Discontinuation of metformin treatment in patients scheduled for elective coronary angiography (C... more Discontinuation of metformin treatment in patients scheduled for elective coronary angiography (CAG) is controversial because of post-procedural risks including acute contrast-induced nephropathy (CIN) and lactic acidosis (LA). This study aims to discuss the safety of continuing metformin treatment in patients undergoing elective CAG with normal or mildly impaired renal functions. Our study was designed as a single-centered, randomized, and observational study including 268 patients undergoing elective CAG with an estimated glomerular filtration rate of >60 mL/min/1.73 m2. Of these patients, 134 continued metformin treatment during angiography, whereas 134 discontinued it 24 h before the procedure. CIN was defined as either a 25% relative increase in serum creatinine levels from the baseline or a 0.5 mg/dL increase in the absolute value that measured 48 h after CAG. Logistic regression analysis was performed to identify independent predictors of CIN and LA after CAG. Both groups ...
Ö Z E T Aralık 1982 ile Mayıs 1995 tarihleri arasında İÜ Kar diyoloji Enstitüsü'ne başvuran ... more Ö Z E T Aralık 1982 ile Mayıs 1995 tarihleri arasında İÜ Kar diyoloji Enstitüsü'ne başvuran 2691 akut myokard infarktüslü (AMI) hastadan ventriküler septum rüptürü (VSR) saptanan 22 hasta retrospektif olarak incelendi. Medikai (11 hasta, grup A) ve cerrahi tedavi (11 hasta, grup B) uygulanan hastalarda rüptür oluş zamanının, hemodlnamik özelliklerin ve multisistem bozukluklarının mortaliteye olan etkisi araştırıldı.
To compare the long-term clinical outcomes between Resolute zotarolimus-eluting stent (R-ZES) and... more To compare the long-term clinical outcomes between Resolute zotarolimus-eluting stent (R-ZES) and paclitaxel-eluting stent (PES) in patients with small coronary artery disease. Patients with a small vessel diameter are independently associated with increased risk of adverse cardiac events after drug-eluting stent implantation. A cohort of 265 patients treated with R-ZES (185 patients with 211 lesions) or PES (80 patients with 100 lesions) in small vessel (≤2.5 mm) lesions were retrospectively analyzed. The primary end point of the study was the composite of major adverse cardiac events. The secondary end points included target lesion revascularization (TLR), target vessel revascularization (TVR), and stent thrombosis at 3 years. The baseline characteristics were similar between the 2 groups. In the R-ZES group, the mean stent diameter was smaller and the total stent length per lesion was longer. Major adverse cardiac events occurred in 8 (10%) patients who had received PES and in 7 ...
OBJECTIVE: P-wave dispersion (PD) is an indicator of inhomogeneous and discontinuous propagation ... more OBJECTIVE: P-wave dispersion (PD) is an indicator of inhomogeneous and discontinuous propagation of sinus impulses. In the present study we aimed to investigate the PD and its association with the severity of the disease. in patients with stable coronary artery disease. METHODS: We prospectively analyzed 60 subjects with coronary artery disease (CAD) and 25 subjects with normal coronary angiograms (control group). The maximum and minimum P-wave duration and PD were measured from the 12-lead surface electrocardiograms. The CAD severity was assessed by the severity score (Gensini score) and the number of vessels involved (vessel score). RESULTS: P max was longer in CAD group compared with the control group (p<0.001). PD was greater in the CAD group, compared with the control group (p<0.001). However, P min did not differ between the two groups. In bi-variate correlation, increased PD was correlated with presence of diabetes mellitus (r=0.316, p=0.014), smoking (r=0.348, p=0.006), left ventricular ejection fraction (r=-0.372, p=0.003), vessel score (r=0.848, p=0.001), and Gensini score (r=0.825, p=0.001). Multiple linear regression analysis showed that PD was independently associ¬ated with vessel score ((3=0.139, p=0.002) and Gensini score ((3=0.132, p=0.007). CONCLUSION: PD was greater in patients with CAD than in controls and it was associated with CAD severity.
We assessed the relation between platelet-to-lymphocyte ratio (PLR) on admission and contrast-ind... more We assessed the relation between platelet-to-lymphocyte ratio (PLR) on admission and contrast-induced nephropathy (CIN) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). A total of 488 patients with NSTE-ACS who underwent urgent coronary angiography were enrolled. Levels of PLR and creatinine were measured before angiography and at 72 hours after angiography. Patients were divided into 2 groups, namely, the CIN group, 80 patients (16.3%; age 65.3 ± 12.5years; 66.7% men) and the non-CIN group, 408 patients (83.7%; age 61.2 ± 12.3 years; 72.5% men). Patients in the CIN group had significantly higher PLR than those in the non-CIN group (152.9 ± 99.6 vs 120.4 ± 66.1, P < .001). In logistic regression analysis, PLR (odds ratio [OR] 1.004, 95% confidence interval [CI] 1.001-1.007, P = .02), diabetes mellitus (OR 1.75, 95% CI 1.02-2.98, P = .03), and ST-segment depression on admission electrocardiogram (OR 1.68, 95% CI 1.00-2.81, P = .04) were independent pre...
A 64-year-old woman with the diagnosis of acute anterior infarction was treated with streptokinas... more A 64-year-old woman with the diagnosis of acute anterior infarction was treated with streptokinase, i.v. heparin, and aspirin. After 20 hours of hospitalization she developed hypotension and a fall in hematocrit level with acute onset of severe abdominal pain. After genitourinary and gastrointestinal bleeding, pulmonary embolism and reinfarction had been ruled out, however, abdominal ultrasonography revealed intraabdominal hemorrhage and the patient was given three units of blood transfusion. Abdominal laparotomy and laparoscopy were not performed as the patient's clinical status stabilized on the 3rd day and hemodynamics did not deteriorate thereafter. Abdominal computerized tomography in the second week revealed a splenic rupture.
JPMA. The Journal of the Pakistan Medical Association, 2014
To demonstrate the presence and importance of apoptotic activity in heart failure during acute ex... more To demonstrate the presence and importance of apoptotic activity in heart failure during acute exacerbations and to investigate the effects of different drugs used and co-morbidities on levels of N-Terminal pro-Brain Natriuretic Peptide and apoptotic activity on admission and during hospitalisation. The descriptive study was conducted at the emergency department of Istanbul University Cardiology Institute between October 2010 and May 2011 and comprised patients with complaints of shortness of breath, and who were evaluated as acutely exacerbated decompensated heart failure with an aetiology of ischaemic or dilated cardiomyopathy. Apoptotic activity and N-Terminal pro-Brain Natriuretic Peptide levels were measured on admission and on the seventh day of treatment. SPSS 15 was used for statistical analysis. Of the 89 patients in the study, 67(75%) were males. Overall mean age of the study sample was 61 +/- 12 years. Patients who had N-Terminal pro-Brain Natriuretic Peptide levels highe...
Aim Spontaneous reperfusion (SR) was associated with better clinical outcomes and lower incidence... more Aim Spontaneous reperfusion (SR) was associated with better clinical outcomes and lower incidence of major adverse cardiovascular events. Endothelin-1 (ET-1) is a potent endothelium-derived vasoconstrictor peptide and elevated systemic ET-1 levels predict a poor prognosis in patients with ST-segment elevation myocardial infarction (STEMI). We aimed to investigate the relationship between systemic ET-1 plasma levels and SR in a group of STEMI patients treated with a primary percutaneous coronary intervention (PCI). Methods and results We measured ET-1 levels acutely (within the first 6 h) in 33 STEMI patients with SR and 45 STEMI patients with non-SR presenting with their first STEMI who underwent primary PCI. Blood samples for ET-1 plasma level measurement were drawn after vascular puncture before angiography in the catheterization laboratory from the peripheral vein. The mean age of the patients was 56.1 ± 13.3 years in the SR group and 57.4 ± 11.4 years in the non-SR group. The circulating level of ET-1 was considerably higher in the non-SR patients than in the SR patients (0.81 ± 0.2, 1.0 ± 0.3, P = 0.004). On multivariable logistic regression analysis, the ET-1 level was the only significant predictor of SR (P = 0.01). The receiver operating characteristic curve analysis showed that the ET-1 level at admission is an indicator of SR, with an area under the curve of 0.62. Conclusion This study shows that in patients admitted with ST-elevation acute myocardial infarction, ET-1 plasma levels are related to angiographic SR before primary PCI.
In this study, we investigated the role of radionuclide venography in the diagnosis of abnormal s... more In this study, we investigated the role of radionuclide venography in the diagnosis of abnormal subclavian venous flow due to the lead in patients (pts) with permanent pacemakers. The study was conducted with 53 frames in 52 asymptomatic pts (26 females, mean age 64.5 +/- 15; range 25-89 years). The mean time after implant was 67.6 +/- 47.5 months. Technetium 99m pertecnetate (250 MBq) was given to both antecubital veins simultaneously. The images were acquired in 0.25-second frames for 20 seconds. The pts were evaluated visually in terms of the activity flow through the subclavian veins bilaterally. The retrograde flow in the jugular vein, decrease in flow rate, and subtotal and total obstruction of the subclavian veins were accepted as abnormal venous flow patterns. In 17 pts with abnormal findings, 10 (58.8%) had retrograde flow in the jugular vein, 4 had (23.5%) decreased flow rate, 1 (5.8%) had subtotal and 2 (11.7%) total obstruction in the subclavian vein. The mean of the body diameter of the leads was significantly greater and the percentage of the silicone-insulated leads was higher (76% vs 52%) in the group with abnormal flow. No complication due to the procedure was seen. In conclusion, radionuclide venography, a noninvasive method, may be used easily and safely to show the venous flow abnormalities due to the lead in pts with permanent pacemakers. The abnormal subclavian venous flow was especially seen in pts who had larger leads.
Hyperglycemia on admission is associated with increased mortality rates in patients with ST-eleva... more Hyperglycemia on admission is associated with increased mortality rates in patients with ST-elevation myocardial infarction (STEMI) who are treated with either fibrinolytic therapy (FT) or primary percutaneous coronary intervention (PCI). However, data regarding the relationship between hyperglycemia and the success of FT are lacking. The aim of this study was to investigate the value of admission blood glucose for the prediction of failed reperfusion following FT. This is a retrospective study of 304 STEMI patients who received FT and whose admission glucose levels were recorded. The main outcome measure was ST segment resolution ≥50 %. The median (interquartile range [IQR]) blood glucose level in the entire study group was 112 (95-153). In 92 (30.2 %) patients, FT was unsuccessful and rescue PCI was performed. Admission glucose (126 [99-192] vs. 110 [94-144] mg/dL, 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;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;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), time from symptom onset to FT (180 [120-270] vs. 150 [120-180] min, p = 0.009), and maximum ST elevation amplitude (3 [2-7] vs. 3 [2-6] mm, p = 0.05) were higher in the failed reperfusion group than in the reperfusion group. Admission hyperglycemia was an independent predictive factor for failed reperfusion (hazard ratio 4.79 [1.80-12.76], p = 0.002), along with time from symptom onset to fibrinolysis and anterior wall myocardial infarction. In patients with STEMI who undergo FT, admission hyperglycemia is an independent predictor of the failure of fibrinolysis.
Contrast medium-induced acute kidney injury (CI-AKI) is associated with morbidity and mortality, ... more Contrast medium-induced acute kidney injury (CI-AKI) is associated with morbidity and mortality, but the long-term outcomes of patients who do not develop CI-AKI remain unknown. We assessed clinical end points during long-term follow-up in patients at high risk for nephropathy who did not develop CI-AKI. Patients (n = 135) with impaired renal function (estimated glomerular filtration rate: 30-60 mL/min/1.73 m2) were divided into 2 groups according to contrast media (CM) exposure. The primary end point of this study was a composite outcome measure of death or renal failure requiring dialysis. Multivariate analyses identified CM exposure to be independently associated with major adverse long-term outcomes (hazard ratio: 2.3; 95% confidence interval, 1.34-6.52; P = .018). Even when CM exposure does not cause CI-AKI in patients with impaired renal function, in the long term, primary end points occur more frequently in patients exposed to CM than in those with no CM exposure.
Left ventricular outflow tract pseudoaneurysm is a rare but a potentially lethal complication, ma... more Left ventricular outflow tract pseudoaneurysm is a rare but a potentially lethal complication, mainly after aortic root endocarditis or surgery. Usually, it originates from a dehiscence in the mitral-aortic intervalvular fibrosa and arises posteriorly to the aortic root. We report a rare case of a patient with cardiac tamponade due to left ventricular pseudoaneurysm after aortic valve replacement. The subsequent surgical resection was performed successfully.
Journal of the American College of Cardiology, 2013
In this study we aimed to investigate whether there is an association between mean platelet volum... more In this study we aimed to investigate whether there is an association between mean platelet volume (MPV), gamma glutamyl transferase (GGT), uric acid and coronary artery ectasia (CAE) in a large patient population. Methods: A total of 406 patients (245 male, mean age 55AE9 years) were selected as study population in a retrospective manner from 3265 individuals who have undergone coronary angiography between August 2011 and December 2012. Study population was consisting of four groups including 117 (%29) patients with isolated CAE, 109 (%27) patients with both CAE and severe stenosis in at least one coronary artery, 104 (%26) patients with isolated significant coronary stenosis and 76 (%18)patients with normal coronary arteries (NCA) as control group. Detailed evaluation of all coronary angiograms was performed by two experienced interventional cardiologist. Information regarding blood tests of patients obtained during hospitalisation were extracted from Institute electronic database. Results: MPV, GGT, and uric acid levels were significantly higher in subjects with stenotic coronary artery disease (CAD) and in subjects with both CAD and CAE compared with subjects with isolated CAE and subjects with NCA. There were no significant differences between subjects with isolated CAE and NCA groups in terms of MPV (8.6AE1.2 fL to 8.6AE1.1, p¼0.993), serum GGT (33AE15 U/L to 30AE15 U/L, p¼0.723) and uric acid levels (5.4AE1.6 mg/dl to 5.2AE1.7 mg/dl, p¼0.845). Conclusıon: Unlike with previous studies our study failed to demonstrate any association between CAE and MPV, uric acid and GGT levels.
Journal of Clinical Pharmacy and Therapeutics, 2013
Although many studies have examined medication adherence in patients with coronary artery disease... more Although many studies have examined medication adherence in patients with coronary artery disease (CAD), no prospective trial has compared medication adherence between patients treated with percutaneous coronary intervention (PCI) or with optimal medical therapy (OMT) in real life. This study sought to compare the adherence to evidence-based secondary preventive medications in patients with documented CAD treated with PCI and OMT, or OMT alone. We evaluated adherence to statins, beta-blockers, and angiotensin converting enzyme inhibitors (ACEI) during a 6-month follow-up in 232 patients with documented CAD, comparing patients treated with PCI and those receiving medical therapy alone. Medication adherence was measured with reference to national reimbursement database records. Of the 232 patients who survived the 6-month follow-up, the percentages of adherent patients according to prescription records (prespecified primary endpoint) were 53·6% (n = 82) in the PCI group and 33·8% (n = 27) in the OMT group (P = 0·004). Analysis of the individual medication classes revealed similar results for beta-blockers (86·0% in PCI group vs. 72·5% in OMT group, P = 0·006) and statins (64·5% in PCI group vs. 44·0% in OMT group, P = 0·003). Adherence to ACEI was also higher in the PCI group, but the difference was not statistically significant (77·6% vs. 69·3%, P = 0·17). By logistic regression analysis, belonging to the PCI group was an independent predictor of medication adherence [B = 2·20 (1·06-4·50), P = 0·03)]. In the present study we demonstrated that adherence to evidence-based medication therapies in patients treated with PCI is significantly higher than in patients treated with OMT alone. Medication adherence should be followed carefully in CAD patients treated with OMT.
Discontinuation of metformin treatment in patients scheduled for elective coronary angiography (C... more Discontinuation of metformin treatment in patients scheduled for elective coronary angiography (CAG) is controversial because of post-procedural risks including acute contrast-induced nephropathy (CIN) and lactic acidosis (LA). This study aims to discuss the safety of continuing metformin treatment in patients undergoing elective CAG with normal or mildly impaired renal functions. Our study was designed as a single-centered, randomized, and observational study including 268 patients undergoing elective CAG with an estimated glomerular filtration rate of >60 mL/min/1.73 m2. Of these patients, 134 continued metformin treatment during angiography, whereas 134 discontinued it 24 h before the procedure. CIN was defined as either a 25% relative increase in serum creatinine levels from the baseline or a 0.5 mg/dL increase in the absolute value that measured 48 h after CAG. Logistic regression analysis was performed to identify independent predictors of CIN and LA after CAG. Both groups ...
Ö Z E T Aralık 1982 ile Mayıs 1995 tarihleri arasında İÜ Kar diyoloji Enstitüsü'ne başvuran ... more Ö Z E T Aralık 1982 ile Mayıs 1995 tarihleri arasında İÜ Kar diyoloji Enstitüsü'ne başvuran 2691 akut myokard infarktüslü (AMI) hastadan ventriküler septum rüptürü (VSR) saptanan 22 hasta retrospektif olarak incelendi. Medikai (11 hasta, grup A) ve cerrahi tedavi (11 hasta, grup B) uygulanan hastalarda rüptür oluş zamanının, hemodlnamik özelliklerin ve multisistem bozukluklarının mortaliteye olan etkisi araştırıldı.
To compare the long-term clinical outcomes between Resolute zotarolimus-eluting stent (R-ZES) and... more To compare the long-term clinical outcomes between Resolute zotarolimus-eluting stent (R-ZES) and paclitaxel-eluting stent (PES) in patients with small coronary artery disease. Patients with a small vessel diameter are independently associated with increased risk of adverse cardiac events after drug-eluting stent implantation. A cohort of 265 patients treated with R-ZES (185 patients with 211 lesions) or PES (80 patients with 100 lesions) in small vessel (≤2.5 mm) lesions were retrospectively analyzed. The primary end point of the study was the composite of major adverse cardiac events. The secondary end points included target lesion revascularization (TLR), target vessel revascularization (TVR), and stent thrombosis at 3 years. The baseline characteristics were similar between the 2 groups. In the R-ZES group, the mean stent diameter was smaller and the total stent length per lesion was longer. Major adverse cardiac events occurred in 8 (10%) patients who had received PES and in 7 ...
OBJECTIVE: P-wave dispersion (PD) is an indicator of inhomogeneous and discontinuous propagation ... more OBJECTIVE: P-wave dispersion (PD) is an indicator of inhomogeneous and discontinuous propagation of sinus impulses. In the present study we aimed to investigate the PD and its association with the severity of the disease. in patients with stable coronary artery disease. METHODS: We prospectively analyzed 60 subjects with coronary artery disease (CAD) and 25 subjects with normal coronary angiograms (control group). The maximum and minimum P-wave duration and PD were measured from the 12-lead surface electrocardiograms. The CAD severity was assessed by the severity score (Gensini score) and the number of vessels involved (vessel score). RESULTS: P max was longer in CAD group compared with the control group (p<0.001). PD was greater in the CAD group, compared with the control group (p<0.001). However, P min did not differ between the two groups. In bi-variate correlation, increased PD was correlated with presence of diabetes mellitus (r=0.316, p=0.014), smoking (r=0.348, p=0.006), left ventricular ejection fraction (r=-0.372, p=0.003), vessel score (r=0.848, p=0.001), and Gensini score (r=0.825, p=0.001). Multiple linear regression analysis showed that PD was independently associ¬ated with vessel score ((3=0.139, p=0.002) and Gensini score ((3=0.132, p=0.007). CONCLUSION: PD was greater in patients with CAD than in controls and it was associated with CAD severity.
We assessed the relation between platelet-to-lymphocyte ratio (PLR) on admission and contrast-ind... more We assessed the relation between platelet-to-lymphocyte ratio (PLR) on admission and contrast-induced nephropathy (CIN) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). A total of 488 patients with NSTE-ACS who underwent urgent coronary angiography were enrolled. Levels of PLR and creatinine were measured before angiography and at 72 hours after angiography. Patients were divided into 2 groups, namely, the CIN group, 80 patients (16.3%; age 65.3 ± 12.5years; 66.7% men) and the non-CIN group, 408 patients (83.7%; age 61.2 ± 12.3 years; 72.5% men). Patients in the CIN group had significantly higher PLR than those in the non-CIN group (152.9 ± 99.6 vs 120.4 ± 66.1, P < .001). In logistic regression analysis, PLR (odds ratio [OR] 1.004, 95% confidence interval [CI] 1.001-1.007, P = .02), diabetes mellitus (OR 1.75, 95% CI 1.02-2.98, P = .03), and ST-segment depression on admission electrocardiogram (OR 1.68, 95% CI 1.00-2.81, P = .04) were independent pre...
A 64-year-old woman with the diagnosis of acute anterior infarction was treated with streptokinas... more A 64-year-old woman with the diagnosis of acute anterior infarction was treated with streptokinase, i.v. heparin, and aspirin. After 20 hours of hospitalization she developed hypotension and a fall in hematocrit level with acute onset of severe abdominal pain. After genitourinary and gastrointestinal bleeding, pulmonary embolism and reinfarction had been ruled out, however, abdominal ultrasonography revealed intraabdominal hemorrhage and the patient was given three units of blood transfusion. Abdominal laparotomy and laparoscopy were not performed as the patient's clinical status stabilized on the 3rd day and hemodynamics did not deteriorate thereafter. Abdominal computerized tomography in the second week revealed a splenic rupture.
JPMA. The Journal of the Pakistan Medical Association, 2014
To demonstrate the presence and importance of apoptotic activity in heart failure during acute ex... more To demonstrate the presence and importance of apoptotic activity in heart failure during acute exacerbations and to investigate the effects of different drugs used and co-morbidities on levels of N-Terminal pro-Brain Natriuretic Peptide and apoptotic activity on admission and during hospitalisation. The descriptive study was conducted at the emergency department of Istanbul University Cardiology Institute between October 2010 and May 2011 and comprised patients with complaints of shortness of breath, and who were evaluated as acutely exacerbated decompensated heart failure with an aetiology of ischaemic or dilated cardiomyopathy. Apoptotic activity and N-Terminal pro-Brain Natriuretic Peptide levels were measured on admission and on the seventh day of treatment. SPSS 15 was used for statistical analysis. Of the 89 patients in the study, 67(75%) were males. Overall mean age of the study sample was 61 +/- 12 years. Patients who had N-Terminal pro-Brain Natriuretic Peptide levels highe...
Aim Spontaneous reperfusion (SR) was associated with better clinical outcomes and lower incidence... more Aim Spontaneous reperfusion (SR) was associated with better clinical outcomes and lower incidence of major adverse cardiovascular events. Endothelin-1 (ET-1) is a potent endothelium-derived vasoconstrictor peptide and elevated systemic ET-1 levels predict a poor prognosis in patients with ST-segment elevation myocardial infarction (STEMI). We aimed to investigate the relationship between systemic ET-1 plasma levels and SR in a group of STEMI patients treated with a primary percutaneous coronary intervention (PCI). Methods and results We measured ET-1 levels acutely (within the first 6 h) in 33 STEMI patients with SR and 45 STEMI patients with non-SR presenting with their first STEMI who underwent primary PCI. Blood samples for ET-1 plasma level measurement were drawn after vascular puncture before angiography in the catheterization laboratory from the peripheral vein. The mean age of the patients was 56.1 ± 13.3 years in the SR group and 57.4 ± 11.4 years in the non-SR group. The circulating level of ET-1 was considerably higher in the non-SR patients than in the SR patients (0.81 ± 0.2, 1.0 ± 0.3, P = 0.004). On multivariable logistic regression analysis, the ET-1 level was the only significant predictor of SR (P = 0.01). The receiver operating characteristic curve analysis showed that the ET-1 level at admission is an indicator of SR, with an area under the curve of 0.62. Conclusion This study shows that in patients admitted with ST-elevation acute myocardial infarction, ET-1 plasma levels are related to angiographic SR before primary PCI.
In this study, we investigated the role of radionuclide venography in the diagnosis of abnormal s... more In this study, we investigated the role of radionuclide venography in the diagnosis of abnormal subclavian venous flow due to the lead in patients (pts) with permanent pacemakers. The study was conducted with 53 frames in 52 asymptomatic pts (26 females, mean age 64.5 +/- 15; range 25-89 years). The mean time after implant was 67.6 +/- 47.5 months. Technetium 99m pertecnetate (250 MBq) was given to both antecubital veins simultaneously. The images were acquired in 0.25-second frames for 20 seconds. The pts were evaluated visually in terms of the activity flow through the subclavian veins bilaterally. The retrograde flow in the jugular vein, decrease in flow rate, and subtotal and total obstruction of the subclavian veins were accepted as abnormal venous flow patterns. In 17 pts with abnormal findings, 10 (58.8%) had retrograde flow in the jugular vein, 4 had (23.5%) decreased flow rate, 1 (5.8%) had subtotal and 2 (11.7%) total obstruction in the subclavian vein. The mean of the body diameter of the leads was significantly greater and the percentage of the silicone-insulated leads was higher (76% vs 52%) in the group with abnormal flow. No complication due to the procedure was seen. In conclusion, radionuclide venography, a noninvasive method, may be used easily and safely to show the venous flow abnormalities due to the lead in pts with permanent pacemakers. The abnormal subclavian venous flow was especially seen in pts who had larger leads.
Hyperglycemia on admission is associated with increased mortality rates in patients with ST-eleva... more Hyperglycemia on admission is associated with increased mortality rates in patients with ST-elevation myocardial infarction (STEMI) who are treated with either fibrinolytic therapy (FT) or primary percutaneous coronary intervention (PCI). However, data regarding the relationship between hyperglycemia and the success of FT are lacking. The aim of this study was to investigate the value of admission blood glucose for the prediction of failed reperfusion following FT. This is a retrospective study of 304 STEMI patients who received FT and whose admission glucose levels were recorded. The main outcome measure was ST segment resolution ≥50 %. The median (interquartile range [IQR]) blood glucose level in the entire study group was 112 (95-153). In 92 (30.2 %) patients, FT was unsuccessful and rescue PCI was performed. Admission glucose (126 [99-192] vs. 110 [94-144] mg/dL, 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;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;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), time from symptom onset to FT (180 [120-270] vs. 150 [120-180] min, p = 0.009), and maximum ST elevation amplitude (3 [2-7] vs. 3 [2-6] mm, p = 0.05) were higher in the failed reperfusion group than in the reperfusion group. Admission hyperglycemia was an independent predictive factor for failed reperfusion (hazard ratio 4.79 [1.80-12.76], p = 0.002), along with time from symptom onset to fibrinolysis and anterior wall myocardial infarction. In patients with STEMI who undergo FT, admission hyperglycemia is an independent predictor of the failure of fibrinolysis.
Contrast medium-induced acute kidney injury (CI-AKI) is associated with morbidity and mortality, ... more Contrast medium-induced acute kidney injury (CI-AKI) is associated with morbidity and mortality, but the long-term outcomes of patients who do not develop CI-AKI remain unknown. We assessed clinical end points during long-term follow-up in patients at high risk for nephropathy who did not develop CI-AKI. Patients (n = 135) with impaired renal function (estimated glomerular filtration rate: 30-60 mL/min/1.73 m2) were divided into 2 groups according to contrast media (CM) exposure. The primary end point of this study was a composite outcome measure of death or renal failure requiring dialysis. Multivariate analyses identified CM exposure to be independently associated with major adverse long-term outcomes (hazard ratio: 2.3; 95% confidence interval, 1.34-6.52; P = .018). Even when CM exposure does not cause CI-AKI in patients with impaired renal function, in the long term, primary end points occur more frequently in patients exposed to CM than in those with no CM exposure.
Left ventricular outflow tract pseudoaneurysm is a rare but a potentially lethal complication, ma... more Left ventricular outflow tract pseudoaneurysm is a rare but a potentially lethal complication, mainly after aortic root endocarditis or surgery. Usually, it originates from a dehiscence in the mitral-aortic intervalvular fibrosa and arises posteriorly to the aortic root. We report a rare case of a patient with cardiac tamponade due to left ventricular pseudoaneurysm after aortic valve replacement. The subsequent surgical resection was performed successfully.
Journal of the American College of Cardiology, 2013
In this study we aimed to investigate whether there is an association between mean platelet volum... more In this study we aimed to investigate whether there is an association between mean platelet volume (MPV), gamma glutamyl transferase (GGT), uric acid and coronary artery ectasia (CAE) in a large patient population. Methods: A total of 406 patients (245 male, mean age 55AE9 years) were selected as study population in a retrospective manner from 3265 individuals who have undergone coronary angiography between August 2011 and December 2012. Study population was consisting of four groups including 117 (%29) patients with isolated CAE, 109 (%27) patients with both CAE and severe stenosis in at least one coronary artery, 104 (%26) patients with isolated significant coronary stenosis and 76 (%18)patients with normal coronary arteries (NCA) as control group. Detailed evaluation of all coronary angiograms was performed by two experienced interventional cardiologist. Information regarding blood tests of patients obtained during hospitalisation were extracted from Institute electronic database. Results: MPV, GGT, and uric acid levels were significantly higher in subjects with stenotic coronary artery disease (CAD) and in subjects with both CAD and CAE compared with subjects with isolated CAE and subjects with NCA. There were no significant differences between subjects with isolated CAE and NCA groups in terms of MPV (8.6AE1.2 fL to 8.6AE1.1, p¼0.993), serum GGT (33AE15 U/L to 30AE15 U/L, p¼0.723) and uric acid levels (5.4AE1.6 mg/dl to 5.2AE1.7 mg/dl, p¼0.845). Conclusıon: Unlike with previous studies our study failed to demonstrate any association between CAE and MPV, uric acid and GGT levels.
Journal of Clinical Pharmacy and Therapeutics, 2013
Although many studies have examined medication adherence in patients with coronary artery disease... more Although many studies have examined medication adherence in patients with coronary artery disease (CAD), no prospective trial has compared medication adherence between patients treated with percutaneous coronary intervention (PCI) or with optimal medical therapy (OMT) in real life. This study sought to compare the adherence to evidence-based secondary preventive medications in patients with documented CAD treated with PCI and OMT, or OMT alone. We evaluated adherence to statins, beta-blockers, and angiotensin converting enzyme inhibitors (ACEI) during a 6-month follow-up in 232 patients with documented CAD, comparing patients treated with PCI and those receiving medical therapy alone. Medication adherence was measured with reference to national reimbursement database records. Of the 232 patients who survived the 6-month follow-up, the percentages of adherent patients according to prescription records (prespecified primary endpoint) were 53·6% (n = 82) in the PCI group and 33·8% (n = 27) in the OMT group (P = 0·004). Analysis of the individual medication classes revealed similar results for beta-blockers (86·0% in PCI group vs. 72·5% in OMT group, P = 0·006) and statins (64·5% in PCI group vs. 44·0% in OMT group, P = 0·003). Adherence to ACEI was also higher in the PCI group, but the difference was not statistically significant (77·6% vs. 69·3%, P = 0·17). By logistic regression analysis, belonging to the PCI group was an independent predictor of medication adherence [B = 2·20 (1·06-4·50), P = 0·03)]. In the present study we demonstrated that adherence to evidence-based medication therapies in patients treated with PCI is significantly higher than in patients treated with OMT alone. Medication adherence should be followed carefully in CAD patients treated with OMT.
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