Browsing by Author "Guntekin, Unal"

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Acute Rupture of a Congenital Sinus of Valsalva Aneurysm After Severe Exercise
(Turkish Soc Cardiology, 2009) Tuncer, Mustafa; Eryonucu, Beyhan; Guntekin, Unal; Gumrukcuoglu, Hasan Ali
Ruptured aneurysms of the sinus of Valsalva may cause manifestations of prompt onset. A 22-year-old man with no previous cardiac complaints presented with dyspnea, palpitation, fatigue, and shortness of breath, all of which occurred after a football match. Transthoracic echocardiography showed an aneurysmal dilatation of the right sinus of Valsalva to the direction of the right ventricle. Color Doppler imaging showed a marked left-to-right turbulent flow from the aortic root to the right ventricle. Continuous Doppler imaging also revealed a continuous left-to-right systolodiastolic shunting. The patient was submitted to cardiovascular surgery for surgical repair.
Anomalous High Origin of the Right Coronary Artery Above the Sinotubular Junction
(Kare Publ, 2018) Tosun, Veysel; Korucuk, Necmettin; Guntekin, Unal
Abnormal origin of the right coronary artery (RCA) from the left side of ascending aorta and continuing between the aorta and the truncus pulmonalis is a very rare congenital anomaly. Systolic expansion of the aorta and pulmonary trunk may lead to compression of the coronary artery and result in myocardial ischemia, particularly with exertion. A 59-year-old man admitted to cardiology department with prolonged chest pain during exercise. Abnormal origin of RCA with an interarterial course between the aorta and pulmonary artery was observed on coronary angiography and multi-detector computed tomography coronary angiography (MCTCA). In addition, RCA output compression was reported on MCTCA.
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)
A Case of Complete Heart Block Induced by Octreotide
(Aves, 2010) Tuncer, Mustafa; Gumrukcuoglu, Hasan Ali; Mete, Rafet; Gunes, Yilmaz; Guntekin, Unal
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.
Compliance With Dyslipidemia Guidelines in Daily Practice: How Effective Is Cardiovascular Risk Prevention
(Elsevier, 2018) Guntekin, Unal; Gumrukcuoglu, Hasan Ali; Yaman, Mehmet; Ozturk, Fatih; Akyol, Aytac; Gumrukcuoglu, Fatma Nur; Kandemir, Yasemin Behram
Purpose: Cardiovascular disease (CVD) due to atherosclerosis is the leading cause of early mortality and morbidity. The current European guidelines on CVD prevention in clinical practice recommend the use of the Systematic Coronary Risk Estimation (SCORE) system. The current American Heart Association guidelines recommend the use of the new pooled cohort risk assessment equations to estimate the 10-year atherosclerotic CVD risk. The purpose of this article was to investigate the compliance of dyslipidemia guidelines in daily practice in patients with dyslipidemia or who have risk factors for CVD. Methods: The study group consisted of 500 outpatients who had dyslipidemia or risk factors for CVD. The risk level was computed according to the European and American Heart Association guidelines. Therapeutic LDL-C targets were identified based on the calculated risk level. Therapeutic target levels were compared based on the dosage of statins used and achievement of the LDL-C goal in daily practice according to the risk levels. Findings: According to the European dyslipidemia guidelines, 231 patients were in the very-high/high-risk group, and 106 patients (45.9%) achieved the LDL-C target (<100 mg/dL); 210 patients were in the moderate-risk group, and 156 (74.3%) patients achieved the LDL-C target (<115 mg/dL); and 59 patients were in the low-risk group, and 55 (93.2%) patients achieved the LDL-C target (<155 mg/dL). Univariate and multivariate logistic regression analyses revealed that the LDL-C level and presence of coronary artery disease were significantly reverse associated with achievement of the LDL-C goal (both, P < 0.001). (C) 2018 Elsevier Inc. All rights reserved.
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 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 P-Wave Duration and Dispersion in Heart Failure Patients
(Wiley, 2009) Gunes, Yilmaz; Tuncer, Mustafa; Guntekin, Unal; Akdag, Serkan; Gumrukcuoglu, Hasan Ali
Background: P-wave duration and dispersion (PWD) have been shown to be noninvasive predictors for development of atrial fibrillation. Thus, it may be possible to attenuate atrial fibrillation risk through normalization of P-wave duration and dispersion. Trimetazidine, a metabolic modulator, has been reported to improve cardiac function in heart failure (HF) patients. Methods: Thirty-six HF patients being treated with angiotensin inhibitors, carvedilol, spironolactone, and furosemide were prescribed trimetazidine, 20 mg three times a day. Electrocardiographic and echocardiographic examinations were obtained before and 6 months after addition of trimetazidine in HF patients and 36 healthy control group patients having normal echocardiographic examination. Results: Maximum P-wave duration (Pmax) (106.7 +/- 15.8 vs. 91.7 +/- 12.7 ms) and PWD (57.2 +/- 15.4 vs. 37.9 +/- 16.7 ms) were significantly longer in HF patients compared to the control group. There were significant correlations of Pmax and PWD with left atrial diameter (r = 0.508, P = < 0.001 and r = 0.315, P = 0.029), left ventricular ejection fraction (LVEF) (r = 0.401, p = 0.005 and r = 0.396, P = 0.005), deceleration time (r = 0.296, P = 0.032 and r = 0.312, P = 0.035), and isovolumetric relaxation time (r = 0.265, P = 0.038 and r = 0.322, P = 0.015). There were significant improvements in LVEF (32.7 +/- 6.5% to 37.2 +/- 5.5%, P = 0.036), left atrial diameter (41.5 +/- 6.7 to 40.3 +/- 6.1 mm, P < 0.001), and Pmax (106.7 +/- 15.8 to 102.2 +/- 11.5 ms, P = 0.006) and PWD (57.2 +/- 15.4 to 48.9 +/- 10.1 ms, P < 0.001) during follow-up. Conclusions: Trimetazidine added to optimal medical therapy in HF may improve Pmax and PWD in association with improved left ventricular function. Longer-term and larger studies are necessary to evaluate whether these findings may have clinical implications on prevention of atrial fibrillation. (PACE 2009; 32:239-244).
Heart Rate Variability in Patients With Iron Deficiency Anemia
(Arquivos Brasileiros Cardiologia, 2009) Tuncer, Mustafa; Gunes, Yilmaz; Guntekin, Unal; Gumrukcuoglu, Hasan Ali; Eryonucu, Beyhan; Guler, Niyazi; Demir, Cengiz
Background: Heart rate variability (HRV) is associated with increased cardiac risk factor in several conditions. The iron status of an individual may play an important role in cardiovascular health. Objective: To evaluate heart rate variability in patients with iron deficiency anemia. Methods: Twenty-three patients with iron deficiency anemia (mean hemoglobin (Hb) 8.6 +/- 2.2 g/dL) and 10 healthy people (mean Hb 13.9 +/- 1.2 g/dL) were assessed with 24-hour ambulatory Holter recordings during in hospital course having limited physical activity. Results: Although mean heart rate was significantly higher in patients with anemia, there was no significant difference regarding HRV parameters compared to the healthy group. Conclusion: There was no significant difference in HRV parameters between patients with iron deficiency anemia with limited physical activity and healthy ambulatory people. (Arq Bras Cardiol 2009; 92(5):368-371)
Improved Left and Right Ventricular Functions With Trimetazidine in Patients With Heart Failure: a Tissue Doppler Study
(Springer, 2009) Gunes, Yilmaz; Guntekin, Unal; Tuncer, Mustafa; Sahin, Musa
Downregulation of glucose and fatty acid oxidation occurs in heart failure (HF). Trimetazidine reduces fatty acid oxidation and increases glucose oxidation. In this single-blind study, trimetazidine, 20 mg three times per day (n = 51) or placebo (n = 36) was added to treatment of 87 HF patients receiving optimal HF therapy. Etiology of heart failure was coronary artery disease in 35 patients (68.6%) in the trimetazidine group and 22 (62.9%) in the placebo group. Fourteen (27.5%) patients in the trimetazidine group and 11 (31.4%) patients in the placebo group had diabetes. Peak systolic velocity (Vs), and the peak early diastolic (Vd) and late diastolic (Va) velocities of various segments left and right ventricles (RV) were obtained with tissue Doppler imaging (TDI) and averaged. Patients were re-evaluated three months later. Significant increases in mean left ventricular ejection fraction (LVEF) (33.3% +/- 5.6% to 42.4% +/- 6.3%, P < 0.001 and 30.6% +/- 8.2% to 33.2% +/- 6.6%, P = 0.021) and LV and RV myocardial velocities and mitral and tricuspid annular TDI velocities were observed in both groups. However, compared to placebo, increments in LVEF (9.1% +/- 4.2% vs. 2.5% +/- 1.4%, P < 0.001) and myocardial velocities were significantly higher with trimetazidine (P < 0.001 for LV Vs, Vd, Va; P = 0.035 for RV Vd; and P < 0.001 for RV Va and Vs). Increase in LVEF with trimetazidine was significantly correlated with presence of diabetes (r = 0.524, P < 0.001). With trimetazidine LVEF increased significantly more in diabetic patients compared to nondiabetics (P < 0.001). Also, patients having both diabetes and ischemic HF tended to have greater improvement in LVEF compared to ischemic HF patients without diabetes (P = 0.063). Addition of trimetazidine to current treatment of HF, especially for those who are diabetic, may improve LV and RV functions.
Increased Frequency of Pulmonary Hypertension in Psoriasis Patients
(Springer, 2008) Gunes, Yilmaz; Tuncer, Mustafa; Calka, Omer; Guntekin, Unal; Akdeniz, Necmettin; Simsek, Hakki; Ozdemir, Ilknur Yorgun
Several reports have demonstrated an association between psoriasis and cardiovascular diseases such as hypertension, valvular disease and arrhythmia. However, the data is scarce. Forty-seven psoriasis patients and 20 healthy people underwent transthoracic echocardiographic examination including pulse- and tissue Doppler analysis and 24-h ambulatory electrocardiographic monitoring including heart rate variability (HRV) analysis. Patients having systemic hypertension, diabetes mellitus, history of structural or ischemic heart disease, chronic obstructive pulmonary disease and any associated systemic disease were excluded. Psoriasis Area and Severity Index (PASI) was calculated and severe psoriasis was defined in the case of history of hospitalizations for psoriasis and/or getting systemic therapy. Mean age of the patients was 35.7 +/- 12.9 years and disease duration was 123.2 +/- 84.3 (3-360) months. PASI ranged from 0.4 to 34.0 (mean +/- SD: 7.1 +/- 6.6) and 20 (42.6%) patients had severe psoriasis. There were no significant differences between psoriasis patients and control group with respect to mean values of blood pressure, body mass index, lipid profile and cardiac dimensions. However, frequency of being overweight was significantly higher in psoriasis patients (42.6 vs. 10.0%, P = 0.011). No patient had valvular disease. Mild pulmonary hypertension (PH) (30-40 mmHg) was significantly more frequent in psoriasis patients (31.9 vs. 0%, P = 0.003). Pulse wave mitral Doppler deceleration and isovolumetric relaxation times were significantly longer in psoriasis patients (195.9 +/- 29.7 vs. 191.6 +/- 14.7 ms, P = 0.002 and 91.6 +/- 14.7 vs. 79.6 +/- 10.5 ms, P = 0.001, respectively). However, frequency of diastolic dysfunction was not significantly different than the control group (8.5 vs. 0%, P = 0.309). HRV parameters and frequency of supraventricular and ventricular premature beats were not significantly different between the groups. No patient had ventricular tachycardia. Echocardiographic follow-up of psoriasis patients may be important due to possible association of PH. However, incidences of structural heart disease and arrythmia are not increased in psoriasis according to our results.
Lack of Diurnal Variation of P-Wave and Qt Dispersions in Patients With Heart Failure
(Wiley, 2008) Gunes, Yilmaz; Tuncer, Mustafa; Guntekin, Unal; Akdag, Serkan; Gumrukcuoglu, Hasan A.
Background: P-wave dispersion (PWD) is a new parameter for the assessment of risk of atrial fibrillation and has been reported to be increased in heart failure. Diurnal variation of the PWD has been reported in patients with coronary artery disease (CAD). QT dispersion (QTD) has also a circadian variation. In this study we aimed to search diurnal variation of PWD and QTD in patients with heart failure. Methods: Fifty-three clinical heart failure patients having left ventricular ejection fraction (LVEF) < 40% were divided into two groups according to presence of CAD. Twelve-lead ECGs were obtained in the morning (07:00-08:00 hours), at noon (12:00-14:00 hours), and at night (22:00-24:00 hours). Results: All the patients were in New York Heart Association class II except one in class I. beta-blocker and angiotensin-converting enzyme inhibitor or angiotensin receptor blocker usage was over 80% and spiranolactone usage was around 75% in the study group. PWD and QTD were not significantly different between patients with (n = 27) and without (n = 26) CAD. There was no significant diurnal variation of P wave and QT parameters. Conclusions: We found that PWD and QTD do not show diurnal variation in patients having either ischemic or nonischemic origin of heart failure treated with optimal drug therapy.