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Öğe Assessment of myocardial performance index and its association with aortic elasticity in patients with ascending aortic aneurysm(Turkish Soc Cardiology, 2016) Baykan, Ahmet Oytun; Gur, Mustafa; Kalkan, Gulhan Yuksel; Acele, Armagan; Seker, Taner; Sen, Omer; Borekci, AbdurrezzakObjective: Ascending aortic aneurysms (AAA) are a leading cause of morbidity and mortality. Nevertheless, their effects on global cardiac functions are yet to be fully understood. Myocardial performance index (MPI) has been widely used to quantitatively assess myocardial functions. The aim of this study was to evaluate left ventricular (LV) functions in patients with AAA using tissue Doppler (TD) echocardiography and MPI in addition to conventional echocardiographic methods. Methods: Fifty patients with AAA (33 men, 17 woman; mean age 55.5+/-7.90 years) were included, and 106 patients without aortic dilatation (mean age 54.1+/-8.18 years) were included as the control group. LV systolic and diastolic functions were analyzed using 2-dimensional, M-mode, and TD echocardiography. Results: Patients with AAA had significantly higher MPI (0.5+/-0.04 vs 0.4+/-0.05, p<0.001), TD-MPI (0.5+/-0.02 vs 0.4+/-0.03, p<0.001), and reduced aortic elasticity, as indicated by reduced aortic distensibility (AD) (1.7+/-1.27 vs 3.1+/-1.25, p<0.001). Multivariate linear regression analysis showed that TD-MPI was independently correlated with reduced aortic distensibility (B=-0.006, p=0.019, 95% confidence interval,-0.011 to -0.001). Conclusion: MPI and TD-MPI indicated impairment of global cardiac functions in patients with AAA, which may be attributed to reduced aortic elasticity.Öğe Biventricular myocardial performance is impaired in proportion to severity of obstructive sleep apnea(Texas Heart Institute, 2016) Akyol, Selahattin; Çörtük, Mustafa; Baykan, Ahmet Oytun; Kiraz, Kemal; Börekçi, Abdürrezzak; Şeker, Taner; Gür, Mustafa; Çaylı, MuratObstructive sleep apnea (OSA) is an independent risk factor for cardiovascular morbidity and death. Little information is available regarding the relationship between the severity of OSA and myocardial performance in OSA patients who have normal ejection fractions. We prospectively investigated this relationship, using the tissue-Doppler myocardial performance index (TD-MPI). We conducted overnight, full-laboratory polysomnographic examinations of 116 patients, and calculated the left and right ventricular TD-MPIs. Patients were classified into 3 groups in accordance with their apnea-hypopnea index (AHI) levels: AHImild(?5 to <15), AHImoderate (?15 to <30), and AHIsevere (?30). Left and right ventricular TD-MPI values were higher in the AHIsevere group than in the AHImild and AHImoderate groups (all P <0.05). In addition, right ventricular TD-MPI values in the AHImoderate group were higher than those in the AHImild group (P <0.05). Right ventricular TD-MPI was significantly associated with AHI (?=0.468, P <0.001), left ventricular TD-MPI, and right ventricular early-to-late filling velocities (E/A ratio) in multiple linear regression analysis. On the other hand, left ventricular TD-MPI was significantly associated with right ventricular TD-MPI and left ventricular E/A ratio (both P <0.05). Our results show that OSA severity, determined by means of AHI, is independently associated with impaired right and left ventricular function as indicated by TD-MPI in patients who have OSA and normal ejection fractions.Öğe Both Systemic and Pulmonary Artery Stiffness Predict Ventricular Functional Recovery after Successful Percutaneous Closure of Atrial Septal Defects in Adults(Tech Science Press, 2016) Baykan, Ahmet Oytun; Gur, Mustafa; Acele, Armagan; Seker, Taner; Kalkan, Gulhan Yuksel; Sahin, Durmus Yildiray; Koc, MevlutBackgroundPercutaneous closure of atrial septal defect (ASD) has become the preferred method in treatment of the majority of cases. The aim of this study was to evaluate the echocardiographic effects of percutaneous closure of secundum ASD in adults and assess which parameters predict good response to closure. DesignWe prospectively included 42 patients with secundum ASD treated successfully with percutaneous device closure. All patients underwent transthoracic echocardiography examination with tissue Doppler imaging before, 24 hours after and within 3 months of intervention. Measurements of arterial stiffness were carried out using a Mobil-O-Graph arteriography system. ResultsRemodeling of heart chambers occurred immediately and persisted at 3 months after ASD closure. Significant decreases were observed in right ventricle (RV) end-diastolic diameter, right atrium volume index, and tricuspid annular plane systolic excursion both after the procedure and at 3 months (P<.01 for all). The RV and left ventricle (LV) tissue Doppler-myocardial performance index demonstrated to decline during follow up (P=.0001). Significant correlations were found between pulse-wave velocity, augmentation index, pulmonary artery stiffness, and LV-RV tissue Doppler-myocardial performance index at third month. Linear regression analyses showed that pulse-wave velocity is the most effective parameter of LV and pulmonary artery stiffness is the most effective parameter of RV functional recovery, respectively, assessed by tissue Doppler-myocardial performance index. ConclusionsPercutaneous closure of secundum ASD in adults has various sustained benefits on multiple echocardiographic parameters within 3 months. The changes in RV and LV function after device closure were significantly correlated with the degree of pulmonary artery stiffness and pulse-wave velocity, respectively.Öğe Coronary collateral development and arterial stiffness in patients with chronic coronary total occlusions(Taylor & Francis Ltd, 2015) Baykan, Ahmet Oytun; Gur, Mustafa; Acele, Armagan; Seker, Taner; Quisi, Alaa; Yildirim, Arafat; Cayli, MuratObjective. Coronary collateral circulation (CCC) mainly develops through arteriogenesis in response to shear forces. Increased arterial stiffness (AS) causes decreased coronary perfusion, which may reduce shear stress, arteriogenesis, and thus collateral formation. The aim of this study was to assess the relationship between CCC and AS in patients with chronic coronary total occlusion (CTO). Design. We prospectively enrolled 163 patients with CTO. Patients were divided into two groups according to their Rentrop scores: (a) poorly developed (PD) CCC group (Rentrop 0-1) and (b) well-developed (WD) CCC group (Rentrop 2-3). AS measurements were carried out using a Mobil-O-Graph arteriography system. Results. Fasting glucose, creatinine, uric acid, neutrophil count, and neutrophil-to-lymphocyte ratio were found to be higher in patients with PD-CCC. Moreover, patients with PD-CCC had significantly higher augmentation index (AIx) and pulse wave velocity (PWV) compared with WD-CCC group (27.3 +/- 8.9 vs. 18.7 +/- 7.4, p < 0.001 and 11.7 +/- 2.6 vs. 8.5 +/- 1.4, p < 0.001, respectively). In multivariate logistic regression analysis, PWV, AIx, and serum uric acid were found to be independently associated with the development of CCC. Conclusion. AS parameters, such as AIx and PWV, as well as serum uric acid are independently associated with the development of CCC in stable coronary artery disease with CTO.Öğe Coronary Flow Velocity Reserve in Donor Artery and Myocardial Performance Index After Successful Recanalization of Chronic Total Coronary Occlusions(H M P Communications, 2015) Baykan, Ahmet Oytun; Kalkan, Gulhan Yuksel; Sahin, Durmus Yildiray; Elbasan, Zafer; Gur, Mustafa; Seker, Taner; Turkoglu, CanerBackground. Percutaneous recanalization of chronic total coronary occlusion (CTO) tends to show a positive effect on left ventricular remodeling and ejection fraction (LVEF). Coronary flow velocity reserve (CFVR) is an important diagnostic index of the functional capacity of coronary arteries. The aim of this study was to evaluate, by non-invasive CFVR, whether the blood flow of donor artery reverts to normal after CTO percutaneous coronary intervention (PCI). Also, we assessed the effects of CTO recanalization on global cardiac functions by using myocardial performance index (MPI). Methods. We evaluated 25 patients (mean age, 57.5 +/- 14.1 years) who underwent CTO-PCI of the right coronary artery, whose collaterals were provided by the left anterior descending (LAD) artery. The coronary flow velocities in the distal LAD were measured using transthoracic echocardiography (TTE) before, 24 hours after, and within 3 months of PCI. Both two-dimensional and tissue Doppler (tD) echocardiography were used to calculate MPI. Results. CFVR at month 3 was significantly increased compared to the basal and early CFVR (1.8 +/- 0.3 vs 2.3 +/- 0.3 [P<.001] and 1.8 +/- 0.2 vs 2.3 +/- 0.3 [P<.001], respectively). MPI at month 3 was significantly decreased compared to the basal and early MPI (0.61 +/- 0.09 vs 0.53 +/- 0.07 [P<.001] and 0.60 +/- 0.08 vs 0.53 +/- 0.07 [P<.001], respectively). Also, tD-MPI within 3 months was significantly decreased (0.58 +/- 0.9 vs 0.53 +/- 0.8 [P=.01] and 0.57 +/- 0.07 vs 0.53 +/- 0.8 [P<.001], respectively, for tD-MPI septal and 0.59 +/- 0.08 vs 0.51 +/- 0.07 [P<.001] and 0.58 +/- 0.08 vs 0.51 +/- 0.07 [P<.001], respectively, for tD-MPI lateral). Conclusion. Successful recanalization of CTO results in increased CFVR-indicated blood flow in the donor artery and MPI-indicated global cardiac functions.Öğe Coronary Flow Velocity Reserve in Patients with Ascending Aorta Aneurysm(Wiley-Blackwell, 2015) Baykan, Ahmet Oytun; Kalkan, Gulhan Yuksel; Gur, Mustafa; Ucar, Hakan; Acele, Armagan; Seker, Taner; Sen, OmerBackgroundAscending aorta aneurysms (AAA) are one of the leading causes of morbidity and mortality. Impairment in coronary flow may contribute to cardiovascular consequences in AAA patients. Coronary flow velocity reserve (CFVR) has been considered an important diagnostic index of the functional capacity of coronary arteries noninvasively. The aim of this study was to evaluate, by noninvasive CVFR, whether patients with AAA demonstrate significant coronary microvascular dysfunction in the absence of coronary artery disease (CAD). MethodsWe prospectively included 44 patients with thoracic AAA in the absence of concomitant CAD (30 men, 14 women; mean age 57.58.4years). A total of 36 patients without aortic dilatation (mean age 55.29.9years) were selected as the control group. Coronary flow velocities in the distal left anterior descending (LAD) artery were measured using transthoracic echocardiography. CFVR was calculated as the hyperemic to resting coronary diastolic peak velocities ratio. ResultsCompared with controls, patients with AAA had higher baseline LAD peak diastolic coronary flow velocities (28.3 +/- 5.8 vs. 25.2 +/- 4.5cm/sec, P=0.01), lower hyperemic LAD flow velocities (54.0 +/- 10.3 vs. 57.2 +/- 12.7cm/sec, P=0.220), and consequently lower CFVR (1.9 +/- 0.3 vs. 2.3 +/- 0.5, P<0.001). Multivariate linear regression analysis showed that CFVR was independently associated only with aortic systolic diameter (AoSD) (=-0.679, P=<0.001). ConclusionsOur study demonstrates that noninvasive CFVR is significantly reduced in patients with AAA and AoSD is the most important determinant of impaired CFVR.Öğe Epicardial fat thickness as associated with left ventricular myocardial performance in patients with newly diagnosed hypertension(Turkish Soc Cardiology, 2015) Borekci, Abdurrezzak; Gur, Mustafa; Seker, Taner; Ucar, Ayse Kalyoncu; Baykan, Ahmet Oytun; Elbasan, Zafer; Harbalioglu, HazarObjective: Epicardial fat thickness (EFth) is associated with both left ventricular hypertrophy (LVH) and diastolic dysfunction. However, the effect of EFth on myocardial performance is not known. The aim of this study was to investigate the relationship between EFth and tissue Doppler myocardial performance index (TD-MPI), which incorporates both systolic and diastolic left ventricular (LV) function, in newly diagnosed hypertension (HT) patients. Methods: A total of 314 consecutive, newly diagnosed HT patients were prospectively included (mean age: 51.9 +/- 1.7 years). EFth was measured perpendicularly on the free wall of the right ventricle at the end of the systole in 2 echocardiographic views (parasternal short and long axis). Myocardial performance index (MPI) was calculated using tissue Doppler (TD) echocar-diography. Patients were divided into 2 groups according to median TD-MPI levels (TD-MPIlow and TD-MPIhigh). Results: EFth values of the TD-MPIhigh group were higher than those of the TD-MPIlow group (p<0.05). Patients in the TD-MPIhigh group also had higher age, body mass index, systolic blood pressure (SBP), diastolic blood pressure (DBP), left ventricular mass index (LVMI), E/A ratio, and aortic distensibility, compared with the TD-MPIlow group (p<0.05 for all). Multivariate linear regression analysis showed that TD-MPI was independently associated with age (beta= 0.089, p= 0.012), LVMI (beta= 0.090, p= 0.05), E/A (beta=-0.118, p=0.005), and EFth (beta= 0.432, p<0.001). Conclusion: TD-MPI was independently associated with EFth in patients with newly diagnosed HT. EFth may be used as a predictor of impaired LV global functions in patients with normal left ventricular ejection fraction (LVEF) and newly diagnosed HT.Öğe Neutrophil to Lymphocyte Ratio Predicts Left Ventricular Remodeling in Patients with ST Elevation Myocardial Infarction after Primary Percutaneous Coronary Intervention(Korean Soc Cardiology, 2016) Borekci, Abdurrezzak; Gur, Mustafa; Turkoglu, Caner; Baykan, Ahmet Oytun; Seker, Taner; Sahin, Durmus Yildiray; Harbalioglu, HazarBackground and Objectives: It has been demonstrated that the neutrophil/lymphocyte ratio (NLR) might be a useful marker to predict cardiovascular risk and events. We aimed to investigate the role of the NLR to predict ventricular remodeling (VR) in patients with anterior ST-elevation myocardial infarction (STEMI) who were treated with primary percutaneous coronary intervention. Subjects and Methods: We prospectively included 274 consecutive anterior STEMI patients. Echocardiography was performed during admission and at six months after myocardial infarction. VR was defined as at least 200/0 increase from baseline in left ventricular end diastolic volume. Patients were divided into two groups according to their VR status: VR (n=67) and non-VR (n=207). Total and differential leukocyte count, N -terminal pro -brain natriuretic peptide (NT-proBNP) and other biochemical markers were measured at admission and 24 hours later. Results: Compared with the non-VR group, peak creatine kinase MB (CK-MB), NT-proBNP (24 h), neutrophil/lymphocyte ratio, presence of diabetes, no-reflow frequency and wall motion score index were significantly higher in patients with VR (p<0.05 for all). On multivariate logistic regression analysis, NLR (beta=2.000, 950/o confidence interval=1.577-2.537, p<0.001) as well as peak CK-MB, NT-proBNP (24 h), WMSI and diabetes incidence were associated with VR. The cutoff value of the neutrophil/lymphocyte ratio obtained by receiver operator characteristic curve analysis was 4.25 for the prediction of VR (sensitivity: 79%, specificity: 74%). Conclusion: In patients with anterior STEMI, initial NLR and NT-proBNP measured 24 hours after admission may be useful for predicting adverse cardiovascular events including left VR.Öğe Predictors of successful percutaneous coronary intervention in chronic total coronary occlusions(Termedia Publishing House Ltd, 2016) Baykan, Ahmet Oytun; Gur, Mustafa; Acele, Armagan; Seker, Taner; Quisi, Alaa; Kivrak, Ali; Yildirim, ArafatIntroduction: Percutaneous coronary intervention (PCI) of chronic total coronary occlusions (CTOs) is one of the most challenging procedures of interventional cardiology and is associated with increased risk of significant complications. However, debate continues in regard to which factors adversely influence the success rate of PCI and whether the benefits of revascularization of CTO outweigh the risks and challenges. Aim: To analyze the relationship between lesion characteristics and overall success rates as well as in-hospital outcomes after PCI for CTO. Material and methods: We retrospectively examined the procedural outcomes of 173 consecutive native coronary artery CTO PCIs performed from February 2012 to March 2013 (78% men; mean age: 60.3 +/- 12.1 years). Results: The CTO target vessel was the right coronary artery (53.8%), circumflex (10.4%) and left anterior descending artery (35.8%), respectively. The retrograde approach was used in 13.9% of all procedures. Successful revascularization was achieved in 83.2% of patients. Major complications occurred in 13.3% of patients. In multivariate analysis, bridge collaterals, severe calcification and tortuosity as well as tandem occlusions were independent predictors of procedural failure, whereas existence of micro-channels was the only predictor of procedural success. Conclusions: Revascularization of coronary CTOs may be performed with high success and low major complication rates. Bridge collaterals, severe calcification and tortuosity, tandem/multiple occlusions and micro-channels were independent predictors of successful CTO revascularization.Öğe Scorpion envenomation-induced acute thrombotic inferior myocardial infarction(Kare Publ, 2016) Baykan, Ahmet Oytun; Gur, Mustafa; Acele, Armagan; Seker, Taner; Cayli, MuratThe occurrence of a serious cardiac emergency following scorpion envenomation has rarely been reported and, when so, mostly presented as non-ST segment elevation myocardial infarction, cardiogenic shock, or myocarditis. Possible mechanisms include imbalance in blood pressure and coronary vasospasm caused by the combination of sympathetic excitation, scorpion venom-induced release of catecholamines, and the direct effect of the toxin on the myocardium. We report a case of a 55-year-old man who presented with acute inferior wall myocardial infarction (MI) within 2 h of being stung by a scorpion. Coronary angiogram revealed total thrombotic occlusion of the left circumflex artery, which was treated successfully with glycoprotein IIb/IIIa inhibitor, thrombus aspiration, antivenom serum, and supportive therapy. Therefore, life-threatening MI can complicate the clinical course during some types of scorpion envenomation and should be managed as an acute coronary syndrome.
