Browsing by Author "Bayturan, O"
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Item Coarctation of the aorta evaluated with 64-row multislice computed tomographyUtuk, O; Karaca, M; Bayturan, O; Oncel, G; Tezcan, UK; Bilge, ARItem Relationship of insulin resistance in chronic haemodialysis patients with inflammatory indicators, malnutrition, echocardiographic parameters and 24 hour ambulatory blood pressure monitoringKursat, S; Colak, HB; Toraman, A; Tekçe, H; Ulman, C; Bayturan, OObjective. The relationship between malnutrition, echocardiographic parameters, 24 h ambulatory blood pressure (ABP) parameters and decreased insulin sensitivity index (ISI-S) in chronic haemodialysis patients was investigated. Material and methods. ISI-S and inflammatory indicators were measured. The nutritional state was assessed by malnutrition score. Echocardiography and 24 h ABP were performed 1 day before the second haemodialysis session of the week. Results. ISI-S was inversely correlated with the night-time mean blood pressure (BP)/day-time mean BP ratio (p = 0.021) and malnutrition score (p < 0.01). High-sensitivity C-reactive protein, night-time mean BP/day-time mean BP and vena cava collapse index were independent risk factors affecting ISI-S (p < 0.001; beta = 0.412, p= 0.025; beta = -0.204, p < 0.001; beta = -0.465). Conclusions. The decrease in ISI-S along with the hypervolaemia suggests that volume overload is a contributory factor in the pathogenesis of insulin resistance in patients with chronic renal failure. This study indicates that, in addition to the traditional cardiovascular risk factors in these patients, insulin resistance can be regarded as a risk factor, but not an independent one, mainly a reflection of the underlying culprit, hypervolaemia.Item Effect of CPAP therapy on catathrenia and OSA: a case report and review of the literatureSongu, M; Yilmaz, H; Yuceturk, AV; Gunhan, K; Ince, A; Bayturan, OIntroduction Catathrenia is a rare, idiopathic, sleep-related respiratory condition characterized by irregular groans, which occur during prolonged expiration in sleep. The origins of catathrenia remain inexplicable, the long-term prognosis unexplained. Moreover, empirical treatment with neither pharmacological nor non-pharmacological approaches was satisfactory. Case report We report a case of catathrenia with concurrent obstructive sleep apnea complicated with pulmonary hypertension and reviewed the literature. Discussion Treatment with nasal continuous positive airway pressure resulted in marked improvement of catathrenia, obstructive sleep apnea, daytime dyspnea, and pulmonary hypertension for our patient. We think that nasal continuous positive airway pressure can be an option for the treatment of this infrequent but sometimes very disturbing sleep disorder.Item Pulmonary hypertension in patients with chronic renal failureHavlucu, Y; Kursat, S; Ekmekci, C; Celik, P; Serter, S; Bayturan, O; Dinc, GBackground: Many etiologies causing pulmonary hypertension (PH) have been reported, and one of the background disease seen with patients with PH is chronic renal failure (CRF); however, the pathogenesis of PH in this group of patients is not explained satisfactorily. Objectives: The aims of this study were to evaluate the incidence of unexplained PH among patients with CRF and to suggest possible etiologic factors. Methods: Two hundred and eleven patients with CRF were evaluated and the ones who have comorbid conditions that cause PH were excluded. Pulmonary arterial pressure (PAP) and cardiac functions were evaluated by Doppler echocardiography. Arteriovenous fistula (AVF) flow was measured by Doppler sonography. The patients were followed for at least 6 months. Results: Forty-eight CRF patients (20 males, 28 females) were included: 23 were predialysis patients, and 25 patients received hemodialysis via AVF. Patients were followed for 7.5 +/- 1.01 months. Systolic PAP>35 mm Hg was found in 56% (14/25) of patients receiving hemodialysis (36.8 +/- 10.7 mm Hg) and in 39.1% (9/23) of predialysis patients ( 29.5 +/- 9.5 mm Hg). The parathyroid hormone level, cardiac output values and CRF duration were found to be increased in patients with elevated systolic PAP (p < 0.05). AVF flow and AVF duration were positively correlated with systolic PAP in patients receiving hemodialysis (p < 0.05). There was a negative correlation between systolic PAP and residual urine volume (p < 0.05). AVF compression in hemodialysis patients decreased systolic PAP from 36.8 +/- 10.7 to 32.8 +/- 10.5 mm Hg. Systolic PAP values were increased at the end of the study in the predialysis group, whereas they were decreased at the end of the follow-up in the hemodialysis group (36.9 +/- 10.5 and 32.04 +/- 10.5 mm Hg, respectively). Conclusions: This study demonstrates a high incidence of PH among patients with CRF.CRF duration, AVF flow, parathyroid hormone level and cardiac output may be involved in the pathogenesis of PH. The effective hemodialysis and dry weight reduction decreased systolic PAP values. Copyright (c) 2007 S. Karger AG, BaselItem HbA1c, coronary atheroma progression and cardiovascular eventsDykun, I; Bayturan, O; Carlo, J; Nissen, SE; Nicholls, SJ; Puri, RItem Effect of losartan on exercise tolerance and echocardiographic parameters in patients with mitral regurgitationSekuri, C; Utuk, O; Bayturan, O; Bilge, A; Kurhan, Z; Tavli, TObjectives. The aim of this study was to assess the effects of losartan treatment on exercise tolerance and echocardiographic parameters in patients with mitral regurgitation (MR) secondary to mitral valve prolapse or rheumatic heart disease. Methods. Twenty-seven patients (14 males, 13 females, mean age 51 +/- 11, range 21-76) with moderate MR due to mitral valve prolapse or rheumatic heart disease were examined by means of Doppler echocardiography. The subjects were submitted to treadmill exercise tests using the modified Bruce protocol at baseline, after six hours and after the six-week treatment period to be evaluated based on their exercise tolerance. Mitral Regurgitant Volume (MRV), effective regurgitant orifice diameter, left atrial volume, left ventricle (LV) end-diastolic volume index, IV end-systolic volume index, IV ejection fraction (LVEF), left ventricle mass index were calculated at baseline and after six weeks of treatment with single dose of losartan (50 mg/day). Results. Total treadmill exercise time increased from 477.7 +/- 147.9 to 535.7 +/- 149.0 seconds after six hours (p < 0.01) and to 559.6 +/- 142.8 seconds after six weeks of treatment. Also, metabolic equivalent values increased following six hours of first dose and six weeks of losartan treatment (from 10.9 +/- 2.9 to 11.8 +/- 3.1, p=0.006 and 12.4 +/- 3.1, p=0.002; respectively). However, peak exercise systolic blood pressure (BP) was reduced after six hours and six weeks of treatment, and resting diastolic BP did not change after six hours but reduced at the end of the treatment period. MR volume decreased significantly from 29.3 +/- 14.1 ml to 25.1 +/- 14.8 ml, (p=0.025) without significant change in regurgitant orifice diameter (0.72 +/- 0.37 cm vs. 0.66 +/- 0.37 cm, p=NS), left atrium diameter and area while LVEF increased from 51.70 +/- 13.37 to 54.11-11-75 (p=0.015) with losartan. Conclusion. We conclude that the angiotensin II receptor antagonist losartan improves exercise tolerance and echocardiographic parameters in patients with moderate MR.Item THE EFFECT OF SMOKING AND DISEASE SEVERITY ON QT DISPERSION IN CHRONIC OBSTRUCTIVE PULMONARY DISEASEHepcivici, U; Acar, M; Tikiz, H; Tezcan, UK; Tavli, T; Bilge, AR; Bayturan, O; Utuk, OItem A RARE CAUSE OF ISCHEMIC CHEST PAIN: CONGENITAL OSTIAL ATRESIA OF THE RIGHT CORONARY ARTERYTavli, T; Alkan, A; Bayturan, O; Dalgic, O; Utuk, O; Kamali, B; Madak, NItem Effects of angiotensin-converting enzyme inhibition and statin treatment on inflammatory markers and endothelial functions in patients with longterm rheumatoid arthritisTikiz, C; Utuk, O; Pirildar, T; Bayturan, O; Bayindir, P; Taneli, F; Tikiz, H; Tuzun, CObjective. To investigate the effects of angiotensin-converting enzyme (ACE) inhibitors and statins (hydroxy-methyl-glutaryl-CoA reductase inhibitors) on inflammatory markers and endothelial functions in patients with rheumatoid arthritis (RA). Methods. A total of 45 patients with longterm RA were randomized into 3 groups to receive 8 weeks of treatment with placebo (n = 15), simvastatin (20 mg/day, n = 15), or quinapril (10 mg/day, n = 15) as an adjunct to existing antirheumatic drug treatment. Factors with a role in the development of endothelial dysfunction, such as C-reactive protein (CRP), fibrinogen, nitric oxide (NO), and serum cytokine concentrations including interleukin 1 beta (IL-1 beta), IL-6, and tumor necrosis factor-alpha (TNF-alpha) were measured at baseline and in the posttreatment period. Brachial artery vasodilator responses were assessed by high resolution ultrasound to evaluate endothelial functions. Results. Simvastatin treatment significantly decreased serum CRP and TNF-alpha [from 14 6 to 7 3 mg/l (p = 0.025) and 30 +/- 5 to 16 +/- 4 pg/ml (p = 0.012), respectively], while quinapril had no significant changes in these 2 measures. IL-1 beta and IL-6 showed insignificant changes in patients in the 2 drug groups. Endothelium-dependent vasodilatation was improved significantly in the simvastatin group [from 5.3 +/- 1.1% to 8.9 +/- 1.4% (p = 0.025)], while there was no difference in endothelium-independent vasodilatation [9.0 +/- 1.8% to 11.2 +/- 2.5% (p = 0.17)]. The quinapril group showed no significant changes in both types of vasodilation although there was a tendency to an increase in endothelium-dependent vasodilatation [from 6.1 +/- 0.8% to 7.8 +/- 0.7% (p = 0.06)]. Treatment with the 2 drugs had no significant effects on resting arterial diameter. Conclusion. We show that simvastatin 20 mg daily improves endothelial function in patients with RA. Its beneficial effect may be attributed to lowering CRP and TNF-a concentrations. ACE inhibition with daily 10 mg quinapril was found to have no significant effects on inflammatory markers and endothelial vasodilator response.Item Thrombosis of a Coronary Artery Related to the Myocardial BridgingUtuk, O; Bilge, A; Bayturan, O; Tikiz, H; Tavli, T; Tezcan, UItem Effects of low-dose combination therapy with an angiotensin-converting enzyme inhibitor and a diuretic on flow-mediated vasodilation in hypertensive patients: A 6-month, single-center studySekuri, C; Bayturan, O; Gocer, H; Tavli, T; Tezcan, UKBackground: Combination therapy with an angiotensin-converting enzyme (ACE) inhibitor and a diuretic has been shown to be highly effective in hypertension. Clinical trials have demonstrated that ACE inhibitors may improve endothelial cell dysfunction in hypertension. However, the effectiveness of the combination treatment in endothelial cell dysfunction is unknown. Objective: This study investigated the effects of a new low-dose combination, perindopril 2 mg plus indapamide 0.625 mg, on brachial artery flow-mediated vasodilation (FMD) and left ventricular diastolic function in hypertension. Methods: Patients aged 18 to 75 with newly diagnosed stage I or II hypertension were eligible. Endothelium-dependent brachial artery FMD and endothelium-independent vasodilation were assessed at baseline. Patients were treated with oral perindopril 2 mg plus indapamide 0.625-mg tablets once daily for 6 months. FMD measurements were then repeated. Percentage changes in FMD from baseline to 6 months, as well as left ventricular diastolic function parameters (isovolumic relaxation time [IVRT] and mitral diastolic E-wave deceleration time [EDT]), indicated the effectiveness of the intervention. Results: Twenty-nine Turkish patients were enrolled (17 women, 12 men; mean [SD] age, 54.5 [9.5] years [range, 38-75 years]). The mean (SD) baseline FMD was 7.00% (2.39%) (endothelial cell dysfunction) and increased significantly to 8.68% (2.78%) at 6 months (P = 0.02); FMD improved in 15 patients (51.7%). At baseline and 6 months of therapy, mean (SD) IVRT was 101.7 (12.4) ms and 95.5 (7.7) ms, respectively (P < 0.001), and EDT was 234.7 (33.9) ms and 217.9 (25.6) ms, respectively (P < 0.001). Conclusions: In this small sample of hypertensive patients, a low-dose combination ACE inhibitor and diuretic significantly improved brachial artery FMD and left ventricular diastolic function. The improvement in FMD values was independent of the stage of hypertension. These findings suggest a relationship between improvement in endothelial cell function and diastolic function. Copyright (C) 2003 Excerpta Medica, Inc.Item Giant unruptured noncoronary sinus of valsalva aneurysmUtuk, O; Bayturan, O; Bilge, AR; Tikiz, H; Tezcan, UKItem Selective COX-2 inhibition with different doses of rofecoxib does not impair endothelial function in patients with coronary artery diseaseTikiz, C; Ütük, O; Bayturan, O; Bayindir, P; Ekmekçi, C; Tikiz, HIn this study, we investigated the effects of both 25 and 50 mg daily doses of rofecoxib on the endothelial functions of patients with coronary artery disease (CAD). For this purpose, 34 patients with documented severe CAD and who were under aspirin treatment (300 mg/day) were randomized to receive 4 weeks of treatment with a placebo (n = 10, group I), rofecoxib 25 mg/day (n = 12, group II), and rofecoxib 50 mg/day (n = 12, group III). Brachial artery vasodilator responses were measured in order to evaluate endothelial function. The percentage of change in endothelial-dependent vasodilation in groups I, II, and III were similar at the baseline level and showed no significant change after treatment (6.2 +/- 3.9% vs. 5.9 +/- 3.1% and 5.8 +/- 3.3% vs. 5.6 +/- 3.8% and 6.1 +/- 4.5% vs. 5.8 +/- 4.1%, respectively; P > 0.05). Compared with the baseline, endothelium-independent vasodilatation, as assessed by nitroglycerine (NTG), remained unchanged after the treatment period (11.2 +/- 6.9% vs. 10.3 +/- 7.1% and 11.2 +/- 6.3% vs. 9.9 +/- 5.1% and 9.5 +/- 4.9% and 8.8 +/- 4.6 %, respectively; P > 0.05). Treatment with both doses also showed no significant effects on high-sensitivity C-reactive protein (hs-CRP) levels and resting arterial diameters (P > 0.05). In conclusion, 4 weeks of treatment with standard and high doses of rofecoxib showed no significant effects on either endothelial-dependent or independent vasodilator response or plasma hs-CRP levels in patients with severe CAD taking concomitant aspirin.Item Huge pulsating cystic cardiac massUtuk, O; Bilge, AR; Bayturan, O; Sirin, H; Iskesen, I; Teznan, UKItem Multi-Center Experience of Coronary Artery Perforation During Percutaneous Coronary Intervention: Clinical and Angiographic Characteristics, Management, and Outcomes Between 2010 and 2020Gündüz, R; Yildiz, BS; Çetin, N; Özgür, S; Çizgici, AY; Tülüce, K; Tülüce, SY; Özen, MB; Duman, S; Bayturan, OBackground: Coronary artery perforations are one of the most feared, rare, and catastrophic complication of percutaneous coronary intervention. Despite the remarkable increase in coronary angiography and percutaneous coronary intervention, there is no large database that collects coronary artery perforation for the Turkish population. Our study aimed to report our experience over a 10-year period for clinical and angiographic characteristics, management strategies, and outcomes of coronary artery perforation during the percutaneous coronary intervention at different cardiology departments in Turkey. Methods: The study data came from a retrospective analysis of 48 360 percutaneous coronary intervention procedures between January 2010 and June 2020. A total of 110 cases who had coronary artery perforation during the percutaneous coronary intervention were found by angiographic review. Analysis has been performed for the basic clinical, angiographic, procedural characteristics, the management of coronary artery perforation, and outcome of all patients. Results: The coronary artery perforation rate was 0.22%. Out of 110 patients with coronary artery perforation, 66 patients showed indications for percutaneous coronary intervention with acute coronary syndrome and 44 patients with stable angina pectoris. The most common lesion type and perforated artery were type C (34.5%) and left anterior descending (41.8%), respectively. The most observed coronary artery perforation according to Ellis classification was type III (37.2%). Almost 52.7% of patients have a covered stent implanted in the perforated artery. The all-cause mortality rate of coronary artery perforation patients in the hospital was 18.1%. Conclusion: The observed rate of coronary artery perforation in our study is consistent with the studies in this literature. However, the mortality rates related to coronary artery perforation are higher than in other studies in this literature. Especially, the in-hospital mortality rate was higher in type II and type III groups due to perforation and its complications. Nevertheless, percutaneous coronary intervention should be done in selected patients despite catastrophic complications.Item Atrial fibrillation, progression of coronary atherosclerosis and myocardial infarctionBayturan, O; Puri, R; Tuzcu, EM; Shao, M; Wolski, K; Schoenhagen, P; Kapadia, S; Nissen, SE; Sanders, P; Nicholls, SJBackground: Despite atrial fibrillation representing an established risk factor for stroke, the association between atrial fibrillation and both progression of coronary atherosclerosis and major adverse cardiovascular events is not well characterized. We assessed the serial measures of coronary atheroma burden and cardiovascular outcomes in patients with and without atrial fibrillation. Methods: Data were analyzed from nine clinical trials involving 4966 patients with coronary artery disease undergoing serial intravascular ultrasonography at 18-24 month intervals to assess changes in percent atheroma volume (PAV). Using a propensity weighted analysis, and following adjustment for baseline variables, patients with (n = 190) or without (n = 4776) atrial fibrillation were compared with regard to coronary plaque volume and major adverse cardiovascular events (death, myocardial infarction, and stroke). Results: Atrial fibrillation patients demonstrated lower baseline PAV (36.0 +/- 8.9 vs. 38.1 +/- 8.9%, p +/- 0.002) and less PAV progression (-0.07 +/- 0.34 vs. + 0.23 +/- 0.34%, p = 0.001) compared with the non- atrial fibrillation group. Multivariable analysis revealed atrial fibrillation to independently predict both myocardial infarction [HR, 2.41 (1.74,3.35), p < 0.001] 2.41 (1.74, 3.35), p < 0.00) and major adverse cardiovascular events [HR, 2.2, (1.66, 2.92), p < 0.001] 2.20 (1.66, 2.92), p < 0.001]. Kaplan-Meier analysis showed that atrial fibrillation compared with non- atrial fibrillation patients had a significantly higher two-year cumulative incidence of overall major adverse cardiovascular events (4.4 vs. 2.0%, logrank p = 0.02) and myocardial infarction (3.3 vs. 1.5%, log-rank p = 0.05). Conclusions: The presence of atrial fibrillation independently associates with a heightened risk of myocardial infarction despite a lower baseline burden and progression rate of coronary atheroma. Further studies are necessary to define the pathogenesis of myocardial infarction in the setting of atrial fibrillation.Item HbA1c, Coronary atheroma progression and cardiovascular outcomesDykun, I; Bayturan, O; Carlo, J; Nissen, SE; Kapadia, SR; Tuzcu, EM; Nicholls, SJ; Puri, RBackground and aims: We tested the hypothesis that on-treatment HbA1c levels independently associate with coronary atheroma progression and major adverse cardiovascular events (MACE: death, myocardial infarction, cerebrovascular accident, coronary revascularization, or hospitalization for unstable angina) rates. Methods: We performed a post-hoc pooled analysis of data from seven prospective, randomized trials involving serial coronary intravascular ultrasonography (IVUS). The percent atheroma volume (PAV) was calculated as the proportion of the entire vessel wall occupied by atherosclerotic plaque. Using multivariable mixed modeling, we determined the association of on-treatment HbA1c with annualized change in PAV. Cox proportional hazard models were used to assess the association of HbA1c with incidence of MACE. Results: Among 3,312 patients (mean age 58.6 +/- 9years, 28.4%women) average on-treatment HbA1c was 6.2 +/- 1.1%. Overall, there was no net significant annualized change in PAV (0.12 +/- 0.19%, p = 0.52). In a fully adjusted multivariable analysis (following adjustment of age, sex, body mass index, systolic blood pressure, smoking, low- and high-density lipoprotein cholesterol, triglyceride levels, peripheral vascular disease, trial, region, and baseline PAV), higher on-treatment HbA1c levels were independently associated with annualized changes in PAV [beta-estimate (95% confidence interval): 0.13(0.08, 0.19), p < 0.001]. On-treatment HbA1c levels were independently associated with MACE [hazard ratio (95% confidence interval): 1.13(1.04, 1.23), p = 0.005]. Conclusions: Independent of achieved cardiovascular risk factor control, greater HbA1c levels significantly associate with coronary atheroma progression rates and clinical outcomes. These results support the notion of a direct, specific effect of glycemic control upon coronary atheroma and atherosclerotic events, supporting the rationale of therapies designed to directly modulate it.Item Warfarin Use Is Associated With Progressive Coronary Arterial Calcification Insights From Serial Intravascular UltrasoundAndrews, J; Psaltis, PJ; Bayturan, O; Shao, MY; Stegman, B; Elshazly, M; Kapadia, SR; Tuzcu, EM; Nissen, SE; Nicholls, SJ; Puri, ROBJECTIVES This study compared serial changes in coronary percent atheroma volume (PAV) and calcium index (CaI) in patients with coronary artery disease who were treated with and without warfarin. BACKGROUND Warfarin blocks the synthesis and activity of matrix Gla protein, a vitamin K-dependent inhibitor of arterial calcification. The longitudinal impact of warfarin on serial coronary artery calcification in vivo in humans is unknown. METHODS In a post hoc patient-level analysis of 8 prospective randomized trials using serial coronary intravascular ultrasound examinations, this study compared changes in PAV and CaI in matched arterial segments in patients with coronary artery disease who were treated with (n = 171) and without (n = 4,129) warfarin during an 18- to 24-month period. RESULTS Patients (mean age 57.9 +/- 9.2 years; male 73%; prior and concomitant 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statin) use, 73% and 97%, respectively) demonstrated overall increases in PAV of 0.41 +/- 0.07% (p = 0.001 compared with baseline) and in CaI (median) of 0.04 (interquartile range [IQR]: 0.00 to 0.11; p < 0.001 compared with baseline). Following propensity-weighted adjustment for clinical trial and a range of clinical, ultrasonic, and laboratory parameters, there was no significant difference in the annualized change in PAV in the presence and absence of warfarin treatment (0.33 +/- 0.05% vs. 0.25 +/- 0.05%; p = 0.17). A significantly greater annualized increase in CaI was observed in warfarin-treated compared with non-warfarin-treated patients (median 0.03; IQR: 0.0 to 0.08 vs. median 0.02; IQR: 0.0 to 0.06; p < 0.001). In a sensitivity analysis evaluating a 1: 1 matched cohort (n = 164 per group), significantly greater annualized changes in CaI were also observed in warfarin-treated compared with non-warfarin-treated patients. In a multivariate model, warfarin was independently associated with an increasing CaI (odds ratio: 1.16; 95% confidence interval: 1.05 to 1.28; p = 0.003). CONCLUSIONS Warfarin therapy is associated with progressive coronary atheroma calcification independent of changes in atheroma volume. The impact of these changes on plaque stability and cardiovascular outcomes requires further investigation. (C) 2018 by the American College of Cardiology Foundation.