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Biomedical subjects

Hurkan Kursaklioglu

Publications and source records attributed to Hurkan Kursaklioglu.

At least 37 records · Page 2Linked to original sources
PubMed2006

P wave dispersion predicts recurrence of paroxysmal atrial fibrillation in patients with atrioventricular nodal reentrant tachycardia treated with radiofrequency catheter ablation.

BACKGROUND: Paroxysmal atrial fibrillation (AF) recurs in up to one-third of patients with atrioventricular nodal reentrant tachycardia (AVNRT) treated with slow pathway ablation. Therefore, identification of patients at risk for recurrence of AF after slow pathway ablation is important because of the necessity for additional therapies. The purpose of this study was to determine whether successful slow pathway ablation influences P wave parameters and whether these parameters predict the recurrence of paroxysmal AF in patients with both AVNRT and paroxysmal AF after ablation. METHODS: Thirty-six patients with AVNRT and documented paroxysmal AF (Group 1) were compared to 36 age-matched controls with AVNRT only (Group 2). P wave durations and P dispersion were measured before and after ablation. RESULTS: No significant differences were observed between P wave parameters observed before and after ablation. Maximum P wave durations (Pmax) and P dispersion (Pdisp) were significantly higher in Group 1 than in Group 2 (P < 0.001 for both) whereas minimum P wave durations did not differ between groups, both before and after ablation. Ten patients (28%) in Group-1 had recurrence of AF during a mean follow-up of 34 +/- 11 months. Univariate predictors of AF recurrence were Pdisp > or =35.5 ms (P < 0.010), left atrial diameter >40 mm (P < 0.010), mitral or aortic calcification (P < 0.010), Pmax > or =112 ms (P < 0.050), valvular heart disease (P < 0.050), and atrial vulnerability (induction of AF lasting >30 second) after ablation (P < 0.050). However, only Pdisp > or =35.5 ms (P < 0.050) and left atrial diameter >40 mm (P < 0.010) were independent predictors of AF recurrences. CONCLUSION: This study suggests that P wave dispersion could identify patients with AVNRT susceptible to recurrence of AF after slow pathway ablation.

Adult↗
PubMed2006

Effects of non-heavy smoking on high-density lipoprotein cholesterol in healthy Turkish young men.

OBJECTIVE: Decreased effects of smoking on serum high-density lipoprotein cholesterol (HDL-c) were demonstrated in subjects smoking more than 20 cigarettes a day. We aimed to evaluate the effects of non-heavy smoking (< or =20 cigarettes a day) on HDL-c in young, healthy men who are similar in terms of age, physical activity and diet. METHODS: A total of 1012 male students between 19 and 25 years old (21.4 +/- 1.5) in a military college who do not smoke or smoking < or =20 cigarettes a day were enrolled. Subjects who were consuming alcohol were excluded. Smoking levels (0: nonsmoker, 1: 1-5 cigarettes, 2: 6-10 cigarettes, 3:11-20 cigarettes a day) and duration were obtained by a questionnaire. Blood samples were taken after an over-night fasting. Blood pressure and anthropometric measurements were reported. RESULTS: HDL-c showed a stepwise decrease as the level of smoking increased (49 +/- 9 mg/dL in level 0, 47 +/- 7 mg/dL in level 1, 46 +/- 8 mg/dL in level 2, 45 +/- 7 mg/dL in level 3, p < 0.001). Total cholesterol, triglycerides and low-density cholesterol were not different among the smoking levels. Body mass index (BMI) and waist/hip ratio were found to be slightly decreased in smokers. In a multivariate regression model including smoking level, duration, BMI, systolic and diastolic blood pressures, smoking level was the only predictor of HDL-c (B = -1.407, p < 0.001). CONCLUSION: Smoking, even in relatively low levels, has a negative stepwise relationship with HDL-c in a homogeneous population of healthy young men in whom other major non-genetic factors that are known to affect HDL-c levels are identical.

Adult↗
PubMed2006

Myocardial bridging confined to the right ventricular branch of the right coronary artery in a patient with severe pulmonary hypertension.

Although myocardial bridges are mostly confined to the left anterior descending coronary artery, several cases of right coronary artery myocardial bridging have been reported in the literature. In the current case report, we present a 65-year-old female with a well-functioning mechanical mitral valve prosthesis, severe pulmonary hypertension and right ventricle wall motion abnormality in whom diagnostic angiography revealed myocardial bridging confined to the right ventricular branch of the right coronary artery.

Aged↗
PubMed2005

A contractile left ventricular diverticulum.

We present the first case report of left ventricle muscular diverticulum which stands in front of the right ventricle in an asymptomatic 20-year-old male. The diverticulum has a connection with the left ventricular outflow truct, and contracts simultaneously with the left ventricle. The patient has been included in our congenital anomaly follow-up program.

Coronary Angiography↗
PubMed2005

A large calcified saccular aneurysm in a patient with aortic coarctation.

Coarctation of the aorta (CA) accounts for 5% of all congenital heart disease. One of the most feared complications of coarctation of the aorta is the development of saccular aortic aneurysm. In this paper, we described a 20-year-old man with coarctation of the aorta in association with a large calcified saccular thoracic aneurysm just distal to the coarcted segment detected both in aortography and magnetic resonance angiography (MRA).

Adult↗
PubMed2005

Woven coronary artery: a case report and review of literature.

Woven coronary artery is an extremely rare and clearly undefined coronary malformation. Up to now, very few cases have been reported. In this anomaly, epicardial coronary artery are branched into thin channels at any segment of the coronary artery and then these longitudinal twisted thin channels merge again as the main coronary lumen. This anomaly is regarded as a benign condition since there is completely normal blood flow after the distal segment of the abnormal coronary artery. In this case report, we present a 48-year-old male patient with a woven coronary artery anomaly in the circumflex artery and who had been followed up for 5 years.

Coronary Angiography↗
PubMed2005

Coexistence of a huge subaortic left ventricular aneurysm and a saccular descending aortic aneurysm.

A huge subaortic left ventricular aneursym was diagnosed in an asymptomatic 22-year-old male patient. The walls of aneurysm were calcific and compressed the left atrium. Also, a saccular descending aortic aneursym and moderate mitral insufficiency associated with subaortic left ventricular aneurysm were found in the current case. Up to now, the coexistence of congenital left ventricular aneurysm and saccular aortic aneursym has not been reported in the literature. We present the first case of congenital left ventricular aneurysm combined with saccular aortic aneurysm in descending thoracic aorta in this case report.

Adult↗
PubMed2005

Intracavitary left ventricular hydatid cysts ruptured during cardiopulmonary resuscitation in a patient with acute myocardial infarction.

Cardiac hydatid cyst is a rare complication of parasitic infection caused by Echinococcus granulosus. Cardiac involvement occurs in only 0.2-2% of hydatidosis cases. Rupture of hydatid cysts into cardiac chambers is very rare. In this report, we present a case of intracavitary left ventricular hydatid cysts ruptured during cardiopulmonary resuscitation in a patient with acute myocardial infarction.

Aged↗
PubMed2005

The comparative effects of telmisartan and ramipril on P-wave dispersion in hypertensive patients: a randomized clinical study.

BACKGROUND: Prolongation of P-wave times and increase of P-wave dispersion (PWD) were shown to be independent predictors of atrial fibrillation (AF). Angiotensin II receptor blockers (AARBs) and angiotensin-converting enzyme inhibitors (ACEIs) have beneficial effects on atrial conduction times. However, there are not enough data about the comparative effects of those drugs on PWD. HYPOTHESIS: We aimed to compare the effects of telmisartan and ramipril on PWD after 6-month treatment in hypertensive patients. METHODS: In all, 100 newly diagnosed hypertensive patients were enrolled in the study and were randomly assigned to two groups. Group 1 and Group 2 each consisted of 50 patients, taking daily doses of 80 mg telmisartan and 10 mg ramipril, respectively. Twelve-lead surface electrocardiograms (ECG) were recorded from all patients before and after 6-month drug therapy. The P-wave duration (Pdur) measurements were calculated from the 12-lead surface ECG. RESULTS: When pretreatment PWD and Pmaximum values were compared with post-treatment values, a statistically significant decrease was found in both groups after 6 months (Group 1 and 2; p < 0.001 for PWD and Pmaximum). P-wave dispersion and Pmaximum values after treatment in Group 1 were statistically significantly lower than those in Group 2 after the 6-month treatment period (p = 0.01 for PWD; p = 0.008 for Pmaximum). CONCLUSIONS: Telmisartan has a much greater lowering effect on PWD and Pmaximum values than ramipril. This finding may be important in the prevention of AF in hypertensive patients.

Angiotensin II Type 1 Receptor Blockers↗
PubMed2005

Impaired coronary collateral vessel development in patients with proliferative diabetic retinopathy.

BACKGROUND: Diabetic patients have been reported to have impaired coronary collateral vessel growth, although they have excessive neovascularization in the retina. HYPOTHESIS: This study was designed to compare coronary collateral circulation (CCC) in patients with proliferative diabetic retinopathy (PDR) with that in patients without DR. METHODS: Ninety diabetic patients with chronic total occlusion in at least one major epicardial coronary artery were enrolled in the study. Groups 1 and 2 consisted of 48 patients without DR and 42 patients with PDR, respectively. Coronary collateral circulation (CCC) was analyzed according to the Rentrop system. Each group was also divided into two subgroups according to poor and good CCC. Serum vascular endothelial growth factor (VEGF) levels were measured using the enzyme-linked immunosorbent assay (ELISA) kit. RESULTS: The mean Rentrop collateral score was higher in Group 1 than in Group 2 (2.39 +/- 1.07 vs. 1.76 +/- 0.76, respectively, p < 0.001). When the two groups were compared with respect to poor and good CCC, poor CCC was higher in patients with PDR (64 vs. 36%, respectively, p = 0.01). Serum VEGF levels were higher in patients with PDR than in those without DR (219 +/- 99 vs. 139 +/- 98 pg/ml, p < 0.001); however, patients with poor and good CCC had similar VEGF levels. CONCLUSIONS: We have shown that patients with PDR have a lower coronary collateral score than patients without DR. Also, serum VEGF was significantly higher in patients with PDR than in those without DR. These findings have suggested that diabetes mellitus may have a different action on retinal and coronary circulation.

Aged↗
PubMed2005

Radiofrequency catheter ablation of accessory pathways during pre-excited atrial fibrillation: acute success rate and long-term clinical follow-up results as compared to those patients undergoing successful catheter ablation during sinus rhythm.

The onset of recurrent or sustained atrial fibrillation (AF) is common during electrophysiological (EP) studies of accessory pathways (AP). We report our experience in patients with Wolff-Parkinson-White (WPW) syndrome in whom AF with rapid antegrade conduction over the AP occurred during an EP study and mapping and ablation were done during sustained AF, as compared to patients ablated during sinus rhythm. The study group consisted of 18 patients (group 1) with WPW syndrome who underwent catheter ablation during pre-excited AF. Two hundred and sixty-three patients, comparable for clinical characteristics, whose manifest APs were ablated under sinus rhythm formed the control group (group 2). Bipolar electrogram criteria recorded from the ablation catheter showing early ventricular activation relative to the delta wave on the surface ECG and AP potentials preceding the onset of ventricular activation were used as targets for ablation. Clinically documented atrial fibrillation was significantly more frequent and antegrade ERP of AP was significantly shorter in group 1 than in group 2 (39% vs 14%, P=0.014 and 268+/-37 vs 283+/-16, P<0.001, respectively). Procedure-related variables, acute success rates (17/18 [94%] in group 1, 251/263 [95%] in group 2; P>0.05) and late recurrence rates (0/18 [0%] in group 1 vs 5/263 [2%] in group 2; P>0.05) during a mean follow-up of 25+/-9 months (range 8-52 months) did not differ significantly. Our results show that both right- and left-sided accessory pathways can be mapped and ablated safely during pre-excited AF without delay, and that acute success and recurrence rates and long-term follow-up results are similar to those of pathways ablated during sinus rhythm.

Adolescent↗
PubMed2005

Aortico-right atrial tunnel in an adult patient.

We describe an asymptomatic 27-year-old man who presented a continuous murmur, and was found to have a tunnel between the aorta and the right atrium. Successful surgical treatment was performed. We emphasize the rarity of this condition, and discuss its major features.

Adult↗
PubMed2005

Atrioventricular nodal reentrant tachycardia with paroxysmal atrial fibrillation: clinical and electrophysiological features and predictors of atrial fibrillation recurrence following elimination of atrioventricular nodal reentrant tachycardia.

INTRODUCTION: Clinical and electrophysiological characteristics of patients with atrioventricular nodal reentrant tachycardia (AVNRT) and paroxysmal atrial fibrillation (AF) have not been studied in a large patient cohort. We aimed to define the clinical features and cardiac electrophysiological characteristics of these patients, and to examine the incidence and identify predictors of AF recurrences after elimination of AVNRT. METHODS AND RESULTS: Thirty-six patients with AVNRT and documented paroxysmal AF (Group 1) and 497 patients with AVNRT alone undergoing ablation in the same period (Group 2) were studied. There were no significant differences between groups regarding clinical features, except age, which was higher in Group 1 (p<0.001). Presence of atrial vulnerability (induction of AF lasting>30 seconds) and multiple AH jumps (>or=50 ms) before ablation were significantly more prevalent in Group 1 (p<0.001, p=0.010 respectively). During follow-up of 34 +/- 11 months, AF recurred in 10 patients (28%) in Group 1, while 2 patients in Group 2 (0.4%) developed paroxysmal AF (p<0.001). Univariate predictors of AF were: left atrial diameter>40 mm (p=0.001), presence of mitral or aortic calcification (p=0.003), atrial vulnerability after ablation (p=0.015) and valvular disease (p=0.042). However, independent predictors of AF recurrences were left atrial diameter>40 mm (p=0.002) and the presence of atrial vulnerability after ablation (p=0.034). CONCLUSION: In patients with both AVNRT and paroxysmal AF, the recurrence rate of AF after elimination of AVNRT is 28%. Left atrial diameter greater than 40 mm and atrial vulnerability after elimination of AVNRT are independent predictors of AF recurrences in the long term.

Adult↗
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↗