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Ates AH, Kivrak A, Karakulak UN, Coteli C, Yorgun H, Sahiner ML, Barıs Kaya E, Aytemir K. Should left atrial appendage closure be considered in resistant left atrial appendage thrombus cases? 'Former Foe, New Ally'. Pacing Clin Electrophysiol 2024; 47:583-590. [PMID: 38477017 DOI: 10.1111/pace.14969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/15/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND The study explores left atrial appendage closure (LAAC) as a safe and effective alternative to anticoagulation for atrial fibrillation (AF) patients at high bleeding risk. Complications, such as cardioembolic events due to left atrial appendage thrombus (LAAT), highlight the need for alternative stroke prevention strategies. AIMS This research assesses LAAC's safety and efficacy in patients with LAAT, aiming to offer valuable insights into its potential as a viable option for stroke prevention in such cases. METHODS The study included 205 patients who underwent LAAC using specific devices between September 2015 and February 2023. Among them, 32 patients had persistent LAAT. Baseline characteristics, antithrombotic medications, risk scores, and LAAC indications were documented. Patients were followed to monitor significant clinical events like stroke, cardiovascular mortality, and all-cause mortality. RESULTS The mean age was 71.9 and mostly female. Indications for LAAC were ischemic cerebrovascular events (CVE) despite anticoagulation (25%), bleeding complications (major/minor, 37.5% each), or both. Successful LAA closure was achieved in all cases, with minimal pericardial effusion in one. One-month follow-up showed no major events or device-related issues. Median follow-up of 16.5 months saw 21.9% non-cardiac deaths. The study underscores LAAC's efficacy for stroke prevention in patients with persistent LAAT. CONCLUSIONS The LAAC in cases of LAAT, whether pursued initially or as a deferred approach, demonstrates feasibility and safety, exhibiting notable procedural success and minimal incidence of periprocedural complications.
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Affiliation(s)
- Ahmet Hakan Ates
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Kivrak
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ugur Nadir Karakulak
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Cem Coteli
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hikmet Yorgun
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Ergun Barıs Kaya
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kudret Aytemir
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Ateş AH, Kivrak A, Şener YZ, Kilic GS, Kaya EB, Sahiner ML, Özer N, Aytemir K. Percutaneous interventions of coronary artery fistulas: a single-center experience. Postepy Kardiol Interwencyjnej 2023; 19:351-358. [PMID: 38187484 PMCID: PMC10767569 DOI: 10.5114/aic.2023.133230] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 09/27/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Coronary artery fistula (CAF) is a congenital communication between the coronary artery and other vascular structures or cardiac chambers. Percutaneous CAF closure is an emerging alternative to surgery, but long-term outcome data are limited. Aim To review our center's experience with percutaneous CAF closure methods. Material and methods Patients who were admitted to our department and underwent percutaneous coronary artery fistula intervention between January 2002 and April 2022 due to presence of CAF-related symptoms or complications were retrospectively analyzed. Data were obtained retrospectively from the hospital electronic database. Results A total of 39 patient were included. Mean age was 57.3 ±12.5 years and 23 (59%) patients were male. The most common symptom was angina (69.2%) and 51.2% of the patients were under treatment with at least one anti-anginal agent at admission. The right coronary artery (n = 19) and left anterior descending artery (n = 19) were the most common sites of CAF origin, and the pulmonary artery (n = 22) was the main drainage site. Coil embolization was performed most frequently and occlusion via cyanoacrylate in 3 patients and detachable balloon angioplasty in 1 patient were preferred. Percutaneous occlusion was achieved in 34 cases, 2 of the 5 failed cases underwent surgical occlusion, and remaining patients were treated with anti-anginal drugs. Complications occurred in 6 (15.3%) patients and all of the patients recovered without sequelae. Conclusions Coronary artery fistulas may present with different symptoms or complications and there are several techniques for percutaneous occlusion. Percutaneous closure of CAF is feasible and safe in anatomically suitable vessels, with good results at follow-up.
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Affiliation(s)
- Ahmet Hakan Ateş
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Kivrak
- Department of Cardiology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Yusuf Ziya Şener
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gul Sinem Kilic
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ergun Baris Kaya
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Necla Özer
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kudret Aytemir
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Ates AH, Kivrak A, Zekeriyeyev S, Menemencioglu C, Coteli C, Ozer N, Sahiner ML, Kaya EB. Unlocking Promising Therapies: Drug-Eluting Stents in Medically Refractory Angina Patients With Myocardial Bridging. Am J Cardiol 2023; 208:72-74. [PMID: 37820549 DOI: 10.1016/j.amjcard.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/03/2023] [Accepted: 09/06/2023] [Indexed: 10/13/2023]
Abstract
Myocardial bridging (MB) is a congenital variation in which a coronary artery segment tunnels through the myocardium instead of following its usual epicardial route. Although MB is usually diagnosed incidentally and has a good long-term prognosis, it can lead to complications such as angina, myocardial infarction, arrhythmias, and sudden death. This study aimed to evaluate the outcomes of drug-eluting stent (DES) implantation in patients with MB and medically refractory angina. The study included 12 patients with significant MB who did not respond to maximal medical therapy and underwent DES implantation. The patients were followed up for a mean duration of 33 months. The procedural success rate was 92%, with only 1 patient experiencing acute coronary artery rupture during the procedure. During the follow-up period, none of the patients reported angina symptoms, required additional percutaneous coronary intervention, or developed stent thrombosis. One patient (8.3%) died from a non-cardiac cause. The procedure demonstrates a high procedural success rate and leads to favorable long-term outcomes, including the absence of angina symptoms and the avoidance of stent-related complications. In conclusion, this study suggests that DES implantation can serve as an effective treatment option for selected patients with medically refractory angina and significant MB.
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Affiliation(s)
- Ahmet Hakan Ates
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Kivrak
- Department of Cardiology, Ankara Etlik City Hospital, Ankara, Turkey.
| | - Samuray Zekeriyeyev
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Can Menemencioglu
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Cem Coteli
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Necla Ozer
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Ergun Barıs Kaya
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Kivrak A, Yildirim A, Horoz L, Beltir G. The Relationship Between Echocardiographic Calcification Score and Grade of Knee Osteoarthritis. Cureus 2023; 15:e48869. [PMID: 38024092 PMCID: PMC10652027 DOI: 10.7759/cureus.48869] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 12/01/2023] Open
Abstract
Background and objective It has been suggested that knee osteoarthritis (KOA) is associated with the development of calcification and an increased risk of cardiovascular (CV) disease, while the contribution of KOA grade is not clearly known enough. This study aimed to investigate the relationship between the grade of KOA, the echocardiographic calcification score (echo-CCS), and CV risk assessment. Methods This cross-sectional study involved 204 patients diagnosed with KOA and classified according to the Kellgren-Lawrence staging criteria. Echo-CCS was obtained according to the presence of calcification in the aortic valve, aortic root, mitral ring, papillary muscle and ventricular septum. Framingham risk score (FRS) was used for CV risk assessment. Results Calcification was detected in 79.4% of patients. The median FRS, echo-CCS, and high-sensitivity C-reactive protein (hs-CRP) levels increased as the KOA grade increased (p<0.05). A one-grade increase in KOA increased the odds of echo-CCS 1-2 group by 5.15 fold (vs. no calcification group) (OR=5.15, p=0.003), while it increased the odds of echo-CCS ≥3 group by 4.61 fold (vs. echo-CCS 1-2 group) (OR=4.61, p=0.003). Median echo-CSS and hs-CRP were higher in the high CV risk group than in the moderate and low CV risk groups. Conclusion The majority of patients with KOA had intracardiac calcification. An increased KOA grade was associated with higher echo-CSS and FRS. These findings indicate that patients with higher grades of KOA may be predisposed to developing subclinical atherosclerosis.
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Affiliation(s)
- Ahmet Kivrak
- Cardiology, Ankara Etlik City Hospital, Ankara, TUR
| | - Alp Yildirim
- Cardiology, Kirsehir Training and Research Hospital, Kirsehir, TUR
| | - Levent Horoz
- Orthopaedics and Traumatology, Kirsehir Training and Research Hospital, Kirsehir, TUR
| | - Galip Beltir
- Orthopaedics and Traumatology, Kirsehir Training and Research Hospital, Kirsehir, TUR
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Kivrak A, Yildirim A. Relationship between systemic inflammation indices and time of symptom onset in cardiac remodeling after first ST-segment elevation myocardial infarction. Kardiol Pol 2023; 81:886-894. [PMID: 37401575 DOI: 10.33963/kp.a2023.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 06/24/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Circadian variations play a pivotal role in both leukocyte trafficking and inflammatory response. This may affect the course of cardiac healing after myocardial infarction (MI). AIMS The present study investigated the relationship between the systemic immune inflammation (SII) index and the systemic inflammation response index (SIRI), two new inflammation indices integrating white blood cell subsets and platelets, and the time of onset of symptoms in left ventricular adverse remodeling (LVAR) after ST-segment elevation MI (STEMI). METHODS In this retrospective study, we included 512 patients with first-time STEMI. The time of onset of symptoms was divided into 4 intervals: 06:00-11:59, 12:00-17:59, 18:00-23:59, and 00:00-05:59. The endpoint was LVAR, defined as an increase in left ventricular end-diastolic and end-systolic volume by ≥12% at 6 months. RESULTS The time of onset of chest pain most often occurred between 06:00 and 11:59 AM. In this window of time, median SII and SIRI indices were higher than in other time intervals. An increased SIRI level (odds ratio [OR], 3.03; P <0.001), symptom onset in the morning hours (OR, 2.92; P = 0.03), and an increased Global Registry of Acute Coronary Events (GRACE) score (OR, 1.16; P <0.001) were determined as independent predictors of LVAR. The threshold value of the SIRI to discriminate between patients with and without LVAR was >2.5 (area under the curve [AUC], 0.84; P <0.001). The SIRI showed superior diagnostic performance compared to the SII index. CONCLUSIONS In STEMI patients, an increased SIRI was independently associated with LVAR. This was more pronounced between 06:00 and11:59 AM. Despite differences across circadian periods, the SIRI may be a potential screening tool for identifying LVAR patients at long-term risk of heart failure.
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Affiliation(s)
- Ahmet Kivrak
- Department of Cardiology, Ankara Etlik City Hospital, Ankara, Turkey.
| | - Alp Yildirim
- Department of Cardiology, Kirsehir Training and Research Hospital, Kirsehir, Turkey
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Kivrak A, Yildirim A. Predictive Performance of Triglyceride-Glucose Index on Asymptomatic Multiple Organ Damage in Patients with Newly Diagnosed Hypertension. Rev Invest Clin 2023; 75:221-232. [PMID: 37918012 DOI: 10.24875/ric.23000113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/31/2023] [Indexed: 11/04/2023]
Abstract
Background Insulin resistance (IR) contributes to the development of hypertension and mediated organ damage (HMOD) through various mechanisms. Objectives The objective of the study was to assess the diagnostic performance of the triglyceride-glucose (TyG) index, a surrogate marker of IR, in predicting the presence and severity of HMOD in newly diagnosed untreated hypertensive patients from an academic training and research hospital Methods The study included 438 patients with newly diagnosed, untreated hypertension. The control group comprised normotensive individuals matched on a 1:1 ratio based on age, gender, body mass index, and smoking using the nearest neighbor method. The presence of HMOD was defined by renal damage (microalbuminuria > 30 mg/day or proteinuria > 150 mg/day), vascular damage (carotid intima-media thickness > 0.9 mm or presence of plaque), or cardiac damage (left ventricular mass index > 95 g/m2 in women and > 115 g/m2 in men). The severity of HMOD was considered as single-, two-, or triple-organ damage. Results TyG index values were higher in the hypertensive group than the normotensive group. An increased TyG index was independently associated with HMOD (OR: 1.33, p < 0.001). The TyG index exhibited gradually increasing threshold values for distinguishing patients with single-organ HMOD (> 8.8 with 77.8% sensitivity and 74.3% specificity), two-organ HMOD (> 9.1 with 77.6% sensitivity and 71.4% specificity), and triple-organ HMOD (> 9.4 with 71.5% sensitivity and 87.7% specificity). Conclusions In newly diagnosed hypertensive patients, the TyG index exhibits significant diagnostic performance in predicting multiple-organ damage beyond the presence of HMOD. Since the detection of multiple-organ HMOD requires a multidisciplinary approach, the TyG index can serve as a simple and inexpensive screening tool.
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Affiliation(s)
- Ahmet Kivrak
- Department of Cardiology, Dışkapı Yıldırım Beyazit Training and Research Hospital, Ankara, Turkey
| | - Alp Yildirim
- Department of Cardiology, Kirsehir Training and Research Hospital, Kirsehir, Turkey
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Kavak E, Algso M, Konus M, Yılmaz C, Lazoğlu A, Karaağaç SU, Kivrak A. Synthesis, Optimization, ADME Analysis, and Antioxidant Activity
of 2-(Arylethynyl)-3-ethynylthiophenes. Russ J Org Chem 2021. [DOI: 10.1134/s1070428021010139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Cengiz O, Kivrak A, Yegen M, Demir M. Sevoflurane induced diffuse alveolar haemorrhage in a young patient after orthopedic surgery: A case report. Niger J Clin Pract 2020; 23:120-122. [PMID: 31929218 DOI: 10.4103/njcp.njcp_51_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We present a very rare case of Sevoflurane Induced Diffuse Alveolar Haemorrhage in a young male patient with a closed tibial fracture after direct trauma to the right cruris. The patient was operated for tibial fracture, but diffuse alveolar haemorrhage developed after sevoflurane inhalation in the postoperative period following general anesthesia. Diffuse alveolar haemorrhage (DAH) is associated with inhalation injury from halogenated gases and reported as a unique entity in the literature that practicing clinicians should be aware of and consider in post-operative cases of acute respiratory distress. As DAH usually presents with symptoms the presence of hemoptysis, anemia, dyspnoea and radiological alveolar infiltrates, rapid detection of the aetiology and initiation of cause-directed treatment are of great importance on survival.
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Affiliation(s)
- O Cengiz
- Kartal Dr. Lütfi Kırdar Training and Research Hospital, Orthopedics and Traumatology Clinic, İstanbul, Turkey
| | - A Kivrak
- Orthopedics and Traumatology Clinic, Muş State Hospital, Muş, Turkey
| | - M Yegen
- Anesthesiology and Reanimation Clinic, Muş State Hospital, Muş, Turkey
| | - M Demir
- Department of Chest Diseases, Dicle University, Faculty of Medicine, Diyarbakır, Turkey
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Ozer HT, Ozer O, Coteli C, Kivrak A, Sahiner ML, Ozer N. P14893D strain echocardiography in assessing left ventricular diastolic dysfunction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0254] [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
Diastolic dysfunction is an important factor in the development of heart failure with preserved ejection fraction (HFpEF). As the ejection fraction is preserved in HFpEF, the diagnosis of this disease with non-invasive methods is difficult.
Purpose
In this study, the relationship of BNP, NT-proBNP, Ghrelin, and echocardiographic 3D strain findings with diastolic dysfunction was investigated in patients undergoing left heart catheterization.
Methods
Our study is a cross-sectional study and included 78 patients in whom echocardiography was performed, and who underwent left heart catheterization based on relevant indications. The patient data recorded for evaluation included the findings from left heart catheterization, follow-up 3D echocardiography; and the levels of blood NT-proBNP, and Ghrelin.
Results
The rate of diastolic dysfunction was 42.3%. Longitudinal 2D and 3D mean strain as absolute values were observed to decrease more in patients with diastolic dysfunction. The median levels of BNP, NT-proBNP, and Ghrelin levels were higher in patients with diastolic dysfunction. The independent predictors of diastolic dysfunction were determined to be the left atrial volume index (LAVI) (OR=1.17; p=0.018), longitudinal 3D strain values (OR=1.88; p<0.001), NT-proBNP (OR=1.11; p=0.001), and Ghrelin (OR=1.40; p=0.001), respectively.
Relationship Between LV EDP and LV Longitudinal Strain LV EDP 2D Strain 3D Strain r p r p r p BNP, pg/ml 0.429 <0.001* 0.115 0.316 0.178 0.118 NT-proBNP, pg/ml 0.484 <0.001* 0.155 0.177 0.186 0.104 Ghrelin, pg/ml 0.478 <0.001* 0.086 0.455 0.157 0.169 SolV DB – – 0.481 <0.001* 0.591 <0.001* dP/dT −0.389 <0.001* −0.283 0.012* −0.307 0.006* Negative dP/dT −0.747 <0.001* −0.337 0.003* −0.458 <0.001* 2D. % 0.481 <0.001* – – 0.852 <0.001* 3D. % 0.591 <0.001* 0.852 <0.001* – – If p value is less than 0.05 shows statistical significance.
Measurement of longitudinal strain
Conclusion
In conclusion, our study found out that the reduced 3D strain absolute values and increased levels of NT-proBNP and Ghrelin biomarkers predicted diastolic dysfunction. If further large-scale studies prove the efficiency of these practical, they may not only allow for making a diagnosis of HFpEF more readily but may also eliminate the confusion in diagnostic algorithms.
Acknowledgement/Funding
None
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Affiliation(s)
- H T Ozer
- Hacettepe University, Cardiology, Ankara, Turkey
| | - O Ozer
- Hacettepe University, Cardiology, Ankara, Turkey
| | - C Coteli
- Hacettepe University, Cardiology, Ankara, Turkey
| | - A Kivrak
- Hacettepe University, Cardiology, Ankara, Turkey
| | - M L Sahiner
- Hacettepe University, Cardiology, Ankara, Turkey
| | - N Ozer
- Hacettepe University, Cardiology, Ankara, Turkey
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Affiliation(s)
- Uğur Canpolat
- 1 Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Cem Çöteli
- 1 Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Kivrak
- 1 Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Elbasan Z, Gur M, Sahin DY, Kirim S, Akyol S, Kuloglu O, Koyunsever NY, Seker T, Kivrak A, Cayli M. N-terminal pro-brain natriuretic peptide levels and abnormal left ventricle geometric patterns in untreated hypertensive patients. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sahin DY, Gur M, Elbasan Z, Kalkan GY, Kivrak A, Gozubuyuk G, Kuloglu O, Sumbul Z, Cayli M. Myocardial performance index and aortic distensibility in patients with different left ventricle geometry in newly diagnosed essential hypertension. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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