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    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, Mevlut
    BackgroundPercutaneous 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.
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    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, Caner
    Background. 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.
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    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, Hazar
    Background 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.
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    A Novel-Modified Provisional Bifurcation Stenting Technique: Jailed Semi-Inflated Balloon Technique
    (Wiley-Blackwell, 2015) Cayli, Murat; Seker, Taner; Guer, Mustafa; Elbasan, Zafer; Sahin, Durmus Yildiray; Elbey, Mehmet Ali; Cil, Habib
    ObjectiveWe proposed a new technique for the treatment of coronary bifurcation lesions, called jailed semi-inflated balloon technique (JSBT). BackgroundCurrently, provisional approach is recommended to treat most of coronary bifurcation lesions. However, it is associated with the risk of side branch (SB) occlusion after main vessel (MV) stenting due to plaque or carina shift into the SB. The SB occlusion may cause peri-procedural myonecrosis or hemodynamic compromise. Therefore, strategies are needed to reduce the SB occlusion during provisional approach. MethodsBetween September 2014 and April 2015, we selected 137 patients (104 male, 33 female; mean age 63.611.7 years) with 148 distinct coronary bifurcation lesions underwent percutaneous coronary intervention using JSBT. All patients were followed with hospital visits or telephone contact up to 1 month. ResultsThe majority of the patients had acute coronary syndrome (64.2%) and Medina 1.1.1. bifurcation lesions (62.8%). The lesion localization was distal left main (LM) coronary artery in 28 patients. After the MV stenting, thrombolysis in myocardial infarction (TIMI) 3 flow was established in 100% of both MV and SB. There was no SB occlusion in any patient. There was no major adverse cardiac event during in-hospital stay and 1 month follow-up. ConclusionsThe JSBT technique can be successfully performed in both LM and non-LM bifurcation lesion. This technique provides high rate of procedural success, excellent SB protection during MV stenting and excellent immediate clinical outcome. (J Interven Cardiol 2015;28:420-429)