Papers by Hamdi Pusuroglu
Vasa, 2015
. Background: The aim of this study was to assess the periprocedural and one-year outcomes of two... more . Background: The aim of this study was to assess the periprocedural and one-year outcomes of two different cerebral protection systems used during carotid artery stenting (CAS). Patients and methods: We enrolled 90 consecutive patients with carotid artery stenosis who underwent CAS with a proximal flow blockage protection system (mean age 69.7 ± 8) or distal protection with a filter (mean age 70.8 ± 7). Results: CAS was performed successively on 89 patients (99 %). Adverse events were defined as major stroke, minor stroke, transient ischemic attack (TIA), myocardial infarction, and death. Two strokes, one TIA, one death, and one myocardial infarction were observed in-hospital. There were no significant differences in safety or benefits between the proximal flow blockage embolic protection system (n = 45) and the distal filter protection system (n = 45) in terms of clinically apparent cerebral embolism, TIA, death, or myocardial infarction during the periprocedural stage or during the one-year follow-up period. Conclusions: Although it has been shown that the proximal flow blockage cerebral protection system decreases the risk of silent cerebral embolism, it has no advantage over the distal filter protection system in terms of adverse cerebrovascular or cardiac events during the periprocedural stage or during the long-term follow-up period.
Introduction Obstructive sleep apnea (OSA) and endothelial dysfunction are associated with cardio... more Introduction Obstructive sleep apnea (OSA) and endothelial dysfunction are associated with cardiovascular risk factors and the development of atherosclerosis. Endocan is a marker of endothelial dysfunction, while obstructive sleep apnea is one of the causes of endothelial dysfunction. In this study, we investigated the relationship between endocan and obstructive sleep apnea severity. Material and methods A total of 179 patients with snoring complaints were included. All patients underwent polysomnography, and based on the results, the participations were allocated to the control group (n = 39) or to the obstructive sleep apnea group (n = 140). The OSA group was classified as having mild (apnea-hypopnea index (AHI) = 5–15; n = 43), moderate (AHI = 15–30; n = 42), or severe OSA (AHI > 30; n = 55). All participations had their endocan levels measured. Results Endocan levels in OSA patients were significantly higher than in the control group (11.8 (3.13–200) vs 3.13 (3.13–23) ng/ml,...
Introduction: Obstructive sleep apnea syndrome (OSAS) has been reported to be related with hypert... more Introduction: Obstructive sleep apnea syndrome (OSAS) has been reported to be related with hypertension, coronary artery disease and heart failure in recent studies. Galectin-3 plays an important r...
Background Although it has been shown that high mean platelet volume (MPV) is associated with tar... more Background Although it has been shown that high mean platelet volume (MPV) is associated with target organ damage in hypertensive patients, the relationship between MPV and the development of long-term major adverse cardiovascular events (MACE) has not been thoroughly investigated. In this study, we investigated the relationship between MPV and long-term MACE in hypertensive patients. Methods From September 2011 to July 2017, 1507 patients with hypertension were included in this study. Ambulatory blood pressure monitoring was performed in all patients. Patients with chronic renal failure, cardiovascular disease, chronic systemic disease and white coat hypertension were excluded from the study. MACE were defined as myocardial infarction, stroke and cardiovascular mortality. Patients were followed-up until january 2020. Results The mean follow-up duration was 87 (83.3 ± 24.4) months, and 876 patients completed the study. MACE developed in 79 patients, while 797 patients were event-fre...
Journal of Ankara University Faculty of Medicine
Clinical and Experimental Hypertension
ABSTRACT Objective: Although neurotensin is found throughout the body including cardiovascular st... more ABSTRACT Objective: Although neurotensin is found throughout the body including cardiovascular structures, the correlation of plasma neurotensin levels with resistant hypertension (RH) has never been examined. Therefore, we aimed to compare plasma neurotensin concentration, between patients with RH and those with controlled hypertension (CH). Methods: Forty-one patients with RH and 45 patients with CH who had undergone outpatient ambulatory blood pressure measurements were prospectively recruited. RH was defined as uncontrolled blood pressure despite using three antihypertensive agents including a diuretic or need of four or more drugs to control blood pressure. The demographic properties, medications, laboratory parameters including neurotensin levels, and echocardiographic parameters were recorded. Results: There was no significant difference among groups in terms of age, sex, smoking or body mass index. Office and ambulatory blood pressures and mean number of antihypertensive drugs used were significantly higher in patients with RH compared to patients with CH. Plasma neurotensin levels were significantly lower in patients with RH (median: 0.380 ng/ml; interquartile range: 0.292–0.471) than in the patients with controlled blood pressure (median: 0.638 ng/ml; interquartile range: 0.483–0.783). Multivariate and receiver-operating characteristics curve analyses showed that neurotensin is an independent predictor for RH and the optimal cut-off value of neurotensin for RH was lower than 0.509 ng/ml, with a sensitivity of 85.4% and a specificity of 73.3% (area under the curve = 0.793, 95% CI: 0.691–0.894, p < .001) Conclusion: This study is the first to show a correlation between lower neurotensin levels and RH.
Blood Pressure Monitoring, 2017
The aim of this study was to investigate the possible correlation of serum visfatin levels with r... more The aim of this study was to investigate the possible correlation of serum visfatin levels with resistant hypertension (RHT). Patients who had undergone ambulatory blood pressure measurements (ABPM) during the outpatient controls were prospectively recruited. Seventy-one patients with RHT and 94 patients with controlled hypertension (CHT) were included in the study. RHT was defined as &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;uncontrolled blood pressure (BP) despite using three antihypertensive agents including a diuretic or need of four or more drugs to control BP&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;. The demographic properties, medications used, and laboratory parameters including visfatin levels were recorded. In the RHT group, left ventricular mass index was significantly higher compared with the CHT group (108.13±26.86 vs. 89.46±24.09 g/m, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). High-sensitivity C-reactive protein and visfatin levels were significantly higher in the RHT group [4.0 (5.2) vs. 2.3 (3.0) mg/l, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01, and 12.87±4.98 vs. 9.46±4.69 ng/ml, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01, respectively] compared with the CHT group. In the multivariate linear regression model, visfatin level remained as an independent predictor for office systolic BP [B: 2.07, 95% confidence interval (CI): 1.17-2.98, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01]; office diastolic BP (B: 0.71, 95% CI: 0.27-1.16, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01); mean 24-h systolic ABPM (B: 1.46, 95% CI: 0.79-2.13, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01); and mean 24-h diastolic ABPM (B: 0.88, 95% CI: 0.42-1.34, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01) and was also correlated independently with left ventricular mass index (B: 3.13, 95% CI: 2.58-3.99, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). In this cohort of RHT patients diagnosed with ABPM, we have found an independent correlation between higher visfatin levels and the presence of RHT and left ventricular hypertrophy.
Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, Jan 17, 2017
Previous studies have demonstrated the predictive value of the neutrophil-to-lymphocyte ratio (NL... more Previous studies have demonstrated the predictive value of the neutrophil-to-lymphocyte ratio (NLR) in many cardiovascular disorders. The aim of this study was to assess whether NLR is associated with echocardiographic or electrocardiographic parameters, or with predicted five-year risk of sudden cardiac death (SCD), in patients with hypertrophic cardiomyopathy (HCM). This prospective observational study included 74 controls and 97 HCM patients. Three years of follow-up results for HCM patients were evaluated. NLR was significantly higher in patients with fragmented QRS, ventricular tachycardia, and presyncope than in those without (p=0.031, 0.030, and 0.020, respectively). NLR was significantly higher in patients whose predicted five-year risk of SCD was more than 6% and whose corrected QT interval was greater than 440 ms (p=0.022 and 0.001, respectively). It was also significantly higher in patients whose left ventricular ejection fraction (LVEF) was <60% than in those with LVE...
Kardiologia Polska, 2014
Obstructive sleep apnea syndrome (OSAS) is reported to be associated with hypertension, coronary ... more Obstructive sleep apnea syndrome (OSAS) is reported to be associated with hypertension, coronary artery disease, atrial fibrillation, and heart failure. Galectin-3 plays an important role in the regulation of inflammation, development of cardiac fibrosis and remodeling. A significant relationship between galectin-3 and the total number of coronary plaques and the macrocalcified plaque structures of patients with type 2 DM has been reported. The aim of this study was to investigate the association between galectin-3 level and coronary plaque burden as well as OSAS severity in patients with obstructive sleep apnea syndrome. A total of 87 consecutive patients with a diagnosis of OSAS and 21 age and gender-matched control subjects were recruited for the present study. The patients with OSAS were also categorized according to their apnea hypopnea index (AHI) as follows: mild (AHI=5-15), moderate (AHI=15-30), and severe (AHI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;30). All study subjects underwent coronary computed tomography angiography (CCTA) to detect coronary atherosclerosis. Also all participants of serum galectin-3 concentrations were measured. Mean galectin-3 level was significantly higher in patients with OSAS compared to control subjects (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and in the severe OSAS group compared to the moderate and mild OSAS groups (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Correlation analysis indicated significant positive relationships between galectin-3 concentrations and the total number of coronary plaques (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), hs-CRP (p=0.001) and severity of OSAS (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). In multivariate analysis, galectin-3 (p=0.01) and age (p=0.025) were significant independent predictors of coronary atherosclerosis, after adjusting for other risk factors. Also it has been found that Galectin-3 concentrations is predictor of OSAS severity (p=0.001). Galectin-3 is associated with coronary atherosclerosis and OSAS severity in OSAS patients.
American Journal of Kidney Diseases, Mar 1, 2003
Background: Endothelial dysfunction (ED), which is a risk factor for atherosclerosis, has been re... more Background: Endothelial dysfunction (ED), which is a risk factor for atherosclerosis, has been reported recently in chronic hemodialysis (CHD) patients. In this study, we aim to investigate the association of ED and presence of left ventricular hypertrophy (LVH) in CHD patients. Methods: One hundred four CHD patients (47 men, 57 women; mean age, 45 ؎ 12 years) and 49 age-and sex-matched controls were included. Mean time on dialysis therapy was 62 months. Echocardiographic examination and flow-mediated endothelium-dependent (EDD) and endotheliumindependent dilatation (EID) of the brachial artery, measured by high-resolution ultrasonography, a noninvasive method for assessing endothelial function, were performed on a nondialysis day. Results: LVH was detected in 72 CHD patients (69%). Patients with LVH had a lower EDD (9.3% ؎ 6.1% versus 12.1% ؎ 8.3%; P ؍ 0.06), but the difference was not significant. Mean EID was significantly lower in CHD patients with LVH (13.6% ؎ 7.6% versus 18.6% ؎ 9.8%; P ؍ 0.008). Left ventricular mass index (LVMI) correlated with both EDD (r ؍ ؊0.22; P ؍ 0.03) and EID (r ؍ ؊0.32; P ؍ 0.002). Patients with LVH had a greater rate of hypertension (35 of 72 versus 7 of 32 patients; P ؍ 0.02) and lower hemoglobin levels (11.0 ؎ 1.8 versus 11.8 ؎ 1.6 g/dL [110 ؎ 18 versus 118 ؎ 16 g/L]; P ؍ 0.05). CHD patients had a lower EDD (10.2% ؎ 6.9% versus 20.9% ؎ 7.6%; P < 0.001) and EID (15.0% ؎ 8.5% versus 27.8% ؎ 8.5%; P < 0.001) compared with controls. In linear regression analysis for predicting LVMI, presence of hypertension, hemoglobin level, and EID, but not EDD, were found to be independent variables. Conclusion: EID, which may reflect decreased elasticity of arteries, contributes to the development of LVH in CHD patients, in addition to hypertension and anemia.
Acta Cardiologica, Feb 1, 2004
Preinfarction angina pectoris has been suggested in some studies to have a beneficial effect on l... more Preinfarction angina pectoris has been suggested in some studies to have a beneficial effect on left ventricular function after acute myocardial infarction (AMI). The precise mechanisms of this protection have not been fully elucidated. The effect of preinfarction angina on myocardial tissue perfusion also needs to be clarified. In this study, we investigated the influence of preinfarction angina on microvasculatory damage by using ST-segment resolution and pressure-derived collateral flow index (CFIp) as a marker of microcirculatory perfusion. We studied 41 patients with a first AMI in whom thrombolysis in myocardial infarction (TIMI) grade 3 flow in the infarct-related artery was established by thrombolytic therapy. The percent resolution of ST-segment deviation (deltasigma ST) after thrombolysis was determined. All of the patients had TIMI grade 3 flow in IRA at the coronary angiography, which was done a mean of 4 days after AMI. Intracoronary pressure measurements and stent implantation to the IRA were performed. After angiography, CFIp was calculated as the ratio of simultaneously measured coronary wedge pressure-central venous pressure (Pv) to mean aortic pressure-Pv. Patients with preinfarction angina pectoris had greater percent deltasigma ST than those without PA (67 +/- 18% vs. 44 +/- 24%, p = 0.03). The mean of the coronary wedge pressure (16.4 +/- 7.4 compared with 23.2 +/- 9.4, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.03) and the pressure-derived collateral flow index (0.15 +/- 0.10 compared with 0.22 +/- 0.08, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.03) were significantly lower in patients with preinfarction angina compared to those without. Preinfarction angina is associated with a greater degree of ST-segment resolution and lower CFI-p in patients with TIMI-3 reflow after thrombolysis. These findings suggest that a protective effect of preinfarction angina against reperfusion injury may result in greater ST resolution and lower CFIp after AMI.
The American Journal of Cardiology, 2016
Zhonghua Minguo xin zang xue hui za zhi = Acta Cardiologica Sinica, 2014
Uric acid (UA) is an independent risk factor for the development of coronary heart disease. Serum... more Uric acid (UA) is an independent risk factor for the development of coronary heart disease. Serum UA levels have been correlated with all major forms of death from cardiovascular disease, including acute, subacute, and chronic forms of coronary artery disease (CAD), heart failure, and stroke. However, its value in acute ST-segment elevation myocardial infarction (STEMI) remains unclear. The aim of this study was to evaluate the prognostic value of UA in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). We prospectively enrolled 434 consecutive Turkish STEMI patients (mean age 55.4 ± 12.4 years, 341 male, 93 female) undergoing primary PCI. The study population was divided into tertiles based on admission UA values. The high UA group (n = 143) was defined as a value in the third tertile (> 5.7 mg/dl), and the low UA group (n = 291) included those patients with a value in the lower two tertiles (≤ 5.7 mg/dl). Clinical characteristics, in-hospital and s...
Zhonghua Minguo xin zang xue hui za zhi = Acta Cardiologica Sinica, 2014
Slow coronary artery flow (SCF) is characterized by angiographically confirmed delayed vessel opa... more Slow coronary artery flow (SCF) is characterized by angiographically confirmed delayed vessel opacification in the absence of any evidence of obstructive epicardial coronary artery disease. Microvolt T-wave alternans (MTWA) is defined as beat-to-beat changes in shape, amplitude, or timing of ST segments and T waves, and is utilized in predicting sudden cardiac death and life-threatening malign ventricular arrhythmias in high-risk patients. In our study, we aimed to evaluate the effects of slow coronary artery flow on MTWA. Thirty-nine consecutive patients (SCF group: 6 women and 33 men; mean age, 49 ± 10 years) with angiographally documented SCF in at least 1 major epicardial artery and 39 patients (control group: 13 women and 26 men; mean age, 50 ± 10 years) with normal coronary arteries were included in the study. Coronary flow rates of all patients were calculated by thrombolysis in myocardial infarction frame count (TFC). The MTWAs of all patients were analyzed using the time-do...
Archives of medical science : AMS, 2016
Both end-organ damage and high red cell distribution width (RDW) values are associated with adver... more Both end-organ damage and high red cell distribution width (RDW) values are associated with adverse cardiovascular events, inflammatory status, and neurohumoral activation in hypertensive disease and in the general population. In this study, we investigated the relationship between RDW and end-organ damage in hypertensive patients. The 446 systo-diastolic hypertensive patients included in the study received 24-hour ambulatory blood pressure monitoring. Left ventricular mass index, glomerular filtration rate, and microalbuminuria were measured to identify end-organ damage. High-sensitivity C-reactive protein (hs-CRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels of all patients were also examined. The mean age of the participants was 49.96 ±11.04 years. The mean RDW was 13.06 ±1.05%. Red cell distribution width was positively correlated with left ventricular myocardial index (LVMI), urinary albumin, hs-CRP, and NT-proBNP (r = 0.298, p < 0.001; r = 0.228, p < ...
Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, Jan 17, 2015
Red cell distribution width (RDW) is a measure of variation in the size of circulating red blood ... more Red cell distribution width (RDW) is a measure of variation in the size of circulating red blood cells. Recent studies have reported a strong independent relation between elevated RDW and short- and long-term prognosis in various disorders. The aim of the present study was to investigate the relationship between admission RDW-to-platelet ratio (RPR) and in-hospital and long-term prognosis in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). A total of 470 consecutive patients with a diagnosis of STEMI who underwent primary PCI were included in this prospective study. The patients were divided into two groups based on their admission RPR: high (>0.061) RPR group and low (≤0.061) RPR group. The patients were followed for adverse clinical outcomes in-hospital and for up to one year after discharge. In-hospital cardiovascular mortality, major adverse cardiovascular events (MACE), advanced heart failure and ca...
Kardiologia polska, Jan 14, 2015
Mean platelet volume to platelet count ratio (MPV/Plt) has been demonstrated to be a good indicat... more Mean platelet volume to platelet count ratio (MPV/Plt) has been demonstrated to be a good indicator of long-term mortality in patients with non-ST-segment elevation myocardial infarction (NSTEMI). However, the prognostic value of MPV/Plt in STEMI is not reported. The aim of this study was to determine whether the MPV/Plt ratio on admission has any predictive value for major adverse cardiac events including short-and long-term mortality in STEMI. In this prospective study, 470 STEMI patients who underwent primary percutaneous coronary angioplasty (PCI) were enrolled. The patients were divided into three tertiles based on the MPV/Plt ratio on admission. The first tertile (n=149) was defined as MPV/Plt ratio ≤0.029, second tertile (n=154) 0.029-0.038, and third tertile (n=159) ≥0.038. Primary clinical outcomes consisted of the sum of cardiovascular (CV) mortality, non-fatal re-infarction and stroke. Secondary clinical outcomes were CV mortality, non-fatal re-infarction, target-vessel r...
Blood Coagulation & Fibrinolysis, 2015
After long years of using warfarin for atrial fibrillation, new oral anticoagulants (NOACs) becam... more After long years of using warfarin for atrial fibrillation, new oral anticoagulants (NOACs) became available for decreasing the risk of ischemic stroke. Our aim was to observe the physicians prescribing patterns of NOACs. This prospective observational study included patients using NOACs applying consecutively to our outpatient clinic. Physical examination was performed, and patient history, electrocardiogram, transthoracic echocardiography, and biochemical results were collected. Bleeding and ischemic stroke risk scores (HAS-BLED and CHA2DS2-VASc scores) were calculated. We evaluated patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; characteristics, risk factors, concomitant drug usage, and physicians&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; choices. The study consisted of 174 patients using NOACs (dabigatran 113 patients, rivaroxaban 61 patients), with a mean age of 70.7 ± 8.8 years. The mean HAS-BLED score was 1.74 ± 0.9 and the mean CHA2DS2-VASc score was 3.7 ± 1.2. Fifty-three (30.4%) patients were prescribed low-dose NOAC according to the optimal dose, and 12 (6.8%) patients were prescribed high-dose NOAC according to the optimal dose. We compared optimal dose and undertreatment groups to find out if there was any predicting factor for physicians to use low dose of NOACs, but there was no significant difference between the two groups for age, sex, concomitant chronic disease, and CHA2DS2-VASc and HAS-BLED scores. NOACs were prescribed to patients mostly with high CHA2DS2-VASc score and low HAS-BLED score. Low-dose NOAC usage according to the optimal dose was frequent. Frequent coagulation monitoring and drug incompliance are big deficiencies at atrial fibrillation in use of warfarin. NOACs overcome these difficulties; however, physicians&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; hesitation to use NOACs with the optimal dosage may be another limitation in real-world practice.
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Papers by Hamdi Pusuroglu