Biomedical subjects

Sedat Kose

Publications and source records attributed to Sedat Kose.

At least 37 records · Page 2Linked to original sources

PubMed2005

The impact of admission C-reactive protein levels on the development of poor myocardial perfusion after primary percutaneous intervention in patients with acute myocardial infarction.

BACKGROUND: Increased preprocedural C-reactive protein (CRP) levels in patients with acute myocardial infarction (MI) undergoing primary percutaneous coronary intervention (PCI) may affect myocardial perfusion. Accordingly, this study was designed to investigate the impact of admission CRP levels on the development of poor myocardial perfusion after PCI in patients with acute MI. METHODS: The study population consisted of 75 patients (62 men, mean age, 61.6+/-6.68 years), who were admitted to our hospital with acute anterior MI and who underwent primary PCI in the left anterior descending coronary artery. All patients underwent stenting following balloon angioplasty. Myocardial perfusion was evaluated by using Thrombolysis In Myocardial Infarction (TIMI) myocardial perfusion grade (TMPG). Patients were divided into two groups according to TMPG after PCI. Group 1 consisted of 25 patients with TMPG 0-1 and group 2 comprised 50 patients with TMPG 2-3. Admission serum high sensitive CRP (hs-CRP) levels were analysed by using nephelometric method. RESULTS: Admission hs-CRP levels, pain to balloon time and white blood cell count (WBC) of patients in group 1 were significantly higher than those of the patients in group 2 (P<0.001; P<0.001; P=0.002, respectively). Univariate analysis identified ejection fraction, pain to balloon time, WBC and hs-CRP levels as the predictors of poor myocardial perfusion. In multivariate logistic regression analysis, hs-CRP levels and pain to balloon time were found to have statistically significant independent association with poor myocardial perfusion. Adjusted odds ratios were calculated as 1.85 for hs-CRP [P=0.003; 95% confidence interval (CI), 1.23-2.80] and 5.49 for pain to balloon time (P=0.04; 95% CI, 1.08-27.84). CONCLUSIONS: On admission, high CRP level in patients with acute MI undergoing primary PCI is likely to be in the causal pathway leading to the development of poor myocardial perfusion, especially when combined with prolonged pain to balloon time.

Aged↗

PubMed2005

The effects of prior use of atorvastatin on coronary blood flow after primary percutaneous coronary intervention in patients presenting with acute myocardial infarction.

BACKGROUND: Statins exert a variety of favourable effects on the vascular system not directly related to their lipid lowering function known as pleiotropic effects. There are not enough data regarding the effects of prior statin use on coronary blood flow after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Accordingly, in the present study, we aimed to investigate the effects of prior statin use on coronary blood flow after primary PCI in patients with AMI using the Thrombolysis In Myocardial Infarction (TIMI) frame count method. METHODS: The study population consisted of 200 patients (161 men; mean age=62+/-7 years) referred to cardiology clinics with AMI who subsequently underwent successful primary PCI. The study population was divided into two groups according to statin use before primary PCI. Group 1 consisted of 98 patients (75 men; mean age=63+/-7 years) not taking statin and group 2 consisted of 102 patients (86 men; mean age=61+/-7 years) taking daily dose of at least 40 mg atorvastatin for at least 6 months. Coronary blood flow was determined by TIMI frame count method using the angiographic images obtained just after PCI and stenting. RESULTS: Only mean TIMI frame count was detected to be significantly lower in patients taking at least 40 mg atorvastatin for at least 6 months compared with that of the patients taking no statin (P<0.001). After confounding variables were controlled for, the mean TIMI frame count of patients in group 2 was significantly lower than that of the patients in group 1 (P=0.001). Pain to balloon time and vessel type were detected as important confounding variables of TIMI frame count after analysis of covariances. CONCLUSIONS: Prior statin use may improve coronary blood flow after PCI in patients with AMI, possibly by its beneficial effects on microvascular function.

Aged↗

PubMed2005

Does coronary artery size really matter?

OBJECTIVE: To evaluate ischemia in right ventricle (RV) in patients with small caliber of right coronary artery (RCA). PATIENTS AND METHODS: The study population consisted of 60 consecutive patients undergoing coronary angiography within 3 months. The patients were divided into three different groups according to lumen diameter of RCA and coronary dominance. Group 1, 2, and 3 consisted of patients with small diameter of RCA, dominant RCA, and dominant circumflex artery, respectively. RV ischemia was assessed by using pulse-wave tissue Doppler sampling obtained from RV free wall close to the lateral tricuspid annulus at the apical four-chamber view during dobutamine stress echocardiography (DSE). RESULTS: When the mean systolic velocity percentages of increase from low to peak dose dobutamine in patients with small RCA were compared to those of other groups, statistically significant difference was found between group 1 and the other groups (P = 0.007 for group 1 vs group 2; P = 0.01 for group 1 vs group 3). The mean systolic velocity at peak dobutamine dose of patients with small caliber of right coronary artery was statistically lower than the other groups (P = 0.001 for group 1 vs group 2, P < 0.001 group 1 vs group 3). CONCLUSIONS: There are a group of patients with small diameter of RCA causing probable ischemia in RV and small caliber of RCA can really matter in these patients.

Analysis of Variance↗

PubMed2005

Effects of primary percutaneous coronary intervention on P wave dispersion.

BACKGROUND: Several studies demonstrated that P wave dispersion (PWD) increased after coronary occlusion. The effect of primary percutaneous coronary intervention (PCI) on PWD needs to be elucidated. METHODS: The study consisted of 125 patients with acute myocardial infarction (110 men, mean age 59.8+/-7.8 years) undergoing primary PCI. The patients were divided into three groups according to thrombolysis in myocardial infarction myocardial perfusion grade (TMPG) after successful PCI. Groups 1 (n=12), 2 (n=9), and 3 (n=104) included the patients with TMPG 0/1, 2, 3, respectively. Electrocardiograms were obtained before and approximately 66+/-18 minutes after PCI. RESULTS: PWD and P(maximum) after PCI were significantly lower than the preintervention values (P<0.001 for both). When PWD and Pmaximum values after PCI were compared among groups, PWD and Pmaximum in groups 1 and 2 were found to be higher than those of group 3 (P<0.001 for PWD and Pmaximum). Atrial fibrillation (AF) occurred in 14 patients. Pmaximum and PWD in patients with AF were higher compared to those of the patients without AF (P<0.001 for both P wave parameters). Also more frequent AF attacks were observed in group 1 compared to group 3 (P<0.001). CONCLUSIONS: PWD and Pmaximum after primary PCI were lower compared to the preintervention values. Prolonged PWD in patients with poor myocardial perfusion can contribute to increased mortality, and also it can can be combined with ST segment resolution to predict clinical reperfusion and might help in predicting AF.

Analysis of Variance↗

PubMed2005

Atrioventricular nodal reentrant tachycardia ablated from left atrial septum: clinical and electrophysiological characteristics and long-term follow-up results as compared to conventional right-sided ablation.

Radiofrequency catheter ablation or modification of the slow pathway is almost always performed on the right atrial side of the interatrial septum, however, this is not possible in rare cases. We evaluated the clinical and electrophysiological characteristics and long-term follow-up results of patients whose AVNRT could only be ablated from the left posterior atrial septum after repeated unsuccessful attempts on the right atrial side and to observe if they differ from those undergoing ablation with the conventional right-sided approach. Of 587 cases with symptomatic typical AVNRT, 9 patients (1.5%) in whom RF energy delivered to the right atrial septum with the integrated approach failed to ablate or modify the slow pathway were enrolled in the study group (group 1) while the others served as controls (group 2). There was no significant difference between the groups regarding clinical characteristics, dual AV nodal physiology, sinus cycle lengths, AH and HV intervals, procedural complication rates, or recurrence rates in the mean follow-up duration of 34 +/- 11 months. Only tachycardia cycle length (TCL) was significantly higher in group 1 than in group 2, which was mainly due to the difference in AH intervals (P < 0.001 for both). Slow pathway ablation was performed at the posteroseptal aspect of the mitral annulus in 6 and the midseptal aspect in 2 cases. In 1 case, attempts at ablation on the left atrial septum also failed. When the conventional right-sided approach fails to ablate or modify the slow pathway conduction, left-sided ablation can safely and effectively be employed, with success rates and long-term follow-up results comparable to the conventional right-sided approach.

Adult↗

PubMed2005

Left ventricular apical aneurysm as a consequence of diffuse type congenital nonfamilial supravalvular aortic stenosis in a 30-year-old female.

Congenital nonfamilial supravalvular aortic stenosis (SVAS) is relatively rare, its diffuse type being the least common. We present a 30-year-old woman with diffuse SVAS complicated with left ventricular apical aneurysm. We believe that subtle left ventricular myocardial ischemia or infarction and long-lasting severe pressure overload to the apical chamber caused LV apical aneurysm in our case. Acquired LV apical aneurysm secondary to supravalvular aortic stenosis, in the absence of atherosclerotic coronary artery disease and hypertrophic obstructive cardiomyopathy, has not been described before.

Adult↗

PubMed2005

Ventriculatrial block during atrioventricular nodal reentrant tachycardia suggesting existence of an upper common pathway.

Studies on the mechanisms of atrioventricular nodal reentrant tachycardia (AVNRT) have yet to clarify whether the slow and fast pathways connect directly with the atria or via an upper common pathway. Although a "final common pathway" connecting the slow and fast pathways to the proximal His bundle was thought to be part of the reentrant circuit, debate on the presence of an upper common pathway continues. We report a case of AVNRT continuing despite the occurrence of ventriculoatrial block, thus supporting the existence of an upper common pathway.

Adult↗

PubMed2005

Successful catheter ablation of a right-sided accessory pathway in a child with interruption of the inferior vena cava and azygos continuation.

Azygos continuation is seen in 0.6% of patients with congenital heart disease. The major significance of this anomaly lies in its association with complex cardiac defects and the technical difficulty that can accompany cardiac catheterization. We report our experience with successful catheter ablation of a right posteroseptal concealed accessory pathway in a 6-year-old boy with infrahepatic interruption of the inferior vena cava and azygos continuation.

Azygos Vein↗

PubMed2005

Two female nonsmoker Buerger's disease cases with anticardiolipin autoantibodies and a poor prognosis.

We present two female nonsmoker Buerger's disease cases with anticardiolipin autoantibodies and a poor prognosis. One was a 64-year-old female who has had multiple lower and upper extremity amputations, while the other was a 32-year-old female with extremity and visceral artery involvement. Since both were positive for anticardiolipin antibodies, we speculate that Buerger's disease is an autoimmune disorder.

Adult↗

PubMed2005

Increased myocardial ischemia during nitrate therapy: caused by multiple coronary artery-left ventricle fistulae?

We present the case of a 54-year-old man who had crescendo angina during nitrate therapy. Selective coronary angiograms showed no atherosclerotic lesions, but did show plexuses of intramural vessels that connected the distal thirds of the left and right coronary systems with the left ventricle. The cause of our patient's increased myocardial ischemia during nitrate therapy may have been the coronary "steal" phenomenon.

Cardiomyopathies↗

PubMed2004

The signal-averaged P-wave duration is longer in hypertensive patients with history of paroxysmal atrial fibrillation as compared to those without.

BACKGROUND: Onset of atrial fibrillation in hypertensive patients is usually associated with a high occurrence of cardiovascular complications. Therefore, it is important to assess non-invasively the risk of developing paroxysmal atrial fibrillation (PAF) in hypertensive patients during sinus rhythm. This study was undertaken to determine if hypertensive patients with history of PAF could be identified while in sinus rhythm by measurement of signal-averaged ECG P-wave duration. METHODS: Signal-averaged electrocardiography (SAECG) P-wave recording was performed in 44 hypertensive patients (30 men and 14 women; mean age 60+/-11 years, group A) who had a history of paroxysmal AF and in 50 hypertensive patients without history of AF (33 men and 17 women; mean age 57+/-12, group B). All patients were also evaluated by using echocardiography to measure left ventricular ejection fraction (LVEF) and left atrial diameter (LAD). RESULTS: SAECG P-wave duration was found to be significantly higher in group A than in group B (146+/-14 ms vs. 128+/-11 ms, p<0.001). Left atrial diameter was not significantly different (40.1+/-3.4 mm vs. 39.3+/-3.0 mm, p>0.05), whereas LVEF was significantly lower in group A than group B (63+/-5% vs. 67+/-4%, p=0.03). There was a correlation between SAECG P-wave duration and age (r=0.32, p<0.05). In univariate analysis, SAECG P-wave duration and LVEF were significant predictors of PAF, but only SAECG P-wave duration remained a significant independent predictor of PAF in multivariate analysis. CONCLUSION: The results of this study indicate that hypertensive patients with history of PAF can be detected while in sinus rhythm by signal-averaged ECG P-wave duration.

Adult↗

PubMed2004

Atrioventricular nodal reentrant tachycardia with multiple discontinuities in the atrioventricular node conduction curve: immediate success rates of radiofrequency ablation and long-term clinical follow-up results as compared to patients with single or no AH-jumps.

BACKGROUND: Some patients with atrioventricular nodal reentrant tachycardia (AVNRT) demonstrate multiple discontinuities (AH jump) in their antegrade AV node conduction curves. We evaluated and compared the immediate success rates, procedure-related complications, long-term clinical follow-up results and recurrence rates after slow pathway ablation in patients with multiple versus single or no AH jumps. METHODS: The study group consists of 278 consecutive patients (mean age 36.6 +/- 15.7) who underwent ablation for typical AVNRT, divided into three categories according to the number of AH jumps (>/=50 ms) before ablation: Group-1 consisted of 63 patients (23%) with continuous AV node function curves; Group-2 of 183 patients (66%) with a single jump and Group-3 of 32 (12%) patients showing more than one AH jumps. RESULTS: Age was significantly higher in Group-3 as compared to Group-1 (43 +/- 18 years vs. 34 +/- 16 years, p = 0.020). The electrophysiological features of AVNRT did not differ among groups. Before ablation, the maximum AH interval was significantly longer in Group-3 as compared to Groups-1 and -2 ( p < 0.001 for both). AV node antegrade ERP was significantly shorter in Group-3 than in Group-2, both before and after ablation ( p < 0.050 for both). AV node Wenckebach cycle length (WCL) was shorter in Group-3 as compared to both Groups-1 and -2, before and after ablation ( p < 0.050 for all). AV node WCL was prolonged significantly in all groups after ablation ( p < 0.001 for all). Residual dual pathways were present in 37 of 278 patients (13%) after ablation and were significantly more frequent in Group-3 than Group-2 (31% vs. 15%, p = 0.023). CONCLUSIONS: Patients with multiple AH jumps are older and more often have residual dual atrioventricular nodal pathway physiology after successful ablation but these features do not affect the immediate and long-term success rates of slow pathway ablation as compared to patients with single or no AH jumps.

Adolescent↗

PubMed2004

Maximum P-wave duration and P-wave dispersion predict recurrence of paroxysmal atrial fibrillation in patients with Wolff-Parkinson-White syndrome after successful radiofrequency catheter ablation.

BACKGROUND: Identification of patients at risk for PAF recurrence after AP ablation is important because of the necessity for additional therapies. OBJECTIVES: To determine whether Maximum P-wave duration (Pmax) and P-wave dispersion (Pd ) detected on surface ECG after successful accessory pathway (AP) ablation can predict the recurrence of paroxysmal atrial fibrillation (PAF). METHODS: Seventy-eight patients with Wolff-Parkinson-White (WPW) syndrome who had at least one documented PAF episode and underwent catheter ablation were enrolled. Pmax, minimum P-wave duration (Pmin) and Pd were determined on a surface ECG recorded on a high resolution computer screen on day 2 after ablation of the AP. RESULTS: There was no significant difference in terms of basic clinical data and electrophysiological findings between patients with (Group-1, n = 19) and without (Group-2, n = 59) recurrence of PAF during follow-up of 21 +/- 10 months. Pmax and Pd were significantly higher in Group-1 than Group-2 (120 +/- 15 vs. 96 +/- 10 ms and 47 +/- 12 vs. 25 +/- 7 ms, respectively; p < 0.001 for both). Pmin didn't differ significantly. A Pmax value of > or = 103 ms separated Group-1 from Group-2 with a sensitivity of 84.2%, specificity of 72.9%, positive predictive value of 50%, and negative predictive value of 93.5%. A Pd value of > or = 32.5 ms separated Group-1 from Group-2 with a sensitivity of 89.5%, specificity of 84.7%, positive predictive value of 65.4%, and negative predictive value of 96.2%. Pmax (p < 0.010) and Pd (p < 0.001) were found to be significant univariate predictors of PAF, whereas only Pd remained significant in multivariate analysis (p = 0.037). CONCLUSION: Pd > or = 32.5 ms and Pmax > or = 103.0 ms predict the recurrence of PAF after ablation with acceptable positive and negative predictive values. Pd > or = 32.5 ms is an independent predictor of recurrence of PAF after catheter ablation in patients with WPW syndrome.

Adolescent↗

PubMed2004

Percutaneous transcatheter repositioning of displaced permanent pacemaker atrial lead with a simple system.

A 48-year-old man who was implanted with a DDD-R pacemaker because of sick sinus syndrome eight days ago presented to our institute with a syncopal attack. Fluoroscopy showed a dislodged active fixation atrial pacemaker lead. With a snare system simply improvised from a 0.014 inch guidewire and a NIH catheter, the lead was repositioned via percutaneous transfemoral approach. The procedure was easy and completed without any complication. Follow-up controls after two weeks and three months showed stability of the lead position with normal pacing and sensing functions.

Cardiac Catheterization↗

PubMed2004

Single coronary artery with anomalous origin of the right coronary artery from the left anterior descending artery with a unique proximal course.

A 62-year-old man with hypertension and hypercholesterolemia was referred to our unit for evaluation of chest pain. A very rare variant of single coronary artery, in which the anomalous right coronary artery originated as a separate branch from the left anterior descending artery, was incidentally found on his coronary angiography. The anomalous right coronary artery in our case appears to be unique in that it courses intraseptally rather than rightwards proximally and has obstructive atherosclerotic lesions resulting in inferior ischemia. Moreover, the acute angle made by the anomalous right coronary artery to turn toward the atrioventricular groove may have reduced the flow velocity and contributed to the development of inferior ischemia.

Coronary Angiography↗

PubMed2004

Angiographic restenosis after myocardial bridge stenting.

Data on restenosis after stent implantation in myocardial bridges (MB) are very limited. Six-month angiographic results for 12 symptomatic patients who underwent stent implantation for myocardial bridges were compared retrospectively with those of 39 patients who underwent direct stent implantation for de novo atherosclerotic lesions in the left anterior descending artery. Diameter stenosis decreased from 69 +/- 8% to 4 +/- 5% in the MB group and from 79 +/- 8% to 7 +/- 6% in the control group after stent deployment. Systolic narrowing was abolished in all patients with MB. In follow-up, quantitative angiography revealed late loss of 1.8 +/- 1.3 mm in the MB group and 0.9 +/- 0.9 mm in the control group (P = 0.025). The in-stent restenosis rate was also higher in the MB group compared to the control group (67% versus 28%; P = 0.037). Despite favorable immediate results, stent implantation in MBs may not be promising because of the higher in-stent restenosis rate compared to stenting in de novo atherosclerotic lesions.

Angioplasty, Balloon, Coronary↗

PubMed2004

Is carotid atherosclerosis more important in patients with mitral annular calcification than in those without?

It has been suggested that mitral annular calcification (MAC) may be a manifestation of generalized atherosclerosis. However, how the incidence and extent of coronary artery disease (CAD) are affected by the coexistence of carotid atherosclerosis (CAS) in patients with versus without MAC have not yet been studied. We studied 101 patients with echocardiographic MAC and 52 controls without MAC to investigate the clinical impact of CAS on the frequency and severity (defined as the number of obstructed vessels) of CAD in patients with MAC. Carotid Doppler ultrasonographic examination was performed on all patients before coronary angiography. In patients with both MAC and CAS, the incidences of CAD and multivessel disease (> or = 2 vessel or left main coronary artery disease) were significantly higher than in the control group with CAS alone (91% versus 68%, P = 0.008 and 76% versus 44%, P = 0.004, respectively). On the other hand, among study and control patients without CAS, although the frequencies of CAD and multivessel disease were higher in patients with MAC, interestingly, the differences were not statistically significant (37% versus 58% and 15% versus 26%, respectively, P > 0.05 for both). Stepwise multiple logistic regression analysis revealed that CAS (P < 0.001), MAC (P < 0.01) and, to a limited extent hypertension (P = 0.054), were independent predictors for the presence of CAD. In conclusion, the coexistence of CAS is more important in patients with MAC than in those without as it provides valuable information about the incidence and severity of underlying CAD. In cases with MAC but without CAS, MAC could be caused by factors other than atherosclerosis.

Aged↗

PubMed2004

Acute myocardial infarction and left subclavian artery occlusion in Behçet's disease: a case report.

A 42-year-old woman with Behcet's disease and pericardial effusion for 14 years presented with acute myocardial infarction and received thrombolytic therapy. Coronary angiography showed total occlusion of the left anterior descending artery. Subsequently, the left internal mammary artery was grafted to the left anterior descending artery. Approximately one year after bypass surgery, digital subtraction angiography of the left subclavian artery, performed because of chest and left arm pain, showed total occlusion of the left subclavian artery. Retrograde flow from the left vertebral artery filled the distal portion of the left subclavian artery. In conclusion, patients with Behcet's disease should be investigated closely for involvement of other arteries when one vessel's involvement has been detected. We also recommend that free arterial grafts be used for any coronary surgical intervention, because of the risk of occlusion associated with the vasculitis of Behcet's disease.

Adult↗