Asymptomatic left ventricular myxoma diagnosed incidentally by transthoracic echocardiography.
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Adult↗
Biomedical subjects
Hasan Turhan
Publications and source records attributed to Hasan Turhan.
Essential thrombocytosis manifested as myocardial infarction and congestive heart failure: two case reports.
Essential thrombocytosis is a chronic disease characterized by both quantitative and qualitative abnormalities of platelets. These platelet abnormalities have been reported to be associated with a thrombogenic and haemorrhagic tendency. Cardiovascular complications may develop in patients with essential thrombocytosis due to an abnormal thrombogenic and haemorrhagic tendency. In the present case, we report two cases in which essential thrombocytosis manifested as cardiovascular complication, one of the patients had a history of anterior myocardial infarction, and the other one had congestive heart failure.
Adult↗
Assessment of coronary blood flow in hypertrophic cardiomyopathy using thrombolysis in myocardial infarction frame count method.
BACKGROUND: Coronary microvascular dysfunction has been reported to be present in patients with hypertrophic cardiomyopathy (HCM) despite normal epicardial coronary arteries. In this study we aimed to evaluate coronary blood flow in patients with HCM by means of Thrombolysis In Myocardial Infarction (TIMI) frame count. METHODS: Thirty-two patients with HCM (22 male, 10 female; mean age=48+/-7 years) and 36 healthy control subjects (23 male, 13 female; mean age=49+/-7 years) without any cardiovascular disease were included in the study. All patients and control subjects were selected from individuals who underwent coronary angiography and left heart catheterization in our hospital and were found to have angiographically normal coronary arteries. All patients had an asymmetrically hypertrophic nondilated left ventricle and a basal intraventricular pressure gradient>30 mmHg recorded in the left ventricular outflow tract. A complete transthoracic echocardiographic examination including two-dimensional, M-mode, pulse and continuous Doppler was performed in all patients and control subjects. Coronary flow rates of all subjects were documented by the TIMI frame count method. To obtain corrected TIMI frame count for the left anterior descending (LAD) coronary artery, TIMI frame count for this vessel was divided by 1.7. RESULTS: Corrected TIMI frame count for the LAD coronary artery was found to be significantly higher in patients with HCM compared to control subjects (35+/-8 vs. 25+/-6, p<0.001). However, we found no significant difference between patients and control subjects regarding TIMI frame counts for the left circumflex (LCx) coronary artery and the right coronary artery (RCA) (LCx: 28+/-6 vs. 26+/-6, p=0.07 and RCA: 26+/-6 vs. 24+/-5, p=0.09). Besides, the corrected TIMI frame count for the LAD coronary artery was found to be significantly correlated with interventricular septal wall thickness (r=0.546, p=0.001) and interventricular septal/posterior wall thickness ratio (r=0.490, p=0.004). However, no significant correlation was detected between the corrected TIMI frame count for the LAD coronary artery and other echocardiographic variables. CONCLUSION: We show that patients with HCM had significantly higher corrected TIMI frame counts for the LAD compared to the control subjects. No such difference was detected between the two groups regarding TIMI frame counts for the LCx and RCA, suggesting the presence of regional (interventricular septal) rather than global impairment of coronary blood flow in patients with HCM.
Adult↗
Comparison of C-reactive protein levels in patients with coronary artery ectasia versus patients with obstructive coronary artery disease.
This study evaluated plasma C-reactive protein (CRP) levels, a specific marker of inflammation, in 32 patients with isolated coronary artery ectasia (CAE) and compared the results with those of 32 patients with obstructive coronary artery disease without coronary artery ectasia and 30 subjects with angiographically normal coronary arteries. CRP levels were found to be significantly higher in patients with isolated CAE (p <0.001), suggesting that more severe inflammation may be involved in the pathogenesis of CAE.
C-Reactive Protein↗
Increased blood coagulation and platelet activation in patients with infective endocarditis and embolic events.
BACKGROUND: Inflammation-induced procoagulant changes and alterations in platelet activity appear to play an important role in thromboembolic complications of infective endocarditis (IE). HYPOTHESIS: The aim of this study was to investigate systemic coagulation activity, fibrinolytic capacity, and platelet activation in patients with IE with and without embolic events by measuring the plasma levels of prothrombin fragment 1+2 (PF1+2), thrombin-antithrombin III complex (TAT), plasminogen activator inhibitor-1 (PAI-1), beta-thromboglobulin (beta-TG), and platelet factor 4 (PF4), respectively. METHODS: The study included 76 consecutive patients (female = 55, male = 21, mean age 26 years, range 8-64 years) with definite IE according to the Duke criteria; of these, 13 (17.1%) had embolic events. RESULTS: Plasma concentrations of PF1+2 (3.2 +/- 1.3 vs. 1.7 +/- 0.7 and 1.4 +/- 0.7 nmol/l, p < 0.001, respectively) and TAT (7.3 +/- 1.5 vs. 2.9 +/- 1.2 and 2.2 +/- 1.1 ng/ml, p < 0.001, respectively) were elevated in patients with embolic events compared with patients without embolic events and control subjects. Similarly, patients with embolic events had increased plasma levels of beta-TG (63.3 +/- 10.9 vs. 33.1 +/- 11.6 and 19.1 +/- 10.6 ng/ml, p < 0.001, respectively) and PF4 (106.0 +/- 28.7 vs. 50.3 +/- 16.7 and 43.0 +/- 15.8 ng/ml, p < 0.001, respectively) compared with those without embolic events and the control group. Embolic patients also had higher PAI-1 levels than nonembolic patients and healthy subjects (14.4 +/- 6.4 vs. 8.6 +/- 5.9 and 5.4 +/- 4.3 ng/ml, p = 0.002, respectively). CONCLUSION: Patients with IE and with subsequent thromboembolism have increased systemic coagulation activation, enhanced platelet activity/damage, and impaired fibrinolysis. The resulting imbalance produces a sustained hypercoagulable state, which contributes to the increased risk of thromboembolic events in this particular group.
Adolescent↗
Increased thrombolysis in myocardial infarction frame counts in patients with isolated coronary artery ectasia.
The Thrombolysis in Myocardial Infarction (TIMI) frame count is a simple clinical tool for assessing quantitative indexes of coronary blood flow. This measurement has been significantly correlated with flow velocity measured with a flow-wire by several investigators during baseline conditions or hyperemia. In this study we aimed to evaluate the coronary flow in patients with isolated coronary artery ectasia by means of the TIMI frame count and to compare the results with those of patients with angiographically normal coronary arteries. The study population consisted of 37 patients with coronary artery ectasia only in the right coronary artery (RCA). The control group consisted of 31 patients with angiographically proven normal coronary arteries. Coronary artery ectasia was defined as nonobstructive lesions of the coronary arteries with a luminal dilatation 1.5-fold or more of the adjacent normal coronary segments. The TIMI frame count was determined for each major coronary artery in each patient according to the methods first described by Gibson et al. The TIMI frame count of RCA in the study group was significantly higher than in that of the control group (51 +/- 17 vs 25 +/- 8, P < 0.0001). The TIMI frame counts of the study group for the left anterior descending and left circumflex coronary artery were also significantly higher than those of the control group (corrected TIMI frame count for LAD = 42 +/- 11 vs 24 +/- 7, P < 0.001; TIMI frame count for LCx = 44 +/- 15 vs 25 +/- 9, P < 0.001). In patients with coronary artery ectasia, the TIMI frame count of the RCA was higher than that of the left anterior descending and left circumflex coronary artery (51 +/- 17 vs 42 +/- 11 and 44 +/- 15, respectively, P < 0.05). We have shown increased TIMI frame counts in patients with isolated coronary artery ectasia and suggest that the pathophysiological mechanism of coronary artery ectasia is not a focal disease. TIMI frame counts can be regarded as an index of the severity of impaired coronary flow in patients with coronary artery ectasia.
Case-Control Studies↗
Correlation between infarct-related coronary artery patency and predischarge electrocardiographic patterns in patients with first anterior myocardial infarction who received thrombolytic therapy.
The aim of this study was to investigate the correlation between the ST-segment and T-wave patterns in predischarge electrocardiogram and patency of left anterior descending coronary artery in patients with a first anterior myocardial infarction (AMI). One hundred and fifty-six of 175 consecutive patients who were admitted to our clinic between January 2000 and September 2002 due to a first episode of transmural AMI and who received thrombolytic therapy were enrolled. Coronary angiography was performed by the Judkins method on the 6th-10th day after the acute infarction. The corrected TIMI frame count (CTFC) was estimated according to the previously described method. According to the combination of the ST-segment and T-wave morphology on the day (6-10) of cardiac catheterization, patients were classified into four groups: group A, ST elevation <<0.1 mV and negative T waves; group B, ST elevation >or=0.1 mV and negative T waves; group C, ST elevation <<0.1 mV and positive T waves; and group D, ST elevation >or=0.1 mV and positive T waves. Of the 99 patients with negative T waves, 47 (48%) had CTFC or=40-100, and 5 (5%) CTFC >>100. Of the 57 patients with positive T waves, CTFC was or=40-100 in 11 (19%), and >>100 in 15 (26%) ( P << 0.001). From the 76 patients with an isoelectric ST segment, 38 (50%) had CTFC or=40-100, and 1 (1%) CTFC >>100. Of the 80 patients with an elevated ST segment, 23 (29%) had CTFC or=40-100, and 19 (23%) CTFC >>100 ( P << 0.001). Use of the combination of two electrocardiographic parameters (ST segment and T waves) also indicated that there were significant differences between groups A and D, and groups B and D ( P << 0.001 and P << 0.05, respectively). Development of an isoelectric ST segment with negative T waves may indicate a better degree of reperfusion after AMI. In contrast, patients in whom ST-segment elevation and positive T waves remain at discharge from the coronary care unit have a higher probability of a nonpatent left anterior descending artery.
Cardiac Catheterization↗
Double left anterior descending coronary artery arising from the left and right coronary arteries: a rare congenital coronary artery anomaly.
Double left anterior descending coronary artery arising from the left and right coronary arteries is a very rare congenital coronary artery anomaly. In this report, we describe a patient with double left anterior descending coronary artery originating from the left and right coronary arteries. To the best of our knowledge, dual connection of the left anterior descending coronary artery to the left and right coronary arteries has been described in only five patients.
Aged↗
Documentation of slow coronary flow by the thrombolysis in myocardial infarction frame count in habitual smokers with angiographically normal coronary arteries.
The thrombolysis in myocardial infarction (TIMI) frame count is a simple clinical tool for assessing quantitative indexes of coronary blood flow. In this study we aimed to evaluate the effects of long-term cigarette smoking on the TIMI frame count in patients with angiographically proven normal coronary arteries. Between May 2001 and January 2002, 41 habitual smokers and 41 sex-matched nonsmokers with angiographically proven normal coronary arteries were included in the study. The TIMI frame count was determined for each major coronary artery in each patient. The TIMI frame count of the smoking group was significantly higher than that of nonsmokers for all three coronary arteries: left anterior descending (corrected), 39 +/- 13 vs 22 +/- 8; right coronary artery, 35 +/- 13 vs 24 +/- 11; and left circumflex artery, 37 +/- 13 vs 25 +/- 8 (P < 0.001 for all). The smokers tended to be younger than nonsmokers (46 +/- 7 vs 49 +/- 9 years; P = 0.07). We have found that smokers with angiographically normal coronary arteries have a higher TIMI frame count than nonsmokers with angiographically normal coronary arteries. An increased TIMI frame count can be regarded as an index of the harmful effects of smoking on coronary circulation regardless of the underlying mechanism.
Adult↗
Impaired coronary blood flow in patients with metabolic syndrome: documented by Thrombolysis in Myocardial Infarction (TIMI) frame count method.
BACKGROUND: Endothelium plays an important role in regulating coronary vascular tone. In addition, several of cardiovascular risk factors that are associated metabolic syndrome have been reported to be associated with endothelial dysfunction. In the present study we aimed to evaluate the coronary blood flow in patients with metabolic syndrome by means of the Thrombolysis in Myocardial Infarction (TIMI) frame count. METHOD: Forty-two patients with metabolic syndrome (group I) and 42 control subjects without metabolic syndrome (group II) were included in the study. All subjects had angiographically proven normal coronary arteries. Diagnosis of metabolic syndrome was based on the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines published in 2001. Coronary flow rates of all subjects were documented by TIMI frame count method. RESULTS: TIMI frame counts for each of the major epicardial coronary arteries were found to be significantly higher in patients with metabolic syndrome compared with control subjects (corrected TIMI frame count for left anterior descending coronary artery: 35 +/- 7 vs 25 +/- 7, respectively; left circumflex coronary artery: 32 +/- 9 vs 25 +/- 7, respectively; right coronary artery: 31 +/- 9 vs 24 +/- 5, respectively; P < .001 for all). Statistically significant independent relationships were found between TIMI frame count and body mass index (R(2) = 0.480, P = .009), waist circumference (R2 = 0.551, P = .001), and triglyceride level (R2 = 0.434, P = .036). CONCLUSION: We have shown for the first time that patients with metabolic syndrome and angiographically normal coronary arteries have higher TIMI frame counts for all 3 coronary vessels, indicating impaired coronary blood flow, compared to control subjects without metabolic syndrome.
Blood Pressure↗
Traumatic type B aortic dissection causing near total occlusion of aortic lumen and diagnosed by transthoracic echocardiography: A case report.
A true dissection of the descending thoracic aorta resulting from blunt chest trauma is a relatively rare injury compared with aortic transsection and occurs mostly in the region of the aortic isthmus. It is a life-threatening condition that requires rapid and accurate diagnosis. In this case, we report a patient with Stanford type B aortic dissection caused by decelerating trauma of the chest in a motor vehicle accident causing near total occlusion of the aortic lumen. The diagnosis was made by transthoracic echocardiography and confirmed by aortography.
Accidents, Traffic↗
P-wave duration and P-wave dispersion in patients with dilated cardiomyopathy.
BACKGROUND: P-wave dispersion (PWD) has been reported to be associated with inhomogeneous and discontinuous propagation of sinus impulses. In the present study, we aimed to investigate PWD in patients with dilated cardiomyopathy. METHOD: The study population consisted of 72 patients with dilated cardiomyopathy and 72 healthy control subjects. Left atrial diameter, left ventricular end-diastolic and end-systolic diameters and left ventricular ejection fraction of all patients and control subjects were measured by means of transthoracic echocardiography. Maximum P-wave duration (Pmaximum) and minimum P-wave duration (Pminimum) were measured from the 12-lead surface electrocardiogram. PWD was calculated as the difference between Pmaximum and Pminimum. RESULTS: Pmaximum and PWD of patients with dilated cardiomyopathy were significantly higher than those of control subjects (Pmaximum: 126+/-12 ms vs. 116+/-10 ms, PWD: 47+/-6 ms vs. 38+/-7 ms, respectively, P<0.001 for all). However, there was no statistically significant difference between patient group and control group regarding Pminimum (79+/-7 ms vs. 78+/-6 ms, respectively, P=0.27). Left atrial diameter was significantly higher in patients with dilated cardiomyopathy compared to control subjects (4.51+/-0.62 cm vs. 3.60+/-0.43 cm, respectively, P<0.001). Left ventricular ejection fraction was found to be significantly lower in patients with dilated cardiomyopathy compared to control subjects (33+/-5% vs. 63+/-7%, respectively, P<0.001). CONCLUSION: PWD was found to be significantly higher in patients with dilated cardiomyopathy than in healthy control subjects.
Aged↗
P-wave durations as a predictor for atrial fibrillation development in patients with hypertrophic cardiomyopathy.
Atrial fibrillation (AF) is the most common arrhythmia observed in hypertropic cardiomyopathy (HCM) and is associated with an acute deterioration. Recently, P wave dispersion (PWD) reflecting inhomogeneous atrial conduction has been proposed as being useful for the estimation of paroxysmal AF. In this study, we aimed to define the clinical, echocardiographic and electrocardiographic predictors for AF occurrence in patients with HCM. Twenty-seven patients diagnosed with HCM and having a history of documented AF attack were compared with 53 age- and gender-matched patients who had no such history. LA diameter was significantly greater and gradient in the left ventricle outflow tract was lower in patients with AF than those without AF. Maximum P-wave duration (Pmax), PWD and PTF1 values were significantly higher in patients with AF. A Pmax>134.5 ms separated the patients with AF from controls with a sensitivity of 92%, specificity of 89% and a positive predictive value of 80%. APWD value>52.5 ms separated patients from controls with a sensitivity of 96%, a specificity of 91% and a positive predictive accuracy of 84%. An LA diameter>4.2 cm separated patients from controls with a sensitivity of 96% and a specificity of 81%. We concluded that LA diameter and PWD values are the most significant predictors for AF occurrence in patients with HCM, and simply by measuring Pmax and PWD values, we could easily identify the patients with high risk, and prescribe the necessary treatment and follow-up protocols for such patients.
Adult↗
Brucella endocarditis complicated with a mycotic aneurysm of the superior mesenteric artery: a case report.
Brucella endocarditis, although a rare complication of brucellosis, is the main cause of death attributable to this disease. Mycotic aneurysm is an important extracardiac complication of infective endocarditis. Mycotic aneurysm of the superior mesenteric artery is extremely rare. In the present case, we report a patient with Brucella melitensis endocarditis complicated with a superior mesenteric artery aneurysm. To our knowledge, this is the first such reported case.
Adult↗
Predictors of left ventricular thrombus formation in patients with dilated cardiomyopathy: role of activated protein C resistance.
OBJECTIVES: The aim of this study was to investigate the association between left ventricular thrombus formation and natural anticoagulant systems including the protein C, protein S and antithrombin in patients with dilated cardiomyopathy. MATERIALS AND METHODS: Sixty patients with dilated cardiomyopathy who met the inclusion criteria were included in the study. Patients were divided into two groups: group I consisted of 22 patients with left ventricular thrombus and group II consisted of 38 patients without left ventricular thrombus. Our main inclusion criteria were ejection fraction </= 35% and left ventricular end-diastolic diameter >/= 6.0 cm. These two groups were compared for clinical and hematologic parameters (activated protein C resistance, protein S and antithrombin). RESULTS: There were no statistically significant differences between patients with or without left ventricular thrombi with respect to left ventricular end-diastolic and end-systolic dimensions, ejection fraction, fractional shortening and left atrial diameter. There were no statistically significant differences between patients with and without left ventricular thrombus with respect to platelet count (252 +/- 64/mm3 x 10(3) compared with 260 +/- 74/mm3 x 10(3) respectively, P=0.68), prothrombin time (12.94 +/- 1.9 s compared with 12.86 +/- 1.3 s respectively, P=0.82), activated partial thromboplastin time (32 +/- 5 compared with 30 +/- 4 s respectively, P=0.32) and fibrinogen levels (36 +/- 9 mg/dl compared with 34 +/- 8 mg/dl respectively, P=0.41). None of the patients had protein S and antithrombin deficiency. Activated protein C resistance was found in 12 patients (12 out of 22, 54%) in group I and four patients (four out of 38, 9.5%) in group II (P < 0.01). It was also shown to be an independent predictor of left ventricular thrombus (P < 0.05). CONCLUSION: Activated protein C resistance is found to be an independent predictor of left ventricular thrombus in patients with dilated cardiomyopathy who have ejection fractions less then 35% and left ventricular end-diastolic dimensions > 6.0 cm.
Activated Protein C Resistance↗
Activation of coagulation system in dilated cardiomyopathy: comparison of patients with and without left ventricular thrombus.
OBJECTIVES: We aimed to investigate plasma levels of molecular markers for platelet activity, thrombin activation and fibrinolytic status in patients with dilated cardiomyopathy (DCM) with and without left ventricular (LV) thrombus and to compare these markers between patients with DCM and control participants. MATERIALS AND METHODS: The study population comprised 60 patients with DCM who met the inclusion criteria. Patients were divided into two groups: 22 patients with LV thrombus and 38 patients without LV thrombus. The age-matched control group consisted of 23 healthy participants (18 men and five women with a mean age of 49). Patients with DCM and healthy participants were compared with respect to platelet activity, thrombin activation and fibrinolytic status. These comparisons were also performed in patients with DCM with and without LV thrombus. RESULTS: Platelet factor 4 (28.2+/-4.4 ng/ml compared with 20+/-3.1 ng/ml, P<0.01) and beta-thromboglobulin (40+/-2 ng/ml compared with 17+/-3 ng/ml) levels, reflecting platelet activity, were significantly higher in patients with DCM than in control participants. Fibrinopeptide A (6.94+/-0.69 ng/ml compared with 1.96+/-0.1 ng/ml, P<0.001) and thrombin-antithrombin III complex (5.26+/-2.60 ng/ml compared with 3.17+/-1.23 ng/ml, P<0.001) levels, as markers of fibrin generation, were also higher in patients with DCM than in normal participants. Plasma levels of D-dimer (118+/-16 ng/ml compared with 85+/-3 ng/ml, P<0.001) and plasmin-alpha2-plasmin inhibitor complex (0.8+/-1.1 microg/ml compared with 0.6+/-1.7 microg/ml, P<0.001) in patients with DCM significantly exceeded those in the normal participants. There were no statistically significant differences between patients with and without LV thrombus in DCM with respect to platelet activity, thrombin activation and fibrinolytic status. CONCLUSION: We have shown that platelet activation, thrombin activation and fibrinolytic activity are increased in patients with DCM compared to control participants. However, these markers reflecting coagulation activation in patients with LV thrombus are comparable to those in patients without LV thrombus.
Adult↗
Migraine headache induced recurrent atrial fibrillation: a case report.
A variety of symptoms that accompany migraine are mediated by the autonomic nervous system. The autonomic nervous system has long been known to play a potentially important role in the occurrence of atrial fibrillation. Clinically significant effects on cardiac rhythm are uncommon during migraine attacks. In the present case, we report a man who experienced recurrent episodes of atrial fibrillation, which were likely secondary to the vomiting component of migraine.
Adult↗
Relationship between control of ventricular rate in atrial fibrillation and systemic coagulation activation in patients with mitral stenosis.
BACKGROUND AND AIM OF THE STUDY: Systemic thromboembolism is a major complication in patients with mitral stenosis (MS), especially in those who have atrial fibrillation (AF). It has been suggested that systemic coagulation activity may be increased in these patients. The study aim was to investigate the relationship between control of ventricular rate and systemic coagulation factors in patients with MS and AF by measuring plasma levels of prothrombin fragment (PF) 1+2, thrombin-antithrombin III complex (TAT) and plasminogen activator inhibitor-1. METHODS: Fifty-four consecutive patients with moderate to severe MS and AF were included in the study. Patients with resting heart rates < 100 beats per min were considered as having a controlled ventricular response rate (group A; n = 28) and those with > 100 beats per min as an uncontrolled ventricular response rate (group B; n = 26). RESULTS: Group A patients had a lower mean mitral gradient and pulmonary artery pressure than group B patients (11 +/- 6 versus 15 +/- 5 and 35 +/- 7 versus 39 +/- 8; p < 0.05, respectively). Plasma concentrations of PF 1+2 (4.17 +/- 2.1 versus 2.95 +/- 1.21; p < 0.01) and TAT III (4.61 +/- 1.75 versus 3.12 +/- 1.01; p < 0.01) were elevated in group B compared with group A. Similarly, group B patients had higher plasminogen activator inhibitor-1 levels than group A patients (7.87 +/- 3.8 versus 5.8 +/- 2.9; p < 0.05). A significant correlation was found between heart rate and plasma PF 1+2 and TAT levels. Multiple logistic regression analysis revealed that heart rate and mean mitral gradient were independent predictors of systemic coagulation activation. CONCLUSION: Besides contributing towards hemodynamic and symptomatic relief, the control of AF rate in MS patients induces a drastic decline in coagulation activation, and may also reduce the incidence of thromboembolism.
Adolescent↗