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    Glucose-insulin-potassium therapy and its effects on signal-averaged electrocardiography in acute myocardial infarction
    (2000) Ulgen M.S.; Iltimur K.; Karadede A.; Alan S.; Toprak N.
    Low amplitude signals (LP) at the end of the QRS in patients with acute myocardial infarction (AMI) are related to fragmentation of the electrical impulse in ventricular myocardium and detected on signal-averaged electrocardiography. In this study, we investigated the use of glucose- insulin-potassium (GIK) solution and its effects on the SAECG in AMI. Methods: Seventy-two consecutive patients diagnosed with first Q-wave AMI were prospectively studied. Thrombolytic therapy was given to all patients unless contraindicated. The patients were randomly given glucose-insulin- potassium (GIK, n=34) solutions which consisted of 300 g of glucose, 50 units of insulin and 80 mEq of KCl in 1000 cc water placebo (saline, n.38). Ambulatory electrocardiographic examinations were performed in all patients between 24-48th hours. Sub-maximal exercise testing (if not contraindicated), signal-averaged electrocardiogram (SAECG) and echocardiographic records were obtained before discharge (6-9, mean 7 days). In postdischarge early period (in 30-40 days after index infarction) SAECG and echocardiography recordings were repeated. Results: There were no differences found between both groups in view of ages, number of risk factors, localization of infarction. In pre- discharge evaluations total filtered QRS duration (FQRS1: 103±7 msec vs 108±11 msec p<0.05), low-amplitude terminal signal duration (HFLA1: 25±8 msec vs 32±11 msec, p<0.01) and frequency of VLP1 (%20 vs %45 p<0.05) were found to be lower while root mean square voltage of the terminal 40 msec of the QRS (RMS-401: 45±18?V vs 36±20?V p<0.05), left ventricle ejection fraction (EF: 54±9 vs 48±8, p<0.05) to be higher in GIK when compared with the placebo group. In post discharge evaluations, FQRS2 (105±8 vs 110±10, p=0.05), HFLA2 (26±7 vs 34±10, p<0.01) and frequency of VLP2, (%25 vs %38, p>0.05) were found to be lower while RMS-402 (47±21 vs 33±19 p<0.05) and EF2 (59±10 vs 52±11, p<0.05) were higher in the GIK compared with the placebo group. The incidence of post-MI angina pectoris was significantly lower in the GIK-administered group (p<0.005) than in the placebo groups. The incidence of premature ventricular contraction was insignificantly lower in the GIK-administrated group (p>0.05). We concluded that using GIK solutions at the early stages of AMI may be beneficial on the SAECG, angina incidence, and left ventricular systolic performance in the pre-and postdischarge early period of AMI.
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    Öğe
    The relation of coronary artery disease with Doppler flow velocity and resistance index in cases without significant carotid artery stenosis
    (2001) Ulgen M.S.; Bilici A.; Acar M.; Onder H.; Sucu M.; Toprak N.
    OBJECTIVE: Atherosclerosis causes functional vasomotor changes as well as well as atheromatous carotid plaques and luminal stenosis resulting in mechanical effect. The relation between functional vasomotor changes in carotid arteries and extent of coronary artery disease is unknown. In our study, the probable relationship between carotid arterial flow velocities and resistance indexes (RI) with the extent of coronary artery disease (CAD) in patients who do not have significant carotid luminal stenosis was evaluated. METHODS: One hundred and fourteen patients (74 males, mean age 53+/-10 years, range 33-72 years) were studied. All patients underwent color Doppler sonography before coronary angiography. Peak systolic flow velocity, end-diastolic flow velocity and resistance index (RI) of right and left common carotid and internal carotid and internal carotid arteries were measured by color Doppler sonographic technique. Doppler parameters were correlated with the extent of CAD and left ventricular ejection fraction. RESULTS: Patients were classified on the basis of presence of significant CAD and the number of affected coronary arteries. Thirty-three patients did not have (normal group) and 81 patients had significant coronary arterial stenosis (22 patients with one-vessel disease, 27, with two-vessel disease and 32 patients with three-vessel disease). Flow velocities were the highest in normal group but the lowest in CAD patients, especially when 3 coronary arteries were affected. Correlation analysis demonstrated negative relationship of age, ejection fraction and number of affected coronary arteries with end-diastolic flow velocity, but positive and significant correlation with RI value. CONCLUSION: Our study is the first on this object. The results suggest that presence and extent of CAD changes flow velocities and RI values of common and internal carotid arteries. However, further investigations are required before these parameters can be applied as diagnostic criteria.
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    Relationship between fluid status as assessed by bioimpedance analysis and NT-pro BNP, blood pressure and left ventricular mass index in hemodialysis patients
    (Societa Editrice Universo, 2014) Yilmaz Z.; Yildirim Y.; Aydin F.Y.; Aydin E.; Kadiroglu A.K.; Yilmaz M.E.; Ulgen M.S.
    Aims: Maintenance of fluid status within an optimal range and accurate assessment of dry weight (DW) is essential in patients on intermittent haemodialysis (HD) treatment. In this study, we aimed to investigate the association of fluid status measured by bioimpedance analysis (BIA) with N-terminal pro-B natriuretic peptide (NT-proBNP), blood pressure and left ventricular mass index (LVMI) in hemodialysis patients. Materials and Methods: A total of 45 hemodialysis patients were enrolled in the study. N-terminal pro-B natriuretic peptide (NT-proBNP) was measured by immunoassay. Blood pressure (BP) was recorded. Echocardiographic examinations were performed in all patients. Multifrequency bioimpedance analysis was used to assess pre- and post-dialysis fluid status. Overhydration/ extracellular water (OH/ECW) ratio was used as fluid status index and OH/ECW ratio >0.15 was defined as clinical overhydration. Patients were divided into two groups; overhydrated (OH/ECW>0.15) and non-overhydrated (OH/ECW?0.15). Results: OH/ECW, systolic blood pressure (SBP), diastolic blood pressure (DBP), LVMI and NT-proBNP levels were significanly reduced after hemodialysis session. The presence of overhydration was more frequent in pre-HD patients compared to post-HD patients (31.1% vs 13.3%, p=0.004). OH/ECW was positively correlated with pre-and post-HD SBP, DBP, LVMI and NT-proBNP (p<0.05). Overhydrated patients had significantly higher values of pre-HD and post-HD SBP, DBP, LVMI and NT-proBNP compared to non-overhydrated patients. In addition, SBP, DBP, LVMI and NT-proBNP levels were significantly reduced after hemodialysis in both overhydrated and non- overhydrated patients group. Conclusions: This study revealed that OH/ECW ratio was significantly associated with SBP, DBP, LVMI and NT-proBNP. © Società Editrice Universo (SEU).