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Cardiac hydatid cyst in the interventricular septum leading to symptoms of subaortic stenosis: a case report
(Turkish Soc Cardiology, 2007) Karadede, Aziz; Alyan, Omer; Karahan, Zulkuf
A 44-year-old man presented with a complaint of dyspnea on exertion. Transthoracic two-dimensional echocardiography showed a cystic lesion in the basal region of the interventricular septum, 4.5x8 cm in size, suggesting a hydatid cyst. Color Doppler echocardiography demonstrated turbulent flow and mild aortic and mitral insufficiency. An indirect hemagglutination test yielded a positive result. The patient refused surgical treatment. A month later, it was found that he had died during surgery for the hydatid cyst at another center.
Complete atrioventricular block and syncope during acute pulmonary thromboembolism: a case report
(Turkish Soc Cardiology, 2007) Alyan, Omer; Ozdemir, Ozcan; Kacmaz, Fehmi; Topaloglu, Serkan
The most common electrocardiographic (ECG) findings in acute pulmonary thromboembolism (PTE) are right bundle branch block, T wave, and ST-segment changes. Complete atrioventricular (AV) block has hitherto been reported in only one patient with PTE. A 63-year-old female patient presented with recurrent syncope and sudden-onset dyspnea. There was complete AV block in the admission ECG. She never had similar complaints before and an ECG taken three months before was completely normal. A temporary pacemaker was placed through the femoral vein. Physical and laboratory findings were suggestive of acute pulmonary embolism. Pulmonary artery angiography demonstrated nearly total occlusion of the proximal right pulmonary artery. Her coronary arteries were normal. Thrombolytic therapy with streptokinase infusion followed by standard heparin infusion resulted in clinical improvement and resolution of complete AV block. The patient was discharged on the 15th day with oral warfarin treatment.
Coronary narrowing secondary to compression by pericardial hydatid cyst
(Elsevier Ireland Ltd, 2008) Karadede, Aziz; Alyan, Omer; Sucu, Murat; Karahan, Zuelkuef
Echinococcus granulosus remains a clinical problem in undeveloped and developing countries. It commonly affects the liver and lung, but, rarely, other organs such as the heart can be involved. In this report, we describe an unusual case in which pericardial hydatid cyst mimicking acute coronary syndrome secondary to compression by pericardial hydatid cyst attached to the anterolateral wall of the left ventricle. We made diagnosis by transthoracic 2D echocardiography, and confirmed by cardiac magnetic resonance imaging and serologic tests. Because our patient refused to have an operation, albendazole therapy was given. It is important to recognize this unusual disease, because it may lead to serious complications. (c) 2007 Elsevier Ireland Ltd. All rights reserved.
Effects of cigarette smoking on heart rate variability and plasma N-terminal pro-B-type natriuretic peptide in healthy subjects
(Wiley, 2008) Alyan, Omer; Kacmaz, Fehmi; Ozdemir, Ozcan; Maden, Orhan; Topaloglu, Serkan; Ozbakir, Cemal; Metin, Fatma
Background: Cigarette smoking increased the risk of acute cardiac events related with endothelial dysfunction and increased sympathetic activity. Impaired autonomic nervous activity is recognized as a considerable symptom of cardiac dysfunction and is strongly associated with increased risk overall mortality. Methods: A total of 75 healthy habitual smokers (40 female, 35 male, mean age 36.5 +/- 8.5 years), and 73 non-smokers subjects (45 female, 28 male, mean age 34.6 +/- 7.2 years) were studied. LF and LF/HF ratio were significantly higher in smokers than in non-smokers. On the contrary, SDNN, SDANN, RMSSD, and HF values were lower in smokers compared to those in non-smokers. Not the duration of smoking but the number of cigarettes smoked per day was correlated with the HRV parameters and NT-pro BNP. Furthermore, the average levels of NT-pro BNP were found to be positively correlated with LF, LF/HF and inversely correlated with SDNN, SDANN, RMSSD and HF. Results: As a result, smoking impaires sympathovagal balance and decreases the heart rate variability in healthy subjects. And even a one cigarette smoking leads to overt sympathetic excitation. Furthermore, smoking results in an increase in NT-proBNP levels and the changes in adrenergic nervous system and NT-proBNP levels are well correlated. Conclusion: These findings could contribute to the higher rate of cardiovascular events in smokers.
Evaluation of oxidative stress in children with congenital heart defects
(Wiley, 2012) Pirinccioglu, Ayfer Gozu; Alyan, Omer; Kizil, Goksel; Kangin, Murat; Beyazit, Nurcan
Background: A significant cause of death and chronic illness in childhood is caused by cardiovascular diseases, including congenital heart disease (CHD). This study aims to investigate the oxidative stress status and to establish its association with CHD in children. Methods: The study involves measurements of malondialdehyde (MDA), protein carbonyl (PCO), total anti-oxidant capacity, high-sensitive C-reactive protein (hs-CRP), fibrinogen and cytokine (interleukin [IL-6] and tumor necrosis factor-alpha) levels in 43 children with CHD and 30 healthy age-matched children. Results: MDA, PCO, hs-CRP, fibrinogen, IL-6 and tumor necrosis factor-alpha were significantly elevated while total anti-oxidant capacity was significantly declined in patients compared with the controls. MDA was positively correlated with PCO, hs-CRP, Qp/Qs and systolic pulmonary artery pressure. PCO was positively correlated with hs-CRP, fibrinogen, IL-6 and systolic pulmonary artery pressure. Conclusion: Oxidative stress and its association with other markers in children with CHD was established. To the best of our knowledge, this is the first time that PCO has been used as a biomarker in CHD and it may be employed as a new diagnostic biomarker in CHD and in the assessment of its severity.
Hepatitis C Infection is Associated With Increased Coronary Artery Atherosclerosis Defined by Modified Reardon Severity Score System
(Japanese Circulation Soc, 2008) Alyan, Omer; Kacmaz, Fehmi; Ozdemir, Ozean; Deveci, Bulent; Astan, Ramazan; Celebi, Aksuyek Savas; Ilkay, Erdogan
Background The link between arteriosclerotic disease in the carotid or coronary artery and chronic hepatitis C virus (HCV) infection has been shown in some studies although other studies have produced contrary results. However, the effect of chronic HCV infection on the extension or severity of coronary artery disease (CAD) has not been determined so the aim of the present study was to determine the effect of HCV infection on the severity of CAD. Methods and Results The study group comprised 139 HCV seropositive and 225 HCV seronegative patients with angiographically documented CAD. A modified scoring system of Reardon et al was used. There were no significant differences between groups in terms of sex, age, hypertension, diabetes mellitus, smoking or family history. Levels of C-reactive protein and fibrinogen were significantly hi,,her in the HCV seropositive group (p<0.001) and the Reardon severity score was higher (8.75 +/- 1.69 vs 6.01 +/- 1.80, p<0.00 1). After adjustment, HCV scropositivity still represented an independent predictor for severity of coronary atherosclerosis demonstrated by higher Reardon severity score with an odds ratio of 2.018 (95% confidence interval 1.575-2.579, p<0.00 1). Conclusion HCV infection is an independent predictor for increased coronary atherosclerosis, as demonstrated by higher Reardon severity score. (Circ J 2008; 72: 1960- 1965)
High levels of high sensitivity C-reactive protein predict the progression of chronic rheumatic mitral stenosis
(Springer, 2009) Alyan, Omer; Metin, Fatma; Kacmaz, Fehmi; Ozdemir, Ozcan; Maden, Orhan; Topaloglu, Serkan; Demir, Ahmet Duran
Background High sensitive C-Reactive Protein (hs-CRP) predicts morbidity and mortality in various clinical conditions. The effect of hsCRP on progression of chronic rheumatic mitral stenosis (CRMS) has not been demonstrated. Methods and results A total of 132 patients with CRMS (95 female, 37 male) and 145 control (100 female, 45 male) were included in the study. Baseline clinical, echocardiographic, hematologic and hs-CRP measurements were collected prospectively. Mean mitral valve area (MVA) was 1.4 +/- 0.3 cm(2), mean wilkins valve score value was 8.9 +/- 1.7, left atrial diameter was 5.0 +/- 0.7 cm, left atrial area was 37.2 +/- 12.6 cm(2), and systolic pulmonary arterial pressure (SPAP) was 44 +/- 11 mmHg in patients with CRMS. The mean levels of hs-CRP value, fibrinogen, and mean platelet volume (MPV) were significantly higher in CRMS group compared to control group. The levels of hsCRP were found to be positively correlated with mean Wilkins valve score value, SPAP, presence of atrial fibrillation (AF), left atrial diameter, left atrial area, presence of LASEC(+), fibrinogen, and MPV and inversely correlated with MVA in patients with CRMS. Linear regression analysis revealed that the hsCRP level independently affects mean Wilkins valve score value, left atrial area (LAA), LASEC(+) and AF in the patients with CRMS. Conclusions These results suggest that increased hsCRP levels are associated with CRMS severity. These association may be important when treating patients with CRMS.
High levels of high-sensitivity C-reactive protein and impaired autonomic activity in smokers
(Turkish Soc Cardiology, 2008) Alyan, Omer; Kacmaz, Fehmi; Ozdemir, Ozcan; Karahan, Zulkuf; Taskesen, Tuncay; Iyem, Hikmet; Alan, Sait
Objectives: We investigated the relationship between high sensitivity C-reactive protein (hs-CRP) activity and autonomic nervous activity using heart rate variability in smokers. Study design: The study consisted of 136 healthy subjects, including 66 smokers (35 women, 31 men; mean age 36 years) and 70 nonsmokers (43 women, 27 men; mean age 34 years). Serum samples were collected from all the subjects. Three-channel, 24-hr Holter monitoring was performed to derive the mean heart rate, standard deviation of normal NN intervals (SDNN), standard deviation of 5-minute mean NN intervals (SDANN), root mean square differences of successive NN intervals (RMSSD), high-(HF) and low-(LF) frequency power components, and the LF/HF ratio. Results: In smokers, the mean duration of smoking was 13.6 +/- 8.2 years (range 3 to 45 years), and the mean number of cigarettes consumed per day was 16.3 +/- 7.1 (range 5 to 40). Smokers exhibited significantly higher mean heart rate, hs-CRP and fibrinogen levels, mean platelet volume, white blood cell count, LF, and LF/HF ratio, with significantly lower SDNN, SDANN, RMSSD, and HF values. In smokers, hs-CRP was correlated with the number of cigarettes consumed per day, duration of smoking, fibrinogen level, mean platelet volume, white blood cell count, LF, and LF/HF ratio, and inversely correlated with HF, SDNN, and SDANN. Even smoking a single cigarette resulted in an acute, 0.07-fold increase in the hs-CRP level (p< 0.0001). In linear regression analysis, both the number of cigarettes consumed per day (beta= 0.52, p= 0.011) and duration of smoking (beta= 0.073, p< 0.0001) had an independent effect on the hs-CRP level. Conclusion: Smoking both impairs the sympathovagal balance and increases the hs-CRP activity in otherwise healthy smokers, the combination of which would probably contribute to a higher rate of cardiovascular events.
Oxidative stress parameters in children with acute rheumatic fever
(Wiley, 2019) Pirinccioglu, Ayfer Gozu; Alyan, Omer; Akin, Alper; Kizil, Goksel; Isik, Fatma Birgul
Background The aim of this study was to investigate of the role of oxidative stress (OS) in acute rheumatic fever (ARF) and its relationship with the progress of the disease. Methods Thirty patients with ARF and 31 age-sex-matched healthy children were enrolled in this study. Serum malondialdehyde (MDA), protein carbonyl (PCO), high-sensitivity C-reactive protein (hs-CRP), cytokines (tumor necrosis factor-alpha and interleukin-6) and total antioxidant capacity (TAC) were measured. The diagnosis of ARF was based on the Jones criteria. Results Patients with ARF had significantly higher serum MDA, PCO, hs-CRP and cytokine levels and lower TAC than healthy controls. On Pearson's correlation analysis we found that oxidative stress markers were positively correlated with hs-CRP and cytokines, while TAC was negatively correlated with MDA, PCO, hs-CRP and cytokines. The number of valves involved as well as the level of mitral valve involvement was also significantly related to the oxidative stress parameters and TAC. All oxidative stress parameters decreased significantly with anti-inflammatory therapy while TAC increased. Conclusion Malondialdehyde and PCO, as biomarkers, as well as hs-CRP together with the other available diagnostic tools, can be used in the evaluation of patients with ARF.
Predictive value of serum NT-proBNP levels in type 2 diabetic people with diabetic nephropathy
(Elsevier Ireland Ltd, 2012) Danis, Ramazan; Ozmen, Sehmus; Arikan, Senay; Gokalp, Deniz; Alyan, Omer
Objective: The serum N-terminal fragment of pro brain natriuretic peptide (NT-proBNP) level in type 2 diabetic subjects with or without diabetic nephropathy (DN) is still unclear. We aimed to evaluate the relationship between serum NT-proBNP levels and different stages of diabetic nephropathy, and identify probable factors predicting serum NT-proBNP level. Subjects and methods: This cross-sectional study included 20 normoalbuminuric (Group-I), 28 microalbuminuric (Group-II), 20 macroalbuminuric type 2 diabetic patients (Group-III), and 20 healthy volunteers (Group-IV). Serum NT-proBNP levels were measured with highly sensitive and specific immunoassay. Results: Mean NT-proBNP levels were 32 +/- 55, 91 +/- 95, 331 +/- 297, 42 +/- 34 pg/ml for Groups I-IV, respectively. When patients with LVH were excluded, mean logNT-proBNP was still significantly higher in Group-III than all other groups. The three diabetic groups were similar in age, BMI, HbA1c, fasting serum glucose, and GFR. In a multivariate linear regression model, adjusting for factors significantly correlated with NT-proBNP levels, the patient group, presence of LVH, and hemoglobin remained as an independent predictor of serum NT-proBNP. These variables explained 68% of the variability of NT-proBNP (adjusted R-2 = 0.683). Conclusions: Mean serum NT-proBNP level of macroalbuminuric diabetic patients was higher than normoalbuminuric and microalbuminuric diabetic patients, and healthy control subjects even after exclusion of LVH. NT-proBNP may be a useful and predictive marker of diabetic nephropathy. (C) 2011 Elsevier Ireland Ltd. All rights reserved.
Relation between Serum Pro-Brain Natriuretic Peptide, Myoglobin, CK Levels and Morbidity and Mortality in High Voltage Electrical Injuries
(Japan Soc Internal Medicine, 2010) Orak, Murat; Ustundag, Mehmet; Guloglu, Cahfer; Gokhan, Servan; Alyan, Omer
Objective In our study, in addition to evaluating the relation between Pro-Brain natriuretic peptide (Pro-BNP), myoglobin and creatinine kinase (CK) levels and morbidity and mortality, we aimed at identifying the demographic characteristics of patients admited to emergency service after exposure to high electrical voltage. Methods In this prospective study, 48 emergency service patients exposed to high electric voltage were included; 19 healthy individuals were included as the control group. Their blood samples and electrocardiographies (ECG) were taken at the time of recourse upon their written approval. Demographic data and laboratory data were checked and compared among the patient group. We investigated the correlation between inpatients that had special clinical manifestations (escaratomy, fasciotomy, exitus, myoglobulinuria, third-degree burn, arrhythmia and etc.) and serum Pro-BNP, myoglobin and CK levels. Results When serum Pro-BNP, myoglobulin and CK levels were compared for the special clinical manifestations; the pro-BNP levels were statistically significantly higher in patients who had arrhythmia than in those without arrhythmia, and significantly higher in patients who died than in those who healed (respectively p=0.002 and p=0.007). In contrast, serum CK and myoglobin levels were not statistically significant. The serum CK and myoglobin levels were statistically significantly higher in patients who had third-degree burn than the others (p<0.001). Conclusion Serum pro-BNP level is a marker that can be used for mortality and morbidity with patients exposed to high voltage electrical injuries.
A retrospective investigation of clinical and laboratory findings in children with acute rheumatic fever, reactivation and compliance with prophylaxis
(Turkish Soc Cardiology, 2012) Pirinccioglu, Ayfer Gozu; Alyan, Omer; Kangin, Murat; Taskesen, Mustafa; Fidan, Mucahit; Mermutoglu, Nihat; Sen, Velat
Objectives: We aimed to retrospectively investigate the patients with acute rheumatic fever (ARF) by evaluating their clinic and laboratory properties, echocardiographic findings as well as the reactivation and the compliance to penicillin prophylaxis. Study design: The study involved 255 patients (143 boys, 112 girls; mean age 10.1 +/- 2.7 years) with ARF. Their sex, age, clinic and laboratory properties, echocardiographic findings, the reactivation and the compliance to penicillin prophylaxis were recorded. Results: Patients spent 13.3 +/- 4.3 days in the hospital, and 94 had a history of ARE. Arthritis was found in 233 patients, carditis in 166. Sydenham's chorea in 14, subcutaneous nodule in 2, and arthritis-carditis in 151 patients. Erythema marjinatum was not found in any patient. Arthralgia (n=15) and fever (n=246) were found in patients. Throat culture was positive in 94 patients and anti-streptolysin-O titers were high in 124 patients. Mitral involvement was found in 205 patients while the combination of mitral and aortic valve involvement were observed in 118 patients. Conclusion: ARF still continues to be a major public health problem in our country. A bad prognosis may be prevented by early diagnosis and treatment. The importance of appropriate prophylaxis should also be emphasized.
The role of the heart-type fatty acid binding protein in the early diagnosis of acute coronary syndrome and its comparison with troponin I and creatine kinase-MB isoform
(W B Saunders Co-Elsevier Inc, 2010) Orak, Murat; Ustundag, Mehmet; Guloglu, Cahfer; Ozhasenekler, Ayhan; Alyan, Omer; Kale, Ebru
Objectives: The aim of this study was to research the effectiveness of the heart-type fatty acid binding protein (H-FABP) in the early diagnosis of acute coronary syndrome (ACS) in patients admitted to emergency service (ES) within 6 hours of onset of chest pain. Equipment and Method: A total of 83 patients admitted with chest pain to our ES were included in this study. The patients were divided into 2 groups: those with a diagnosed ACS and those diagnosed with non cardiac-related chest pain. Patients were also were divided into 2 groups according to the time of admission: those admitted within 0 to 3 hours and 3 to 6 hours of onset of chest pain. Peripheral venous blood samples were obtained from all patients for H-FABP, troponin I, and creatine kinase-MB (CK-MB) serum concentration measurements. Results: Of a total of 83 patients, 21.6% (n = 18) were in the control group and 78.3% (n = 65) were in the ACS group. The average H-FABP value for the patients in the control group was 0.86 +/- 0.54 ng/mL. When the ACS and control groups were compared in means of cardiac markers for CK-MB (P = .000) and H-FABP (P = .000), there was a statistically significant difference, whereas no difference was observed for troponin I (P = .013). In the ACS group, H-FABP sensitivity for diagnosis was found to be 98% and specificity was 71%; CK-MB sensitivity was 86% and specificity was 52%; and troponin 1 sensitivity was 77% and specificity was 20%. Conclusions: For patients admitted with chest pain to ES, H-FABP was found to be more sensitive and specific than troponin I and CK-MB in the early diagnosis of ACS. (C) 2010 Elsevier Inc. All rights reserved.
Simultaneous ST-segment elevation in the precordial and inferior leads in acute myocardial infarction
(Turkish Soc Cardiology, 2007) Alyan, Omer; Metin, Fatma; Topaloglu, Serkan; Kacmaz, Fehmi
In general, ST-segment elevation in either the precordial or inferior leads is the most common electrocardiography (ECG) finding in patients with acute myocardial infarction (AMI). However, simultaneous ST-segment elevation in the precordial and inferior leads is a rare finding. A 48year-old male patient was admitted with a diagnosis of AMI upon detection of ST-segment elevation in the DI, aVL, and V1-6 leads and reciprocal changes in inferior leads. A subsequent ECG taken before submission to the cardiac catheterization laboratory showed that the STsegment approached the isoelectric line in the anterior leads, while remaining elevated in the D2, D3, and aVF leads. Coronary angiography revealed 95% stenosis in the left anterior descending (LAD) coronary artery with total occlusion distally, and some insignificant stenoses in the right coronary artery. A bare metal stent was placed in the LAD, with balloon dilatation of the distal lesion. He was discharged on the seventh day of admission.
Successful coronary sinus lead placement after stenting of coronary vein stenosis
(Oxford Univ Press, 2007) Demir, Ahmet Duran; Alyan, Omer; Kacmaz, Fehmi
In this paper, we describe a 62-year-old man with ischemic cardiomyopathy who underwent biventricular pacing and left ventricular lead could be implanted after stenting of a coronary vein stenosis.
Sympathetic overactivity in patients with pulmonary stenosis and improvement after percutaneous balloon valvuloplasty
(Wiley, 2008) Alyan, Omer; Ozdemir, Ozcan; Kacmaz, Fehmi; Topaloglu, Serkan; Ozbakir, Cemal; Gozu, Ayfer; Korkmaz, Sule
Objective: Percutaneous balloon valvulotomy (PBV) is the procedure of choice for the treatment of valvular pulmonary stenosis (PS) with similar results comparable to surgical valvotomy but less invasive. . Methods and Results: Twenty-seven consecutive patients with PS being evaluated for PBV were enrolled in the study. Peak instantaneous transvalvular gradient, right ventricle (RV) diameter, mean atrial pressures, RV systolic pressure (RVSP), pro-brain natriuretic peptide (proBNP) levels significantly decreased immediately after PBV. Regarding heart rate variability (HRV) parameters, mean HR (heart rate), LF (low frequency) day and night, LF/HF day and night significantly decreased and standard deviation of all NN intervals (SDNN), root mean square of successive differences (RMSSD), P number of NN intervals that differed by more than 50 ms from adjacent interval divided by the total number of all NN intervals (PNN50), HF (High frequency) day and night significantly increased 1 day after PBV and these changes were shown to be preserved at the first month. The increase in SDNN was correlated with the decrease in right atrial pressure (RAP) (r = -0.5, P = 0.04); the increase in standard deviation of the 5-minute mean RR intervals (SDANN) was correlated with the decrease in proBNP (r = -0.4, P = 0.03). Conclusions: Sympathetic overactivity and increased proBNP levels were associated with the symptomatic status of patients with PS. Associated with a decrease in atrial pressures and proBNP levels, PBV yielded a decrease in adrenergic overactivity in the patients with PS.

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