol septal ablation is recommended for hypertrophic obstructive cardiomyopathy patients who had refractory symptoms despite optimal medical treatment. We compared the periprocedural, short-, and long-term clinical outcomes and mortality predictors in hypertrophic obstructive cardiomyopathy patients who underwent alcohol septal ablation. Methods Hypertrophic obstructive cardiomyopathy patients aged ≥18 years (63 females and 71 males) who underwent alcohol septal ablation were included. The primary endpoint was all-cause mortality. Results The mean patient age was 60.0 (standard deviation 13.7) years. The median follow-up time was 13 (7.6-18.5) years. During the procedure, 9, 2, and 1 patients developed ventricular fibrillation, remote site myocardial infarction, and pericardial tamponade, respectively, but none died. One patient died during hospitalization. During the long-term follow-up, 17, 5, 20, and 8 patients developed heart failure, myocardial infarction, chronic atrial fibrillation, and non-fatal stroke, respectively, and 24 died. There was no significant difference between the sexes (all P > .05). Age (hazard ratio = 0.69, 95% CI = 0.61‒0.78, P < .001), body mass index (hazard ratio = 1.20, 95% CI = 1.04-1.40, P = .01), age at diagnosis (hazard ratio = 1.57, 95% CI = 1.34-1.78, P < .001), and time from diagnosis to ablation (hazard ratio = 1.57, 95% CI = 1.35-1.84, P < .001) predicted all-cause mortality. In Kaplan‒Meier curves, long-term all-cause mortality was similar in men and women (P[log-rank] = .43). Conclusion Alcohol septal ablation has similar short- and long-term outcomes for both sexes in hypertrophic obstructive cardiomyopathy patients. Risk factors for long-term mortality were age, body mass index, diagnosis age, and time delay to operation. Therefore, alcohol septal ablation timing is essential for better clinical outcomes. Our findings may contribute to the increased performance of alcohol septal ablation in hypertrophic obstructive cardiomyopathy patients in our country.
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Affiliation(s)
- Umut Karabulut
- Department of Cardiology, Acıbadem International Hospital, İstanbul, Turkey
- Corresponding author:Umut Karabulut ✉
| | - Yeşim Yılmaz Can
- Departments of Internal Medicine and Cardiology, Fachklinik Sonnennof, Waldachtal, Germany
| | - Egemen Duygu
- Department of Cardiology, Acıbadem International Hospital, İstanbul, Turkey
| | - Dilay Karabulut
- Department of Cardiology, İstanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
- Corresponding author:Umut Karabulut ✉
| | - Kudret Keskin
- Department of Cardiology, İstanbul Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Tuğrul Okay
- Department of Cardiology, Acıbadem Bodrum Hospital, İstanbul, Turkey
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7
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Karabulut U, Keskin K. The Predictive Value of Nutritional Indexes for Developing Ascending Aortic Aneurysm in Elderly Patients with Hypertension. Haseki 2022. [DOI: 10.4274/haseki.galenos.2022.8094] [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: 12/01/2022] Open
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Keskin K, Sığırcı S, Gürdal A, Ser ÖS, Kilci H, Sümerkan MÇ, Er A, Alyan Ö. In-Hospital Bleeding in Elderly Patients With Acute Coronary Syndrome: Are Potent Antiplatelet Agents Safe? Angiology 2022; 73:827-834. [PMID: 35348027 DOI: 10.1177/00033197221075858] [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] [Indexed: 11/16/2022]
Abstract
Despite implementation of new interventional techniques and therapeutic advances, elderly patients with acute coronary syndrome (ACS) continue to be susceptible to in-hospital bleeding compared with younger ones. Thus, we investigated the incidence of in-hospital bleeding events and associated risk factors in elderly (≥ 75°years) ACS patients. We also wanted to define the bleeding sites, characteristics, and associated mortality. Bleeding Academic Research Consortium (BARC) classification type 2, 3, or 5 was used to define bleeding events. Overall, 539 patients were included in the study (mean age: 82.5 ± 4.8°years; 282 (52.3%) females). Of these patients, 69 (12.8%) developed in-hospital bleeding. Factors that were independently related with in-hospital bleeding were age (odds ratio (OR): 1.08; 95% confidence interval (CI): 1.011.14, P = .01), acute kidney injury (OR: 3.66; 95% CI: 2.016.69; P < .01), tirofiban (OR: 4.43; 95% CI: 1.7810.99; P < .01), and ticagrelor (OR: 1.93; 95% CI: 1.013.73; P = .04) administration. The urinary tract was the most frequent bleeding site, followed by femoral arteries. In conclusion, ticagrelor and tirofiban should be used with caution in elderly ACS patients.
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Affiliation(s)
- Kudret Keskin
- Department of Cardiology, 64159Şişli Hamidiye Etfal Education and Research Hospital, İstanbul, Turkey.,ŞiŞli Hamidiye Etfal Education and Research Hospital, İstanbul, Turkey
| | - Serhat Sığırcı
- Department of Cardiology, 64159Şişli Hamidiye Etfal Education and Research Hospital, İstanbul, Turkey.,ŞiŞli Hamidiye Etfal Education and Research Hospital, İstanbul, Turkey
| | - Ahmet Gürdal
- Department of Cardiology, 64159Şişli Hamidiye Etfal Education and Research Hospital, İstanbul, Turkey.,ŞiŞli Hamidiye Etfal Education and Research Hospital, İstanbul, Turkey
| | - Özgür S Ser
- Department of Cardiology, 64159Şişli Hamidiye Etfal Education and Research Hospital, İstanbul, Turkey
| | - Hakan Kilci
- Department of Cardiology, 64159Şişli Hamidiye Etfal Education and Research Hospital, İstanbul, Turkey
| | - Mutlu Ç Sümerkan
- Department of Cardiology, 64159Şişli Hamidiye Etfal Education and Research Hospital, İstanbul, Turkey
| | - Arzu Er
- Department of Cardiology, 64159Şişli Hamidiye Etfal Education and Research Hospital, İstanbul, Turkey
| | - Ömer Alyan
- Department of Cardiology, 64159Şişli Hamidiye Etfal Education and Research Hospital, İstanbul, Turkey.,ŞiŞli Hamidiye Etfal Education and Research Hospital, İstanbul, Turkey
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9
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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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10
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Karabulut U, Keskin K, Karabulut D, Yiğit E, Yiğit Z. Effect of Sacubitril/Valsartan Combined with Dapagliflozin on Long-Term Cardiac Mortality in Heart Failure with Reduced Ejection Fraction. Angiology 2021; 73:350-356. [PMID: 34560822 DOI: 10.1177/00033197211047329] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan and sodium-glucose cotransporter-2 (SGLT-2) inhibitor dapagliflozin have been shown to reduce rehospitalization and cardiac mortality in patients with heart failure (HF) with reduced ejection fraction (HFrEF). We aimed to compare the long-term cardiac and all-cause mortality of ARNI and dapagliflozin combination therapy against ARNI monotherapy in patients with HFrEF. This retrospective study involved 244 patients with HF with New York Heart Association (NYHA) class II-IV symptoms and ejection fraction ≤40%. The patients were divided into 2 groups: ARNI monotherapy and ARNI+dapagliflozin. Median follow-up was 2.5 (.16-3.72) years. One hundred and seventy-five (71.7%) patients were male, and the mean age was 65.9 (SD, 10.2) years. Long-term cardiac mortality rates were significantly lower in the ARNI+dapagliflozin group (7.4%) than in the ARNI monotherapy group (19.5%) (P = .01). Dapagliflozin [Hazard Ratio (HR) [95% Confidence Interval (CI)] = .29 [.10-.77]; P = .014] and left ventricular ejection fraction (LVEF) [HR (95% CI) = .89 (.85-.93); P < .001] were found to be independent predictors of cardiac mortality. Our study showed a significant reduction in cardiac mortality with ARNI and dapagliflozin combination therapy compared with ARNI monotherapy.
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Affiliation(s)
- Umut Karabulut
- Department of Cardiology, 64296Acıbadem International Hospital, Istanbul, Turkey
| | - Kudret Keskin
- Department of Cardiology, İstanbul Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Dilay Karabulut
- Department of Cardiology İstanbul, İstanbul Bakırköy Dr.Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Ece Yiğit
- Department of Internal Medicine, 218502İstanbul Pendik Medipol University Hospital, İstanbul, Turkey
| | - Zerrin Yiğit
- Department of Cardiology, İstanbul University, Cerrahpaşa Cardiology Institute, İstanbul, Turkey
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11
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Ser ÖS, Çetinkal G, Kiliçarslan O, Dalgıç Y, Batit S, Keskin K, Özkara G, Aslan EI, Aydoğan HY, Yıldız A, Yiğit Z. The comparison of serum TGF-beta levels and associated polymorphisms in patients with coronary artery ectasia and normal coronary artery. Egypt Heart J 2021; 73:32. [PMID: 33788038 PMCID: PMC8012455 DOI: 10.1186/s43044-021-00153-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/16/2021] [Indexed: 11/19/2022] Open
Abstract
Background Coronary artery ectasia (CAE) is described as the enlargement of a coronary artery segment by 1.5 times or more, which is generally associated with the atherosclerotic process. Atherosclerotic changes lead to arterial remodeling result in CAE. In our study, we measured serum transforming growth factor (TGF)-β1 levels, which have a protective role against atherosclerosis. Further, we aimed to assess the TGF-β1 gene variants rs1800469 (–509C>T, c.−1347C>T) and rs1800470 (c.+29T>C, p.Pro10Leu, rs1982073), which might have an effect on TGF production. Overall, 2877 patients were screened including 56 patients with CAE and 44 patients with normal coronary arteries who were included in the study. Serum TGF-β1 levels were measured using ELISA and compared between two groups. Additionally, TGF-β1 rs1800469 and rs1800470 gene variations were determined using TaqMan® SNP Genotyping Assays. Results Serum TGF-β1 levels were significantly lower in patients with CAE than in controls (p=0.012). However, there was no difference in terms of the genotype and allele distributions of TGF-β1 rs1800469 and rs1800470 polymorphisms. Serum TGF-β1 levels were higher in individuals carrying the TGF-β1 rs1800470 G allele (GG+AG) than in individuals with normal homozygous AA genotype in the CAE group (p=0.012). Conclusion Our findings suggest that lower serum TGF-β1 levels are associated with an increased risk for CAE development and that TGF-β1 polymorphisms exert a protective effect. Furthermore, TGF-β1 rs1800470 G allele carriers were shown to have higher TGF-β1 levels in the CAE group. This suggests that having the G allele in the TGF-β1 rs1800470 polymorphism could prevent CAE development.
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Affiliation(s)
- Özgür Selim Ser
- Department of Cardiology, Institute of Cardiology, Istanbul University-Cerrahpasa, Haseki / Fatih, 34100, Istanbul, Turkey.
| | - Gökhan Çetinkal
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Onur Kiliçarslan
- Department of Cardiology, Institute of Cardiology, Istanbul University-Cerrahpasa, Haseki / Fatih, 34100, Istanbul, Turkey
| | - Yalçın Dalgıç
- Department of Cardiology, Institute of Cardiology, Istanbul University-Cerrahpasa, Haseki / Fatih, 34100, Istanbul, Turkey
| | - Servet Batit
- Department of Cardiology, Institute of Cardiology, Istanbul University-Cerrahpasa, Haseki / Fatih, 34100, Istanbul, Turkey
| | - Kudret Keskin
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Gulçin Özkara
- Department of Molecular Medicine, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Ezgi Irmak Aslan
- Department of Molecular Medicine, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Hülya Yilmaz Aydoğan
- Department of Molecular Medicine, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Ahmet Yıldız
- Department of Cardiology, Institute of Cardiology, Istanbul University-Cerrahpasa, Haseki / Fatih, 34100, Istanbul, Turkey
| | - Zerrin Yiğit
- Department of Cardiology, Institute of Cardiology, Istanbul University-Cerrahpasa, Haseki / Fatih, 34100, Istanbul, Turkey
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12
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Keskin K, Demir T, Balkaya Aİ, Eryilmaz ÖT, Alyan Ö. Coexistence of atrial septal defect with atrial myxoma. J Card Surg 2021; 36:707-708. [PMID: 33386767 DOI: 10.1111/jocs.15279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 12/21/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Kudret Keskin
- Department of Cardiology, Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Tolga Demir
- Department of Cardiovascular Surgery, Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Ahmet İbrahim Balkaya
- Department of Cardiovascular Surgery, Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Özlem Ton Eryilmaz
- Department of Pathology, Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Ömer Alyan
- Department of Cardiology, Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
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13
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Gürdal A, Keskin K, Sığırcı S, Balaban Koçaş B, Çetin Ş, Orta Kılıçkesmez K. Assessment of electrocardiographic criteria for the diagnosis of left ventricular hypertrophy in the octogenarian population. Int J Clin Pract 2021; 75:e13643. [PMID: 32748475 DOI: 10.1111/ijcp.13643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/28/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Although there are several electrocardiographic (ECG) diagnostic criteria for identifying left ventricular hypertrophy (LVH), the sensitivity of these criteria remains low. Recently, the Peguero-Lo Presti criterion provides a higher sensitivity than the current criteria. We aimed to test this ECG criterion prospectively, in the octogenarian population. METHODS We prospectively enrolled outpatients over 80 years of age who were referred to our echocardiography laboratory. The Peguero-Lo Presti criterion was assessed along with other established ECG criteria. Left ventricular mass was calculated by echocardiography. Performance of ECG indices in diagnosing LVH were evaluated. RESULTS Overall, 119 patients were included in the study. The sensitivity and specificity of the Peguero-Lo Presti criterion were 62.5% and 87.3%, respectively. In addition, the highest sensitivity belonged to the Peguero-Lo Presti criterion, and the highest AUC value was also seen in this criterion (AUC: 0.787, 95% CI, 0.698-0.876, P < .001). CONCLUSION The Peguero-Lo Presti criteria showed the highest sensitivity for LVH detection, and it outperformed the other validated criteria in this octogenarian population. The Peguero-Lo Presti criteria seemed to be more effective for diagnosing LVH in this setting.
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Affiliation(s)
- Ahmet Gürdal
- Department of Cardiology, University of Health Sciences, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Kudret Keskin
- Department of Cardiology, University of Health Sciences, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Serhat Sığırcı
- Department of Cardiology, University of Health Sciences, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Betül Balaban Koçaş
- Department of Cardiology, University of Health Sciences, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Şükrü Çetin
- Department of Cardiology, University of Health Sciences, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Kadriye Orta Kılıçkesmez
- Department of Cardiology, University of Health Sciences, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
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14
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Karabulut U, Keskin K. Does short-term dialysis significantly increase coronary artery disease burden in diabetic patients who undergo renal transplantation? Int J Cardiovasc Acad 2021. [DOI: 10.4103/ijca.ijca_17_21] [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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15
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Sigirci S, Ser ÖS, Keskin K, Yildiz SS, Gurdal A, Kilickesmez KO. Comparing the Prognostic Value of Hematological Indices in Patients With ST Segment Elevation Myocardial Infarction: "A Head to Head" Analysis. Angiology 2020; 72:348-354. [PMID: 33272027 DOI: 10.1177/0003319720977754] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although there are reviews and meta-analyses focusing on hematological indices for risk prediction of mortality in patients with ST segment elevation myocardial infarction (STEMI), there are not enough data with respect to direct to head-to-head comparison of their predictive values. We aimed to investigate which hematological indices have the most discriminatory capability for prediction of in-hospital and long-term mortality in a large STEMI cohort. We analyzed the data of 1186 patients with STEMI. In-hospital and long-term all-cause mortality was defined as the primary end point of the study. In-hospital mortality rate was 8.6% and long-term mortality rate 9.0%. Although the neutrophil to lymphocyte ratio (NLR) and age were found to be independent predictors of in-hospital mortality in the multivariate regression analyses; Cox regression analysis revealed that age, ejection fraction, red cell distribution width (RDW), and monocyte to high-density lipoprotein ratio (MHDLr) were independently associated with long-term mortality. Neutrophil to lymphocyte ratio had the highest area under curve value in the receiver operating characteristic curve analyses for prediction of in-hospital mortality. In conclusion, while NLR may be used for prediction of in-hospital mortality, RDW and MHDLr ratio are better hematological indices for long-term mortality prediction after STEMI than other most common indices.
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Affiliation(s)
- Serhat Sigirci
- Department of Cardiology, 64159Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Özgür Selim Ser
- Department of Cardiology, 64159Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Kudret Keskin
- Department of Cardiology, 64159Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Süleyman Sezai Yildiz
- Department of Cardiology, 64159Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Ahmet Gurdal
- Department of Cardiology, 64159Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Kadriye Orta Kilickesmez
- Department of Cardiology, 64159Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
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16
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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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17
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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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18
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Gürdal A, Keskin K, Siğirci S, Yildiz SS, Kiliçkesmez KO. Prognostic Value of the Neutrophil-to-Lymphocyte Ratio in Patients With Myocardial Infarction With Non-obstructive Coronary Arteries. Angiology 2020; 71:812-816. [PMID: 32715720 DOI: 10.1177/0003319720938621] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous entity with an inflammatory etiopathogenesis. This study investigated the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in patients with MINOCA. Coronary angiographies performed between June 2015 and August 2018 were analyzed retrospectively and included 72 patients with MINOCA and 248 controls with normal coronary angiograms. The predictors of mortality were determined by univariate Cox regression analysis. The mean age of the subjects was 46 ± 9 years, and 176 (55%) were female. Median follow-up was 21 (max: 42) months. Neutrophil-to-lymphocyte ratio was significantly higher in the MINOCA group than in the controls (P < .01). During long-term follow-up, the number of deaths was 6 in the MINOCA group and none in the control patients (P < .01). Univariate Cox regression analysis revealed that the NLR (hazard ratio: 1.24, 95% confidence interval: 1.09-1.41, P = .001) was a predictor of mortality in patients with MINOCA. Kaplan-Meier analysis also showed that patients with MINOCA had relatively higher mortality rate (long-rank test; P < .01). In conclusion, the NLR is significantly higher in patients with MINOCA compared with controls, and it is a predictor of long-term mortality.
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Affiliation(s)
- Ahmet Gürdal
- Department of Cardiology, University of Health Sciences, 64159Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Kudret Keskin
- Department of Cardiology, University of Health Sciences, 64159Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Serhat Siğirci
- Department of Cardiology, University of Health Sciences, 64159Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Süleyman Sezai Yildiz
- Department of Cardiology, University of Health Sciences, 64159Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Kadriye Orta Kiliçkesmez
- Department of Cardiology, University of Health Sciences, 64159Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
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Cetin S, Çetin AŞ, Gurdal A, Yıldız SS, Keskin K, Sığırcı S, Bayraktar A. Assessment of Tp-e interval and Tp-e/QT ratio in patients with human immunodeficiency virus. Rev Port Cardiol 2020; 39:155-160. [PMID: 32307210 DOI: 10.1016/j.repc.2019.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/06/2018] [Revised: 03/29/2019] [Accepted: 04/07/2019] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE Sudden cardiac death (SCD) plays an important part in all-cause mortality in patients infected with human immunodeficiency virus (HIV). The T-peak to T-end (Tp-e) interval, corrected Tp-e (Tp-ec) interval, and Tp-e/QT ratio on the ECG are parameters used to stratify risk for SCD. The objective of this study was to investigate the differences between HIV-infected patients and healthy individuals in terms of Tp-e interval, Tp-ec interval, and Tp-e/QT ratio, as well as other influencing factors. METHODS Ninety-eight HIV-infected patients and 62 healthy controls were included in this prospective case-control study. Tp-e interval, Tp-ec interval, and Tp-e/QT ratio were measured in all participants. Echocardiographic examination and routine laboratory analysis were performed. In addition, CD4 T-cell count and HIV RNA levels were assessed in HIV-infected patients. RESULTS All baseline characteristics were comparable in both groups. The median survival of those living with HIV was 20.63 months; 53% of them had controlled viral load, and 74% were receiving antiretroviral therapy. Mean baseline CD4 T-cell count was 409. In HIV-infected patients, the Tp-e interval and Tp-ec interval were prolonged, and the Tp-e/QT ratio was higher (p<0.001, p<0.001 and p=0.021, respectively). In bivariate and partial correlation analyses, there was a negative correlation between CD4 T-cell level and Tp-e interval, Tp-ec interval, and Tp-e/QT ratio. CONCLUSION Tp-e interval, Tp-ec interval, and Tp-e/QT ratio were greater in HIV-infected patients compared with healthy individuals. HIV-infected patients, particularly those with low baseline CD4 T-cell counts, should be closely monitored due to risk of SCD.
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Affiliation(s)
- Sukru Cetin
- Department of Cardiology, Sancaktepe Şehit Prof İlhan Varank Training and Research Hospital, Istanbul, Turkey.
| | - Ayşe Şabablı Çetin
- Department of Infectious Diseases and Clinical Microbiology, Sancaktepe Şehit Prof İlhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Gurdal
- Department of Cardiology Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Süleyman Sezai Yıldız
- Department of Cardiology Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Kudret Keskin
- Department of Cardiology Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Serhat Sığırcı
- Department of Cardiology Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ali Bayraktar
- Department of Cardiology, Sancaktepe Şehit Prof İlhan Varank Training and Research Hospital, Istanbul, Turkey
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Yıldız SS, Sutaşır MN, Sığırcı S, Topçu H, Gürdal A, Keskin K, Kılıçkesmez KO. Acute effects of synthetic cannabinoids on ventricular repolarization parameters. Turk Kardiyol Dern Ars 2020; 47:384-390. [PMID: 31311906 DOI: 10.5543/tkda.2019.64569] [Citation(s) in RCA: 2] [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: 11/04/2022] Open
Abstract
OBJECTIVE An association between ventricular repolarization parameters (VRPs) and ventricular arrhythmias has been demonstrated in previous studies. However, there are limited data related to a relationship between synthetic cannabinoids (SCs) and VRPs. The aim of this study was to analyze the acute effects of SCs on VRPs using electrocardiogram (ECG) measurements of the T-peak to T-end interval (Tp-e), Tp-e/QT ratio, and Tp-e/corrected QT (QTc) ratio. METHODS The present study included 58 patients who were admitted to the emergency department who used SCs (SC +) between 2014 and 2016, and 50 healthy control subjects (SC -). The QT and QTc intervals, Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were measured from a 12-lead ECG. These parameters were compared between groups and correlation analysis was performed. RESULTS The Tp-e and QTc intervals were significantly higher in SC + patients when compared with the SC- group (92.2±177;10.0, 77.4 ±177;9.3, p<0.001; 434.5±177;30.8, 410.9±177;27.3, p<0.001, respectively). Tp-e/QT and Tp-e/QTc ratios were greater in SC + patients in comparison with SC - participants (0.26±177;0.02, 0.22±177;0.02, p<0.001; 0.21±177;0.02, 0.18±177;0.02, p<0.001, respectively). Significant correlations were found between the use of SCs and the 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). CONCLUSION The Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were greater in subjects who used SCs. Therefore, SC users might have an increased risk of ventricular arrhythmia.
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Affiliation(s)
- Süleyman Sezai Yıldız
- Department of Cardiology, University of Health Science, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Necmeddin Sutaşır
- Department of Emergency Medicine, University of Health Science, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Serhat Sığırcı
- Department of Cardiology, University of Health Science, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Hatice Topçu
- Department of Emergency Medicine, University of Health Science, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Ahmet Gürdal
- Department of Cardiology, University of Health Science, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Kudret Keskin
- Department of Cardiology, University of Health Science, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Kadriye Orta Kılıçkesmez
- Department of Cardiology, University of Health Science, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
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21
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Sığırcı S, Sarıkaya R, Keskin K, Yıldız SS, Pilten Güzel S, Çetinkal G, Önur İ, Kılıçkesmez KO. [Can biomarkers help us to understand the pathogenesis of coronary slow flow? Endocan and omentin-I in slow coronary flow phenomenon]. Turk Kardiyol Dern Ars 2019; 47:251-257. [PMID: 31219439 DOI: 10.5543/tkda.2018.27708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The pathophysiology of the slow coronary flow (SCF) phenomenon is still unclear. The two most frequently cited mechanisms of SCF are endothelial dysfunction and subclinical diffuse atherosclerosis. The aim of this study was to investigate the relation of SCF to serum endocan levels which is associated with endothelial dysfunction and to serum omentin-I levels which is associated with atherosclerosis. METHODS A total of 42 patients with SCF and 43 controls with normal coronary flow based on a coronary angiogram were enrolled. Serum endocan and omentin-I levels were measured and the presence of SCF was determined according to Thrombolysis in Myocardial Infarction frame count (TFC) calculations. RESULTS The omentin-I level was significantly lower and the endocan level was significantly higher in patients with SCF than in the controls. Receiver operating characteristic curve analysis revealed that the sensitivity and specificity of endocan for SCF was 66% and 70%, respectively (area under the curve [AUC]: 0.760, 95% confidence interval [CI]: 0.65-0.86; p<0.001), and the comparable values for omentin were 66% and 61% (AUC: 0.630, 95% CI: 0.51-0.75; p=0.049). Multivariate logistic regression analysis revealed that a high endocan level (odds ratio [OR]: 6.8, 95% CI: 1.849-2.439, cutoff: 2.45 ng/mL; p=0.003) and a low omentin-I level (OR: 3.6, 95% CI: 1.057-12.893, cutoff: 4.63 ng/mL; p=0.041) were independently associated with the presence of SCF. In patients with SCF, the endocan level was positively correlated with the mean TFC, while the omentin-I level was negatively correlated (r=0.44; p<0.001 and r=-0.22; p=0.049, respectively). CONCLUSION These results revealed that endocan and omentin-I might be useful biomarkers for predicting the presence and severity of SCF.
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Affiliation(s)
- Serhat Sığırcı
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital
| | - Remzi Sarıkaya
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University
| | - Kudret Keskin
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital
| | | | | | - Gökhan Çetinkal
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital
| | - İmran Önur
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University
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Kilci H, Keskin K, Aksan G, Yildiz SS, Orta Kilickesmez K. Incidental Right Atrial Thrombus in an 18-Year-Old Female Patient. Turk J Nephrol 2019. [DOI: 10.5152/turkjnephrol.2019.3469] [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: 11/22/2022]
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23
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Sigirci S, Keskin K, Yildiz SS, Cetinkal G, Gurdal A, Kilci H, Tezcan M, Kilickesmez KO. Reply to the Letter to the Editor Entitled "Which Comes First in Contrast-Induced Nephropathy? Inflammation or Thrombus Formation?". Angiology 2019; 71:196. [PMID: 31607146 DOI: 10.1177/0003319719882228] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Serhat Sigirci
- Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Kudret Keskin
- Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Suleyman Sezai Yildiz
- Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Gokhan Cetinkal
- Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Ahmet Gurdal
- Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Hakan Kilci
- Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Tezcan
- Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Kadriye Orta Kilickesmez
- Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
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Keskin K, Çetinkal G, Yıldız SS, Sığırcı S, Doğan GM, Orta Kılıçkesmez K. Clinical characteristics and intermediate-term outcomes of young patients with uncomplicated myopericarditis. Turk Kardiyol Dern Ars 2019; 47:581-586. [PMID: 31582679 DOI: 10.5543/tkda.2019.63306] [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] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Although the long-term prognosis of myopericarditis is good, recurrence continues to be a problem. In addition, there are concerns regarding the safety of the empirical use of anti-inflammatory drugs. This study was an investigation of the clinical outcomes of young patients with uncomplicated myopericarditis, the majority of whom received both nonsteroidal anti-inflammatory drugs and colchicine. METHODS Patients aged 18 to 40 years who were admitted between May 2015 and May 2018 due to myopericarditis and had normal left ventricular function were included in the study. The primary outcome of the research was analysis of major adverse cardiac events (MACEs): all-cause mortality, myopericarditis recurrence, development of significant arrhythmia, heart failure, and cardiac tamponade. A total of 60 patients were included in the study. The median duration of follow-up was 19 months. RESULTS A MACE occurred in 11.7% of the patients. None of the patients experienced heart failure, significant arrhythmia, cardiac tamponade, or all-cause mortality. Recurrence of myopericarditis was the only MACE observed. Most patients were treated with both nonsteroidal anti-inflammatory drugs and colchicine (96% and 95% of the patients, respectively). Univariate cox regression analysis indicated that only the maximum in-hospital C-reactive protein (CRP) level was associated with recurrence (hazard ratio: 1.01, 95% confidence interval: 1.01-1.02; p=0.04). CONCLUSION The intermediate-term prognosis of myopericarditis patients was excellent in terms of mortality. However, recurrence remains a challenge. The role of CRP, particularly in recurrence, should be explored further.
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Affiliation(s)
- Kudret Keskin
- Department of Cardiology, Health Sciences University Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Gökhan Çetinkal
- Department of Cardiology, Health Sciences University Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Süleyman Sezai Yıldız
- Department of Cardiology, Health Sciences University Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Serhat Sığırcı
- Department of Cardiology, Health Sciences University Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Güneş Melike Doğan
- Department of Cardiology, Health Sciences University Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Kadriye Orta Kılıçkesmez
- Department of Cardiology, Health Sciences University Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
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25
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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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Yıldız SS, Sığırcı S, Gürdal A, Keskin K, Kilci H, Doğan GM, Hamit T, Kılıçkesmez K. In-hospital Outcomes of Patients with ST-segment Elevation Myocardial Infarction who were Intubated before Primary Percutaneous Intervention: Experience of a tertiary center. Sisli Etfal Hastan Tip Bul 2019; 53:179-185. [PMID: 32377079 PMCID: PMC7199833 DOI: 10.14744/semb.2019.00878] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/11/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES ST-segment elevation myocardial infarction (STEMI) complicated by respiratory failure is associated with a greater number of in-hospital and out-of-hospital adverse cardiovascular events (CVEs). The aim of this study was to analyze in-hospital outcomes and the factors affecting the outcomes of intubated patients diagnosed with STEMI who underwent primary percutaneous coronary intervention (pPCI) at a single tertiary care center. METHODS The data of 592 patients diagnosed with acute STEMI who were admitted to the emergency department between May 2017 and January 2019 and subsequently underwent pPCI were retrospectively reviewed. Cardiovascular risk factors as well as biochemical and angiographic characteristics of patients who were intubated in the emergency room or ambulance due to cardiac arrest and those who were not intubated were compared. Adverse CVEs were defined as in-hospital death, cerebrovascular stroke, and acute stent thrombosis. RESULTS A total of 60 patients (70% male; mean age: 63.6±14.0 years) who were intubated and 532 non-intubated patients (81% male; mean age: 60.2±12.1 years) were included in the study. The angiographic features of the 2 groups were similar. An adverse CVE was experienced by 43.3% of the intubated patients and 3.6% of the non-intubated patients. Multivariate analysis indicated that age (odds ratio [OR]: 1.065; p<0.001), serum lactate level (OR: 1.308; p<0.001), and left ventricle ejection fraction (OR: 0.946; p<0.001) were independent predictors of in-hospital adverse CVE in the intubated patient group. CONCLUSION The results of this single-center study showed that 1 in 10 patients hospitalized with STEMI were intubated, and approximately 4 in 10 intubated STEMI patients had an in-hospital CVE.
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Affiliation(s)
- Süleyman Sezai Yıldız
- Department of Cardiology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Serhat Sığırcı
- Department of Cardiology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Gürdal
- Department of Cardiology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Kudret Keskin
- Department of Cardiology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Hakan Kilci
- Department of Cardiology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Güneş Melike Doğan
- Department of Cardiology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Turgun Hamit
- Department of Cardiology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Kadriye Kılıçkesmez
- Department of Cardiology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Sigirci S, Keskin K, Yildiz SS, Cetinkal G, Gurdal A, Kilci H, Tezcan M, Kilickesmez KO. Reply to the Letter to the Editor Entitled "What Are the Essential Risk Factors for Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction?". Angiology 2019; 70:675. [PMID: 31014073 DOI: 10.1177/0003319719844386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Serhat Sigirci
- 1 Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Kudret Keskin
- 1 Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Suleyman Sezai Yildiz
- 1 Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Gokhan Cetinkal
- 1 Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Ahmet Gurdal
- 1 Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Hakan Kilci
- 1 Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Tezcan
- 1 Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Kadriye Orta Kilickesmez
- 1 Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
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28
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Sigirci S, Keskin K, Yildiz SS, Cetinkal G, Gurdal A, Kilci H, Tezcan M, Kilickesmez KO. Can Thrombus Burden Predict Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction? Angiology 2019; 70:642-648. [PMID: 30621429 DOI: 10.1177/0003319718822638] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The incidence of contrast-induced nephropathy (CIN) increases in the range from patients with unstable angina to ST-segment elevation myocardial infarction (STEMI). Platelet activation has been associated with pathophysiology of nephropathy and thrombus burden in the infarct-related arteries. We investigated the impact of thrombus burden on CIN in patients with STEMI. We enrolled 883 patients with STEMI who received primary percutaneous coronary intervention. Patients were divided into groups according to thrombus burden and CIN development. Thrombus burden was scored based on thrombolysis in myocardial infarction thrombus grades (TGs). Thrombus grade 4 was defined as large thrombus burden (LTB), while thrombus burden <TG 4 was defined as small thrombus burden. A total of 126 (14.2%) patients with STEMI had CIN, while 313 (35.4%) patients had LTB. Compared to CIN (-) patients, CIN (+) patients were older, had lower hemoglobin levels, lower ejection fraction, and higher contrast media volume administration. Multivariate logistic regression analysis demonstrated that LTB, age, hypertension, and admission glomerular filtration rate were independent predictors of CIN (P = .016, P < .001, P = .028, P < .001, respectively). Thrombus burden, which is measurable during angiography, may be helpful in the determination of CIN risk in patients with STEMI.
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Affiliation(s)
- Serhat Sigirci
- 1 Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Kudret Keskin
- 1 Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Süleyman Sezai Yildiz
- 1 Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Gökhan Cetinkal
- 1 Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Ahmet Gurdal
- 1 Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Hakan Kilci
- 1 Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Tezcan
- 1 Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Kadriye Orta Kilickesmez
- 1 Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
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Çetinkal G, Koçaş C, Koçaş BB, Arslan Ş, Abacı O, Karaca OŞ, Dalgıç Y, Ser ÖS, Keskin K, Yıldız A, Doğan SM. Author`s Reply. Anatol J Cardiol 2018; 20:371-372. [PMID: 30504744 PMCID: PMC6287444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Gökhan Çetinkal
- Department of Cardiology, Şişli Hamidiye Etfal Training and Research Hospital; İstanbul-Turkey,Address for Correspondence: Dr. Gökhan Çetinkal, Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, Şişli 34360 İstanbul-Türkiye Phone: +90 212 373 50 00 Fax: +90 212 373 50 04 E-mail:
| | - Cüneyt Koçaş
- Department of Cardiology, İstanbul University Institute of Cardiology; İstanbul-Turkey
| | - Betül Balaban Koçaş
- Department of Cardiology, Şişli Hamidiye Etfal Training and Research Hospital; İstanbul-Turkey
| | - Şükrü Arslan
- Department of Cardiology, İstanbul University Institute of Cardiology; İstanbul-Turkey
| | - Okay Abacı
- Department of Cardiology, İstanbul University Institute of Cardiology; İstanbul-Turkey
| | - Osman Şükrü Karaca
- Department of Cardiology, İstanbul University Institute of Cardiology; İstanbul-Turkey
| | - Yalçın Dalgıç
- Department of Cardiology, İstanbul University Institute of Cardiology; İstanbul-Turkey
| | - Özgür Selim Ser
- Department of Cardiology, İstanbul University Institute of Cardiology; İstanbul-Turkey
| | - Kudret Keskin
- Department of Cardiology, Şişli Hamidiye Etfal Training and Research Hospital; İstanbul-Turkey
| | - Ahmet Yıldız
- Department of Cardiology, İstanbul University Institute of Cardiology; İstanbul-Turkey
| | - Sait Mesut Doğan
- Department of Cardiology, İstanbul University Institute of Cardiology; İstanbul-Turkey
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Yildiz SS, Cetin S, Keskin K, Gunduz A, Cetinkal G, Bulbun G, Sigirci S, Pilten S, Kilickesmez KO. Pregnancy-associated plasma protein-a is associated with subclinical atherosclerosis in men with HIV infection. J Investig Med 2018; 67:821-825. [PMID: 30487186 DOI: 10.1136/jim-2018-000859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2018] [Indexed: 11/04/2022]
Abstract
The pathophysiology of an early and accelerated atherosclerotic process is complex and multifactorial in HIV-infected men compared with HIV-non-infected men. Several biomarkers have been well studied in the detection of the early stage of atherosclerosis, but studies are limited in HIV-infected men. The objective of this study was to investigate the association between serum pregnancy-associated plasma protein-A (PAPP-A) and carotid intima-media wall thickness (CIMT) in asymptomatic HIV-infected men. This a case-control study group comprising 118 HIV-infected men and 60 age-matched and gender-matched HIV-non-infected men. Serum PAPP-A was measured using an ELISA kit and carotid IMT was evaluated by Doppler ultrasonography in all subjects. Statistical analysis included receiver-operating characteristic (ROC) analysis, Pearson correlation and logistic regression analysis. Serum PAPP-A level was significantly higher in HIV +CIMT+ group compared with HIV +CIMT group and HIV-CIMT- group. We found a positive correlation between PAPP-A and increased CIMT (r=0.737, p<0.0001), and a negative correlation between nadir CD4 T cell counts and increased CIMT (r=-0.526, p<0.001). In multivariate logistic regression analyses, PAPP-A, nadir CD4 T cell count and age were significantly associated with subclinical atherosclerosis (p<0.001, p=0.006 and p=0.032, respectively). In ROC analysis, PAPP-A levels of >3.70 µg/mL were associated with subclinical atherosclerosis in HIV+ men with a specificity of 100% and a sensitivity of 71% (area under the curve: 0.949, 95% CI 0.875 to 1.000, p<0.001). Serum PAPP-A level was strongly correlated with increased CIMT in HIV-infected men. PAPP-A might be used as an early biomarker to identify atherosclerosis in asymptomatic HIV-infected men.
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Affiliation(s)
- Suleyman Sezai Yildiz
- Cardiology, University of Health Science, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Sukru Cetin
- Cardiology, University of Health Science, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Kudret Keskin
- Cardiology, University of Health Science, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Alper Gunduz
- Infectious Diseases, University of Health Science, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Gokhan Cetinkal
- Cardiology, University of Health Science, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Goncagul Bulbun
- Radiology, University of Health Science, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Serhat Sigirci
- Cardiology, University of Health Science, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Saadet Pilten
- Medical Biochemistry, University of Health Science, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Kadriye Orta Kilickesmez
- Cardiology, University of Health Science, Sisli Hamidiye Etfal Training 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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Yıldız SS, Keskin K, Avsar M, Cetinkal G, Sigirci S, Aksan G, Cetin S, Okuyan E, Kilickesmez KO. Electrocardiographic diagnosis of atrial infarction in patients with acute inferior ST-segment elevation myocardial infarction. Clin Cardiol 2018; 41:972-977. [PMID: 29802729 DOI: 10.1002/clc.22987] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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] [Received: 03/03/2018] [Revised: 04/21/2018] [Accepted: 05/24/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Patients with atrial myocardial infarction (ATMI) have frequent cardiac and noncardiac complications. However, ATMI is uncommonly diagnosed because of its nonspecific ECG changes. Our objective was to analyze the ECG characteristics of ATMI in patients with inferior STEMI. HYPOTHESIS Electrocardiographic P wave parameters can help in diagnosis of ATMI. METHODS We evaluated 932 patients who underwent coronary angiography and recruited 39 patients with ATMI and 33 patients without ATMI with inferior STEMI for a retrospective study. Twelve-lead ECGs were obtained to measure P-wave parameters in diagnosis of ATMI. P-wave parameters and PR-segment displacement were compared in patients with and without ATMI. RESULTS In inferior leads, PWD and PWDisp were significantly longer in the ATMI group than in the non-ATMI group (limb lead II, 109.79 ±15.51 ms and 86.65 ±5.02 ms, respectively; P < 0.001; limb lead III, 108.31 ±12.51 ms and 85.27 ±7.47 ms, P < 0.001; aVF, 106.49 ±13.68 ms and 83.01 ±7.89 ms, P < 0.001; PWDisp, 41.67 ±10.72 ms and 25.18 ±5.17 ms, P < 0.001). By contrast, PWA was significantly lower in the ATMI group than in the non-ATMI group (limb lead II, 0.96 ±0.18 mV and 1.39 ±0.22 mV, respectively; P < 0.001; limb lead III, 0.90 ±0.11 and 1.21 ±0.23, P < 0.001; aVF, 0.88 ±0.17 and 1.26 ±0.28, P < 0.001). PR-segment displacement was found in 8 (20.5%) patients with ATMI. A PWD ≥95.5 ms in lead DII diagnosed ATMI with a higher sensitivity and specificity (90%, 94%) than did PWA or PWDisp. CONCLUSIONS This study suggests P-wave parameters might be considered ECG findings in diagnosis of ATMI in patients with inferior STEMI.
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Affiliation(s)
- Suleyman Sezai Yıldız
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Kudret Keskin
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Murat Avsar
- Department of Cardiology, Yedikule Chest Disease and Thoracic Surgery Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gokhan Cetinkal
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Serhat Sigirci
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gokhan Aksan
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sukru Cetin
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ertugrul Okuyan
- Department of Cardiology, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Kadriye Orta Kilickesmez
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Keskin K, Çetinkal G, Sığırcı S, Yıldız SS, Çetin Ş, Gürdal A, Kocaş BB, Kılıçkesmez KO. The impact of infection on mortality in octogenarians who were admitted due to acute coronary syndrome. Arch Gerontol Geriatr 2018; 76:48-53. [PMID: 29455059 DOI: 10.1016/j.archger.2018.01.012] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 01/26/2018] [Accepted: 01/29/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND The prevalence of coronary artery disease is on the rise as the life expectancy of the population increases. However, treatment of acute coronary syndrome in the elderly patients has its own problems that have not been thoroughly addressed in the clinical trials. Since these patients are generally fragile and have multiple co-morbidities, the course of acute coronary syndrome can frequently be complicated. Infection, which co-exists either at the initial presentation or is acquired during the hospital stay, is a condition about which there is little published data. Therefore, in our study, we wanted to assess the impact of infection on mortality in octogenarians who have acute coronary syndrome METHODS: We retrospectively analyzed the data of 174 octogenarians who had been admitted to the coronary care unit with acute coronary syndrome. All-cause mortality was defined as the primary endpoint of the study. RESULTS Overall 53 octogenarian patients (30.5%) had an infection along with acute coronary syndrome. The mean duration of follow-up was 10 months (1-25 months). Both in-hospital and long-term mortality were higher in these patients (18.9% vs 6.6%, p = 0.01; 52.8% vs 27.5%, p < 0.01; respectively). Kaplan-Meier analysis also showed lower cumulative survival. (p [log-rank] = 0.002). In multivariate Cox regression analysis; undergoing coronary angiography, infection (HR 1.96, 95% CI 1.15-3.34, p = 0.01), left ventricular ejection fraction and maximum C reactive protein levels were found as independent predictors of long-term survival. CONCLUSION Infection in octogenarians who were admitted due to acute coronary syndrome was frequent and increased their mortality substantially.
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Affiliation(s)
- Kudret Keskin
- Şişli Hamidiye Etfal Education and Research Hospital, Department of Cardiology, Cardiologist, Turkey.
| | - Gökhan Çetinkal
- Şişli Hamidiye Etfal Education and Research Hospital, Department of Cardiology, Cardiologist, Turkey.
| | - Serhat Sığırcı
- Şişli Hamidiye Etfal Education and Research Hospital, Department of Cardiology, Cardiologist, Turkey.
| | - Süleyman Sezai Yıldız
- Şişli Hamidiye Etfal Education and Research Hospital, Department of Cardiology, Cardiologist, Turkey.
| | - Şükrü Çetin
- Şişli Hamidiye Etfal Education and Research Hospital, Department of Cardiology, Cardiologist, Turkey.
| | - Ahmet Gürdal
- Şişli Hamidiye Etfal Education and Research Hospital, Department of Cardiology, Cardiologist, Turkey.
| | - Betül Balaban Kocaş
- Şişli Hamidiye Etfal Education and Research Hospital, Department of Cardiology, Cardiologist, Turkey.
| | - Kadriye Orta Kılıçkesmez
- Şişli Hamidiye Etfal Education and Research Hospital, Department of Cardiology, Cardiologist, Turkey.
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Sığırcı S, Keskin K, Sezai Yıldız S, Aksan G, Bambul Sığırcı B, Orta Kılıçkesmez K. Treatment of Simultaneous Thromboembolism of the Right and Left Coronary Arteries with Thrombus Aspiration in a Patient with a Prosthetic Mitral Valve. J Heart Valve Dis 2018; 27:107-109. [PMID: 30560607] [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: 06/09/2023]
Abstract
Prosthetic heart valve thrombosis is a rare, difficult-to-treat condition that increases morbidity and mortality by leading to systemic embolism. Clinically, it presents mainly in the form of stroke, though an embolism be observed in many systems. Acute coronary syndrome, which is rarely observed in patients with a prosthetic heart valve, mostly occurs as non-ST segment elevation myocardial infarction (MI). There is no specific recommendation for the treatment of this condition. Revascularization success rates have been shown to be variable in cases wherein thrombolytic therapy, balloon angioplasty, stent implantation, and a combination of all of these techniques are used. Herein are presented details of the successful revascularization of a patient with ST segment elevation MI presenting with simultaneous right and left coronary system embolism, and without embolism in any other system. In cases of acute coronary syndrome in patients with a prosthetic heart valve with no known coronary artery disease, starting the procedure with thrombus aspiration may prevent unnecessary stent and balloon angioplasty procedures being required, by accelerating the revascularization process.
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Affiliation(s)
- Serhat Sığırcı
- Department of Cardiology, Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey. Electronic correspondence:
| | - Kudret Keskin
- Department of Cardiology, Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Süleyman Sezai Yıldız
- Department of Cardiology, Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Gökhan Aksan
- Department of Cardiology, Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Buket Bambul Sığırcı
- Department of Pathology, İstanbul Education and Research Hospital, Istanbul, Turkey
| | - Kadriye Orta Kılıçkesmez
- Department of Cardiology, Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
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35
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Yıldız SS, Sahin I, Cetinkal G, Aksan G, Kucuk SH, Keskin K, Cetin S, Sigirci S, Avcı İİ, Kilci H, Kiliçkesmez K. Usefulness of Serum Omentin-1 Levels for the Prediction of Adverse Cardiac Events in Patients with Hypertrophic Cardiomyopathy. Med Princ Pract 2018; 27:107-114. [PMID: 29402833 PMCID: PMC5968372 DOI: 10.1159/000487396] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 05/07/2017] [Accepted: 02/05/2018] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To investigate the association between serum omentin-1 levels and adverse cardiac events in patients with hypertrophic cardiomyopathy (HCM). SUBJECTS AND METHODS This prospective, observational study included 87 patients with HCM and 50 age- and sex-matched control subjects. Serum omentin-1 and brain natriuretic peptide (BNP) levels were measured in all subjects, using enzyme-linked immunosorbent assay and electrochemiluminescence, respectively. Patients with HCM were divided into 2 groups according to their omentin levels, i.e., low: ≤291 ng/mL (n = 48) and high: > 291 ng/mL (n = 39). Cardiac mortality, hospitalization due to heart failure, and implantable cardioverter-defibrillator (ICD) implantation were considered adverse cardiac events. Statistical analysis included uni- and multivariant logistic regression, receiver-operating characteristic (ROC) analysis, and the Kaplan-Meier method. RESULTS Serum omentin-1 levels were significantly lower in the obstructive (253.9 ± 41.3 ng/mL) and nonobstructive (301.9 ± 39.8 ng/mL) HCM groups than in the control group (767.1 ± 56.4 ng/mL), p < 0.001, respectively. The BNP levels were higher in the obstructive and nonobstructive HCM groups than in the control group (269.5 ± 220, 241.0 ± 227, and 24.0 ± 18.9 pg/mL, respectively, p < 0.001). The Kaplan-Meier analysis indicated that patients with low omentin-1 levels showed a significantly higher (48.2%) 2-year cumulative incidence of overall adverse cardiac events than those with high omentin-1 levels (16.2%) (log-rank test, p = 0.001). In the multivariate logistic regression analysis, omentin-1, interventricular septum (IVS) thickness, and male gender were independent predictors of adverse cardiac events in the follow-up. CONCLUSION Omentin-1 levels were lower in patients with HCM than in the control group, and this was associated with worse cardiac outcomes.
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Affiliation(s)
- Suleyman Sezai Yıldız
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
- *Suleyman Sezai Yıldız, Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, Halaskargazi Caddesi, Etfal Sokak, TR-34371 Sisli-İstanbul (Turkey), E-Mail
| | - Irfan Sahin
- Department of Cardiology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Gokhan Cetinkal
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Gokhan Aksan
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Suat Hayri Kucuk
- Department of Clinical Biochemistry, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Kudret Keskin
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Sukru Cetin
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Serhat Sigirci
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - İlhan İlker Avcı
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
| | - Hakan Kilci
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Kadriye Kiliçkesmez
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Keskin K, Sezai Yıldız S, Çetinkal G, Çetin Ş, Sığırcı S, Kilci H, Aksan G, Helvacı F, Gürdal A, Balaban Kocaş B, Arslan Ş, Orta Kılıçkesmez K. Persistent smoking rate after coronary revascularization and factors related to smoking cessation in Turkey. J Public Health (Oxf) 2017; 40:806-812. [DOI: 10.1093/pubmed/fdx138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Indexed: 12/13/2022] Open
Affiliation(s)
- Kudret Keskin
- Department of Cardiology, Şişli Hamidiye Etfal Education and Research Hospital, Sisli, Istanbul, Turkey
| | - Süleyman Sezai Yıldız
- Department of Cardiology, Şişli Hamidiye Etfal Education and Research Hospital, Sisli, Istanbul, Turkey
| | - Gökhan Çetinkal
- Department of Cardiology, Şişli Hamidiye Etfal Education and Research Hospital, Sisli, Istanbul, Turkey
| | - Şükrü Çetin
- Department of Cardiology, Şişli Hamidiye Etfal Education and Research Hospital, Sisli, Istanbul, Turkey
| | - Serhat Sığırcı
- Department of Cardiology, Şişli Hamidiye Etfal Education and Research Hospital, Sisli, Istanbul, Turkey
| | - Hakan Kilci
- Department of Cardiology, Şişli Hamidiye Etfal Education and Research Hospital, Sisli, Istanbul, Turkey
| | - Gökhan Aksan
- Department of Cardiology, Şişli Hamidiye Etfal Education and Research Hospital, Sisli, Istanbul, Turkey
| | - Füsun Helvacı
- Department of Cardiology, Şişli Hamidiye Etfal Education and Research Hospital, Sisli, Istanbul, Turkey
| | - Ahmet Gürdal
- Department of Cardiology, Şişli Hamidiye Etfal Education and Research Hospital, Sisli, Istanbul, Turkey
| | - Betül Balaban Kocaş
- Department of Cardiology, Şişli Hamidiye Etfal Education and Research Hospital, Sisli, Istanbul, Turkey
| | - Şükrü Arslan
- Cardiolgy Department, Taksim Gaziosmanpaşa Education and Research Hospital, Istanbul, Turkey
| | - Kadriye Orta Kılıçkesmez
- Department of Cardiology, Şişli Hamidiye Etfal Education and Research Hospital, Sisli, Istanbul, Turkey
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Keskin K, Kilci H, Aksan G, Çetinkal G, Yıldız SS, Kocaman Türk F, Bingöl G. Serum oxidized low-density lipoprotein level as a marker of oxidative stress in patients undergoing hyperbaric oxygen therapy. Turk Kardiyol Dern Ars 2017; 45:533-537. [PMID: 28902644 DOI: 10.5543/tkda.2017.28302] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Oxidative stress (OS) is involved in the pathogenesis of atherosclerosis. Hyperbaric oxygen therapy (HBOT), in which 100% oxygen is inhaled under hyperbaric pressure, may create OS. Therefore, the aim of this research was to measure the serum oxidized low-density lipoprotein (oxLDL) level in patients undergoing HBOT. METHODS Twenty-nine patients who underwent HBOT to treat various diseases were enrolled in this study. The serum oxLDL level was measured at the beginning of the first and after the 10th therapy session. RESULTS There was no significant difference between the oxLDL level of patients before and after HBOT (4.96±0.1 vs. 4.94±0.1 U/mL; p=0.36). CONCLUSION HBOT seems to be safe in terms of oxLDL production up to 10 sessions. However, further large-scale studies investigating longer duration of HBOT treatment are required to understand the role of OS.
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Affiliation(s)
- Kudret Keskin
- Department of Cardiology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey.
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Cetin S, Yıldız SS, Mazı EE, Keskin K, Cetinkal G, Gurdal A, Karabay U, Orta Kilickesmez K. Relationship between a fragmented QRS and microalbuminuria in patients with type 2 diabetes mellitus. ACTA ACUST UNITED AC 2017; 64:464-470. [PMID: 29050702 DOI: 10.1016/j.endinu.2017.07.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/20/2017] [Accepted: 07/01/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Microalbuminuria (MAU), a complication of diabetes, is closely related to cardiovascular events. A fragmented QRS (fQRS) in the electrocardiogram (ECG) was found to be strongly associated to cardiovascular morbidity and mortality. OBJECTIVE The aim of this study was to assess the association between a fQRS and MAU in patients with type 2 diabetes mellitus (T2DM). PATIENTS AND METHODS One hundred and twenty-seven patients (mean age, 50.49 years; 44.01% male) with T2DM of at least six months duration and at least two urine albumin/creatinine ratios (ACRs) available were enrolled into the study between December 2015 and May 2016. All patients underwent ECG and echocardiography, and were taken blood and urine samples. Patients were divided into two groups according to presence of fQRS (group 1) or absence of fQRS (group 2). RESULTS Both groups had similar baseline characteristics. MAU and glycosylated hemoglobin (HbA1c) levels and left ventricular end-diastolic diameter (LVEDd) were increased in patients with a fQRS in the ECG (p=0.002, p=0.02, and p=0.007, respectively). Univariate and multivariate logistic regression analysis showed MAU and an increased LVEDd to be independent risk factors for the presence of a fQRS in the ECG of T2DM patients. DISCUSSION AND CONCLUSIONS In this study, a fQRS was associated to MAU. In T2DM, MAU may be related to subclinical diastolic and systolic dysfunction.
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Affiliation(s)
- Sukru Cetin
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
| | - Suleyman Sezai Yıldız
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Emrah Erkan Mazı
- Department of Internal Medicine, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Kudret Keskin
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Gokhan Cetinkal
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Gurdal
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Umut Karabay
- Department of Internal Medicine, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Keskin K, Sığırcı S, Yıldız SS, Çetinkal G, Kılıçkesmez K. A practical tip to engage the left main coronary artery in patients presenting with aortic aneurysms. International Journal of the Cardiovascular Academy 2017. [DOI: 10.1016/j.ijcac.2017.10.001] [Citation(s) in RCA: 1] [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: 11/26/2022] Open
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Yıldız SS, Aksan G, Sığırcı S, Keskin K, Kılıçkesmez K. Thrombosis of the left internal mammary artery graft causing acute coronary syndrome after 4 years of coronary bypass surgery. Anatol J Cardiol 2016; 15. [PMID: 26663227 PMCID: PMC5368458 DOI: 10.5152/anatoljcard/ol.2015.6614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Süleyman Sezai Yıldız
- Department of Cardiology, Şişli Hamidiye Etfal Training and Research Hospital; İstanbul-Turkey,Address for Correspondence: Dr. Süleyman Sezai Yıldız Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi, Halaskargazi Caddesi Etfal Sokak 34360 Şişli, İstanbul-Türkiye Phone: +90 532 422 53 83 Fax: +90 212 224 07 72 E-mail:
| | - Gökhan Aksan
- Department of Cardiology, Şişli Hamidiye Etfal Training and Research Hospital; İstanbul-Turkey
| | - Serhat Sığırcı
- Department of Cardiology, Şişli Hamidiye Etfal Training and Research Hospital; İstanbul-Turkey
| | - Kudret Keskin
- Department of Cardiology, Şişli Hamidiye Etfal Training and Research Hospital; İstanbul-Turkey
| | - Kadriye Kılıçkesmez
- Department of Cardiology, Şişli Hamidiye Etfal Training and Research Hospital; İstanbul-Turkey
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Koektuerk B, Yorgun H, Koch A, Turan CH, Keskin K, Dahmen A, Hoppe C, Gorr E, Bansmann PM, Turan RG, Horlitz M, Yang A. Pulmonary vein isolation in patients with paroxysmal atrial fibrillation. Herz 2016; 42:91-97. [DOI: 10.1007/s00059-016-4441-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/28/2016] [Accepted: 05/07/2016] [Indexed: 12/18/2022]
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Aksan G, Gedikli Ö, Keskin K, Nar G, İnci S, Yıldız SS, Kaplan Ö, Soylu K, Kılıçkesmez KO, Şahin M. Is galectin-3 a biomarker, a player-or both-in the presence of coronary atherosclerosis? J Investig Med 2016; 64:764-70. [PMID: 26912009 DOI: 10.1136/jim-2015-000041] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2015] [Indexed: 11/04/2022]
Abstract
Atherosclerosis is a complex process mediated by leukocytes, macrophages and various inflammatory markers. Galectin-3 is secreted by activated macrophages and is involved in cardiac fibrosis, cardiac remodeling, and inflammation. The present study aimed to determine the relationship between the presence and severity of coronary artery disease (CAD) and serum galectin-3 levels. The study included 82 patients with CAD confirmed via coronary angiography and 82 healthy participants as control group. Angiographic CAD was defined as ≥50% luminal diameter stenosis of at least one major epicardial coronary artery. The severity of CAD was determined by the Gensini score; and the serum galectin-3 levels were measured via ELISA. Serum galectin-3 levels were significantly higher in the patient group with CAD than in the control group (12.96±4.92 vs 5.52±1.9 ng/mL, p<0.001). In the correlation analysis, serum galectin-3 showed significant correlation with the Gensini score (r=0.715, p<0.001), number of diseased vessels (r=0.752, p<0.001) and serum hs-CRP level (r=0.607, p<0.001). In addition, multivariate logistic regression analysis showed that the serum galectin-3 levels were significant and independent predictors of the presence of angiographic CAD (OR=3.933, 95% CI 2.395 to 6.457; p<0.001). In the present study, the serum galectin-3 levels were higher in the patients with CAD than in healthy controls. Also, serum galectin-3 levels showed a significant positive correlation with the severity of CAD. An increased serum galectin-3 level may be considered an important activator and a marker of the atherosclerotic inflammatory process in CAD.
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Affiliation(s)
- Gökhan Aksan
- Department of Cardiology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Ömer Gedikli
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Kudret Keskin
- Department of Cardiology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Gökay Nar
- Department of Cardiology, Ahi Evran University, Kırşehir, Turkey
| | - Sinan İnci
- Department of Cardiology, Aksaray State Hospital, Aksaray, Turkey
| | - Süleyman Sezai Yıldız
- Department of Cardiology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Özgür Kaplan
- Department of Cardiology, Faculty of Medicine, İstanbul Bilim University, İstanbul, Turkey
| | - Korhan Soylu
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | | | - Mahmut Şahin
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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Keskin K, Yıldız SS, Sığırcı S, Çetin Ş, Kılıçkesmez K. Giant left ventricular thrombus extending into the left ventricular outflow tract. Turk Kardiyol Dern Ars 2015; 43:751. [PMID: 26717343 DOI: 10.5543/tkda.2015.97832] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Kudret Keskin
- Department of Cardiology, Şişli Hamidiye Etfal Training and Research Hosptial, İstanbul, Turkey
| | - Süleyman Sezai Yıldız
- Department of Cardiology, Şişli Hamidiye Etfal Training and Research Hosptial, İstanbul, Turkey
| | - Serhat Sığırcı
- Department of Cardiology, Şişli Hamidiye Etfal Training and Research Hosptial, İstanbul, Turkey
| | - Şükrü Çetin
- Department of Cardiology, Şişli Hamidiye Etfal Training and Research Hosptial, İstanbul, Turkey
| | - Kadriye Kılıçkesmez
- Department of Cardiology, Şişli Hamidiye Etfal Training and Research Hosptial, İstanbul, Turkey
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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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45
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Keskin K, Şahin A, Yıldız SS, Aksan G. Resistant spontaneous coronary artery spasm. Turk Kardiyol Dern Ars 2015; 43:637-9. [PMID: 26536989 DOI: 10.5543/tkda.2015.67763] [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] [Indexed: 11/04/2022] Open
Abstract
Coronary artery spasm should always be suspected in patients who have myocardial infarction with normal coronary arteries. This case report presents a 33-year-old woman with anterior myocardial infarction, whose coronary angiograph revealed normal left anterior descending artery and new onset complete occlusion of the circumflex artery at the time of the procedure. Nitroglycerin up to 800 mcg was administered without success. In such resistant cases, when all efforts fail, including prompt recognition and application of vasodilator drugs, retracting the catheter and waiting may play a role.
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Affiliation(s)
- Kudret Keskin
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Alparslan Şahin
- Department of Cardiology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Süleyman Sezai Yıldız
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Gökhan Aksan
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Abstract
We present a patient who underwent endoscopic retrograde cholangiopancreatography procedure for bile duct stone removal and sphincterotomy. Upon completion of the procedure, the patient experienced severe chest pain. Because myocardial infarction was the likely diagnosis, we immediately performed a coronary angiography, which identified severe coronary lesions without any total occlusion. Being skeptical of the possible cause, we searched for alternative causes and interestingly found pneumothorax, pneumomediastinum, and retro-intra-abdominal free air. This rare complication is particularly important for a cardiologist because they should be aware of such a complication, and correlation with the symptoms and coronary lesions should always be made.
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Affiliation(s)
- Kudret Keskin
- Department of Cardiology, Bahçelievler Medicana Hospital, İstanbul, Turkey.
| | - Murat Başkurt
- Department of Cardiology, Bahçelievler Medicana Hospital, İstanbul, Turkey
| | - Faruk Aktürk
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Cenk Conkbayır
- Department of Cardiology, Near East University, Nicosia, (North) Cyprus
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Abstract
Traumatic arteriovenous fistulas (AVF) are almost exclusively the result of penetrating trauma and there is usually a history of hemorrhage. Typically, the patient demonstrates a thrill and bruit over the site of injury. We report a woman who presented with longstanding pain and swelling of the right hand due to radial AVF that possibly occurred following an injury to the right hand that happened 10 years prior to the date of admission. Since surgery was considered high risk due to multiple fistulas and previous surgery, percutaneous coil embolization was performed via the ipsilateral antegrade radial approach.
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Affiliation(s)
- Kudret Keskin
- Department of Cardiology, Türkiye Diyanet Vakfı 29 Mayıs Hospital, İstanbul, Turkey.
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Olcay A, Cakmak H, Bigmurad T, Eren F, Keskin K, Yıldız A, Canturk E, Kayhan B. OP-051 SLOW AD HOC PERCUTANEOUS CORONARY INTERVENTION STRATEGY AND CORONARY DIAMETERS. Int J Cardiol 2013. [DOI: 10.1016/s0167-5273(13)70052-4] [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: 12/01/2022]
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Aktürk I, Çaglar N, Durmuş G, Keskin K, Yalçın A, Çaglar İ, Bıyık İ, Çelik Ö, Uzun F, Ertürk M, Ozyılmaz S. OP-047 AWARENESS AND APPROACH OF TURKISH DENTISTS FOR CORONARY STENTING AND DUAL ANTIPLATELET THERAPY. Int J Cardiol 2013. [DOI: 10.1016/s0167-5273(13)70048-2] [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: 11/27/2022]
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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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