Serdar Demir

Efficiency of atorvastatin in the protection of anthracycline-induced cardiomyopathy.

To the Editor: Antineoplastic agents of the anthracycline (ANT) group are commonly and effectively used in various forms of malignancies. Anthracyclines might lead to irreversible cardiomyopathy (CMP), despite their beneficial effects. A number of mechanisms, such as elevation in free superoxide

The Importance of Gamma‐Glutamyltransferase Activity in Patients with Coronary Artery Disease

In this study, we sought to investigate the relation of gamma‐glutamyltransferase (GGT) levels with the significance of coronary artery disease (CAD), clinical presentation, left ventricular (LV) function, and inflammatory activity.

Long-Term Anabolic Androgenic Steroid Use Is Associated with Increased Atrial Electromechanical Delay in Male Bodybuilders

We investigated the effect of long-term supraphysiologic doses of anabolic androgenic steroids (AAS) on atrial electromechanical delay (AEMD) in male bodybuilders. We clearly demonstrated that long-term consumption of supraphysiologic doses of AAS is associated with higher values of inter- and intra-AEMD in healthy young bodybuilders.

Relation of Plasma Fibrinogen Level With the Presence, Severity, and Complexity of Coronary Artery Disease.

Background: Relation of plasma fibrinogen levels with extent, severity, and complexity of coronary artery disease (CAD) in patients with stable angina pectoris (SAP) has not been adequately investigated. The aim of this study was to evaluate whether plasma fibrinogen level is associated with coronary complexity, severity, and extent assessed by SYNTAX (Synergy between percutaneous coronary intervention with TAXUS and Cardiac Surgery) score (SS). Methods: We enrolled 134 consecutive patients with SAP who underwent coronary angiography. Baseline serum fibrinogen levels were measured, and SS was calculated from the study population. The patients were classified into 3 groups by tertiles of SS (SS, control group = 0; intermediate group < 22; and high group ≥ 22). Results: Plasma fibrinogen levels demonstrated a stepwise increase from control group to high SS group. There was a strong correlation between fibrinogen and the SS (r = .535, P < .001). Area under the receivers operating characteristic curve of fibrinogen was 0.72 (95% confidence interval [CI] 0.61-0.82; < .001) for predicting a high SS. Fibrinogen value higher than 411 mg/dL has a sensitivity of 75% and a specificity of 64% in prediction of high SS. In multivariate analyses, plasma fibrinogen was observed to be an independent predictor for high SS in patients with stable CAD (odds ratio [OR] 1.01; 95% CI, 1.01-1.02; P < .001). Conclusion: Plasma fibrinogen is a readily measurable systemic inflammatory marker and is independently associated coronary severity and complexity in patients with CAD.

Papillary Muscle Free Strain in Patients with Severe Degenerative and Functional Mitral Regurgitation

Fundamento The role of papillary muscle function in severe mitral regurgitation with preserved and reduced left ventricular ejection fraction and the method of choice to evaluate PM have still been the subjects of controversy. Objectives To evaluate and compare papillary muscle function in and between patients with severe degenerative and functional mitral regurgitation by using the free strain method. Methods 64 patients with severe mitral regurgitation - 39 patients with degenerative mitral regurgitation (DMR group) and 25 patients with severe functional mitral regurgitation (FMR group) - and 30 control subjects (control group) were included in the study. Papillary muscle function was evaluated through the free strain method from apical four chamber images of the anterolateral papillary muscle (APM) and from apical three chamber images of the posteromedial papillary muscle (PPM). Global left ventricular longitudinal and circumferential strains were evaluated by applying 2D speckle tracking imaging. Results Global left ventricular longitudinal strain (DMR group, -17 [-14.2/-20]; FMR group, -9 [-7/-10.7]; control group, -20 [-18/-21] p < 0.001), global left ventricular circumferential strain (DMR group, -20 [-14.5/-22.7]; FMR group, -10 [-7/-12]; control group, -23 [-21/-27.5] p < 0.001) and papillary musle strains (PPMS; DMR group, -30.5 [-24/-46.7]; FMR group, -18 [-12/-30]; control group; -43 [-34.5/-39.5] p < 0.001; APMS; DMR group, (-35 [-23.5/-43]; FMR group, -20 [-13.5/-26]; control group, -40 [-32.5/-48] p < 0.001) were significantly different among all groups. APMS and PPMS were highly correlated with LVEF (p < 0.001, p < 0.001; respectively), GLS (p < 0.001, p < 0.001; respectively) and GCS (p < 0.001, p < 0.00; respectively) of LV among all groups. No correlation was found between papillary muscle strains and effective orifice area (EOA) in both groups of severe mitral regurgitation. Conclusions Measuring papillary muscle longitudinal strain by the free strain method is practical and applicable. Papillary muscle dysfunction plays a small role in severe MR due to degenerative or functional causes and papillary muscle functions in general seems to follow left ventricular function. PPM is the most affected PM in severe mitral regurgitation in both groups of DMR and FMR.

A successful catheter ablation of a ventricular fibrillation

Malignant ventricular arrhythmias are challenging to manage, requiring a multidisciplinary approach. The mechanism, which triggers ventricular fibrillation (VF) associated with ventricular extrasystoles has not been clarified yet, however, abolishing ventricular extrasystoles may stop ventricular fibrillation in these patients. By this case presentation, we aimed to present a successful treatment of an electrical storm (ES), which developed after an acute myocardial infarction, by catheter ablation.

Removal of broken lead in the extraction process using the FlexCath steerable sheath; a new technique

Bes yil once VDD-R kalp pili yerlestirilmis olan 33 yasindaki erkek hasta, pacemaker elektrodu endokarditi tanisiyla ileri inceleme ve tedavi amaciyla yatirildi. Kalp pili ve elektrotlarinin tumuyle cikarilmasina karar verildi. Elektrotlarin Evolutiontm sistemi (Evolutiontm lead cikarma sistemi, Cook Vascular, USA) ile cikarilmasi sirasinda ventrikul elektrodu silikon kilifindan siyrilarak kirildi. Sag kalp icerisinde serbest kalan ve artik silikon korumasi bulunmayan kirik elektrodu guvenli olarak cikarmak icin 10f FlexCath yonlendirilebilir kilif (Medtronic, USA) kullanilmasi kararlastirildi. FlexCath kilif, sag femoral ven ponksiyonunu takiben vena kava inferiyor yoluyla sag atriyuma ilerletildi (Şekil A). FlexCath kilif icerisinden ilerletilen Amplatz gose-neck tipi kement sistemi ile kirik elektrot parcasi yakalandi, kilif ise bu sistemin uzerinden ileri dogru kaydirilarak sag ventrikul apeksine ilerletildi (Şekil B-D ve Video 1*). Boylece keskin kirik elektot parcasi tamamen kilif icerisine hapsedilmis oldu. Kement ile yakalanmis olan elektrodun cekilerek cikarilmasi esnasinda trikuspit kapak ve diger kalp ici yapilarin hasarlanmasi engellenmis oldu. Sonuc olarak, kirik elektrodun uc bolumu disinda kalan tamami, guvenli ve basarili bir bicimde tamamen cikarilmis olundu (Şekil E, F, Video 2*). Hasta izleme suresince klinik ve ekokardiyografik olarak stabil idi. Antibiyotik tedavisi 30 gune tamamlandi. Hastanede yattigi sure icerisinde kalp pili ihtiyaci olmayan hastanin hastaneden cikistan sonra alti ay sure ile yapilan aylik ritm holter kontrollerinde de bir patoloji saptanmadi. 120

Percutaneous treatment of huge congenital coronary-cameral fistula

An 11-year-old girl was admitted to our hospital with a history of fatigue, effort dyspnea, and chest pain. On transthoracic echocardiography, the parasternal short-axis and apical four-chamber color Doppler flow imaging showed a structure matching the level of the coronary sinus and pouring into the right ventricle. On multi-slice computed tomography, the circumflex artery became immediately narrowed just before draining in to the base of the right ventricle, close to the septal leaflet of the tricuspid leaflet, and the Qp/Qs was 1.6. Congenital coronary-cameral fistula is an infrequent condition that establishes a direct link between coronary arteries and cardiac chambers. Although coronary artery fistulae are commonly asymptomatic, they may cause severe symptoms depending on the severity of the shunt, and may be treated medically, surgically or by transcatheter closure. In this case report, we present a patient with a huge circumflex artery-to-right ventricle fistula treated successfully with a duct occluder device.

A cockscomb-like aneurysm of the right coronary artery after bare metal stent implantation

Coronary artery aneurysm (CAA) formation is an uncommon but potentially life-threatening event after coronary balloon angioplasty or stent implantation. In this report, we present a case of a patient who had a cockscomb-like aneurysm after bare metal stent implantation which was successfully treated with a coronary graft stent.

Hipertansif Hastalarda Grup İçi Sık İlaç Değişiminin Kan Basıncı Kontrolüne ve Tedavi Uyumuna Etkisi

Introduction: In this study, we investigated the effects of frequent and unnecessary change in medication to control of blood pressure. Also we investigated the role of the regular use of drugs in the treatment of hypertension. Patients and Methods: Nine hundred hypertensive patients (509 males and 391 females; mean age 62.4 ± 12.1 years) were evaluated retrospectively. Only the patients taking anti-hypertensives for at least six months were included. Patients’ records were examined in terms of anti-hypertensive treatment. Intra-group exchange and use of regularly in anti-hypertensive drugs were investigated. Effects of the change in blood pressure and patient compliance were investigated. Results: When intra-group drug change was examined, rates of drug changes were as follows; angiotensin receptor blocker group, 62.3%; angiotensin converting enzyme group, 55.1%; betablockers group, 39.9%; calcium channel blocker group, 20.9%. While the ratio of non-compliance was 28.7% in the patient group with drug change, it was only 9.3% in the group without change in treatment. Average blood pressure difference was found 6.1 ± 7.6 mmHg and 7.6 ± 7.5 mmHg respectively (p < 0.001). The average number of drug usage with and without change of antihypertensive drug were 2.5 ± 0.87 and 2.2 ± 0.89 (p < 0.001) respectively. Conclusion: In patients under angiotensin converting enzyme inhibitors and angiotensin receptor blocker treatments, intra-group change of medication is common. Frequent intra-group change of anti-hypertensive drugs has negative effects on blood pressure control.