Journal of Cardiovascular Magnetic Resonance, 2015
Previous work indicates that dilatation of the pulmonary artery (PA) itself or in relation to the... more Previous work indicates that dilatation of the pulmonary artery (PA) itself or in relation to the ascending aorta (PA:Ao ratio) predicts pulmonary hypertension (PH). Whether these results also apply for heart failure with preserved ejection fraction (HFpEF) is unknown. In the present study we evaluated the diagnostic and prognostic power of PA diameter and PA:Ao ratio on top of right ventricular (RV) size, function, and septomarginal trabeculation (SMT) thickness by cardiovascular magnetic resonance (CMR) in HFpEF. 159 consecutive HFpEF patients were prospectively enrolled. Of these, 111 underwent CMR and invasive hemodynamic evaluation. By invasive assessment 64 % of patients suffered from moderate/severe PH (mean pulmonary artery pressure (mPAP) ≥30 mmHg). Significant differences between groups with and without moderate/severe PH were observed with respect to PA diameter (30.9 ± 5.1 mm versus 26 ± 5.1 mm, p < 0.001), PA:Ao ratio (0.93 ± 0.16 versus 0.78 ± 0.14, p < 0.001), and SMT diameter (4.6 ± 1.5 mm versus 3.8 ± 1.2 mm; p = 0.008). The strongest correlation with mPAP was found for PA:Ao ratio (r = 0.421, p < 0.001). By ROC analysis the best cut-off for the detection of moderate/severe PH was found for a PA:Ao ratio of 0.83. Patients were followed for 22.0 ± 14.9 months. By Kaplan Meier analysis event-free survival was significantly worse in patients with a PA:Ao ratio ≥0.83 (log rank, p = 0.004). By multivariable Cox-regression analysis PA:Ao ratio was independently associated with event-free survival (p = 0.003). PA:Ao ratio is an easily measureable noninvasive indicator for the presence and severity of PH in HFpEF, and it is related with outcome.
Subclinical hypothyroidism (SH) is considered to be a potential risk factor for cardiovascular di... more Subclinical hypothyroidism (SH) is considered to be a potential risk factor for cardiovascular disease. Epicardial adipose tissue (EAT) thickness is also closely related to cardiovascular disorders. The aim of this study was to evaluate whether SH is associated with higher EAT thickness. Fifty-one consecutive patients with SH and 51 healthy control subjects were prospectively enrolled into this trial. Thyroid hormone levels, lipid parameters, body mass index, waist and neck circumference, and EAT thickness measured by echocardiography were recorded in all subjects. Mean EAT thickness was increased in the SH group compared to the control group (6.7±1.4 mm vs. 4.7±1.2 mm, p<0.001). EAT thickness was shown to be correlated with thyroid stimulating hormone level (r=0.303, p=0.002). Multivariate logistic regression analysis revealed that EAT thickness was independently associated with SH {odds ratio (OR): 3.87, 95% confidence interval (CI): 1.92-7.78, p<0.001; OR: 3.80, 95% CI: 2.1...
Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology, 2014
We report a 68-year-old man who presented with heart failure and atrial fibrillation (AF) with ra... more We report a 68-year-old man who presented with heart failure and atrial fibrillation (AF) with rapid ventricular response and wide QRS complexes. Tachycardia-induced cardiomyopathy (TIC) due to persistent AF developing on the basis of Wolff-Parkinson-White (WPW) syndrome was considered. Signs and symptoms of heart failure improved with restoration of sinus rhythm. This case suggested that persistent AF in a patient with WPW syndrome is one of the rare causes of TIC.
Management of aortic regurgitation depends on the assessment for severity. Echocardiography remai... more Management of aortic regurgitation depends on the assessment for severity. Echocardiography remains as the most widely available tool for evaluation of aortic regurgitation. In this manuscript, we describe a novel parameter, jet length/velocity ratio, for the diagnosis of severe aortic regurgitation. A total of 30 patients with aortic regurgitation were included to this study. Severity of aortic regurgitation was assessed with an aortic regurgitation index incorporating five echocardiographic parameters. Jet length/velocity ratio is calculated as the ratio of maximum jet penetrance to mean velocity of regurgitant flow. Jet length/velocity ratio was significantly higher in patients with severe aortic regurgitation (2.03 ± 0.53) compared to patients with less than severe aortic regurgitation (1.24 ± 0.32, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Correlation of jet length/velocity ratio with aortic regurgitation index was very good (r(2) = 0.86) and correlation coefficient was higher for jet length/velocity ratio compared to vena contracta, jet width/LVOT ratio and pressure half time. For a cutoff value of 1.61, jet length/velocity ratio had a sensitivity of 92% and specificity of 88%, with an AUC value of 0.955. Jet length/velocity ratio is a novel parameter that can be used to assess severity of chronic aortic regurgitation. Main limitation for usage of this novel parameter is jet impringement to left ventricular wall.
Pulmonary hypertension is caused by a heterogenous group of disorders with diverse pathophysiolog... more Pulmonary hypertension is caused by a heterogenous group of disorders with diverse pathophysiological mechanisms, with ultimate structural changes in the pulmonary vascular bed. Platelet activation plays an important role in the development of pulmonary arterial hypertension, while it is unknown whether it contributes to pathogenesis in other conditions. We aimed to investigate platelet activation in different causes of pulmonary hypertension by means of mean platelet volume measurement. A total of 67 patients with different causes of pulmonary hypertension, and 31 controls, were retrospectively reviewed. Patients with pulmonary hypertension were further grouped according to underlying disease, including pulmonary arterial hypertension, pulmonary hypertension due to left ventricular failure, and pulmonary hypertension due to chronic obstructive pulmonary disorder. All patients and controls past medical data, admission echocardiograms and complete blood counts were reviewed. Patients with pulmonary hypertension had higher mean platelet volume levels compared to healthy controls (8.77 ± 1.18 vs 7.89 ± 0.53; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), and statistical significance was still present when pulmonary arterial hypertension patients were not included in the pulmonary hypertension group (8.59 ± 1.23 vs 7.89 ± 0.53; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Among patients with pulmonary hypertension, the pulmonary arterial hypertension group and the pulmonary hypertension due to left ventricular failure group had higher mean platelet volumes compared to healthy controls. Mean platelet volume did not correlate with pulmonary artery pressure. Our results indicate that mean platelet volume is not only elevated in pulmonary arterial hypertension, but also due to other causes of pulmonary hypertension.
Journal of the American College of Cardiology, 2013
Aıms: Our trial is goal is to investigate the effect of epicardial fat thickness which is calcula... more Aıms: Our trial is goal is to investigate the effect of epicardial fat thickness which is calculated with transthoracic echocardiography on reperfusion and prognosis in st segment elevated myocardial infarction patients who underwent primary percutenaous intervention. Design-METHOD: 144 patients who admitted with st segment elevated myocardial infarction to Ankara Numune Education and Research Hospital, Department of Cardiology Clinic and underwent primary percutenaous intervention afterwards were included in this trial.Epicardial fat thickness was calculated on the parasternal long axis view with the anatomic reference of aortic annulus from right ventricle free wall.Addiotionally these patients were followed about major adverse cardiac events for six months.Anjiographically reperfusion success was evaluated with three different methods which includes TIMI(thrombolysis in myocardial infarction)TIMI frame count(TFC) and myocardial blush grade(MBG). Results: 41 female and 103 male patients were included in this trial.In the group of TIMI flow 0-1-2 epicardial fat thickness was significantly higher than the TIMI flow 3 group. (0,89 [0,3-1,4] and 0,73 [0,33-1,2] p¼<0,001). Also in the group of MBG 0-1 epicardial fat thickness was higher than the MBG 2-3 group patients. (0,87 [0,3-1,4] and 0,72 [0,33-1,2] p¼<0,001). And between the two groups six month mortality was higher in patients with bigger epicardial fat thickness values (p¼0,01). Conclusıon: Increase in epicardial fat thickness in patients with STEMI who underwent primary percutenaous intervention was related with failure of reperfusion and increased mortality.
Conventional noninvasive methods have well-known limitations for the detection of coronary artery... more Conventional noninvasive methods have well-known limitations for the detection of coronary artery disease (CAD) in patients with left bundle branch block (LBBB). However, advancements in Doppler echocardiography permit transthoracic imaging of coronary flow velocities (CFV) and measurement of coronary flow reserve (CFR). Our aim was to evaluate the diagnostic value of transthoracic CFR measurements for detection of significant left anterior descending (LAD) stenosis in patients with LBBB and compare it to that of myocardial perfusion scintigraphy (MPS). Simultaneous transthoracic CFR measurements and MPS were analyzed in 44 consecutive patients with suspected CAD and permanent LBBB. Typical diastolic predominant phasic CFV Doppler spectra of distal LAD were obtained at rest and during a two-step (0.56-0.84 mg/kg) dipyridamole infusion protocol. CFR was defined as the ratio of peak hyperemic velocities to the baseline values. A reversible perfusion defect at LAD territory was accepted as a positive scintigraphy finding for significant LAD stenosis. A coronary angiography was performed within 5 days of the CFR studies. The hyperemic diastolic peak velocity (44 +/- 9 cm/sec vs 62 +/- 2 cm/sec; P=0.01) and diastolic CFR (1.38 +/- 0.17 vs 1.93 +/- 0.3; P=0.001) were significantly lower in patients with LAD stenosis compared to those without LAD stenosis. The diastolic CFR values of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1.6 yielded a sensitivity of 100% and a specificity of 94% in the identification of significant LAD stenosis. In comparison, MPS detected LAD stenosis with a sensitivity of 100% and a specificity of 29%. CFR measurement by transthoracic Doppler echocardiography is an accurate method that may improve noninvasive identification of LAD stenosis in patients with LBBB.
To determine the subclinical effects of isolated obesity and its duration on cardiac function by ... more To determine the subclinical effects of isolated obesity and its duration on cardiac function by using routine echocardiography and tissue Doppler myocardial strain rate. Forty-nine subjects were enrolled in this study; 29 with isolated obesity defined as a body mass index &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 30 kg/m(2) with no other cardiovascular comorbidities, and 20 nonobese controls. All subjects underwent two-dimensional and Doppler echocardiography including tissue Doppler imaging and myocardial strain rate. The average duration of obesity was 12.1 years (4-18 years). Abnormalities of left ventricular (LV) wall thickness, mass, diastolic function, and left atrial size were detected in obese individuals, despite having preserved ejection fractions. The LV global longitudinal peak strain rate was significantly lower in obese subjects compared to nonobese control subjects (1.07 +/- 0.14 vs. 1.38 +/- 0.12, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Using multivariate analysis, the duration of obesity (ss=-0.76, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), body mass index (ss=-0.35, P = 0.023), and age (ss=-0.29, P = 0.009) were independent predictors of the decreased LV global longitudinal peak strain rate, while the duration of obesity (ss=-0.66, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and body mass index (ss=-0.28, P = 0.037) were independent predictors of the decreased right ventricular (RV) peak strain rate. The presence and the duration of obesity were associated with impairment of subclinical biventricular systolic and diastolic function. These findings have the potential to increase awareness of subclinical cardiac manifestations in patients with isolated obesity and influence their early management.
Alcohol-induced septal ablation (AISA) is an accepted treatment for hypertrophic cardiomyopathy (... more Alcohol-induced septal ablation (AISA) is an accepted treatment for hypertrophic cardiomyopathy (HCM) patients with left ventricular (LV) outflow obstruction who are unresponsive to medical therapy. As left atrial (LA) enlargement has been correlated with increased morbidity and mortality in HCM, we assessed LA volumes and ejection fraction (EF) prior to and after AISA using real time three-dimensional (3D) transthoracic echocardiography (TTE) in 12 patients (9 women; mean age 52 +/- 15 years; 11 Caucasian). All patients underwent successful AISA with no complications and their resting left ventricular outflow gradients decreased from 40.5 +/- 22.2 to 9.1 +/- 17.6 mmHg (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) while their gradients with provocation decreased from 126.2 +/- 31.7 to 21.8 +/- 28.0 mmHg (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). All patients showed improvements in their New York Heart Association (NYHA) functional class. Both the LA end-systolic (45.2 +/- 12.9 to 37.2 +/- 13.7 ml, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001) and end-diastolic (79.6 +/- 18.9 to 77.1 +/- 18.6 ml, P = 0.001) volumes decreased after AISA. The LA EF increased from 43.1 +/- 9.0 to 52.5 +/- 8.8% (P = 0.001). The increase in LA EF correlated with the decrease in the resting left ventricular outflow gradient (R =-0.647, P = 0.03). In conclusion, 3D echocardiography can be utilized to follow LA function after AISA for HCM. AISA results in clinical improvement in patients with HCM and in improvement of LA EF that is correlated with the decrease in the left ventricular outflow gradient.
A 50-year-old male patient with dilated cardiomyopathy was evaluated for cardiac resynchronizatio... more A 50-year-old male patient with dilated cardiomyopathy was evaluated for cardiac resynchronization therapy. A transthoracic echocardiogram revealed a mass in close proximity to the coronary sinus ostium.The mass was considered to be a thrombus and found to have disappeared at the repeat echocardiogram performed following a month of anticoagulation therapy with warfarin. In this case report, we aim to emphasize the importance of coronary sinus imaging, especially during echocardiographic evaluation for cardiac asynchrony.
2011 DEDICATION I dedicate this thesis to my loved parents, sisters and wife for their love and e... more 2011 DEDICATION I dedicate this thesis to my loved parents, sisters and wife for their love and encouragement. My parents' integrity, humility, love, and compassion. I am eternally grateful for their constant encouragement and for setting the right example in my life. My father; who taught me that the best kind of knowledge to have is that is learned for its own sake. I dream of being like him for my son. My mother, who taught me that even the largest task can be accomplished if it is done one step at a time. My sisters, for their constant love, support and inspiration. And i dedicate this thesis to my hope, my present and future life: My wife; for her unconditional love and enthusiastic spirit and for standing beside me. Thank you for being a pillar of support in my life. Without you all this would have been an impossible task.
Journal of the American College of Cardiology, 2013
Background: Contrast-induced acute kidney injury (CI-AKI) is a serious complication associated wi... more Background: Contrast-induced acute kidney injury (CI-AKI) is a serious complication associated with the use of iodinated contrast medium (CM). Intravascular volume expansion by intravenous (I.V.) route is the only protective approach with proven efficacy in preventing CI-AKI. However, efficacy of oral volume expansion, or oral hydration, which shortens the duration of hospitalization, is less expensive and increases patient comfort, has not been well established. The objective of this study was to evaluate the efficacy of oral hydration in the prevention of CI-AKI Methods: We prospectively randomized 225 patients undergoing coronary angiography and/or percutaneous coronary intervention with a non-ionic, low-osmolality contrast media in two different volume expansion strategies, oral hydration vs. I.V. hydration. Patients at high risk of developing CI-AKI [age !70 years old, diabetes mellitus, anemia, hyperuricemia, a history of cardiac failure or systolic dysfunction (ejection fraction <%40)] were included in the study. All patients had an estimated glomerular filtration rate of !60 mL/min/1.73 m2 [ i.e., normal renal function or stages 1 and 2 chronic kidney disease (CKD)]. Patients in the oral hydration group, except for those with cardiac failure, were recommended to consume fluids freely whereas isotonic saline (0.9%) was administered intravenously at a rate of 1 mL/kg/h for 12 hours before and 12 hours after the administration of CM in the I.V. hydration group. The primary outcome was the occurrence of CI-AKI which was defined as !25% increase in serum creatinine from the baseline at 48 hours in the absence of an alternative etiology. Results: CI-AKI occurred in 8/116 patients (6.9%) in the oral group and 8/109 patients (7.3%) in the I.V. group (p¼0.89) ( and 2). When different CI-AKI definitions were taken into account, there was also no statistically significant difference between the two groups despite a high variability in the incidence of CI-AKI. Conclusıon: Oral hydration is as effective as I.V. hydration in the prevention of CI-AKI in patients with normal kidney function or with stages 1 and 2 CKD and who have also one of the other high risk factors such as advanced age, diabetes mellitus, anemia, hyperuricemia, a history of heart failure or systolic dysfunction.
Journal of Cardiovascular Magnetic Resonance, 2015
Previous work indicates that dilatation of the pulmonary artery (PA) itself or in relation to the... more Previous work indicates that dilatation of the pulmonary artery (PA) itself or in relation to the ascending aorta (PA:Ao ratio) predicts pulmonary hypertension (PH). Whether these results also apply for heart failure with preserved ejection fraction (HFpEF) is unknown. In the present study we evaluated the diagnostic and prognostic power of PA diameter and PA:Ao ratio on top of right ventricular (RV) size, function, and septomarginal trabeculation (SMT) thickness by cardiovascular magnetic resonance (CMR) in HFpEF. 159 consecutive HFpEF patients were prospectively enrolled. Of these, 111 underwent CMR and invasive hemodynamic evaluation. By invasive assessment 64 % of patients suffered from moderate/severe PH (mean pulmonary artery pressure (mPAP) ≥30 mmHg). Significant differences between groups with and without moderate/severe PH were observed with respect to PA diameter (30.9 ± 5.1 mm versus 26 ± 5.1 mm, p &amp;amp;amp;amp;lt; 0.001), PA:Ao ratio (0.93 ± 0.16 versus 0.78 ± 0.14, p &amp;amp;amp;amp;lt; 0.001), and SMT diameter (4.6 ± 1.5 mm versus 3.8 ± 1.2 mm; p = 0.008). The strongest correlation with mPAP was found for PA:Ao ratio (r = 0.421, p &amp;amp;amp;amp;lt; 0.001). By ROC analysis the best cut-off for the detection of moderate/severe PH was found for a PA:Ao ratio of 0.83. Patients were followed for 22.0 ± 14.9 months. By Kaplan Meier analysis event-free survival was significantly worse in patients with a PA:Ao ratio ≥0.83 (log rank, p = 0.004). By multivariable Cox-regression analysis PA:Ao ratio was independently associated with event-free survival (p = 0.003). PA:Ao ratio is an easily measureable noninvasive indicator for the presence and severity of PH in HFpEF, and it is related with outcome.
Subclinical hypothyroidism (SH) is considered to be a potential risk factor for cardiovascular di... more Subclinical hypothyroidism (SH) is considered to be a potential risk factor for cardiovascular disease. Epicardial adipose tissue (EAT) thickness is also closely related to cardiovascular disorders. The aim of this study was to evaluate whether SH is associated with higher EAT thickness. Fifty-one consecutive patients with SH and 51 healthy control subjects were prospectively enrolled into this trial. Thyroid hormone levels, lipid parameters, body mass index, waist and neck circumference, and EAT thickness measured by echocardiography were recorded in all subjects. Mean EAT thickness was increased in the SH group compared to the control group (6.7±1.4 mm vs. 4.7±1.2 mm, p<0.001). EAT thickness was shown to be correlated with thyroid stimulating hormone level (r=0.303, p=0.002). Multivariate logistic regression analysis revealed that EAT thickness was independently associated with SH {odds ratio (OR): 3.87, 95% confidence interval (CI): 1.92-7.78, p<0.001; OR: 3.80, 95% CI: 2.1...
Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology, 2014
We report a 68-year-old man who presented with heart failure and atrial fibrillation (AF) with ra... more We report a 68-year-old man who presented with heart failure and atrial fibrillation (AF) with rapid ventricular response and wide QRS complexes. Tachycardia-induced cardiomyopathy (TIC) due to persistent AF developing on the basis of Wolff-Parkinson-White (WPW) syndrome was considered. Signs and symptoms of heart failure improved with restoration of sinus rhythm. This case suggested that persistent AF in a patient with WPW syndrome is one of the rare causes of TIC.
Management of aortic regurgitation depends on the assessment for severity. Echocardiography remai... more Management of aortic regurgitation depends on the assessment for severity. Echocardiography remains as the most widely available tool for evaluation of aortic regurgitation. In this manuscript, we describe a novel parameter, jet length/velocity ratio, for the diagnosis of severe aortic regurgitation. A total of 30 patients with aortic regurgitation were included to this study. Severity of aortic regurgitation was assessed with an aortic regurgitation index incorporating five echocardiographic parameters. Jet length/velocity ratio is calculated as the ratio of maximum jet penetrance to mean velocity of regurgitant flow. Jet length/velocity ratio was significantly higher in patients with severe aortic regurgitation (2.03 ± 0.53) compared to patients with less than severe aortic regurgitation (1.24 ± 0.32, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Correlation of jet length/velocity ratio with aortic regurgitation index was very good (r(2) = 0.86) and correlation coefficient was higher for jet length/velocity ratio compared to vena contracta, jet width/LVOT ratio and pressure half time. For a cutoff value of 1.61, jet length/velocity ratio had a sensitivity of 92% and specificity of 88%, with an AUC value of 0.955. Jet length/velocity ratio is a novel parameter that can be used to assess severity of chronic aortic regurgitation. Main limitation for usage of this novel parameter is jet impringement to left ventricular wall.
Pulmonary hypertension is caused by a heterogenous group of disorders with diverse pathophysiolog... more Pulmonary hypertension is caused by a heterogenous group of disorders with diverse pathophysiological mechanisms, with ultimate structural changes in the pulmonary vascular bed. Platelet activation plays an important role in the development of pulmonary arterial hypertension, while it is unknown whether it contributes to pathogenesis in other conditions. We aimed to investigate platelet activation in different causes of pulmonary hypertension by means of mean platelet volume measurement. A total of 67 patients with different causes of pulmonary hypertension, and 31 controls, were retrospectively reviewed. Patients with pulmonary hypertension were further grouped according to underlying disease, including pulmonary arterial hypertension, pulmonary hypertension due to left ventricular failure, and pulmonary hypertension due to chronic obstructive pulmonary disorder. All patients and controls past medical data, admission echocardiograms and complete blood counts were reviewed. Patients with pulmonary hypertension had higher mean platelet volume levels compared to healthy controls (8.77 ± 1.18 vs 7.89 ± 0.53; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), and statistical significance was still present when pulmonary arterial hypertension patients were not included in the pulmonary hypertension group (8.59 ± 1.23 vs 7.89 ± 0.53; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Among patients with pulmonary hypertension, the pulmonary arterial hypertension group and the pulmonary hypertension due to left ventricular failure group had higher mean platelet volumes compared to healthy controls. Mean platelet volume did not correlate with pulmonary artery pressure. Our results indicate that mean platelet volume is not only elevated in pulmonary arterial hypertension, but also due to other causes of pulmonary hypertension.
Journal of the American College of Cardiology, 2013
Aıms: Our trial is goal is to investigate the effect of epicardial fat thickness which is calcula... more Aıms: Our trial is goal is to investigate the effect of epicardial fat thickness which is calculated with transthoracic echocardiography on reperfusion and prognosis in st segment elevated myocardial infarction patients who underwent primary percutenaous intervention. Design-METHOD: 144 patients who admitted with st segment elevated myocardial infarction to Ankara Numune Education and Research Hospital, Department of Cardiology Clinic and underwent primary percutenaous intervention afterwards were included in this trial.Epicardial fat thickness was calculated on the parasternal long axis view with the anatomic reference of aortic annulus from right ventricle free wall.Addiotionally these patients were followed about major adverse cardiac events for six months.Anjiographically reperfusion success was evaluated with three different methods which includes TIMI(thrombolysis in myocardial infarction)TIMI frame count(TFC) and myocardial blush grade(MBG). Results: 41 female and 103 male patients were included in this trial.In the group of TIMI flow 0-1-2 epicardial fat thickness was significantly higher than the TIMI flow 3 group. (0,89 [0,3-1,4] and 0,73 [0,33-1,2] p¼<0,001). Also in the group of MBG 0-1 epicardial fat thickness was higher than the MBG 2-3 group patients. (0,87 [0,3-1,4] and 0,72 [0,33-1,2] p¼<0,001). And between the two groups six month mortality was higher in patients with bigger epicardial fat thickness values (p¼0,01). Conclusıon: Increase in epicardial fat thickness in patients with STEMI who underwent primary percutenaous intervention was related with failure of reperfusion and increased mortality.
Conventional noninvasive methods have well-known limitations for the detection of coronary artery... more Conventional noninvasive methods have well-known limitations for the detection of coronary artery disease (CAD) in patients with left bundle branch block (LBBB). However, advancements in Doppler echocardiography permit transthoracic imaging of coronary flow velocities (CFV) and measurement of coronary flow reserve (CFR). Our aim was to evaluate the diagnostic value of transthoracic CFR measurements for detection of significant left anterior descending (LAD) stenosis in patients with LBBB and compare it to that of myocardial perfusion scintigraphy (MPS). Simultaneous transthoracic CFR measurements and MPS were analyzed in 44 consecutive patients with suspected CAD and permanent LBBB. Typical diastolic predominant phasic CFV Doppler spectra of distal LAD were obtained at rest and during a two-step (0.56-0.84 mg/kg) dipyridamole infusion protocol. CFR was defined as the ratio of peak hyperemic velocities to the baseline values. A reversible perfusion defect at LAD territory was accepted as a positive scintigraphy finding for significant LAD stenosis. A coronary angiography was performed within 5 days of the CFR studies. The hyperemic diastolic peak velocity (44 +/- 9 cm/sec vs 62 +/- 2 cm/sec; P=0.01) and diastolic CFR (1.38 +/- 0.17 vs 1.93 +/- 0.3; P=0.001) were significantly lower in patients with LAD stenosis compared to those without LAD stenosis. The diastolic CFR values of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1.6 yielded a sensitivity of 100% and a specificity of 94% in the identification of significant LAD stenosis. In comparison, MPS detected LAD stenosis with a sensitivity of 100% and a specificity of 29%. CFR measurement by transthoracic Doppler echocardiography is an accurate method that may improve noninvasive identification of LAD stenosis in patients with LBBB.
To determine the subclinical effects of isolated obesity and its duration on cardiac function by ... more To determine the subclinical effects of isolated obesity and its duration on cardiac function by using routine echocardiography and tissue Doppler myocardial strain rate. Forty-nine subjects were enrolled in this study; 29 with isolated obesity defined as a body mass index &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 30 kg/m(2) with no other cardiovascular comorbidities, and 20 nonobese controls. All subjects underwent two-dimensional and Doppler echocardiography including tissue Doppler imaging and myocardial strain rate. The average duration of obesity was 12.1 years (4-18 years). Abnormalities of left ventricular (LV) wall thickness, mass, diastolic function, and left atrial size were detected in obese individuals, despite having preserved ejection fractions. The LV global longitudinal peak strain rate was significantly lower in obese subjects compared to nonobese control subjects (1.07 +/- 0.14 vs. 1.38 +/- 0.12, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Using multivariate analysis, the duration of obesity (ss=-0.76, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), body mass index (ss=-0.35, P = 0.023), and age (ss=-0.29, P = 0.009) were independent predictors of the decreased LV global longitudinal peak strain rate, while the duration of obesity (ss=-0.66, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and body mass index (ss=-0.28, P = 0.037) were independent predictors of the decreased right ventricular (RV) peak strain rate. The presence and the duration of obesity were associated with impairment of subclinical biventricular systolic and diastolic function. These findings have the potential to increase awareness of subclinical cardiac manifestations in patients with isolated obesity and influence their early management.
Alcohol-induced septal ablation (AISA) is an accepted treatment for hypertrophic cardiomyopathy (... more Alcohol-induced septal ablation (AISA) is an accepted treatment for hypertrophic cardiomyopathy (HCM) patients with left ventricular (LV) outflow obstruction who are unresponsive to medical therapy. As left atrial (LA) enlargement has been correlated with increased morbidity and mortality in HCM, we assessed LA volumes and ejection fraction (EF) prior to and after AISA using real time three-dimensional (3D) transthoracic echocardiography (TTE) in 12 patients (9 women; mean age 52 +/- 15 years; 11 Caucasian). All patients underwent successful AISA with no complications and their resting left ventricular outflow gradients decreased from 40.5 +/- 22.2 to 9.1 +/- 17.6 mmHg (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) while their gradients with provocation decreased from 126.2 +/- 31.7 to 21.8 +/- 28.0 mmHg (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). All patients showed improvements in their New York Heart Association (NYHA) functional class. Both the LA end-systolic (45.2 +/- 12.9 to 37.2 +/- 13.7 ml, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001) and end-diastolic (79.6 +/- 18.9 to 77.1 +/- 18.6 ml, P = 0.001) volumes decreased after AISA. The LA EF increased from 43.1 +/- 9.0 to 52.5 +/- 8.8% (P = 0.001). The increase in LA EF correlated with the decrease in the resting left ventricular outflow gradient (R =-0.647, P = 0.03). In conclusion, 3D echocardiography can be utilized to follow LA function after AISA for HCM. AISA results in clinical improvement in patients with HCM and in improvement of LA EF that is correlated with the decrease in the left ventricular outflow gradient.
A 50-year-old male patient with dilated cardiomyopathy was evaluated for cardiac resynchronizatio... more A 50-year-old male patient with dilated cardiomyopathy was evaluated for cardiac resynchronization therapy. A transthoracic echocardiogram revealed a mass in close proximity to the coronary sinus ostium.The mass was considered to be a thrombus and found to have disappeared at the repeat echocardiogram performed following a month of anticoagulation therapy with warfarin. In this case report, we aim to emphasize the importance of coronary sinus imaging, especially during echocardiographic evaluation for cardiac asynchrony.
2011 DEDICATION I dedicate this thesis to my loved parents, sisters and wife for their love and e... more 2011 DEDICATION I dedicate this thesis to my loved parents, sisters and wife for their love and encouragement. My parents' integrity, humility, love, and compassion. I am eternally grateful for their constant encouragement and for setting the right example in my life. My father; who taught me that the best kind of knowledge to have is that is learned for its own sake. I dream of being like him for my son. My mother, who taught me that even the largest task can be accomplished if it is done one step at a time. My sisters, for their constant love, support and inspiration. And i dedicate this thesis to my hope, my present and future life: My wife; for her unconditional love and enthusiastic spirit and for standing beside me. Thank you for being a pillar of support in my life. Without you all this would have been an impossible task.
Journal of the American College of Cardiology, 2013
Background: Contrast-induced acute kidney injury (CI-AKI) is a serious complication associated wi... more Background: Contrast-induced acute kidney injury (CI-AKI) is a serious complication associated with the use of iodinated contrast medium (CM). Intravascular volume expansion by intravenous (I.V.) route is the only protective approach with proven efficacy in preventing CI-AKI. However, efficacy of oral volume expansion, or oral hydration, which shortens the duration of hospitalization, is less expensive and increases patient comfort, has not been well established. The objective of this study was to evaluate the efficacy of oral hydration in the prevention of CI-AKI Methods: We prospectively randomized 225 patients undergoing coronary angiography and/or percutaneous coronary intervention with a non-ionic, low-osmolality contrast media in two different volume expansion strategies, oral hydration vs. I.V. hydration. Patients at high risk of developing CI-AKI [age !70 years old, diabetes mellitus, anemia, hyperuricemia, a history of cardiac failure or systolic dysfunction (ejection fraction <%40)] were included in the study. All patients had an estimated glomerular filtration rate of !60 mL/min/1.73 m2 [ i.e., normal renal function or stages 1 and 2 chronic kidney disease (CKD)]. Patients in the oral hydration group, except for those with cardiac failure, were recommended to consume fluids freely whereas isotonic saline (0.9%) was administered intravenously at a rate of 1 mL/kg/h for 12 hours before and 12 hours after the administration of CM in the I.V. hydration group. The primary outcome was the occurrence of CI-AKI which was defined as !25% increase in serum creatinine from the baseline at 48 hours in the absence of an alternative etiology. Results: CI-AKI occurred in 8/116 patients (6.9%) in the oral group and 8/109 patients (7.3%) in the I.V. group (p¼0.89) ( and 2). When different CI-AKI definitions were taken into account, there was also no statistically significant difference between the two groups despite a high variability in the incidence of CI-AKI. Conclusıon: Oral hydration is as effective as I.V. hydration in the prevention of CI-AKI in patients with normal kidney function or with stages 1 and 2 CKD and who have also one of the other high risk factors such as advanced age, diabetes mellitus, anemia, hyperuricemia, a history of heart failure or systolic dysfunction.
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