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Öğe Clopidogrel resistance in patients with type 2 Diabetes Mellitus: A comparison between oral antidiabetic agents and insulin(Drunpp-Sarajevo, 2012) Ariturk, Zuhal; Cil, Habib; Gunduz, Ercan; Yavuz, Celal; Kaya, Hasan; Ertas, Faruk; Oylumlu, MustafaBackground: Clopidogrel resistance has been found in certain patient populations, including patients with acute coronary syndrome, ischemic stroke, patients undergoing percutaneous coronary intervention with a drug-eluting stent, diabetes mellitus, ischemic stroke and stent restenosis. The aim of this study was to assess clopidogrel resistance in diabetic patients taking oral antidiabetic drugs and insulin. Methods and Results: Platelet aggregation was measured after clopidogrel treatment in 101 diabetic patients undergoing percutaneous coronary intervention. Two diabetic patient subpopulations were compared: patients who used insulin (group 1) and patients who used oral antidiabetic agents (group 2). Clopidogrel nonresponders and responders were defined by a relative inhibition of adenosine diphosphate (20 mol/L) induced platelet aggregation of < 10% and >= 30%, respectively. Among group 1 patients, 12.5% were clopidogrel nonresponders and Among group 2 patients, 9.4% were clopidogrel nonresponders. There were no statistical differences found between the two groups (P=0.618). Conclusions: This study demonstrates that there was no significant difference in the clopidogrel resistance between type 2 diabetes mellitus patients taking insulin or oral antidiabetes medication. The clinical implications of this finding are unknown and need to be evaluated in large-scale clinical trials.Öğe Comparison of left ventricular functional parameters obtained from three different commercial automated software cardiac quantification program packages and their intraobserver reproducibility(Springer, 2011) Dostbil, Zeki; Ariturk, Zuhal; Cil, Habib; Elbey, Mehmet Ali; Tekbas, Ebru; Yazici, Mehmet; Yildiz, IsmailObjective ECG-gated myocardial perfusion scintigraphy (MPS) can be used to determine several cardiac functional parameters (e. g., left ventricular ejection fraction (LVEF), end-diastolic volume (EDV), and end-systolic volume (ESV)). In this study, we aimed to compare these cardiac functional parameters calculated by the following cardiac quantification programs: Emory Cardiac Toolbox (ECTb), Quantitative Gated SPECT (QGS), and Myometrix. We also evaluated reproducibility of the cardiac programs. Methods Fifty-seven patients (27 male, 30 female) at Elazig Research and Training Hospital from 2008 to 2009 were included in this study. In all patients, (99m)Tc-MIBI ECG-Gated (8-bin frame mode) myocardial perfusion scintigraphies were performed. By using 3 different cardiac quantification programs (ECTb, QGS, and Myometrix); LVEF, EDV, and ESV were calculated. The same raw data of MPS images were reprocessed at different time periods, and these 3 parameters were recalculated. LVEF, EDV, and ESV yielded by 3 different programs were compared for interprogram variability assessment, and parameters calculated at two different time periods were compared to evaluate intraprogram reproducibility. Results There were statistically significant differences between ECTb, QGS, and Myometrix programs for LVEF, EDV, and ESV (p < 0.001). There was also a statistically significant correlation between LVEF and EDV (p < 0.001, r = 0.546; p < 0.001, r = 0.45, respectively), but no statistically significant correlation was present between the ESV values (p > 0.05, r = 0.09). Statistically significant differences were not found between the values of LVEF, EDV, and ESV obtained from the first and second reconstruction analysis of 3 cardiac quantification programs. Discussion Different MPS cardiac software programs give variable (but correlated) LVEF and left ventricular volumetric measures. Those obtained from different cardiac softwares cannot be used interchangeably. Our findings have shown that ECTb, QGS, and Myometrix programs are reproducible, with respect to LVEF, EDV, and ESV.Öğe Elevated plasma N-terminal pro-brain natriuretic peptide levels in acute ischemic stroke(Mosby-Elsevier, 2006) Iltumur, Kenan; Karabulut, Aziz; Apak, Ismail; Aluclu, Ufuk; Ariturk, Zuhal; Toprak, NizamettinBackground B-type natriuretic peptide (BNP) is a neurohormone secreted mainly in the cardiac ventricles in response to volume expansion and pressure overload. The aim of this study was to assess plasma N-terminal proBNP (NT-proBNP) changes in acute ischemic stroke (AIS). Methods The study group consisted of 57 (37 women aged 64 12 years) patients who had their first AIS and no history or signs of cardiovascular disease. An age-matched control group was also included (n = 57, 36 women aged 61 6 years). NT-proBNP, troponin I (TnI), and creatine kinase-MB were evaluated. A thorough cardiovascular and neurological investigation, including imaging techniques and lesion size determination, was also performed. Results The log NT-proBNP peak levels, TnI, and creatine kinase-MB levels were significantly higher in AIS compared with controls (7.25 +/- 1.77 vs 3.48 +/- 0.76 mu g/mL, P < .0001; 0.76 +/- 0.54 vs 0.5 +/- 0.0 ng/mL, P < .001; 57 +/- 37 vs 13 +/- 4 U/L, P < .001, respectively). The log NT-proBNP correlated positively with TnI (r = 0.29, P = .03) and heart rate (r = 0.41, P = .002), and negatively with left ventricular ejection fraction (r = -0.67, P < .0001). Patients with signs of marked myocardial ischemia and patients with insular cortex involvement had even higher NT-proBNP levels. After adjustment for relevant factors, the relation between the log NT-proBNP and AIS as well as insular cortex involvement was observed to be insignificant (P > .05 for both). Conclusions Our results show that NT-proBNP plasma levels are significantly elevated in AIS and might be of clinical importance as a supplementary tool for the assessment of cardiovascular function in patients with AIS.Öğe THE EVALUATION OF RELATIONSHIP BETWEEN PLASMA ASYMMETRIC DIMETHYLARGININE (ADMA) AND AORTIC STIFFNESS IN PATIENTS 'WITH SYSTEMIC SCLEROSIS(Nobel Ilac, 2013) Ariturk, Zuhal; Dag, Sevin; Elbey, M. Ali; Kaya, Hasan; Ertas, Faruk; Bozkurt, Mehtap; Cevik, RemziObjective: Endothelial dysfunction and vasculopathy are crucial pathogenic factors in systemic sclerosis. Increased concentrations of plasma asymmetric dimethylarginine (ADMA) may also contribute to endothelial dysfunction in patients with systemic sclerosis. We evaluated the relationship between ADMA and aortic elastic properties in patients with systemic sclerosis. Material and Method: Plasma ADMA levels were measured in 30 patients with systemic sclerosis (28females, mean age 40.7 +/- 11.6) and 30 healthy subjects (27 females, mean age 40.6 +/- 13). Aortic stiffness was determined with echocardiography Results: In patients with systemic sclerosis, the mean value of ADMA was 0.53 +/- 0.13ymolficompared with 0.46 +/- 0.15 mu mol/l for control group. Systolic blood pressure, pulse pressure and aortic 'strain' were found to be higher in patients with systemic sclerosis (p=0.027, p=0.048, p=0.037, respectively), diyastolic blood pressure and aortic distensibility was found lower in systemic sclerosis (p=0.039, p=0.045, respectively). There was no significant correlations between ADMA and aortic 'strain'. Conclusion: ADMA serum levels were increased in patients with systemic sclerosis, but no significant correlation was found between ADMA and aort's elastic structure (aortic 'strain', distensibility, and aortic stiffness index).Öğe Famotidine-induced acquired long QT syndrome: a case report(Aves Press Ltd, 2012) Tekbas, Ebru; Ariturk, Zuhal; Cil, Habib; Islamoglu, YahyaIt is known that a number of drugs caused acquired long QT syndrome. Although the often use of famotidine, acquired long QT syndrome associated with this drug has rarely been reported. We presented a case of famotidine associated with acquired long QT syndrome.Öğe Mean platelet volume in predicting short- and long-term morbidity and mortality in patients with or without ST-segment elevation myocardial infarction(Informa Healthcare, 2011) Tekbas, Ebru; Kara, Ali F.; Ariturk, Zuhal; Cil, Habib; Islamoglu, Yahya; Elbey, Mehmet A.; Soydinc, SerdarMean platelet volume (MPV) is a marker of platelet activation. An increased MPV is associated with acute myocardial infarction (AMI) and long-term mortality. The aim of this study was to compare MPV in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). Also, we investigated the value of MPV on in-hospital mortality and long-term prognosis of patients with STEMI and NSTEMI. We studied 429 patients with AMI (70.4% male, 61.9 +/- 12.4 years; 279 patients with STEMI, 150 patients with NSTEMI). MPV and platelet count were similar in both groups. Elevated MPV increased the risk of death by 3.1-fold (p < 0.001) in STEMI group during the hospitalization. However, increased MPV was not associated with in-hospital mortality in NSTEMI group. The area under the receiver operating characteristic curve of MPV was 0.868 (95% CI, 0.830-0.907) for predicting two-year mortality. A cut-off point of 11.1 fL showed a sensitivity of 81% and a specifity of 77% for prediction of two-year mortality. Kaplan-Meier survival curve showed two-year mortality rate of 12.5% in patients with MPV > 11.1 fL versus 9.9% in patients with MPV < 11.1 fL (p < 0.001). Cox regression analysis showed MPV to be an independent predictor of two-year mortality (Hazard ratio 1.7; 95% CI 1.5-1.9; p < 0.001). An increased MPV is an independent predictor of in-hospital mortality in patients with STEMI. However, elevated levels of MPV did not predict in hospital mortality in NSTEMI group. The increase in MPV values was independently correlated with two-year mortality in all study patients.Öğe Resolution of Intracoronary Thrombus with Tirofiban Infusion: A Case Report(Aves Press Ltd, 2010) Ariturk, Zuhal; Tekbas, Ebru; Cil, Habib; Islamoglu, Yahya; Elbey, M. Ali; Yazici, MehmetA 27 year-old man presented with chest pain lasting for fourteen-hour duration. The patient had electrocardiographic evidence of subacute anterior wall myocardial infarction. Coronary angiography revealed total occlusion of the left anterior descending coronary artery. Tirofiban infusion was administered for 48 hours. Then, coronary angiography showed intraluminal filling defects due to a massive thrombus in the proximal segment of the left anterior descending coronary artery. Vie present a case of effective thrombolysis with tirofiban in young myocardial infarction case.Öğe Simultaneous Occurrence of a Large Asymptomatic Prolapsing Left Atrial Myxoma with a Cutaneous Squamous Cell Carcinoma(Forum Multimedia Publishing, Llc, 2015) Iltumur, Kenan; Demir, Tolga; Ariturk, Zuhal; Toprak, Nizamettin; Oto, OztekinSynchronous myxoma of the heart and other malignancies are extremely rare. We report a case of a 64-year-old man who had a large left atrial myxoma that obstructed the mitral valve, as well as an unrelated, coexistent cutaneous squamous cell carcinoma in the sacral area. During the preoperative evaluation for non-cardiac surgery, the tumor was diagnosed coincidentally by echocardiographic examination. Echocardiography findings were consistent with a large left atrial myxoma originating from the posterior wall and prolapsing into the left ventricular cavity through the mitral valve, causing mitral stenosis. The mass was successfully completely excised. Histologic examination of the mass confirmed the diagnosis of cardiac myxoma. We report a casual echocardiographic finding of a left atrial myxoma that obstructed the mitral valve outflow tract, and an unrelated, synchronous cutaneous squamous cell carcinoma in the sacral area.Öğe Successful VT ablation in a patient with ventricular assist device and implantable cardiac defibrillator(Aves Yayincilik, 2011) Islamoglu, Yahya; Aktas, M. Kemal; Cil, Habib; Ariturk, Zuhal; Tekbas, Ebru; Elbey, Mehmet Ali[Abstract Not Available]
