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Biomedical subjects

Mehmet Birhan Yilmaz

Publications and source records attributed to Mehmet Birhan Yilmaz.

At least 19 recordsLinked to original sources
PubMed2006

Herbals in cardiovascular practice: are physicians neglecting anything?

BACKGROUND: Herbal products have been widely used by many patients with cardiovascular problems solely expecting benefit out of them. Since, it is important to consider patients' needs and believes to prevent breaking off the relationship of patients and physicians, we conducted a survey on patients admitted to our outpatient Cardiology department. METHODS: A questionnaire was prepared including 49 questions. After giving informed consent, 310 participants were enrolled into our survey. Participants were asked about disease states, use of herbal products and their tendencies. RESULTS: There were 169 male (mean age: 54.7+/-13.3 years) and 141 female participants (mean age: 56.2+/-14.7 years). 54.5% (n=169) had hypertension (HT), 48.7% (n=151) had coronary artery disease (CAD). Among all participants, 38.7% (n=120) stated that they have used herbals in part of their lives. Presence of dyslipidemia was associated with herbal use. Three fourths of herbal users (73.3%, n=88) stated that they thought they benefited some extent from the use of herbals, and 25% (n=30) of herbal users stated that they did not take their medicine regularly. Herbal users more frequently agreed the statement "herbals are beneficial when added to medicine" compared to nonusers (20.8% vs. 15.8%, p<0.001). CONCLUSION: Considering the facts that increasing interest on herbals is likely to continue by the people and the potentially hazardous interactions between the herbals and the drugs might be risky for the patients, there seems a need for closer, careful and respectful look for physicians onto herbal users and herbals themselves for the safety of population.

Adult↗
PubMed2006

Fine vs. coarse atrial fibrillation: which one is more risky?

BACKGROUND: Atrial fibrillation (AF) is a frequent arrhythmia, associated with morbidity and mortality. It is identified by two types on surface electrocardiogram as fine and coarse AF. We aimed to search the association of subtypes of AF with clinical parameters. METHODS: Eight hundred and eleven consecutive patients, who had AF attack which lasted longer than 24 h or more, were evaluated along with clinical and laboratory data. RESULTS: Coarse AF was noticed in 51.7% (n = 419), and fine AF in 48.3% (n = 392). Sex was associated with subtype of AF such that coarse AF was present in 46.5% of male patients, but in 56.1% of female patients (p = 0.009). Coarse AF was present in 85.3% of patients with mitral stenosis, whereas it was present in 35.3% of patients with normal heart valve (p < 0.001). ). Patients having fine AF were significantly older than those having coarse AF (64 +/- 12, 57 +/- 13 years, p < 0.001). 19.6% of those with coarse AF had history of cerebrovascular event (CVE), whereas 13.5% of those with fine AF had history of CVE (p = 0.021). After controlling for age in the multivariable logistic regression analysis, presence of coarse AF (B = 1.585, p = 0.031) was found to be independently associated with the history of CVE. CONCLUSION: AF is identified by two morphological forms on the surface electrocardiogram. These two forms were found to be associated with different clinical parameters, acting on vascular endpoints differently.

Aged↗
PubMed2006

A case of myocardial infarction due to acute left main coronary artery occlusion presenting with peculiar electrocardiographic changes.

Myocardial infarction (MI) due to acute obstruction of the left main coronary artery (LMCA) occlusion is a medical emergency, requiring early and prompt diagnosis and revascularization, and unless it is treated, it will frequently result in cardiogenic shock, which has a high fatality rate. Our case focused on a patient, who was transferred to our hospital relatively late due to peculiar ECG. He had acute MI, and was in cardiogenic shock. ECG is the easiest diagnostic method in the early diagnosis of the acute coronary syndromes and in deciding on the early invasive intervention in the high risk group. Before he was sent to us, the patient had an ECG showing right bundle branch block (RBBB) and a AVR ST segment elevation. At the time of the urgent coronary angiography, it was noticed that the LMCA was totally occluded. This case has been presented in order to emphasize that peculiar changes might bring about devastating consequences as in our rare case, showing acute left main coronary artery occlusion, and ST segment elevation only in the AVR on the 12-lead ECG along with upward deflection of ST segment vector might be critical for accurate diagnosis.

Aged↗
PubMed2006

Atrial natriuretic peptide predicts impaired atrial remodeling and occurrence of late postoperative atrial fibrillation after surgery for symptomatic aortic stenosis.

BACKGROUND: Aortic stenosis (AS) and atrial fibrillation (AF) are commonly encountered in clinical practice. Natriuretic peptides (NP) are endogenous cardiac hormones, which have been shown to increase in patients with heart failure, and valvular or congenital heart disease. We aimed to determine the association between atrial NP (ANP) and late postoperative AF after surgery for AS along with temporal changes in plasma ANP levels and left atrial (LA) volumes. METHODS: 22 patients (16 males/6 females, mean age: 61 years) with symptomatic AS and 8 healthy volunteers (5 males/3 females) were enrolled into our study. All the patients studied underwent transthoracic echocardiography, which was repeated during the follow-up. N-terminal ANP (N-ANP) was studied initially and at the 2-month follow-up. Postoperatively, the patients were followed up for 12 months for AF attacks. RESULTS: Patients with AS had significantly higher levels of N-ANP, left ventricular (LV) end-diastolic pressure, E/A ratio, LV mass and LA volumes compared to the controls. Patients with postoperative AF attacks were significantly older, had higher N-ANP levels and LV end-diastolic pressure in addition to higher LA volumes and longer symptom duration compared to patients without AF. Age at the time of operation (p = 0.011) and N-ANP at the 2nd month (p = 0.047) were found to be independent predictors for late AF attacks during follow-up in regression analysis. Besides, N-ANP (p < 0.001) at the 2-month follow-up independently predicted impaired LA remodeling. CONCLUSION: ANP might be an important factor to identify AS patients at risk for late postoperative AF attacks.

Aortic Valve Stenosis↗
PubMed2006

Relation of coronary collateral vessel development in patients with a totally occluded right coronary artery to the metabolic syndrome.

Development of coronary collaterals (CCs) is triggered by the gradient between arteries due to obstruction and myocardial ischemia. Presence of CCs that feed the jeopardized myocardial area may limit the infarct size after coronary occlusion and may even provide a survival benefit. However, some patients develop good CCs, whereas others do not. The metabolic syndrome (MS) has been identified as a secondary target to decrease cardiovascular risk, although the effect of MS on development of CCs has not been investigated. We prospectively enrolled 596 consecutive patients (337 men and 259 women; mean age 56 +/- 8 years) who underwent coronary angiography at our center and were found to have total occlusion of the right coronary artery. Patients were then classified as having good CCs (Rentrop's grades 2 to 3) or poor CCs (Rentrop's grades 0 to 1). There were significant differences in terms of body mass index (kilograms of body weight divided by square meters of height), glucose levels, triglyceride levels, and years with angina pectoris between those with good and poor CCs. Prevalences of diabetes mellitus were 27.1% among patients with good CCs and 44% among those with poor CCs (p <0.001). Presence of MS was significantly higher in patients with poor CCs than in those with good CCs (78.4% vs 49.2%, p <0.001). In regression analysis, duration of angina pectoris (beta = 0.347, 95% confidence interval [CI] 0.266 to 0.453, p <0.001), presence of diabetes mellitus (beta = 1.829, 95% CI 1.021 to 3.279, p = 0.042), wall score (beta = 2.379, 95% CI 1.356 to 4.173, p = 0.003), and presence of MS (beta = 2.993, 95% CI 1.541 to 5.813, p = 0.001) were independent predictors of angiographically determined poor CCs. In conclusion, MS seems to be independently associated with poor CCs in patients with an occluded right coronary artery.

Aged↗
PubMed2006

Metabolic syndrome negatively impacts early patency of saphenous vein grafts.

BACKGROUND: Coronary artery bypass grafting has been performed for a long period utilizing saphenous vein grafts, the fate of which might be crucial to prognosis following the operation. Metabolic syndrome, on the other hand, has become an increasingly important part of cardiovascular practice. We examined whether there was any negative effect of metabolic syndrome on saphenous vein graft patency in a relatively short term (< or =5 years). METHODS: Coronary angiograms of 314 consecutive patients (mean age 62.6+/-8.5 years), having at least one saphenous vein bypass graft within the last 5 years, were evaluated. RESULTS: One hundred and twenty-one patients (group 1) had either an occluded saphenous vein graft or a saphenous vein graft with a significant lesion, and 193 patients (group 2) had patent saphenous vein grafts. Metabolic syndrome was present in 46.2% of all patients (n=145), in 57% of patients in group 1 and in 39.4% of patients in group 2 (P=0.002). Having metabolic syndrome increased the risk of saphenous vein graft occlusion or having a significant lesion on saphenous vein grafts by 2.04-folds. In multivariable logistic regression, smoking (P=0.015, odds ratio=1.88), metabolic syndrome (P=0.019, odds ratio=1.81) and diabetes mellitus (P=0.048, odds ratio=1.36) were found to be associated with poor venous graft fate in the relatively short-term period after bypass. CONCLUSION: Metabolic syndrome seems to impact saphenous vein graft patency negatively in the relatively short term.

Coronary Angiography↗
PubMed2006

Metabolic syndrome increases the risk of significant coronary artery involvement in patients with peripheral artery disease.

BACKGROUND: Peripheral artery disease is a common condition, mainly associated with clinical cardiovascular risk factors. Patients with peripheral artery disease suffer from coronary artery disease-related complications. On the other hand, metabolic syndrome, as a constellation of specific risk factors, represents a risk factor for cardiovascular mortality. Metabolic syndrome might increase the risk of significant coronary artery disease in patients with peripheral artery disease. We aimed to examine the association of metabolic syndrome with the angiographically shown coronary artery involvement in patients with peripheral artery disease. METHODS: Two hundred and forty-seven patients with peripheral artery disease (mean age 60+/-9.5 years, 223 men/24 women), who were referred to coronary angiography, were evaluated. The resting ankle-brachial pressure index was measured with the patient in supine position. Patients with >70% diameter stenosis were considered to have significant coronary artery disease. RESULTS: In all, there were 223 male/24 female patients with mean ankle-brachial pressure index of 0.7+/-0.2, and mean age of 60+/-9.5 years. Metabolic syndrome was present in 53% (n=131) of all patients. Significant coronary artery disease was more frequently encountered in patients with peripheral artery disease and metabolic syndrome than in those without metabolic syndrome (73.3 vs. 40.5%, P<0.001). The presence of metabolic syndrome increased the risk of having significant coronary artery disease in patients with peripheral artery disease by 4.027 fold. Lower ankle-brachial pressure index (P=0.038, B=2.567), older age (P<0.001, B=1.075), presence of metabolic syndrome (P=0.015, B=2.247), and presence of diabetes mellitus (P<0.001, B=1.293) were found to be independent predictors of significant coronary artery disease in patients with peripheral artery disease in multivariable regression. CONCLUSION: Metabolic syndrome seems to increase the risk of significant coronary artery disease in patients with peripheral artery disease.

Chi-Square Distribution↗
PubMed2005

Association of lipid profile with echocardiographic Wilkins score in patients with moderate to severe mitral stenosis: possible impact on prognosis.

BACKGROUND: Association of valvular heart disease and lipid profile might be important as in the case of aortic stenosis. However, it has not been so far considered in detail the probable association of other valvular diseases, particularly of mitral stenosis (MS) with lipid profile. In our study, we aimed to search possible association of echocardiographic mitral valve score, evaluated according to Wilkins score, with lipid parameters in a group of patients with mitral stenosis, who were referred for possible percutaneous balloon valvuloplasty. MATERIAL AND METHOD: We retrospectively reviewed 401 patients (316 female, 85 male), who were referred as possible candidates for PMBV, with moderate to severe MS of predominantly rheumatic origin. Mitral valve was evaluated according to Wilkins score by an experienced author as indicated. RESULTS: Mean age of all patients was 36.6+/-11.3 years, and was not different in both genders. Mean mitral valve area was 1+/-0.1 mm2. Considering all patients, total Wilkins score was significantly, but mildly correlated with ratio of total/HDL cholesterol ratio (r=0.174, p=0.02). Presence of more than one recurrent attack of rheumatic fever, narrow mitral valve area, high total/HDL cholesterol and being male were independent predictors of poor echocardiographic Wilkins score (>8). CONCLUSION: We think that Wilkins echocardiographic score of mitral stenosis, particularly of leaflet thickening, might well be associated with serum lipids, probably as the same extent does aortic stenosis.

Adult↗
PubMed2005

Intracranial bleeding associated with clopidogrel.

Clopidogrel is an effective antiplatelet agent and is useful in the prevention of stroke, myocardial infarction, and related vascular death in patients with vascular disease. Intracranial hemorrhage related with using antithrombotic agents, including clopidogrel can occur. We report a case of a 68-year-old-man who developed intracranial bleeding following clopidogrel usage that, until now such a complication has not been yet reported.

Aged↗
PubMed2005

Being well-informed about statin is associated with continuous adherence and reaching targets.

BACKGROUND: Statins are life saving drugs in cardiovascular practice. However, they still are underprescribed in many situations despite their well-established benefits. Adherence may be improved by increased comprehension of the patients. METHODS: Patients enrolled into a previous survey were randomized into two groups as those, who were informed comprehensively (Group 1) and those not (Group 2). 202 patients, all of whom were on secondary prevention, were contacted after median 15 months of follow up and evaluated whether they continued the statins, and reached targets. RESULTS: 102 out of 202 patients were those enrolled into Group 1, and 100 of them were those enrolled into Group 2. In Group 1, 62.7% of patients were on continuous statin therapy during period between initial and secondary contact, whereas, only 46% of patients in Group 2 were on continuous statin therapy (p = 0.017). Being well-informed about statin increased the likelihood of being on continuous statin therapy after median of 15 months by 1.977 folds. Concerning targets, 64.7% of those in Group 1 reached the targets, whereas, 43% of those in Group 2 reached the targets (p = 0.002). Being well-informed about statin increased the likelihood of having suggested targets by ATP III after median of 15 months by 2.430 folds. CONCLUSION: Providing patients with comprehensive knowledge about statins, even in patients, who were already on statin therapy, seems not only to improve adherence but also increase the percentage of those reaching targets.

Cardiovascular Diseases↗
PubMed2005

Late saphenous vein graft occlusion in patients with coronary bypass: possible role of aspirin resistance.

BACKGROUND: Late venous graft thrombosis, leading to recurrent ischemia, is frequently encountered in old, degenerated vein grafts with advanced atherosclerotic plaque formation. Aspirin has been indicated to maintain venous graft patency in the post-operative period. However, there is considerable evidence that aspirin resistance is of concern in patients with venous grafts. MATERIAL AND METHOD: Prospectively enrolled 14 patients (11 male, 3 female, Group 1), who were shown to have at least one occluded saphenous vein graft on their late control coronary angiogram after bypass operation, were compared for the presence of aspirin resistance by PFA-100 with age- and sex-matched 14 patients (10 male, 4 female, Group 2), who were found patent and well-functioning vein grafts without wall irregularities on late post-operative coronary angiograms (mean 6.5+/-2.5 years), enrolled as a control group. RESULTS: Mean CT of collagen/epinephrine cartridge in Group 1 was 197+/-85 s and significantly less than in Group 2 (279+/-44 s; p=0.011). It was found that 50% of patients in Group 1 were so-called aspirin resistant, whereas in Group 2, this ratio was 7.1% (p=0.033). BMI (p=0.038, Beta=-0.322), uric acid level (p=0.023, Beta=-0.355), and CT by collagen/epinephrine cartridge (p=0.008, Beta=0.431) were independently predicting late occlusion of saphenous vein graft. CONCLUSION: Aspirin resistance is highly prevalent in patients with occluded venous grafts at a relatively late period.

Aged↗
PubMed2005

Aortic pulse pressure and aortic pulsatility are associated with angiographic coronary artery disease in women.

BACKGROUND: Studies indicated that both aortic pulse pressure (PP) and aortic pulsatility are independently associated with angiographic coronary artery disease (CAD). However, most of these studies included a majority of male subjects, and women were underrepresented. OBJECTIVE: We investigated the relation of aortic PP and aortic pulsatility derived from invasively measured ascending aortic pressure waveform and presence of angiographic CAD in women undergoing diagnostic coronary angiography. METHODS AND RESULTS: From September 2003 to April 2004, 262 unselected female subjects undergoing first cardiac catheterization were consecutively included in the study. Systolic, diastolic and mean pressure waveforms of the ascending aorta were measured during cardiac catheterization with a fluid-filled system. Aortic pulsatility was estimated as the ratio of aortic PP to mean pressure. Angiographic CAD was detected in 175 (67%) patients. In multiple-adjusted logistic regression, both aortic PP and aortic pulsatility were significantly associated with the presence of CAD (for a 10-mmHg increase in PP: odds ratio [OR] = 1.3, 95% confidence interval [CI] = 1.1-1.76; for a 0.1 increase in aortic pulsatility: OR = 1.8, 95% CI = 1.3-2.4). When patients were divided into tertiles according to the level of aortic pulsatility, it was noted that multiple-adjusted OR of presence CAD was 2.2 (95% CI = 1.1-4.4) for the middle tertile of the aortic pulsatility level and 5.9 (95% CI = 2.7-12.8) for the highest tertile of the aortic pulsatility level compared with the lowest tertile. CONCLUSION: In female subjects referred to coronary angiography, ascending aorta PP and aortic pulsatility are significantly associated with the presence of angiographic CAD and these associations are independent of age and other cardiovascular risk factors.

Aged↗
PubMed2005

Metabolic syndrome is associated with extension of coronary artery disease in patients with non-ST segment elevation acute coronary syndromes.

BACKGROUND: Metabolic syndrome (MS) comprises a group of factors that are associated with increased risk for cardiovascular events. Acute coronary syndromes account for the most important part of cardiovascular events with considerable morbidity and mortality. We aimed to investigate the association of MS with extension of coronary artery disease in patients presenting with non-ST segment elevation (NSTE) acute coronary syndromes (ACS). METHODS: Three hundred and six consecutive patients (220 men, 86 women patients) with the diagnosis of NSTE ACS, who were hospitalized within the first 24 h of their chest pain in the coronary care unit, were prospectively enrolled into our study. Patients with elevation of troponins (T or I) were classified as NSTE myocardial infarction (MI) and otherwise as unstable angina pectoris (USAP). Components of MS were noted as previously identified. Coronary angiograms were evaluated by two authors, who were blinded to the study plan and each other, via Sullivan's method. RESULTS: MS was noted in 49% of all patients, and was significantly more common in women than in men (62.8 versus 43.6%, P=0.003). The mean total stenosis score of patients with MS was significantly higher than for those without MS (16+/-6 versus 12+/-5, P<0.001), and the mean extension score of patients with MS was significantly higher than for those without MS (63+/-29 versus 44+/-26, P<0.001). The presence of MS together with some clinical factors and poor total cholesterol/high-density lipoprotein cholesterol ratio, hypertension and diabetes mellitus, was found to be independently predictive of extension of coronary artery disease (CAD) in a group of patients presenting with NSTE ACS. CONCLUSIONS: MS is independently associated with CAD extension, and hence, might account for poor cardiovascular outcomes through CAD extension in patients with NSTE ACS.

Acute Disease↗
PubMed2004

Level of awareness of on-treatment patients about prescribed statins.

BACKGROUND: Statins are frequently prescribed drugs for patients with coronary heart disease according to evidence-based medicine. However, compliance with these agents has still been far from ideal, since they require long term, probably life long therapy. We conducted a survey on patients who were already on statin treatment and evaluated their level of awareness of prescribed statins. METHODS: 236 participants (117 male, 119 female), who had been on treatment with statins for at least three months, were enrolled in our study after giving informed consent. Patients were asked close-ended survey questions. RESULTS: Only 5.5% of participants were on statin treatment for primary prevention, and 16.1% of them had a CHD equivalent, defined as those with clinical manifestations of noncoronary forms of atherosclerotic disease (peripheral arterial disease, abdominal aortic aneurysm, carotid artery disease) and diabetes mellitus. Most participants (70%) stated that they had been using statins to decrease cholesterol, whereas 16.5% stated that they had no idea. More than half of the participants (58%) stated that they did not know how long they would have to keep using their statins, whereas 21% replied that they would use them continuously. One fifth of participants had some idea about side effects. Participants in whom statin therapy was started during hospitalisation for coronary angiography and/or PCI more frequently answered that statins should be used continuously (49% vs. 12% not hospitalised, p < 0.01). Also, therapy adjustment by the physician led to a better understanding of the need for continuous use (55% vs. 31% without medication change, p < 0.001), as was the case for patients with < 2 co-medications (36% vs. 17% with > 2 co-medications, p 0.002). Presence of other risk factors did not have any impact on level of awareness. CONCLUSION: Comprehensive information at initial prescription, initiation of statins during hospitalization, dose adjustment during follow up, and as little co-medication as possible seem to increase the level of awareness of the benefits of long-term statin treatment. This might result in better compliance rates.

Adult↗