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Öğe Akut miyokard enfarktüsü sonrası gelişen geniş ventriküler septal rüptürün başarılı tedavisi(Aves, 2007) Kaya, Ahmet; Kaya, Yasemin; Ordu, Serkan; Özkökeli, Mehmet; Özhan, Hakan; Dağlar, Bahadır; Yazıcı, MehmetPostinfarct ventricular septal rupture (VSR) is a rare but mortal complication of acute myocardial infarction (MI). VSR must be diagnosed earlier and the correct treatment must be applied immediately. Abrupt surgical repair is the choice of treatment, which decreases early mortality and improves long term survival. Septal rupture occurs more frequently with anterior than with other types of acute myocardial infarction. VSR occurs usually within 2 weeks after infraction. We describe here a 76-year-old woman with a giant VSR with little hemodynamic disturbance that developed twenty days after anterior myocardial infarction. She was successfully treated with abrupt surgical closure.Öğe Assessment of cardiac functions in patients with adenotonsillar hypertrophy(Duzce University Medical School, 2011) Ordu, Serkan; Ozhan, Hakan; Uzun, Hakan; Alemdar, Recai; Erden, Ismail; Yazici, Mehmet; Gultekin, ErolBackground: The aim of this study is to compare cardiac function in children with and without adenotonsillar hypertrophy (ATH). Materials and methods: Ninety-one children (26 female 65 male) who were diagnosed as ATH in the pediatric outpatient clinic and twenty-three completely healthy, age-sex matched children (10 female 13 male) were included in the study. All patients underwent a complete twodimensional transthoracic echocardiographic and Doppler study. Results: Mean mitral E, A and deceleration time were significantly longer in ATH group. Also chamber areas and volumes were bigger. Pulmonary and mitral regurgitation were statistically more frequent in ATH group. Adenotonsillar grade was positively related with mean pulmonary arterial pressure (r: 0.44 p: <0.001). Mitral valve thickness was strongly correlated with tonsillar hypertrophy grade (r: 0.73; p.<0.001). Conclusions: ATH may lead to mild diastolic dysfunction and chamber dilatation. Mitral valve thickness was strongly correlated with adenotonsillar grade. © 2011 Düzce Medical Journal.Öğe Association between BNP and in Stent Restenosis in Patients who had Undergone Coronary Angioplasty(Aves, 2007) Kaya, Ahmet; Kaya, Yasemin; Ordu, Serkan; Albayrak, Enver Sinan; Satilmisoglu, M. Hulusi; Erkan, Melih Engin; Ozhan, HakanIntroduction: Brain natriuretic peptide (BNP) is a highly sensitive and specific diagnostic tool used in prediction of cardiovascular events in patients with ischemic and non-ischemic cardiovascular heart disease. In this study, we sought to test the efficacy of BNP in predicting restenosis rate in patients who had undergone PCI. Materials and Methods: Seventy-three consecutive stable angina and acute coronary syndrome patients who were admitted to cardiology department and performed percutaneous coronary intervention (PCI) were included in this study. The study was performed in Duzce University School of Medicine, Dept of Cardiology between 2006 and 2008. Pre and post PCI BNP levels were measured in all the patients. The patients were followed up for stent restenosis. Results: Sixteen out of 23 patients who were screened for restenosis with coronary angiography were found to have restenosis. The differences between the mean BNP levels measured before and after PCI were not statistically significant. Conclusion: BNP measured before and after PCI could not predict restenosis.Öğe Carbohydrate antigen-125 and N-terminal pro-brain natriuretic peptide levels: Compared in heart-failure prognostication(2012) Ordu, Serkan; Ozhan, Hakan; Alemdar, Recai; Aydin, Mesut; Caglar, Onur; Yuksel, Hatice; Kandis, HayatiCarbohydrate antigen-125 (CA-125) is emerging as a prognostic biomarker of risk in heart failure. In a prospective study, we compared the prognostic values of CA-125 and aminoterminal pro-brain natriuretic peptide (NT-proBNP) in patients with stable heart failure. We enrolled 102 consecutive chronic, stable, systolic-heart-failure patients (68 men and 34 women; median age, 71 yr) from November 2008 through February 2010. We measured baseline NT-proBNP and CA-125 levels and compared their prognostic values. The primary endpoint was all-cause death and other major adverse events, defined as hospitalization for decompensated heart failure or acute coronary syndrome. During a mean follow-up period of 14 ± 2 months, 12 patients died and 35 others sustained major adverse events. We found that CA-125 level significantly correlated with New York Heart Association functional class, pulmonary artery pressure, microalbuminuria, creatine kinase-MB fraction, and hemoglobin, albumin, and NT-proBNP levels. Upon receiver operating characteristic curve analysis, CA-125 and NT-proBNP had similar accuracy in predicting major adverse events and death: for major adverse events, area under the curve (AUC) was 0.699 for CA-125 (P=0.002) and 0.696 for NT-proBNP (P=0.002); for death, AUC was 0.784 for CA-125 (P=0.003) and 0.824 for NT-proBNP (P=0.001). Multivariate Cox regression analysis showed that CA-125 levels greater than 32 U/mL and NT-proBNP levels greater than 5,300 pg/mL had independent prognostic value for major adverse events and death. We conclude that baseline CA-125 and NT-proBNP levels are comparably reliable as heart-failure markers, and that CA-125 can be used for prognosis prediction in heart failure. © 2012 by the Texas Heart® Institute, Houston.Öğe A case of acute stent thrombosis treated successfully with intracoronary tirofiban(Via Medica, 2010) Erden, Ismail; Ozhan, Hakan; Ordu, SerkanAcute stent thrombosis (AST) is occasionally observed during percutaneous coronary intervention in patients with acute coronary syndrome (ACS). It may jeopardize hemodynamic status. Currently, there is no adequate solution for this problem. We report our experience with an ACS patient who developed AST associated with cardiogenic shock after percutaneous coronary stent deployment. Intracoronary administration of tirofiban immediately restored the coronary flow of the target vessel, and the disastrous condition was reversed. Our experience suggests that intracoronary administration of tirofiban can be considered as an option in cases of AST during percutaneous coronary intervention.Öğe A case successfully treated giant ventricular septal rupture after acute myocardial infarction(Springer, 2007) Kaya, Ahmet; Kaya, Yasemin; Ordu, Serkan; Özkökeli, Mehmet; Özhan, Hakan; Dağlar, Bahadır; Yazıcı, MehmetVSR occurs in 1-3 % of all MI cases, usually within 2 weeks after infraction. 50-80% of partients die within the first week after the rupture unless they are surgically treated.Öğe Correlation of plasma B-type natriuretic peptide with shunt severity in patients with atrial or ventricular septal defect(Springer, 2007) Özhan, Hakan; Albayrak, Sinan; Uzun, Hakan; Ordu, Serkan; Kaya, Ahmet; Yazıcı, MehmetThe goal of this study was to test the utility of bedside plasma concentration of B-type natriuretic peptide (BNP) assay as a screen for large shunts in pediatric patients with atrial septal defects (ASDs) and ventricular septal defects (VSDs). Thirty-five children at a mean age of 70 +/- 129 weeks with ASD or VSD were included in the study. Nine patients had VSD and 26 had ASD. Plasma BNP values were compared with the Q(p)/Q(s) ratios derived from quantitative Doppler flow measurements. Mean BNP was 29 +/- 42 pg/ml, with a range between < 5 pg/ml and 208 pg/ml. Sixteen patients had Q(p)/Q(s) values > 1.5 and 19 had values < 1.5. The difference of mean BNP in these patient groups was statistically significant (45 +/- 56 vs 14 +/- 17, p = 0.03). BNP was positively correlated with shunt significance. Receiver operating characteristic curve analysis revealed a sensitivity of 69% and a specificity of 79% at a plasma BNP cut-off level of >= 20 pg/ml. Bedside measurement of BNP correlates with magnitude of ASD and VSD in children. BNP can provide information for the management of children with ASD or VSD. It can be used as part of the evaluation of a child with a preliminary diagnosis of a congenital defect.Öğe Effects of ivabradine therapy on heart failure biomarkers(Via Medica, 2015) Ordu, Serkan; Yıldız, Bekir Serhat; Alihanoğlu, Yusuf İzzettin; Özsoy, Aybars; Tosun, MehmetBackground: Heart rate (HR) reduction is associated with improved outcomes in patients with heart failure (HF) and biomarkers can be a valuable diagnostic tool in HF management. The primary aim of our study was to evaluate the short-term (6 months) effect of ivabradine on N-terminal pro B-type natriuretic peptide (NT-proBNP), CA-125, and cystatin-C values in systolic HF outpatients, and secondary aim was to determine the relationship between baseline HR and the NT-proBNP, CA-125, cystatin-C, and clinical status variation with ivabradine therapy. Methods: Ninety-eight patients (mean age: 65.81 +/- 10.20 years; 33 men), left ventricular ejection fraction < 35% with Simpson method, New York Heart Association (NYHA) class II-III, sinus rhythm and resting HR > 70/min, optimally treated before the study were included. Among them, two matched groups were formed: the ivabradine group and the control group. Patients received ivabradine with an average (range of 10-15) mg/day during 6 months of follow-up. Blood samples for NT-proBNP, CA-125, and cystatin-C were taken at baseline and at the end of a 6-month follow-up in both groups. Results: There was a significant decrease in NYHA class in the ivabradine group (2.67 +/- +/- 0.47 vs. 1.85 +/- 0.61, p < 0.001). When ivabradine and control groups were compared, a significant difference was also found in NHYA class 6 months later (p = 0.013). A significant decrease was found in HR in the ivabradine and control groups (84.10 +/- 8.76 vs. 68.36 +/- +/- 8.32 bpm, p = 0.001; 84.51 +/- 10 vs. 80.40 +/- 8.3 bpm, p = 0.001). When both groups were compared, a significant difference was also found in HR after 6 months (p = 0.001). A significant decrease was found in cystatin-C (2.10 +/- 0.73 vs. 1.50 +/- 0.44 mg/L, p < 0.001), CA-125 (30.09 +/- 21.08 vs. 13.22 +/- 8.51 U/mL, p < 0.001), and NT-proBNP (1,353.02 +/- 1,453.77 vs. 717.81 +/- 834.76 pg/mL, p < 0.001) in the ivabradine group. When ivabradine and control groups were compared after 6 months, a significant decrease was found in all HF parameters (respectively; cystatin-C: p = 0.001, CA-125: p = 0.001, NT-proBNP: p = 0.001). Creatinine level was significantly decreased and glomerular filtration rate (GFR) was significantly increased in the ivabradine group (1.02 +/- 0.26 vs. 0.86 +/- 0.17, creatinine: p = 0.001; 79.26 +/- +/- 18.58 vs. 92.48 +/- 19.88, GFR: p = 0.001). There was no significant correlation between NYHA classes (before and after ivabradine therapy) and biochemical markers, or HR. Conclusions: In the outpatients with systolic HF, persistent resting HF > 70/min with optimal medical therapy, the NT-proBNP, CA-125, and cystatin-C reductions were obtained with ivabradine treatment. Measurement of NT-proBNP, CA-125, and cystatin-C may prove to be useful in biomarker panels evaluating ivabradine therapy response in HF patients.Öğe Efficacy of nebivolol on flow-mediated dilation in patients with slow coronary flow(2009) Albayrak, Sinan; Ordu, Serkan; Yuksel, Hatice; Ozhan, Hakan; Yazgan, Ömer; Yazici, MehmetSlow coronary flow (SCF) is the phenomenon of slow progression of angiographic contrast in the coronary arteries in the absence of stenosis in the epicardial vessels in some patients presenting with chest pain. There are no definite treatment modalities for patients with SCF. Our aim was to investigate the efficacy of nebivolol in patients with slow coronary flow by monitoring its effects on endothelial function and different markers of inflammation. Forty-two patients (16 females, 26 males; mean age, 55±10) with slow coronary flow (SCF) were included in the study. After baseline assessment, the patients were administered nebivolol 5 mg once daily. After 12 weeks of nebivolol therapy, the biochemical and ultrasonographic examinations were repeated. Chest pain relief was detected in 38 patients after treatment (90%). Systolic and diastolic blood pressure and high sensitive CRP were significantly decreased after nebivolol therapy. Among brachial artery dilation variables that reflect endothelial function, basal resistive index (RI), post-flow mediated dilation RI, and post-nitrate mediated dilation RI were significantly decreased after therapy. Nebivolol is effective at improving endothelial function in patients with SCF. It controls chest pain, decreases CRP, and has favorable effects on brachial artery dilation variables in patients with coronary slow flow.Öğe OUTCOME OF PRIMARY PERCUTANEOUS INTERVENTION IN PATIENTS WITH INFARCT RELATED CORONARY ARTERY ECTASIA(Elsevier Ireland Ltd, 2010) Erden, Ismail; Ordu, Serkan; Alemdar, Recai; Aydin, Mesut; Ozhan, Hakan; Yazici, Mehmet; Basar, CengizÖğe Performance of Bioelectrical Impedance Analysis in the Diagnosis of Metabolic Syndrome(Bmj Publishing Group, 2012) Ozhan, Hakan; Alemdar, Recai; Caglar, Onur; Ordu, Serkan; Kaya, Ahmet; Albayrak, Sinan; Turker, YasinObjective: Central obesity is a prerequisite for the diagnosis of metabolic syndrome (MetS). Precise measurement of visceral fat by bioelectrical impedance analysis (BIA) has been validated. The aim of this study was to investigate the diagnostic performance of BIA in MetS and validate the best cutoff in a large adult cohort. Materials and Methods: The study was performed on the MELEN Study cohort-a prospectively designed survey on the prevalence of cardiometabolic risk factors in Turkish adults. The final cohort consisted of 2219 participants. Weight and visceral body composition were measured without shoes in light indoor clothes using a bioimpedance analyzer (Omron BF 510; Omron Corp, Kyoto, Japan). Plasma concentrations of cholesterol, insulin, fasting triglycerides, high-density lipoprotein cholesterol, glucose, and other biochemical variables were measured. The diagnostic performance of visceral fat measurement by BIA in patients with MetS was assessed. Results: Metabolic syndrome was detected in 751 participants (520 women and 231 men with a mean age of 55 [12] years; 34% of the whole study population). Total body fat and visceral fat levels were higher in subjects with MetS. Correlation analyses showed that there were significant correlations between anthropometric and BIA measurements. Receiver operating curve characteristics of visceral adiposity revealed the best cutoff values as greater than 12% for men and greater than 9% for women. The diagnostic performance was good in both sexes (the sensitivity/specificity and area-under-the-curve values were 76%/75% and 0.83 for men and 83%/67% and 0.81 for women, respectively). Conclusions: Visceral fat measured with BIA is an easily applicable and useful method for identifying people with MetS. The best cutoff values were higher than 12% for men and higher than 9% for women.Öğe Pioglitazone improves ventricular diastolic function in patients with diabetes mellitus: A tissue Doppler study(Acta Cardiologica, 2010) Ordu, Serkan; Ozhan, Hakan; Alemdar, Recai; Aydin, Mesut; Basar, Cengiz; Caglar, Onur; Yazici, MehmetObjective - Pioglitazone treatment in type 2 diabetes mellitus produced significant improvements in glycaemic control, plasma lipids, blood pressure and inflammation. The aim of this study was to investigate the effect of pioglitazone on systolic and diastolic function in diabetic patients. Methods and results - Forty-nine diabetic patients were included in the study.The patients had never received thiazolidinedione therapy before. Clinical and echocardiographic variables were measured. 30 mg pioglitazone were administered. The patients were followed up for six months and all the measurements were re-evaluated for comparison. Body mass index (BMI) significantly increased after treatment. Fasting glucose, HbA1c and systolic blood pressure decreased. Insulin resistance improved and the HOMA-IR index decreased after pioglitazone treatment. Mean aortic diameter, left atrial systolic and diastolic volumes significantly decreased after therapy. Among diastolic function variables mitral E wave, E/A, ejection time and pulmonary vein peak reverse flow velocity (PVA) significantly increased whereas isovolumetric relaxation time (IVRT), isovolumetric contraction time (IVCT), deceleration time, E/E' and pulmonary vein late systolic flow (PVS2) decreased after pioglitazone therapy. Among tissue Doppler variables early (E) ventricular inflow velocities measured from the tricuspid lateral annulus, the mitral septal and lateral annulus, the anterior, inferior and posterior free wall significantly increased. Late (A) ventricular inflow velocities measured from the anterior, inferior free wall and the mitral septal annulus also increased. Conclusion - Pioglitazone treatment in type 2 diabetes mellitus produced significant improvements in measures of glycaemic control and diastolic ventricular function.Öğe The prognostic value of mean platelet volume in decompensated heart failure(2011) Kandis, Hayati; Ozhan, Hakan; Ordu, Serkan; Erden, Ismail; Caglar, Onur; Basar, Cengiz; Yalcin, SubhanBackground: Congestive heart failure (CHF) is a major public health problem that is related to substantial morbidity, impaired quality of life and diminished survival. Mean platelet volume (MPV) is an indicator of platelet activation. Aim: To investigate whether there is a difference of MPV in patients with decompensated and stable heart failure (SHF), and test the prognostic value of MPV in decompensated heart failure (DHF). Methods: 136 consecutive patients with DHF were enrolled. 71 with SHF were also enrolled for comparison. Patients were followed up for a mean of 18±12 months. The primary endpoint was death from any cause. Clinical characteristics of patients with DHF who died during follow-up were compared with the those of the survivors. Results: MPV was significantly higher in DHF group than in the SHF group. 71 patients died during the follow-up period (18±12 months). Comparison with survivors revealed that mortality was associated with age, systolic blood pressure, pulmonary artery pressure, serum creatinine, urea and MPV. MPV was determined as an independent risk factor for mortality (OR 1.553, 95% CI 1.024 to 2.354, p=0.038). Receiver operating characteristic analysis showed that MPV level on admission was a predictor of mortality (area under the curve (AUC) for in-hospital mortality was 0.716 (95% CI 0.632 to 0.789, p=0.003) and AUC for 6-month mortality was 0.815 (95% CI 0.74 to 0.877, p<0.001), respectively). Conclusion: MPV is increased in patients with DHF. Also, MPV on admission is an independent predictor of in-hospital mortality and 6-month mortality.
