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Biomedical subjects

Cihangir Kaymaz

Publications and source records attributed to Cihangir Kaymaz.

At least 19 recordsLinked to original sources
PubMed2006

Dramatic decrease in the pulmonary artery systolic pressure and disappearance of the interatrial shunt with sildenafil treatment in a patient with primary pulmonary hypertension with atrial septal aneurysm and a severe right to left shunt through the patent foramen ovale.

This report describes a patients with PPH with atrial septal aneurysm and a severe right to left shunt through the patent foramen ovale who showed a dramatic decrease in the pulmonary artery systolic pressure and interatrial shunt disappeared after sildenafil treatment.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed2006

Effects of isolated coronary artery ectasia on electrocardiographic parameters reflecting ventricular heterogeneity.

Isolated coronary ectatic but otherwise normal epicardial coronary arteries are an infrequent angiographic finding. We sought to determine whether coronary artery ectasia (CAE) may alter QT-interval duration and dispersion. The study population consisted of 24 patients with isolated CAE and otherwise normal epicardial coronary arteries (group 1) and sex- and age-matched subjects with atypical chest pain and otherwise normal coronary flow (group 2). Both groups underwent a routine standard 12-lead surface electrocardiogram recorded at 50 mm/s during rest. QT dispersion (QTd), corrected QT (QTc), and corrected QT dispersion (QTcd) were calculated. Distribution of sex, age, body mass index, and cardiac risk factors were similar in the 2 groups. Mean heart rate was similar in the 2 groups (74 +/- 10 vs 70 +/- 7, P > .05). In group 1, QTd, QTcd, and QTc were significantly higher than those of group 2 (QTd, 40 +/- 17 vs 29 +/- 10 milliseconds [P < .05]; QTcd, 43 +/- 19 vs 30 +/- 10 milliseconds [P < .05]; QTc, 410 +/- 21 vs 397 +/- 19 milliseconds [P < .05]). In conclusion, CAE was found to be associated with prolonged QT interval and increased QTd. Microvascular dysfunction and/or ischemia may be responsible mechanisms.

Coronary Aneurysm↗
PubMed2006

Relationship between circulating plasma matrix metalloproteinase-9 (gelatinase-B) concentration and aortic root dilatation.

BACKGROUND: Expression of matrix metalloproteinase (MMP) has been shown in aortic dissection and aneurysms indicating increased proteolysis compared with the normal aorta. However, its role in the development of aortic root dilatation has not been studied. We therefore attempted to determine the relationship between aortic root diameter and MMP-9 concentration in a hypertensive population. METHODS: The 53 hypertensive patients with (n = 27) and without aortic dilatation (n = 26) were included in the study. All participants underwent a complete transthoracic echocardiographic examination including aortic root measurement. Plasma concentration of MMP-9 were determined by the one-step sandwich enzyme immunoassay method and compared in both groups. RESULTS: Baseline demographic properties were similar in both groups. No subject had significant valvular disorder and wall motion abnormality on echocardiographic evaluation. On echocardiographic examination only five patients had bicuspid aortic valve. In patients with aortic root dilatation, 21 patients were using an antihypertensive agent, whereas in patients without aortic root dilatation, 19 patients were using an antihypertensive agent. Plasma MMP-9 level was significantly higher in patients with aortic root dilatation than in those without dilatation (2.5 +/- 1.0 v 1.6 +/- 0.9 ng/mL; P = .003). On correlation analysis, we found a positive correlation between aortic diameter and plasma MMM-9 levels (r = 0.43, P = .001). CONCLUSIONS: Aortic root dilatation is associated with higher MMP release, which may indicate the role of increased collagenolytic and elastolytic activities in hypertension-induced aortic root dilatation.

Aged↗
PubMed2006

Contribution of plasma matrix metalloproteinases to development of left ventricular hypertrophy and diastolic dysfunction in hypertensive subjects.

Matrix metalloproteinases (MMPs) are involved in the regulation of the extracellular matrix (ECM) of the myocardium and thus the pathogenesis of vascular and cardiac hypertrophy. In this study, we investigated contribution of plasma matrix metalloproteinases to development of left ventricular hypertrophy (LVH) and diastolic dysfunction in hypertensive subjects. Hypertensive patients with (n = 27) and without LVH (n = 23) were included. All participants underwent a complete transthoracic echocardiographic examination, including recordings of the mitral annular early, late, systolic and diastolic velocities by Doppler imaging. Plasma concentrations of MMP-3 and MMP-9 were determined by the one-step sandwich enzyme immunoassay method. Plasma MMP-3 and MMP-9 concentrations were significantly higher in patients with LVH than those without LVH (2.4 +/- 1.2 vs 1.5 +/- 0.7 ng/ml, p = 0.006 and 5.2 +/- 2.8 vs 3.3 +/- 1.7 ng/ml, p = 0.003, respectively). MMP-3 and MMP-9 levels were also correlated with left ventricular posterior wall thickness and Doppler indices of diastolic dysfunction. Our findings have suggested that increased MMP levels may contribute to LVH and left ventricular diastolic dysfunction. Therefore, treatment of hypertension with MMP lowering drugs, such as angiotensin converting enzyme inhibitors and angiotensin receptor blockers, may have favorable effects on LVH and left ventricular diastolic dysfunction.

Aged↗
PubMed2005

Serum anti-p53 antibodies do not occur in patients with heart failure due to idiopathic dilated and ischemic cardiomyopathies.

BACKGROUND: P53 is a key protein which controls cell cycle arrest and apoptosis in response to DNA damage. Auto-antibodies against p53 have been detected in some cancer patients and also in patients with autoimmune diseases. In these patients, the main cause of anti-p53 antibody occurrence was considered to be increased intracellular p53 protein in cancer cells and autoreactive lymphocytes, respectively. Intracellular p53 also increases with cardiomyocyte apoptosis during heart failure and autoreactive lymphocytes play a role in the course of idiopathic dilated cardiomyopathy (IDC) and ischemic cardiomyopathy (ICM). Based on these observations, we hypothesized that anti-p53 antibody response may also occur in patients with heart failure due to ICM and IDC. AIM: The aim of this study was to evaluate anti-p53 antibodies in the serum of patients with heart failure due to IDC and ICM. METHODS: 70 eligible patients with heart failure and severe left ventricular systolic dysfunction (mean fractional shortening 12.03 +/- 3.93%) were included in the study. The aetiology of heart failure was IDC in 26 patients and ICM in 44 patients, according to the angiographic and echocardiographic findings. RESULTS: Anti-p53 antibodies were not detected in any of the patients. CONCLUSION: Anti-p53 antibodies do not occur in patients with heart failure due to IDC and ICM, possible explanations are discussed in the text.

Adolescent↗
PubMed2005

Differentiating clinical and echocardiographic characteristics of chordal rupture detected in patients with rheumatic mitral valve disease and floppy mitral valve: impact of the infective endocarditis on chordal rupture.

AIMS: We aimed to compare the clinical and echocardiographic correlates of chordal rupture in patients with rheumatic mitral valve disease and floppy mitral valve. METHODS AND RESULTS: The study group comprised of 224 patients who underwent transthoracic and transesophageal echocardiography because of the severe mitral regurgitation. Chordal rupture was detected in 58 (25.9%) out of the 224 patients, in 33 out of the 83 (39.7%) patients with floppy mitral valve, and in 25 out of the 141 (17.7%) patients with rheumatic mitral valve disease. Chordal rupture was more frequently associated with anterior leaflet (80%) in patients with rheumatic mitral valve disease, and posterior leaflet (72.7%) in patients with floppy mitral valve (p<0.05). Univariate correlates of chordal rupture were age, male sex, posterior mitral leaflet thickening and chordal elongation in patients with floppy mitral valve (p<0.05), and chordal shortening (p<0.0001) and infective endocarditis involving mitral anterior leaflet (p<0.05) in rheumatic group. Independent predictors of chordal rupture were age (>50 years), posterior mitral leaflet thickness (> or =0.45cm), and male sex (p<0.05) in patients with floppy mitral valve while infective endocarditis involving mitral anterior leaflet (p<0.05) in patients with rheumatic mitral valve disease. Patients with chordal rupture due to floppy mitral valve had an older age (p<0.0001), a male dominance, longer mitral leaflets and chordae, and a larger mitral annulus circumference (p<0.05) as compared to those with rheumatic chordal rupture. Despite the comparable severity of mitral regurgitation and left atrial diameters between the two groups of chordal rupture (p>0.05), functional class and pulmonary artery systolic pressure were higher, and atrial fibrillation, acute deterioration, infective endocarditis, mitral leaflet rupture and need for mitral valve surgery in the 3 months were more frequent in rheumatic chordal rupture subgroup (p<0.05). CONCLUSION: Chordal rupture seems to be more frequently associated with anterior mitral leaflet in rheumatic mitral valve disease, whereas it was the posterior leaflet in floppy mitral valve. Chordal rupture was related to male sex, older age, posterior leaflet thickening, and chordal elongation in patients with floppy mitral valve. However, infective endocarditis, acute deterioration, and need for early mitral surgery were more frequent in patients with rheumatic chordal rupture.

Adult↗
PubMed2005

Comparison of the predictors for atrial rhythm disturbances between trained athletes and control subjects.

Atrial rhythm disturbances, particularly atrial fibrillation (AF), are frequently encountered in trained athletes. P wave dispersion (PWD) is a recent electrocardiographic (ECG) marker that reflects velocity of atrial impulse propagation. However, it remains unknown whether the P wave duration and PWD are different between athletes and sedentary controls. In this study we therefore determined the P wave duration and PWD, markers for conduction abnormalities, in trained athletes and controls. Fifty athletes and sex and age-matched 40 healthy sedentary controls were included in the study. All of the athletes were the members of a local athletic college and they were regularly maintaining their sportive activities; the duration of athletic competition was 7.7 +/- 3.3 years and the average athletic time was 10.1 +/- 1.6 hours/week. The 12-lead surface ECG was obtained from each subject in the supine position. The P wave duration was measured, and the difference between the maximum and minimum P wave duration was defined as the PWD. Distribution of sex, age, body mass index, blood pressure was similar in athletic groups and controls. Heart rate was significantly lower in the athletes than in the controls (66 +/- 7 vs 73 +/- 9 beats/min, p < 0.05). Maximum and minimum P wave durations were not statistically different in athletic group and controls (115 +/- 6 vs 114 +/- 4 ms and 74 +/- 8 vs 74 +/- 7 ms, respectively). In addition, PWD did not differ significantly in both groups (41 +/- 6 vs 40 +/- 7 ms, respectively). Thus, athlete's heart is not associated with prolonged P wave duration and increased PWD, indicating that P wave duration or PWD could not be used as a predictor for AF developed in trained athletes.

Adult↗
PubMed2004

[Surgical treatment of iatrogenic cardiac traumas induced by heart catheterization].

BACKGROUND: A retrospective evaluation was made on iatrogenic cardiac traumas requiring surgical treatment, that were induced by cardiac catheterizations and interventions performed within a 17-year period. METHODS: A total of 64,911 patients underwent cardiac catheterizations and interventions from 1985 to 2002. Complications of iatrogenic cardiac traumas induced by these interventions were examined together with the surgical treatment performed within 24 hours after catheterization. RESULTS: Iatrogenic cardiac trauma requiring prompt surgical intervention was documented in 20 patients (6 females, 14 males; mean age 51 years; range 31 to 69 years). These were due to coronary angiography/balloon angioplasty-stenting in 14 (70%), percutaneous mitral balloon valvuloplasty in four (20%), and to heart catheterization in two patients (10%). Acute cardiac tamponade was detected in 10 patients (50%) resulting from perforations to the cardiac chambers in six, coronary arteries in two, and major vessels in two patients. Surgical interventions included coronary artery by-pass in 14, mitral valve surgery in four, and repair of major vessels in two patients. Perioperative mortality occurred in two patients. Six patients developed complications contributing to morbidity, including perioperative myocardial infarction (3 patients), infection (2 patients), and prolonged intubation (1 patient). CONCLUSION: In case of major cardiac complications induced during cardiac catheterizations, early diagnosis and prompt surgical intervention are of vital importance regardless of considerably high risks.

Adult↗
PubMed2003

Spontaneous echo contrast in the descending aorta in patients without aortic dissection: associated clinical and echocardiographic characteristics.

The objective of the study was to evaluate the frequency, clinical and echocardiographic correlates of spontaneous echo contrast in the descending aorta in the absence of dissection. Prevalence of spontaneous echo contrast in the descending aorta in the absence of dissection, and its clinical and echocardiographic correlates were investigated in 1199 consecutive patients who underwent transesophageal echocardiography. Spontaneous echo contrast in the descending aorta was detected in 54 (4.5%) patients. Patients with spontaneous echo contrast in the descending aorta had an older age (60.6+/-8 vs. 40.6+/-14.2 years, P=0.0001), an increased prevalence of male gender (66.7 vs. 43.9%, P=0.001), an increased diameter of ascending aorta (4.2+/-1.0 vs. 3.3+/-1.1 cm, P=0.0001), an increased diameter of descending aorta (3.1+/-0.9 vs. 2.1+/-0.4 cm, P=0.0001), a higher prevalence of aortic wall calcification (9.3 vs. 0.5%, P=0.00001), complex plaque in the descending aorta (13 vs. 0.7%, P=0.0001), left ventricular dysfunction (7.4 vs. 2.1%, P<0.05), a lower incidence of severe aortic regurgitation (0 vs. 3.5%, P<0.05), a lower peak flow velocity in the descending aorta (28+/-9 vs. 51+/-21 cm/s, P<0.00001), and a lower maximal shear rate in the descending aorta (51+/-29 vs. 105+/-47 s(-1), P<0.00001) compared with patients without spontaneous echo contrast in the descending aorta. However, prevalence of atrial fibrillation, mitral valve disease, intracardiac spontaneous echo contrast and/or thrombus and embolic event were not different between patients with and without spontaneous echo contrast in the descending aorta (P>0.05). Shear rate, diameter of the descending aorta, aortic wall calcification, complex plaque in the descending aorta, absence of severe aortic regurgitation and male gender were independent variables of spontaneous echo contrast in the descending aorta. Spontaneous echo contrast in the descending aorta is a local and flow-dependent phenomenon related to aortic dilation, atherosclerosis, and decreased shear rates in the descending aorta. However, in this study, spontaneous echo contrast in the descending aorta was not found to be associated with embolic events.

Adult↗
PubMed2003

Intravascular ultrasound correlates of corrected TIMI framecount.

The TIMI frame count (TFC) is an index of coronary blood flow, and a correction in TFC (CTFC) for left anterior descending artery (LAD) has also been proposed. However, the relationship between TFC and intravascular ultrasound (IVUS) parameters of culprit coronary arteries has not been reported. The aim of this study was to investigate IVUS-derived correlates of TFC before and after stenting, and to assess the validation of its correction for LAD. The study population was comprised of 38 patients with acute coronary syndrome or stable coronary artery disease studied by IVUS before and after stenting (LAD 21, circumflex 8, right coronary artery 9). For LAD, CTFC was calculated by dividing the TFC by 1.7. Preintervention luminal % area stenosis was 82 +/- 12.3%. Pre- and postintervention target lesion lumen areas were 1.8 +/- 0.5 mm2 and 8.5 +/- 0.5 mm2 (P<0.0001), and CTFC were 35.3 +/- 16.8 and 16.9 +/- 4.3 (P<0.0001), respectively. In the 76 IVUS studies, CTFC showed a good correlation to luminal % area stenosis (r = 0.69, P<0.001), and a good and negative correlation to target lesion lumen area (r = -0.70, P<0.001). Postprocedural improvement in CTFC showed a modest correlation to acute lumen gain (r = 0.5, P<0.05). With respect to culprit arteries, pre and postintervention IVUS parameters and CTFC, and net CTFC change after stenting were not different (P>0.05). However, uncorrected TFC of LAD was significantly higher than both the CTFC of LAD and TFC of the other two coronary arteries (P<0.05). We conclude that CTFC is closely correlated to target lesion luminal area and luminal % area stenosis whereas a modest correlation is present between improvement in CTFC and acute luminal gain due to stenting. Results from different coronary arteries with comparable IVUS parameters seem to support the validity of a correction in TFC.

Coronary Angiography↗
PubMed2003

Huge prosthetic mitral valve thrombus: use of serial transesophageal echocardiography guidance in resolution.

The case is presented of a 35-year-old woman with major thrombotic obstruction of a 29-mm St. Jude Medical mitral valve prosthesis. The thrombi were treated with successive intravenous fibrinolysis under transesophageal echocardiographic guidance, without complication. One large and obstructive thrombus with a long and mobile component, and other smaller and mobile thrombi were detected. These were gradually lysed after two successive administrations of streptokinase (1.5 x 10(6) units over 24 h), and one session of recombinant tissue type plasminogen inhibitor (100 mg over 6 h).

Adult↗
PubMed2002

Spontaneous echo contrast in the descending aorta in patients without aortic dissection: associated clinical and echocardiographic characteristics.

OBJECTIVE: To evaluate the frequency, clinical and echocardiographic correlates of spontaneous echo contrast in the descending aorta in the absence of dissection. METHODS: Prevalence of spontaneous echo contrast in the descending aorta in the absence of dissection, and its clinical and echocardiographic correlates were investigated in 1,199 consecutive patients who underwent transesophageal echocardiography. RESULTS: Spontaneous echo contrast in the descending aorta was detected in 54 (4.5%) patients. Patients with spontaneous echo contrast in the descending aorta had an older age (60.6+/-8 vs. 40.6+/-14.2 years, p=0.0001), an increased prevalence of male gender (66.7 vs. 43.9%, p=0.001), an increased diameter of ascending aorta (4.2+/-1.0 vs. 3.3+/-1.1 cm, p=0.0001), an increased diameter of descending aorta (3.1+/-0.9 vs. 2.1+/-0.4 cm, p=0.0001), a higher prevalence of aortic wall calcification (9.3 vs. 0.5%, p=0.00001), complex plaque in the descending aorta (13 vs. 0.7%, p=0.0001), left ventricular dysfunction (7.4 vs. 2.1%, p<0.05), a lower incidence of severe aortic regurgitation (0 vs. 3.5%, p<0.05), a lower peak flow velocity in the descending aorta (28+/-9 vs. 51+/-21 cm/s, p<0.00001), and a lower maximal shear rate in the descending aorta (51+/-29 vs. 105+/-47 s(-1), p<0.00001) compared with patients without spontaneous echo contrast in the descending aorta. However, prevalence of atrial fibrillation, mitral valve disease, intracardiac spontaneous echo contrast and/or thrombus and embolic event were not different between patients with and without spontaneous echo contrast in the descending aorta (p>0.05). Shear rate, diameter of the descending aorta, aortic wall calcification, complex plaque in the descending aorta, absence of severe aortic regurgitation and male gender were independent variables of spontaneous echo contrast in the descending aorta. CONCLUSIONS: Spontaneous echo contrast in the descending aorta is a local and flow dependent phenomenon relates to aortic dilation, atherosclerosis, and decreased shear rates in the descending aorta. However, in this study, spontaneous echo contrast in the descending aorta was not found to be associated with embolic events.

Adult↗
PubMed2002

Spontaneous echocardiographic microbubbles associated with prosthetic mitral valves: mechanistic insights from thrombolytic treatment results.

The purpose of this study was to determine the prevalence of microbubbles (MBs) in patients with prosthetic mitral valves (PMVs). The clinical and echocardiographic predictors of MB were investigated. We also analyzed the temporal relation between MBs and the thrombolytic treatment of thrombotic PMV dysfunction. The study material comprised 307 transesophageal echocardiography examinations in 279 patients (170 women and 109 men with a mean age of 37.9 +/- 13.3 years) with PMV. The PMV was mechanical in 245 patients (tilting-disk valves in 129, and bileaflet aortic valves in 116) and bioprosthetic mitral valves in 34 patients. Twenty-eight sessions of thrombolytic treatment were performed because of the obstructive (n = 18) and nonobstructive (n = 10) thrombi involving the PMV. No MBs were seen in any of the bioprosthetic valves. The MBs were present in 128 of 227 (56.4%) PMV without obstruction compared with only 1 of 18 (5.5%) valves with thrombotic obstruction (P <.0001). The MB were documented in 75.4% of the normal bileaflet valves compared with 38.5% of the tilting-disk valves (P <.0001). The MB intensity score was also significantly higher in the bileaflet valves (2.0 +/- 0.8 vs 0.7 +/- 0.7, P <.05). The incidence of MBs increased from 5.5% to 68.7% after successful thrombolysis in patients with obstructive PMV thrombi (P <.001). There were no other predictors of MBs in this series. The passage of MBs in the aortic root was not documented in any instances. We conclude that MBs are normal echocardiographic findings depending on the type and function of the mechanical PMVs.

Adult↗