Browsing by Author "Gunes, Yilmaz"

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Association of Coronary Sinus Diameter With Pulmonary Hypertension
(Blackwell Publishing, 2008) Gunes, Yilmaz; Guntekin, Unal; Tuncer, Mustafa; Kaya, Yuksel; Akyol, Aytac
Background: Impaired venous drainage secondary to increased right atrial pressure (RAP) may result in coronary sinus (CS) dilatation. Methods: Two hundred fifteen patients referred for transthoracic echocardiography were included in the study. CS diameters were measured from apical four-chamber view with the transducer being slightly tilted posteriorly to the level of the dorsum of the heart. Pulmonary artery systolic pressure (PASP) is estimated by measurement of tricuspid regurgitation velocity (v) and estimate RAP based on size and collapsibility of inferior vena cava (VCI) with the formula PASP: 4v(2)+ RAP. Patients with PASP > 35 mmHg were considered to have pulmonary hypertension (PH). Results: CS diameter was measured in 80.3% of the patients with normal PASP (8.1 +/- 2.4 mm) and 93.1% of the patients having PH (12.3 +/- 2.5 mm). PASP was significantly correlated with CS diameter (r = 0.647, P < 0.001), RA volume index ( r = 0.631, P < 0.001), RV volume index (r = 0.475, P < 0.001), VCI diameter (r = 0.365, P < 0.001), and left ventricular ejection fraction (LVEF) (r = - 0.270, P < 0.001). CS diameter was also correlated significantly with estimated RAP (r = 0.557, P < 0.001), RA volume index (r = 0.520, P < 0.001), RV volume index (r = 0.386, P < 0.001), LVEF (r = - 0.327, P < 0.001), and VCI diameter (r = 0.313, P < 0.001). Multivariate analyses, testing for independent predictive information of CS size, VCI diameter, RA and RV volume indexes, and estimated RAP for the presence of PH revealed that estimated RAP (beta = 0.465, P < 0.001) and CS size (beta = 0.402, P = 0.003) were the significant predictors. Conclusions: Coronary sinus is dilated in patients with pulmonary hypertension. Coronary sinus diameter significantly correlates with PASP, RAP, right heart chamber volumes, LVEF, and VCI diameter.
Association of Increased Qtc Dispersion and Right Ventricular Hypertrophy
(int Scientific information, inc, 2008) Tuncer, Mustafa; Gunes, Yilmaz; Guntekin, Unal; Aslan, Sukru; Gumrukcuoglu, Hasan Ali; Eryonucu, Beyhan; Ermis, Cengiz
Background: There have been reports demonstrating an association between increased QT dispersion and ventricular arrhythmia in a variety of pathological cardiac conditions, including left ventricular hypertrophy. However, there are limited data about an association of right ventricular hypertrophy (RVH) and corrected QT (QTc) dispersion. Material/Methods: Eighty-five persons who emigrated from a high-altitude region (2800-4200 in) of Afghanistan to Van, Turkey, (altitude: 1700-1800 in) 25 years ago were referred to our hospital for transthoracic examination between April 2003 and May 2007. RVH was detected in 37 of the persons, 12 of whom were not included in the study due to coexisting systemic hypertension, COPD, or pulmonary hypertension. Twenty-five individuals of the same population with normal echocardiographic findings were enrolled as the control group. Symptoms that may be consequent to arrhythmia (such as palpitation, dizziness, and syncope) were not reported by the study population. Twelve-lead electrography was performed to measure the heart rate, QTc intervals, and QTc dispersion values. Results: The age and gender of both the patient and control groups were similar. There was no significant difference between patients and controls with respect to QTinax, QTinin, and heart rate. However, mean QTc dispersion values were significantly increased in patients with RVH compared with the control group (59.0 +/- 14.7 vs. 35.9 +/- 11.4 ms, p < 0.001). Conclusions: Right ventricular hypertrophy is associated with an increase in QTc dispersion.
Atrial Septal Defect Presenting With Brucella Endocarditis
(Japanese Circulation Soc, 2008) Tuncer, Mustafa; Ekim, Hasan; Gunes, Yilmaz; Guntekin, Unal
Brucellosis is a zoonosis that behaves as a systemic infection with various clinical signs and symptoms. Brucella endocarditis, although a rare complication of Brucella infection, is nevertheless responsible for the majority of deaths related to this illness. Brucella endocarditis was associated with an atrial septal defect (ASD) in a 45-year-old woman. Echocardiography showed a secundum ASD with vegetations of 0.5x8cm arising from the border of the defect, and serologic analysis was positive for Brucella agglutinin, thus confirming the diagnosis. She was initially treated with a 1-month preoperative course of antibiotics. At Surgery, the vegetations were excised and the defect was closed with polypropylene. Postoperative recovery was uneventful and she was discharged on the 10(th) postoperative day. (Circ J 2008; 72: 2096-2097)
Bicuspit Aorta, Aneurysm of Ascendan Aorta, Significant Aort and Mitral Insufficiency in Patient With Marfan Syndrome
(Elsevier Ireland Ltd, 2010) Tuncer, Mustafa; Akdag, Serkan; Gumrukcuoglu, Hasan Ali; Akyol, Aytac; Gunes, Yilmaz
A Case of Complete Heart Block Induced by Octreotide
(Aves, 2010) Tuncer, Mustafa; Gumrukcuoglu, Hasan Ali; Mete, Rafet; Gunes, Yilmaz; Guntekin, Unal
Cesarean Delivery in Patient With Thromsosis on Prosthetic Mitral Valve and Postoperative Thrombolytic Treatment
(Galenos Yayincilik, 2011) Gusler, Ayse; Kurdoglu, Zehra; Tuncer, Mustafa; Fiahin, Hanim Guler; Gunes, Yilmaz
On echocardiographic examination of G8 P4 pregnant patient at 35th gestational week, a 2.0x0.7 cm mobile thrombosis moving in and out the left ventricle was determined. The patient was thirthy four years old and was operated for mitral and aortic valve replacement three years ago because of rheumatic heart disease. According to the New York Heart Association (NYHA) functional classification, the patient was Class II. Since the risk of embolization was quite high, termination of the pregnancy without any delay was recommended. Elective cesarean delivery and tubal ligation were performed in order to provide permanent contraception. After the control of vaginal bleeding was provided, thrombolytic therapy with streptokinase was administered at postoperative twelfth hour. Following thrombolytic therapy, treatment was continued with warfarin. Control echocardiography revealed that the thrombosis was completely resolved. The case that thrombolytic therapy was successfully applied in early postpartum period after cesarean was presented with discussion of literature.
Clinical and Laboratory Aspects of Our Patients Have Pericardial Effusion
(Elsevier Ireland Ltd, 2010) Gumrukcuoglu, Hasan Ali; Akyol, Aytac; Tuncer, Mustafa; Gunes, Yilmaz; Akdag, Serkan; Begenik, Huseyin; Simsek, Hakki
Clinical Characteristics and Outcome of Brucella Endocarditis
(Royal Soc Medicine Press Ltd, 2009) Gunes, Yilmaz; Tuncer, Mustafa; Guntekin, Unal; Akdag, Serkan; Gumrukcuoglu, Hasan Ali; Karahocagil, Mustafa; Ekim, Hasan
Brucella endocarditis, a rare complication of brucellosis, is the main cause of death attributable to this disease. There are difficulties in the diagnosis and uncertainty regarding many aspects of the treatment of Brucella endocarditis. We retrospectively examined the clinical characteristics and outcome of patients diagnosed with Brucella endocarditis. Of the six patients diagnosed as having Brucella endocarditis, four had valvular disease, one had aortic and mitral mechanic valve prosthesis (AVR + MVR) and one had secundum type atrial septal defect. Transesophageal echocardiography showed vegetations in four patients. Blood culture grew Brucella mellitensis only in two patients. Standard agglutination tests were elevated in all patients (range 1/320-1/10240). Four patients were managed with combined antibiotherapy and surgery. One refused further treatment and one refused an operation and follow-up was lost for that patient. Two patients died during follow-up; one having had a previous AVR + MVR operation refused further treatment and the other suffering renal failure. Due to the fulminant course of the disease, treatment should be initiated when there is a clinical suspicion, even if the culture results are unknown or negative. Agglutination titres aid in the diagnosis. A combination of antibiotherapy and surgery seems to be preferable treatment modality.
Comparison of the Effects of Quinapril and Irbesartan on P-Wave Dispersion in Hypertensive Patients
(Springer, 2008) Guntekin, Unal; Gunes, Yilmaz; Tuncer, Mustafa; Simsek, Hakki; Gunes, Ahmet
Introduction: P-wave dispersion (PWD) has been shown to be a non-invasive electrocardiographic predictor for development of atrial fibrillation (AF). Thus, it may be possible to attenuate AF risk through improvement of PWD. In this study, we compared the effects of an angiotensin-converting enzyme (ACE) inhibitor, quinapril, and an angiotensin receptor blocker (ARB), irbesartan, on PWD. Methods: A total of 38 newly diagnosed hypertensive patients were enrolled in the study. The patients were randomly assigned to receive treatment with either irbesartan (150-300 mg) or quinapril (20-40 mg). P-wave durations and PWD were measured at baseline and after 6 and 12 months of treatment. Echocardiographic examinations were performed at baseline and after 12 months of treatment. Results: Both drugs significantly reduced blood pressure to a similar degree (P < 0.001). Deceleration time (both P < 0.001) and isovolumetric relaxation time (both P=0.007) were also significantly reduced, whereas there was no significant change in the early diastolic flow/atrial contraction signal ratio. Both irbesartan and quinapril significantly decreased maximum P-wave duration (Pmax) (P < 0.001 and P=0.002, respectively) and PWD (from 68.0 +/- 22.1 to 41.0 +/- 25.1 msec for irbesartan, and from 70.5 +/- 20.4 to 46.6 +/- 13.3 msec for quinapril; both P < 0.001). Baseline and follow-up blood pressure, heart rate, echocardiographic findings, and P-wave values were not significantly different between the irbesartan and quinapril groups. No patient developed AF during follow-up. There was no significant correlation between PWD and blood pressure or diastolic function parameters. Conclusion: Antihypertensive treatment with either irbesartan or quinapril is associated with significant reductions in Pmax and PWD.
Constrictive Pericarditis Associated With a Mass Mimicking Pericardial Cyst
(int Scientific Literature, inc, 2008) Ekim, Hasan; Tuncer, Mustafa; Basel, Halil; Gunes, Yilmaz
Background: Constrictive pericarditis can be defined as a syndrome resulting from compression of the heart caused by rigid, thickened, and frequently fused pericardial membranes, and represents the end stage of any inflammatory process involving the pericardium. We present a rare case of chronic calcified constrictive pericarditis associated with a calcified mass mimicking pericardial cyst. Case Report: A 55-year-old man was admitted to our hospital due to shortness of breath, cough, chest pain, abdominal swelling, and edema of lower extremities. Computed tomography (CT) demonstrated a thickened calcified pericardium associated with a pericardial mass with a thick calcified shell (8x6x4.5 cm) compressing the right ventricle. Results of thoracic magnetic resonance imaging (MRI) were in compliance with the CT results. Based on these findings, a diagnosis of chronic calcified constrictive pericarditis associated with a pericardial cyst was made. At the time of surgery, extensive pericardial calcifications and a cystic mass containing only hematoma were found. The calcified pericardial sac was decorticated laterally at a level just above the course of the phrenic nerve on both sides. A pathological diagnosis of idiopathic constrictive pericarditis was made. The postoperative recovery was uneventful. Ten days after the operation, he was discharged in good condition. Conclusions: Presentation of constrictive pericarditis associated with a cystic mass consisted of hematoma and compressing the right ventricle is extremely rare but does occur. It should be operated on with CPB on standby, especially if erosion of the right ventricle has suspected.
Decreased Risk of Ventricular Arrhythmias With Treatment of Nebivolol in Patients With Coronary Slow Flow
(Via Medica, 2016) Simsek, Hakki; Yaman, Mehmet; Babat, Naci; Akdag, Serkan; Akyol, Aytac; Demirel, Koray Celal; Gunes, Yilmaz
Background: Coronary slow-flow (CSF) is an angiographic phenomenon characterised by delayed opacification of vessels in the absence of any evidence of obstructive epicardial coronary disease. QT interval dispersion (QTD) reflects regional variations in ventricular repolarisation and cardiac electrical instability and has been reported to be longer in patients with CSF. Aim: To examine QT duration and dispersion in patients with CSF and the effects of nebivolol on these parameters. Methods: The study population included 67 patients with angiographically proven normal coronary arteries and CSF, and 38 patients with angiographically proven normal coronary arteries without associated CSF. The patients were evaluated with 12-lead electrocardiography, and echocardiography before and three months after treatment with nebivolol. Results: Compared to the control group QTcmax and QTcD were significantly longer in patients with CSF (p = 0.036, p = 0.019, respectively). QTcD significantly correlated with the presence of CSF (r = 0.496, p < 0.001). QTcmax (p = 0.027), QTcD (p = 0.002), blood pressure (p = 0.001), and heart rate (p < 0.001) values significantly decreased after treatment with nebivolol. Conclusions: Coronary slow flow is associated with increased QTD. Nebivolol reduced increased QTD in patients with CSF after three months.
Demir Eksikliği Anemisi ve Tedavisinin P Dalga Süreleri ve Diyastolik Fonksiyon Parametreleri Üzerine Etkileri
(2010) Kaya, Yüksel; Gunes, Yilmaz; Demir, Cengiz; Şahin, Musa; Gümrükcüoğlu, Hasan Ali; Tuncer, Mustafa; Şimşek, Hakkı
Amaç: Bu makalenin amacı kronik demir eksikliği anemisinin (DEA) hastaların sol ventrikül (SV) diyastolik fonksiyon parametreleri ile P dalga sürelerine etkisi ve anemi tedavisinin bu parametreler üzerinde yapabileceği değişiklikleri araştırmaktır.Gereç ve yöntem: Çalışmaya kalp-damar hastalığı olmayan 56 kronik DEA hastası ve 50 sağlıklı birey alındı. Vakalar başlangıçta ve anemi tedavi edildikten sonra anamnez, fizik muayene, elektrokardiyografi (EKG) ve transtorasik ekokardiyografi (TTE) ile değerlendirildi. TTE ile konvansiyonel parametrelerin yanı sıra doku doppler yapıldı. 12 derivasyonlu EKG de en uzun P dalga süresinden (Pmaks) en kısa P dalga süresi (Pmin) çıkarılarak P dalga dispersiyonu (PDD) hesaplandı.Bulgular: Kontrol grubuna göre, DEA hastalarında sol atriyum (SA) çapı (p=0.02), sol ventrikül diastol sonu çapı (LVDÇ) (p=0.001), diastolik disfonksiyon sıklığı (p=0.02), Pmaks (p=0.002) ve PDD (p=0.001) anlamlı derecede artmıştı. Korelasyon analizi ile diastolik disfonksiyon sıklığının (r=0.231, p=0.02) ve PDD’nin (r=0.367, p=0.001) anemi derinliğiyle anlamlı derecede ilişkili olduğu saptandı. Tedavi öncesiyle kıyaslandığında tedavi sonrasında SA çapı (p=0.001), LVDÇ (p=0.001), diastolik disfonksiyon sıklığı (p=0.001), Pmaks (p=0.001), Pmin ( p=0.001) ve PDD (p=0.001) anlamlı derecede azalmıştı.Sonuç: DEA’nin şiddetine paralel olarak PDD, sol kalp boyutları ve SV diyastolik disfonksiyon sıklığının arttığı gözlendi. Aneminin tedavisiyle bozulan bu değişkenlerde düzelme sağlandı.
Differential Effects of Nebivolol and Atenolol on Transmitral Diastolic Filling Parameters in Patients With Essential Hypertension
(Springer, 2008) Tuncer, Mustafa; Guntekin, Unal; Gunes, Yilmaz; Gumrukcuoglu, Hasan Ali; Eryonucu, Beyhan
Introduction: Impaired left ventricular (LV) diastolic relaxation, detected by pulsed Doppler echocardiography, is predictive of a higher incidence of major cardiovascular events in hypertensive patients. An improvement in LV diastolic function is an important goal of treatment. However, treatment of LV diastolic dysfunction remains empirical. The objective of our study was to compare the short-term effects of nebivolol and atenolol on Doppler diastolic filling parameters in hypertensive patients. Methods: A total of 32 patients with mild-to-moderate hypertension were enrolled in the study. The patients were randomly assigned to receive treatment with either nebivolol (5 mg/day) or atenolol (50 mg/day) for 1 month. Diastolic filling parameters, with pulsed-wave Doppler transmitral flow velocities, were measured 1 day before and 1 month after treatment. Results: Compared with baseline, both agents significantly decreased heart rate and blood pressure. However, there was no significant difference in pre-and post-treatment values between the nebivolol and atenolol groups. Both drugs significantly improved LV transmitral flow measured by early diastolic flow/atrial contraction signal (E/A) ratio, decreased deceleration time (DT) and isovolumetric contraction time (IVRT), but post-treatment improvement in E/A, DT and IVRT values was more significant with nebivolol compared with atenolol (P=0.05, P=0.05 and P=0.003, respectively). Conclusion: Although treatment with nebivolol or atenolol results in improved LV transmitral diastolic function filling parameters (E/A ratio, IVRT and DT), nebivolol has a greater effect compared with atenolol in patients with mild-to-moderate hypertension.
The Effect of Altitude on P-Wave and Qt Duration and Dispersion
(Wiley, 2008) Guntekin, Unal; Gunes, Yilmaz; Tuncer, Mustafa; Gumrukcuoglu, Hasan Ali; Kaya, Yuksel
Background: Short-term and long-term exposure to high altitude has been reported to change the surface electrocardiogram. We aimed to compare P-wave and QT parameters between healthy people living at high altitude and sea level. Methods: Twelve-lead electrocardiographies of 38 healthy people living at sea level (Antalya,Turkey) and 38 healthy people living at high altitude (Van, Turkey; 1,700-1,800 m) were obtained. Minimum and maximum P-wave durations, P-wave dispersion, minimum and maximum corrected QT intervals, and corrected QT dispersion were calculated. Results: There was no significant difference between the two groups in respect to heart rate and QT variables. Mean Pminimum values were slightly but significantly lower in the high altitude group (P = 0.029). Mean Pmaximum values tended to be lower at high altitude but did not reach statistical significance (P = 0.085). However, there was no significant difference in respect to P-wave dispersion values. Conclusions: In a sample of men and women living at high altitude in Turkey, significant reduction of Pminimum and borderline reduction of Pmaximum duration, but no significant change of P-wave and QT dispersion, were observed.
Effects of Ankylosing Spondylitis on the Heart
(Taylor & Francis Ltd, 2009) Gunes, Yilmaz; Tuncer, Mustafa; Guntekin, Unal; Sahin, Musa; Yazmalar, Levent
Background - Various cardiac pathologies have been linked to ankylosing spondylitis (AS) in various conflicting reports. Objectives - A pilot exploration is done to search frequencies of structural heart involvement, arrhythmias and heart rate variability (HRV) in AS patients. Methods - Thirty-five AS patients and 25 healthy people were evaluated with 12-lead electrocardiography, echocardiography and 24-hour Holter monitoring. Results - No patient had significant valvular heart disease except one. Ventricular and supraventricular premature beat counts were significantly higher in AS patients compared to the control group (P = 0.002 and 0.01). Frequency of ventricular premature beats was significantly correlated with isovolumetric relaxation time (IVRT) (r = 0.291, P = 0.025). Abnormal ECG was defined in 4 AS patients; 2 incomplete right bundle-branch block (RBBB), one left axis deviation and one complete RBBB and left anterior hemiblock. QT and P wave dispersions were not significantly different between AS patients and the control group. Although mitral inflow deceleration time (DT) and IVRT were significantly longer in AS patients (P < 0.001, both), frequency of diastolic dysfunction was not significantly different. Among HRV parameters rMSSD (day time), PNN50 (day time) and SDSD (day and night time) were significantly lower than the control group. There were weak to moderate but significant negative correlations of IVRT and DT with these parameters. Conclusions - In this small sample there is no significant increase in structural heart disease in patients with AS. Diastolic functions may be affected in the course of disease and this may be associated with increased frequency of premature beats. Day time heart rate variability is decreased and associated with diastolic function parameters of IVRT and DT in AS patients.
The Effects of Iron Deficiency Anemia on P Wave Duration and Dispersion
(Hospital Clinicas, Univ Sao Paulo, 2010) Simsek, Hakki; Gunes, Yilmaz; Demir, Cengiz; Sahin, Musa; Gumrukcuoglu, Hasan Ali; Tuncer, Mustafa
OBJECTIVES: The association between P wave dispersion and iron deficiency anemia has not been documented in the literature. In this study, we evaluated P wave dispersion in patients with iron deficiency anemia and the possible relationships between P wave dispersion and other echocardiographic parameters. INTRODUCTION: The iron status of an individual may play an important role in cardiovascular health. Anemia is an independent risk factor for adverse cardiovascular outcomes. P wave dispersion is a simple electrocardiographic marker that has a predictive value for the development of atrial fibrillation. Apart from cardiovascular diseases, several conditions, such as seasonal variation, alcohol intake and caffeine ingestion, have been demonstrated to affect P wave dispersion. METHODS: The study included 97 patients who had iron deficiency anemia and 50 healthy subjects. The cases were evaluated with a clinical examination and diagnostic tests that included 12-lead electrocardiography and transthoracic echocardiography. RESULTS: Compared to the control group, patients with iron deficiency anemia showed significantly longer maximum P wave duration (Pmax) ( 91.1 +/- 18.0 vs. 85.8 +/- 6.7 msec, p = 0.054), P wave dispersion (PWD) (48.1 +/- 7.7 vs. 40.9 +/- 5.6 msec, p < 0.001), mitral inflow deceleration time (DT) (197.5 +/- 27.9 vs. 178.8 +/- 8.9 msec, p < 0.001) and isovolumetric relaxation time (IVRT) (93.3 +/- 9.2 vs. 77.4 +/- 8.2 msec, p < 0.001); they also showed increased heart rate (85.7 +/- 16.1 vs. 69.0 +/- 4.4, p < 0.001) and frequency of diastolic dysfunction (7 (7.2%) vs. 0). Correlation analysis revealed that PWD was significantly correlated with IVRT, DT, heart rate, the presence of anemia and hemoglobin level. CONCLUSIONS: Iron deficiency anemia may be associated with prolonged P wave duration and dispersion and impaired diastolic left ventricular filling.
The Effects of Nebivolol on P Wave Duration and Dispersion in Patients With Coronary Slow Flow
(Turkish Soc Cardiology, 2009) Gunes, Yilmaz; Tuncer, Mustafa; Guntekin, Unal; Ceylan, Yemlihan
Objective: Coronary slow flow (CSF) is characterized by delayed opacification of coronary arteries in the absence epicardial occlusive disease. P wave duration and dispersion have been reported to be longer in patients with CSF Nebivolol, besides its selective beta-blocking activity, causes an endothelium dependent vasodilatation through nitric oxide release. In this study, we searched for the association between left ventricular diastolic functions and atrial conduction dispersion, the effects of nebivolol on P wave duration and dispersion in patients with CSF Methods: This prospective case-controlled study included 30 patients having CSF and 30 subjects having normal coronary arteries in coronary angiography. The patients were evaluated with 12-leads electrocardiography and echocardiography before and three months after treatment with nebivolol. The difference between maximum and minimum P wave durations was defined as P-wave dispersion (PWD). Early diastolic flow (E), atrial contraction wave (A) and E deceleration time (DT) and isovolumetric relaxation time (IVRT) were measured. Unpaired and paired t-tests, Chi-square test, Mann-Whitney's U-test and Pearson correlation analysis were used in statistical analysis. Results: Compared to control group maximum P wave duration (Pmax) (104.3 +/- 12.2 vs. 93.4 +/- 9.8 msec, p<0.001) and PWD (35.0 +/- 8.6 vs. 24.8 +/- 5.4 msec, p<0.001), DT (245.4 +/- 54.9 vs. 198.0 +/- 41.7 msec, p<0.001) and IVRT (112.9 +/- 20.8 vs. 89.5 +/- 18.2 msec, p<0.001) were significantly longer and E/A ratio (0.89 +/- 0.27 vs.1.27 +/- 0.27, p<0.001) was lower in patients with CSF as compared with control subjects. There were no significant correlations of Pmax and PWD with clinical and echocardiographic variables. Systolic and diastolic blood pressures (130.5 +/- 15.5 mmHg to 117.8 +/- 12.3 mmHg and 84.5 +/- 9.8 mmHg to 75.0 +/- 6.2 mmHg, p<0.001), Pmax (to 98.7 +/- 11.7 msec, p=0.038), PWD (to 21.3 +/- 5.1 msec, p<0.001) and DT (to 217.3 +/- 41.4 msec, p<0.001) and IVRT (to 101.2 +/- 17.4 msec, p<0.001) significantly decreased and E/A ratio (to 1.1 +/- 0.23, p<0.001) significantly increased after treatment with nebivolol. Correlation analysis revealed that the change in PWD was not significantly correlated with any of the clinical and echocardiographic variables including decrease in blood pressures. Conclusions: Coronary slow flow is associated with prolonged P wave duration and dispersion and impaired diastolic filling. Nebivolol may be helpful in restoration of these findings. P wave duration and dispersion may not be associated with left ventricular function parameters in patients with CSF (Anadolu Kardiyol Derg 2009, 9: 290-5)
The Effects of Perindopril on Qt Duration and Dispersion in Patients With Coronary Slow Flow
(Springer, 2011) Guntekin, Unal; Gumrukcuoglu, Hasan Ali; Gunes, Yilmaz; Gunes, Ahmet; Simsek, Hakki; Sahin, Musa; Tuncer, Mustafa
Coronary slow flow (CSF) is characterized by delayed opacification of coronary arteries in the absence epicardial occlusive disease. QT duration and dispersion have been reported to be longer in patients with CSF. ACE inhibitors may improve CSF through positive effects on endothelial function. The study included 32 patients having CSF and 25 subjects having normal coronary arteries in coronary angiography. The patients were evaluated with 12-leads electrocardiography and echocardiography before and 3 months after treatment with perindopril. Compared to the control group, maximum corrected QT duration (QTcmax) (432.0 +/- A 28.9 vs. 407.0 +/- A 39.1 ms, p = 0.008) and QT dispersion (QTcD) (64.0 +/- A 16.5 vs. 37.3 +/- A 12.1 ms, p < 0.001), mitral inflow deceleration time (DT) (251.3 +/- A 49.4 vs. 218.8 +/- A 44.5 ms, p = 0.013), and isovolumetric relaxation time (IVRT) (115.8 +/- A 18.4 vs. 107.2 +/- A 22.9 ms, p < 0.001) were significantly longer and E/A ratio 0.85 +/- A 0.2 vs. 1.1 +/- A 0.3, p = 0.004) was lower in patients with CSF. QTcmax (to 407.0 +/- A 28.0 ms, p = 0.001), QTcD (to 44.5 +/- A 11.4 ms, p < 0.001), DT (to 221.6 +/- A 37.7 ms, p < 0.001) and IVRT (to 103.8 +/- A 16.1 ms, p < 0.001) were significantly decreased and E/A ratio (to 0.98 +/- A 0.3, p < 0.001) was significantly increased after treatment with perindopril. Coronary slow may be associated with prolonged QT interval and increased QT dispersion and impaired diastolic filling. Perindopril may be helpful in restoration of these findings.
The Effects of Perindopril on Qt Duration and Dispersion in Patients With Coronary Slowflow
(Elsevier Ireland Ltd, 2010) Guntekin, Unal; Gunes, Yilmaz; Gunes, Ahmet; Gumrukcuoglu, Hasan Ali; Ceylan, Yemlihan; Simsek, Hakki; Tuncer, Mustafa
The Effects of Trimetazidine on Heart Rate Variability in Patients With Heart Failure
(Arquivos Brasileiros Cardiologia, 2009) Gunes, Yilmaz
Background: Reduced measures of heart rate variability (HRV) have been shown to be related with prognosis in heart failure. Chronic administration of trimetazidine in addition to the conventional therapy has been shown to improve functional class and left ventricular functions of heart failure patients. Objective: To assess the effects of trimetazidine on HRV in optimally treated patients with heart failure of ischemic origin. Methods: Trimetazidine 20 mg three times/day was added to therapy of 30 patients with heart failure being treated with angiotensinogen converting enzyme inhibitors or angiotensin receptor blockers, carvedilol, spironolactone, digitalis and furosemide. The etiology of heart failure was coronary artery disease in all patients. Patients were evaluated with echocardiography and 24-hour heart rate variability analysis before and 3 months after addition of trimetazidine. Results: Mean left ventricular ejection fraction (LVEF) significantly increased after the addition of trimetazidine (33.5 +/- 5.1% to 42.5 +/- 5.8%, p<0.001). Of the HRV parameters, SDNN (97.3 +/- 40,1 to 110.5 +/- 29,2 msecs, p=0.049) and SDANN (80.5 +/- 29,0 to 98.3 +/- 30,5 msecs) were significantly increased after trimetazidine treatment. Baseline SDNN was significantly correlated with baseline LVEF (r = 0.445, p = 0.023, p = 0.008) and the increment in SDNN was correlated with increase in LVEF (r = 0.518, p = 0.007). Conclusions: Adding trimetazidine to optimal medical therapy in patients with heart failure of ischemic origin may improve heart rate variability in association with improved left ventricular ejection fraction. (Arq Bras Cardiol 2009; 93(2): 145-148)