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Biomedical subjects

Sule Korkmaz

Publications and source records attributed to Sule Korkmaz.

At least 19 recordsLinked to original sources
PubMed2006

Plasma level of soluble P-selectin in patients with rheumatic mitral stenosis and sinus rhythm undergoing percutaneous mitral balloon valvuloplasty.

OBJECTIVE: To determine whether plasma level of soluble P-selectin (sP-selectin) increases in rheumatic mitral stenosis (MS) patients with sinus rhythm, who have scheduled for percutaneous mitral balloon valvuloplasty (PMBV), and to examine the effect of PMBV on sP-selectin level. METHODS: Twenty-six patients with MS and sinus rhythm (study group, 20 female, mean age 33 +/- 8 years) and a well-matched control group composed of 21 healthy volunteers (15 female, mean age 35 +/- 6 years) were enrolled in the study. In each patient left atrial (LA) thrombus was excluded by transesophageal echocardiography. sP-selectin levels were compared between study patients and controls, and between peripheral and LA blood. Changes in sP-selectin level 24 h and 4 weeks after PMBV were also analyzed. RESULTS: A significantly higher basal sP-selectin level was noted in study group. After PMBV, the mitral valve area (MVA) increased and the transmitral mean gradient decreased significantly. At 24th hour after PMBV, sP-selectin level decreased from 1080.38 +/- 143.87 ng/ml to 960.00 +/- 103.26 ng/ml (p < 0.0001) and at 4th-week follow-up it was decreased from 960.00 +/- 103.26 ng/ml to 879.61 +/- 98.16 ng/ml (p < 0.0001). No significant difference was found between peripheral and LA blood regarding the sP-selectin level. Correlation analysis between the difference in MVA measured 24-hour after and before PMBV and the difference in sP-selectin level measured 24-hour after and before PMBV showed a significant direct relationship between these variables. CONCLUSION: This study suggests that in patients with MS and sinus rhythm sP-selectin level increases probably due to turbulent flow across the stenotic valve. After PMBV sP-selectin shows a progessive decline, which is directly correlated with the increase in MVA.

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

Ventricular septal defect and Swyer-James (Macleod's) syndrome together: a case report.

Swyer-James (MacLeod's) syndrome is a rare entity that is characterized by the hyperlucent appearance of one or more lobes of one lung, diminished ipsilateral hilar shadow and hardly visible arterial structure on chest radiography. Ventricular septal defect is the most common childhood congenital heart defect and, if left untreated, this will result to irreversible pulmonary hypertension, reversing of the shunt and Eisenmenger's syndrome. In this case report, we describe a 19-year-old female patient who had diagnosis of VSD and Swyer-James syndrome at the same time.

Adult↗
PubMed2006

Non-compaction cardiomyopathy associated with myocardial bridging: A frequently overlooked or misdiagnosed cardiomyopathy.

Isolated ventricular non-compaction (IVNC) is an unclassified cardiomyopathy which occurs due to a morphogenetic abnormality involving an arrest of compaction of the loose myocardial meshwork during fetal ontogenesis. Despite recent advances in knowledge, diagnosis remains problematic because of its similarity to other diseases of the myocardium and endocardium. In this report, we describe a case of IVNC and myocardial bridging. The patient had been misdiagnosed with apical hypertrophic cardiomyopathy 2 years earlier. The correct diagnosis was established by transthoracic echocardiography and confirmed by cardiac catheterization and angiocardiography.

Cardiomyopathies↗
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

Differential diagnosis and management of acute profound thrombocytopenia by tirofiban: a case report.

Although the glycoprotein IIb/IIIa receptor inhibitors have improved outcomes of patients with acute coronary syndrome (ACS), therapy with these agents may cause thrombocytopenia with bleeding complications. This adverse effect is seemed to be rare with tirofiban. In this report, we describe a case of acute profound thrombocytopenia within two hours of tirofiban administration and review the differential diagnosis and the management of thrombocytopenia.

Acute Disease↗
PubMed2006

Clinical features of isolated ventricular noncompaction in adults long-term clinical course, echocardiographic properties, and predictors of left ventricular failure.

BACKGROUND: Isolated ventricular non-compaction (IVNC) is a rare disorder characterized by prominent trabecular meshwork and deep recesses. We retrospectively assessed the clinical characteristics and natural course of IVNC in adults diagnosed at our hospital. METHODS AND RESULTS: Sixty-seven adult patients (44 male, mean age 41 +/- 18 years) with the diagnosis of IVNC were evaluated in this retrospective cohort. Its prevalence was found to be .14%. Forty-seven patients (70%) had class I/II functional capacity. Fifty-seven patients (85%) had electrocardiographic abnormalities, and the most common one was left ventricular (LV) hypertrophy (25%). LV systolic function was depressed in 44 patients (66%), with a median ejection fraction (EF) of 35% (range: 20%-48%) at diagnosis. Multiple regression analysis revealed that age at initial presentation, the total number of affected segments, and the ratio of non-compaction/compaction (NC/C) were the independent predictors of LV systolic dysfunction. Familial occurrence of IVNC was 33%. During a mean follow-up of 30 months (range: 9-50 months), major complications including ventricular tachycardia, heart failure requiring hospitalization, and cerebrovascular events were observed in 36%, 34%, and 9% of the patients, respectively. Ten patients (15%) with IVNC died in this study. LVEF at initial presentation and functional capacity at last visit were found to be independent predictors of mortality. CONCLUSION: This study suggests that IVNC is a form of cardiomyopathy with higher prevalence and relatively better prognosis than previously reported. Age at initial presentation, ratio of NC/C, and number of affected segments seem to be major determinants of LV systolic dysfunction, while initial LVEF and last functional capacity predict mortality in this cohort.

Adult↗
PubMed2006

Preserved systolic function with isolated left ventricular noncompaction in an elderly patient.

Isolated left ventricular noncompaction (IVNC) is a rare congenital cardiomyopathy resulting from an arrest in normal endomyocardial embryogenesis. Clinical presentations of IVNC include systolic and diastolic dysfunction, systemic embolism and ventricular arrhythmias. In recent years there has been an increasing awareness of this anomaly; however, especially in elderly, clinical characterization and natural course of IVNC are still in question. In this case, we report a case of a 78-year-old patient with the diagnosis of IVNC with preserved left ventricular (LV) systolic function. To the best of our knowledge, this is the oldest IVNC case with preserved LV systolic function in the literature.

Aged↗
PubMed2006

Increased aortic pulse and fractional pulse pressures in patients with cardiac syndrome X.

BACKGROUND: Angina with normal coronary arteries, cardiac syndrome X, is a diagnosis of exclusion. The exact mechanism of this clinical syndrome remains unclear. Although the prognosis is as good as equal to that of the normal population, symptoms related to the syndrome largely impair quality of life. Aortic pulse and fractional pulse pressures are strong and independent indicators of the risk of coronary heart disease. An increase in these hemodynamic parameters is significantly associated with the presence of coronary artery disease in men and women. METHODS AND RESULTS: We evaluated aortic pulse and fractional pulse pressures of patients with cardiac syndrome X and control subjects, and investigated the relation between the two groups. One hundred and twenty-six patients with cardiac syndrome X with a mean age of 53.1 +/- 9.5 years and 76 patients without the syndrome with a mean age of 53.1+/-11.2 years were studied consecutively from May 2004 to May 2005. Aortic systolic, diastolic, mean and pulse pressures were measured and the fractional pulse pressure was calculated (aortic pulse pressure/mean pressure). Aortic pulse and fractional pulse pressures were significantly higher in the cardiac syndrome X group than in the control group (51 +/- 13 mmHg and 43+/-9 mmHg, p < 0.001; 0.54 +/- 0.11 and 0.47 +/- 0.08, p < 0.001, respectively). All patients were classified into tertiles of aortic pulse pressure level to evaluate whether aortic pulse pressure was associated with the presence of cardiac syndrome X in the study. The multiple-adjusted odds ratio of the risk of cardiac syndrome X was 6.72 (95% CI 2.76-16.37) for tertile 2 and 29.94 (95% CI 5.59-160.44) for tertile 3 of aortic pulse pressure level compared with tertile 1. In addition, all patients were divided into two groups as lower and higher levels of aortic fractional pulse pressure. The multiple-adjusted OR of the risk of cardiac syndrome X was 4.09 (95% CI 2.05-8.15) for the higher group compared with the lower group of aortic fractional pulse pressure level. CONCLUSION: Ascending aorta pulse and fractional pulse pressures are significantly associated with the presence of cardiac syndrome X and these associations are independent of age and other cardiovascular risk factors.

Adult↗
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

Serum level of lipoprotein (a) is inversely associated with the development of coronary collateral circulation.

BACKGROUND: This study sought to determine the relationship between serum lipoprotein (a) levels and angiographically visible coronary collateral circulation and to evaluate whether lipoprotein (a) exerts any effect on vascular endothelial cell growth factor. METHODS: The study population included 60 patients (39 men, mean age 59+/-13 years) with angiographically documented total occlusion in one of the major coronary arteries. Development of collaterals was classified by Rentrop's method. Patients were defined as having poorly developed collaterals for grades 0 and 1 (group 1), or well-developed collaterals for grades 2 and 3 (group 2). Serum lipoprotein (a) and vascular endothelial cell growth factor levels were determined by enzyme-linked immunosorbent assay. RESULTS: In group 1, lipoprotein (a) levels were significantly higher and vascular endothelial cell growth factor levels were significantly lower than in group 2 (34+/-19 vs. 20+/-12 mg/dl, P<0.001, and 2.5+/-0.7 vs. 3.4+/-0.8 ng/dl, P<0.001, respectively). Poorly developed collaterals were significantly more frequent in patients with lipoprotein (a) levels >or=30 mg/dl than in patients with levels <30 mg/dl (72 vs. 37%, P=0.008). A strong negative correlation was observed between lipoprotein (a) and vascular endothelial cell growth, factor (r=-0.708, P<0.0001). Multivariate analysis revealed that a high level of lipoprotein (a) negatively affected the development of collaterals, whereas the duration of angina had a positive effect. CONCLUSION: This study demonstrated for the first time that the high level of lipoprotein (a) negatively affects the formation of coronary collateral vessels in human beings. Reduced production or bioactivity of vascular endothelial cell growth factor caused by high levels of lipoprotein (a) may be the possible responsible mechanisms of hyperlipoprotein (a)-related poor collateral formation.

Adult↗
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↗
PubMed2006

Uncomplicated heart and lung perforation by a displaced ventricular pacemaker lead: a case report.

Lead perforation is a rare complication of pacemaker implantation and associated with the risk of disastrous results like cardiac tamponade or pneumo-hemothorax. We report a patient in whom a ventricular lead perforated the right ventricle and left lung parenchyma without the development of cardiac tamponade, pneumothorax, or hemothorax. No objective evidence for perforation was found on echocardiographic evaluation and thorax computed tomography has made the definite diagnosis. In the literature available to us, it is the first reported case of an uncomplicated right ventricular and lung parenchymal perforation associated with pacemaker implantation.

Adult↗
PubMed2006

Myocardial bridging as a cause of acute anterior myocardial infarction.

Myocardial bridging is systolic compression of an epicardial coronary arterial segment by overlying myocardium. It is a rare coronary anomaly, which is generally considered to be benign. It has been suggested that myocardial ischaemia may be seen. In this article, a case of myocardial infarction caused by myocardial bridging is presented.

Adult↗
PubMed2006

Angiographic prevalence of myocardial bridging.

OBJECTIVE: Muscle fibers overlying the intramyocardial segment of an epicardial coronary artery are termed myocardial bridging. Variable prevalence has been described at autopsy and angiographic series with small and large sample sizes. The aim of the study was to investigate the angiographic prevalence of myocardial bridging in 25982 patients from Turkey. METHODS: We performed a retrospective study, evaluated the cases with myocardial bridging among patients undergone selective coronary angiography, and searched the angiographic prevalence of myocardial bridging in a very large sample size. We studied also the correlation between the severity of the bridging and risk factors for coronary artery disease. RESULTS: Among 25982 patients we found 316 cases of myocardial bridging in a retrospective manner. The total prevalence was 1.22%. Although, 96.52% of patients with myocardial bridging had the lesion in the left anterior descending coronary artery (LAD) as expected, distribution of bridges between mid- and distal segments were almost equal (52.79% and 47.21%, respectively). We subclassified patients in two groups, Group A (<50% of systolic compression) and Group B (>or=50% of systolic compression), according to the amount of systolic compression of LAD and studied relationship of risk factors for coronary artery disease between groups. Another subclassification was also made for patients having myocardial bridging without coronary or valvular heart disease and hypertrophic obstructive cardiomyopathy; Group 1 (<50% of systolic compression) and Group 2 (>or=50% of systolic compression). In these patients we studied correlation between the severity of the myocardial bridging and risk factors for coronary artery disease. The prevalence of bridges in circumflex and right coronary arteries individually and in all arteries as combination was also studied. CONCLUSION: In a very large group of patients from Turkey undergone selective coronary artery angiography, the angiographic prevalence of myocardial bridging was slightly higher than expected. Only diabetes mellitus as a risk factor for coronary artery disease was higher in groups representing <50% of systolic compression (Group A and 1) than in groups representing >or=50% of systolic compression (Group B and 2) but the importance of this result is not known.

Autopsy↗
PubMed2006

Inadvertent lumbosacral plexopathy due to temporary pacemaker implantation.

Reported here is a 70-year-old man who suffered from a lumbosacral plexopathy after a temporary pacemaker implantation. Drawing attention to the increased number of femoral catheterizations in cardiovascular practice, we have highlighted some neuromuscular complications pertaining to these type of interventions.

Aged↗