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A Rare Combination: Myocardial Infarction and Cerebral Ischemia
(Düzce Üniversitesi, 2012) Bulur, Serkan; Ercan, Nurten; Büyükkaya, Ramazan; Dikici, Süber
Myocardial infarction (MI) is death of heart cells due to the decreased blood flow to a part ofthe heart. Reduction in blood flow increases the oxygen demand of the heart and if it leftuntreated for a sufficient period of time, can cause damage or death of heart muscle tissue.Cerebral ischemia,represents metabolic damage in the brain as a result of insufficient bloodflow. Cerebral hypoxia leads to death of brain tissue that named cerebral infarction. Symptomsof brain ischemia can include unconsciousness (from somnolance to stupor), blindness,coordination problems, body weakness, cardiorespiratory arrest and irreversible brain damage.Observation of cerebral ischemia and MI are a rare combination. Combination of MI andcerebral ischemia is a rare situation we evaluated the case in light of recent literature
Acute coronary stenosis in a young man with Behcet's syndrome
(Karger, 2008) Erbilen, Enver; Albayrak, Sinan; Gülcan, Erim; Taşer, Figen; Bulur, Serkan; Özhan, Hakan; Yazıcı, Mehmet
Objective: To present a case of myocardial infarction due to Behcet's syndrome. Clinical Presentation and Intervention: A 27-year-old man who was known to have Behcet's syndrome for 1 year presented with retrosternal fluctuating chest pain, which radiated to the epigastrium 5 h prior to admission. Coronary angiography showed total occlusion of the left anterior descending coronary artery, which was successfully treated with coronary stent implantation. Conclusion: This case shows that patients with Behcet's syndrome who had acute chest pain should be thoroughly examined for any signs of acute myocardial infarction. Copyright (C) 2008 S. Karger AG, Basel.
Akut Koroner Sendromda Eş Zamanlı İki Koroner Damarda Trombüs Görülmesi: Üç Olgu Sunumu
(Düzce Üniversitesi, 2011) S, Bulur; Bulur, Serkan; Erkan, Melih Engin; Aydın, Mesut; Çağlar, Sabri Onur; Alemdar, Recai; Yalçın, Sübhan
[Abstract Not Available]
Association of omentin Val109Asp polymorphism with coronary artery disease
(Turkish Soc Cardiology, 2014) Yörük, Ümit; Yaykaşlı, Kürşat Oğuz; Özhan, Hakan; Memişoğulları, Ramazan; Karabacak, Ahmet; Bulur, Serkan; Kaya, Ertuğrul
Objective: Coronary artery disease (CAD) is the most important morbidity and mortality disease in the world. It is also one of the leading causes of death in Turkey. Omentin, a recently found adipocytokine, is reported to regulate insulin sensitivity. It has anti-inflammatory properties and is inversely associated with CAD. Omentin gene polymorphism in patients with CAD has not been studied yet. The aim of this study is to investigate the relationship between omentin Val109Asp polymorphism and CAD. Methods: This is an observational study on genetic association. 157 consecutive patients who had undergone coronary angiography were included in the study. Seventy-five of them had CAD and the rest serves the control group. Val109Asp polymorphism was analyzed and compared. Chi-square test was used in comparison of genotype frequencies, whereas ANOVA and chi-square tests were used in comparison of clinical characteristics according to the genotypes. Results: There was no significant difference between CAD patients and control subjects regarding omentin Val109Asp polymorphism. However, a 2.5 fold increase in Val/Val (homozygous mutant) genotype was detected in patients with CAD. The OR (80% Cl) for Val/Val genotype was 3.46 (1.14-10.49). Conclusion: Although no significant difference was detected regarding omentin Val109Asp polymorphism, Val/Val genotype frequency was found to be more in patient group than control group. In conclusion, it may be speculated that Val/Val genotype increases the tendency for CAD, but this experiment should done with larger population to clarify this issue.
Associations of alcohol consumption with blood pressure, lipoproteins, and subclinical inflammation among Turks
(Elsevier Science Inc, 2008) Onat, Altan; Hergenç, Gülay; Dursunoğlu, Dursun; Ordu, Serkan; Can, Günay; Bulur, Serkan; Yüksel, Hüsniye
Gender-related impact of alcohol consumption on blood pressure (BP), serum lipoprotein profile, and C-reactive protein (CRP) concentrations was evaluated prospectively. Alcohol drinking status was assessed as abstainers and categories of light, moderate, and heavy (daily >40 ml ethanol) intake. Mean age of the 3,443 men and women who were followed up for a mean of 7.4 years was 47.6 +/- 12 years. In each multivariable linear or logistic regression analysis, alcohol drinking status was adjusted for age, sex, smoking status, and physical activity. Among men. drinking was significantly associated positively with low-density lipo protein (LDL) cholesterol, apolipoprotein (apo) B, systolic and diastolic BR and with CRP in a log-linear manner exhibiting features of a threshold at heavy drinking. With respect to response of serum triglycerides to light-to-moderate drinking, whereas men exhibited a significant increase, women exhibited a decline (P < .05). Lower BPs (P < .03) and CRP levels (P = .032) were observed in female drinkers than abstainers and, as distinct from men, no increases in LDL cholesterol and apoB were noted. Heavy drinking tended to protect the sexes against the risk of developing low high-density lipoprotein cholesterol levels in prospective multi adjusted analyses. Sex modulates response of cardiometabolic risk variables to moderate alcohol consumption among Turks. Only women respond with lower triglycerides and CRP, whereas men show a log-linear positive association of drinking categories with BP, LDL cholesterol, apoB, and CRP. (C) 2008 Elsevier Inc. All rights reserved.
Carotid intima media thickness and cardiometabolic risk associates in Turkish adults
(Taylor & Francis Ltd, 2011) Beşir, Fahri Halit; Yazgan, Ömer; Özhan, Hakan; Aydın, Yusuf; Başar, Cengiz; Aydın, Mesut; Bulur, Serkan
Objective Carotid intima media thickness (CIMT) is a strong predictor of future vascular events. However, data for Turkish individuals are limited and the association between cardiometabolic risk factors and CIMT has not been studied before. Therefore, we sought to investigate the CIMT and cardiometabolic risk associates in a large cohort of Turkish adults. Methods and results The study was conducted on 2230 participants (1427 women, 803 men with a mean age of 49). The participants underwent a Doppler Ultrasound examination of CIMT. Mean CIMT was 0.61 +/- 0.19 mm. Age- and sex-adjusted partial correlation analysis revealed that only systolic blood pressure and smoking amount was significantly correlated with CIMT. Receiver operator characteristics (ROC) calculations showed that age had the best area under the curve (AUC =0.84), smoking had the best sensitivity (86%) and diastolic blood pressure (>88 mmHg) had the best specificity (74%) in predicting a person with thickened carotid intima media (>0.8 mm). Independent predictors of thickened carotid intima media were hypertension [(odds ratio (OR) = 2.74; 95% confidence interval (Cl) = 1.663-4.53; P value <= 0.001)], systolic blood pressure [OR= 1.01; 95% Cl = 1.002-1.022; P value = 0.022] and age [OR= 1.11; 95% Cl = 1.079-1.136; P value <= 0.001). Conclusion Age, systolic blood pressure and smoking amount (pack/year) were the only age- and sex-adjusted associates of CIMT. Age had the best AUC in ROC analysis predicting thickened carotid artery intima media. Hypertension, systolic blood pressure and age were independent predictors of high CIMT in Turkish adults.
A closed interatrial septal aneurysm mimicking a tumor in the left atrium
(Texas Heart Inst, 2006) Akdemir, Ramazan; Duran, Sadık; Bulur, Serkan; Kaya, Ahmet; Sözen, Serhat Bahadır; Bilir, Cemil; Uyan, Cihangir
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Color M-mode regurgitant flow propagation velocity: A new echocardiographic method for grading of mitral regurgitation
(Blackwell Publishing, 2005) Akdemir, Ramazan; Özhan, Hakan; Bulur, Serkan; Ünlü, Hakan; Gündüz, Hüseyin; Arınç, Hüseyin; Uyan, Cihangir
Purpose: The aim of this study was to evaluate the reliability of mitral regurgitation color M-mode regurgitant flow propagation velocity (RFPV) in grading mitral regurgitation (MR). Methods: We prospectively examined 52 consecutive patients with grades of MR mild in 10 patients, moderate in 19 patients, and severe in 23 patients with quantitative pulse Doppler echocardiography. MR was evaluated by vena contracta diameter (VCD), regurgitant jet area (RJA), and RFPV. These qualitative and quantitative methods were compared with the pulsed Doppler quantitative flow measurements and concordance of these three methods was determined. Results: The mean RFPV for mild, moderate, and severe MR were 26.4 +/- 7 cm/sec, 43.3 +/- 7 cm/sec, and 60.3 +/- 7.3 respectively (P < 0.001). RFPV is highly sensitive and moderately specific in differentiating mild and severe MR from other subgroups. Sensitivity and specificity were 92.1%-64.3% for mild and 100%-68.5% for severe MR, respectively. Significant correlation was observed between pulse Doppler quantitative grades, RFPV, VC, and RJA (P < 0.0001, r = 0.87; P < 0.0001, r = -0.84, P < 0.0001, r = 0.76, respectively). Conclusion: This results show that RFPV is a reliable and simple semiquantitative new method that can be used for determining severity of MR.
Complete dissection of left anterior descending artery in a young woman after myocardial infarction
(Termedia Publishing House Ltd, 2012) Özhan, Hakan; Bulur, Serkan; Kayapınar, Osman; Türker, Yasin
Spontaneous coronary artery dissection (SCAD) is a rare clinical condition that causes acute coronary syndrome and sudden cardiac death. Herein, we report a case of left anterior descending artery dissection after myocardial infarction. On the third day of myocardial infarction after successful thrombolysis, the patient had recurrent chest pain without any ST wave elevation. She was referred to our clinic for coronary angiography which showed completely dissected left anterior descending (LAD) artery. She was referred to a tertiary centre with intravascular ultrasonography (IVUS) capability. Her control angiogram showed restored flow with only minimal dissection (so IVUS was not performed) in the mid LAD. The lesions in the distal and mid LAD were stented. The final angiogram showed TIMI-III flow. Percutaneous coronary intervention is the first choice of treatment in patients with single-vessel spontaneous coronary artery dissection with ongoing signs of ischemia.
Coronary-to-pulmonary artery fistula due to a penetrating trauma
(2012) Bulur, Serkan; Satılmışoğlu, Muhammet Hulusi; Özhan, Hakan; Yazıcı, Mehmet
[No abstract available]
Cystatin C Levels in Patients With Dipper and Nondipper Hypertension
(Lippincott Williams & Wilkins, 2012) Ordu, Serkan; Özhan, Hakan; Alemdar, Recai; Yıldırım, Hayriye; Güngör, Adem; Çağlar, Sabri Onur; Bulur, Serkan
Objective: Subjects with nondipper hypertension carry a higher risk of cardiovascular events than their normotensive counterparts. The present study was designed to investigate cystatin C levels in patients with dipper and nondipper hypertension. Methods: Eighty-eight consecutive patients who had been treated with antihypertensive drugs for at least 6 months were included in the study. Dipping and nondipping patterns were detected with ambulatory blood pressure monitoring. Clinical, laboratory, and ambulatory blood pressure monitoring data of patient groups with nondipper and dipper hypertension were compared. Results: Patients in the nondipper group were older than those in the dipper group. Serum cystatin C level was higher in the patients in the nondipper group. Cystatin C was negatively correlated with the rate of systolic blood pressure fall at night (r = -0.41; P < 0.001). Linear regression analyses revealed that only cystatin C level was a significant correlate of nocturnal systolic blood pressure decrease. Logistic regression analyses also showed that cystatin C was an independent predictor of nondipping pattern (odds ratio, 3.586; 95% confidence interval, 1.432-8.98; P = 0.006]). Conclusion: The present study showed that cystatin C is higher in patients with nondipper hypertension patients.
Echocardiographic Evaluation Of The Left Ventricular Diastolic Functions In Rheumatoid Arthritis
(Düzce Üniversitesi, 2010) Bulur, Serkan; Önder, Elif; Ordu, Serkan; Çalık, Yalkın; Baki, Ali Erdem; Ozhan, Hakan; Yazıcı, Mehmet
Background and aim: The aim of this study was to evaluate LVDF in patients with RA, analyzing conventional Doppler and tissue Doppler echocardiographic imaging (TDI) which is a new echocardiographic application. Method: Forty-six patients with RA and 31 healthy persons were included in this study. Duration of disease ranged from 0 to 12 years (mean 4,2 ± 4,3 / years). All patients and the control group were evaluated by M-mode, two-dimensional, conventional Doppler echocardiography and TDI. Results: When compared with controls, the RA group showed that basal clinic and echocardiographic parameters, left atrial diameter, left ventricular diameters, left ventricular ejection fraction, left ventricular wall thicknesses of these two groups were similar. Among conventional Doppler transvalvular mitral flow parameters, early diastolic flow velocity (E) (p = 0,001), late diastolic flow velocity (A) (p = 0,03) and deceleration time (p ? 0,001) values were higher in patients with RA than that in the control group. E/A ratio was found to be lower in patients with RA than that in the control group (p ? 0,001). Mitral annular early diastolic velocity, among TDI parameters, was found to be lower in patients with RA than that in the control group (p = 0,01). Mitral annular late diastolic velocity was also found to be higher in RA patients (p = 0,007). Conclusion: A comparison between age and sex of RA patients and healthy individuals revealed that left ventricular conventional Doppler and TDI parameters of RA patients were impaired
Editöre Mektup Üstdüzey kardiyovasküler tıp makale sayısı ve kalitesi 2010 yılında çok düştü
(2011) Bulur, Serkan; Özhan, Hakan; Albayrak, Enver Sinan; Türker, Yasin
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Effect of combined oral contraceptive use on platelet volume in women at reproductive age
(I R O G Canada, Inc, 2012) Bulur, Serkan; Albayrak, Mustafa; Bulur, S.; Keskin, Fatih; Köse, Seyit Ali; Aslantaş, Yusuf; Özhan, Hakan
Investigation: Combined oral contraceptives use is associated with an increased risk of developing venous and arterial thromboembolic events. Platelet size, measured as mean platelet volume (MPV), is associated with platelet reactivity. Methods: Ninety-five women using oral contraceptives for contraception were investigated retrospectively. The patients' blood pressure, pulse and hematological values at application and at the sixth month were evaluated retrospectively. Results: There was no difference between the values of blood pressure (systolic and diastolic), pulse, hematological values (which contain leukocytes, platelets and mean platelet volume) at application and at the sixth month. Conclusion: We determined that using oral contraceptives for contraception did not change MPV values in young women.
The effect of Ramadan fasting on circadian variation of Turkish patients with acute myocardial infarction
(Termedia Publishing House Ltd, 2012) Türker, Yasin; Aydın, Mesut; Aslantaş, Yusuf; Özaydın, Mehmet; Uysal, Bayram Ali; Bulur, Serkan; Özhan, Hakan
Introduction: The mechanisms of circadian variation in cardiovascular events are not clear. Aim: Evaluation of the effect of Ramadan fasting on circadian variation of acute ST-elevation myocardial infarction (STEMI) in Turkish patients. Material and methods: This comparative cross-sectional study included 151 consecutive patients with acute STEW. The time of onset of STEMI was determined by the attending physician on the basis of patients' self-reports. The patients were divided into two group based on the history of fasting. The standard hourly profile of the onset of STEMI was obtained over a 24-h period. Patients were then categorized into four 6-hour increments according to the time that the symptoms began (00:00-05:59; 06:00-11:59; 12:00-17:59 and 18:00-23:59 11). Results: In all study participants, the highest incidence of STEMI was between 12.00 and 18.00; the odds ratio was 2.77 (95% CI: 2.63-2.92, p < 0.001). In the non-fasting group, the highest incidence of STEM! occurred between 06:00 and 12:00 AM. The highest incidence of AMI occurred between 12.00 A.M. and 18.00 in patients with fasting; the odds ratio was 2.70 (95% CI: 2.51-2.91, p < 0.001). There were significant differences between fasting and non-fasting groups regarding circadian variation of STEMI (p < 0.001). Conclusions: There are significant changes in the circadian variation of patients with STEMI in relation to Ramadan fasting.
Efficacy of olmesartan therapy on fibrinolytic capacity in patients with hypertension
(Lippincott Williams & Wilkins, 2011) Bulur, Serkan; Özhan, Hakan; Erden, İsmail; Alemdar, Recai; Aydın, Mesut; Çağlar, Onur; Ordu, Serkan
The efficacy of olmesartan on fibrinolytic capacity has not been studied yet. Therefore, the aim of the present study was to investigate the efficacy of olmesartan on hemostatic/fibrinolytic status by measuring plasma level of plasminogen activator inhibitor-1 (PAI-1) and soluble thrombomodulin levels in patients with hypertension. Forty-two consecutive, newly diagnosed (25 women and 17 men with a mean age of 48 +/- 8 years) patients with untreated essential hypertension were included in the study. Olmesartan medoxomil (20 mg/day) was started and the patients were followed up for 6 months. Baseline biochemical variables, thrombomodulin, and PAI-1 levels were compared with the levels of these variables measured at the end of the 6-month follow-up period. After 6 months of treatment with olmesartan medoxomil, there was a significant reduction in systolic and diastolic blood pressure (from 159.5 +/- 10.9 to 134.6 +/- 12.7 mmHg and from 98.0 +/- 6.3 to 83.9 +/- 7.0 mmHg, respectively). Mean plasma PAI-1 and thrombomodulin levels were also significantly decreased (59.73 +/- 41.91 vs. 48.60 +/- 33.65 ng/ml, P=0.001 and 8.09 +/- 2.29 vs. 6.92 +/- 1.42 mu g/l, P<0.001, respectively). Olmesartan medoxomil decreased plasma PAI-1 and thrombomodulin levels after 6 months of therapy, indicating a favorable effect on fibrinolytic capacity in patients with essential hypertension. Blood Coagul Fibrinolysis 22:29-33 (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.
Elastic properties of the ascending aorta and left ventricular function in patients with hypothyroidism
(Blackwell Publishing, 2005) Özhan, Hakan; Yazıcı, Mehmet; Albayrak, Sinan; Erbilen, Enver; Bulur, Serkan; Akdemir, Ramazan; Uyan, Cihangir
Background: We sought to clarify the possible role of elastic properties of the ascending aorta in the development of cardiac disease associated with hypothyroidism (HT). Methods: A total of 37 patients with HT (age: 39.3 +/- 8.9years) and 29 control subjects were studied. AscendingAortic (Ao) diameter, Ao elastic indexes, strain (AoST), distensibility (AoD), stiffness index (AoSI), and pressure strain modulus were calculated from the echocardiographically derived Ao diameters. Myocardial performance index (MPI), E/A ratio, isovolumetric relaxation time (IVRT), deceleration time (DT) were measured by Doppler echocardiography to assess diastolic LV function. Patients were treated with levothyroxine and followed-up for 6 months. Thyroid function tests and echocardiographic measurement's were repeated at the end of the study. Results: AoD (cm(2) dyn(-1) 10(-3)) and AoST (%) were significantly lower (3.8 vs. 6.1; P < 0.001, 7.4 vs. 12.6, P < 0.001; respectively), whereas AoSI was higher in HT patients (6.2 vs. 3.3; P < 0.001). After treatment, AoD and AoST were increased (5.7; P < 0.001 and 11.8; P < 0. 001; respectively), whereas AoSI was decreased significantly (3.7; P < 0. 001). Also, early / late mitral peak velocity ratio (Emax/Amax) was significantly lower in HT patients (1.19 vs 1.34; P < 0.001), whereas MPI was higher (0.52 vs. 0.42; P < 0.001). MPI showed a strong correlation with aortic root indexes [AoST (r = -0.61/P < 0.001); AoD, (r = -0.57/P < 0.002); AoSI, (r = 0.531P < 0.005)] in the HT group. After 6 months of therapy, MPI significantly decreased P < 0.001) and EIA ratios were normalized (P < 0.001). Conclusions: Ao root functions have an important role on diastolic LV function. Levothyroxine replacement therapy can reverse all of these adverse effects of HT.
Elektrokardiyografide Eş zamanlı Anteriyor, İnferiyor, Posteriyor ve Sağ Ventriküler ST Yükselmesi Görülen Sol İnen Arter Tam Tıkanması; Sıra Dışı Bir Akut Miyokard İnfarktüsü Olgusu
(Düzce Üniversitesi, 2013) Ekinözü, İsmail; Başar, Cengiz; Albayrak, Enver Sinan; Bulur, Serkan; Aslantaş, Yusuf
Ellidört yaşında bayan hasta acil servise 1 saatlik göğüs ağrısı ile başvurdu. Risk faktörü olaraksadece sigara vardı. Sistemik başka bir hastalık öyküsü yoktu. Çekilen EKG’de V1-V6,V4R,V5R,V6R, D2,D3,AVF ve posteriyor derivasyonlarda ST yükselmesi saptandı. Acilkoroner anjiografi uygulandı. Koroner anjiyografi sonucunda sol inen arter 1. diagonalsonrasında total tıkanıklık saptandı. Lezyon balonla pre dilatasyon edildi. Daha sonra lezyonabaşvurudan 45 dakika sonra çıplak metal stent takıldı. Lezyon tam açıldı. Perkutan koronergirişim sonrası ST yükselmesi geriledi. Göğüs ağrısı geçti. Koroner anjiografi sonucu sol inenarterin inferoapikal duvara uzandığı görüldü. Çok nadir rastlanan bu durum “wrapped LAD”olarak isimlendirilmektedir. Sirkumfleks arter ve sağ koroner arter normal saptandı
Emergency Revascularization Strategies In An Acute Myocardial Infarction Due To The Occlusion Of The Left Main Coronary Artery: A Report Of Three Cases
(Düzce Üniversitesi, 2013) Çağlar, Sabri Onur; Alemdar, Recai; Aydın, Mesut; Ercan, Nurten; Albayrak, Enver Sinan; Bulur, Serkan
Although acute left main coronary artery (LMCA) occlusion is rare, it carries a very highmortality rate. Several studies have compared the efficacy of elective coronary artery stentingand coronary artery bypass grafting (CABG) in patients with LMCA disease. However, a definitereperfusion modality has yet to be established in ST-elevation myocardial infarction (STEMI)due to acute total occlusion of LMCA, which has catastrophic clinical results. We presentedthree patients with acute anterior STEMI and angiographically documented acute total occlusionof LMCA. All of them were taken to the catheterization laboratory. One patient who was referredto CABG for emergency revascularization died. One died on the 3th day of admission becauseof heart failure.. The other patient, thrombolysis in myocardial infarction (TIMI) III flow wasachieved after percutaneous coronary intervention (PCI), and he was discharged with acceptableshort-term results
Epidemiology of atrial fibrillation in Turkey: Preliminary results of the multicenter AFTER study
(Turkish Anaesthesiology and Intensive Care Society, 2013) Ertaş, Faruk; Kaya, Hasan; Kaya, Zekeriya; Bulur, Serkan; Köse, Nuri; Gül, Mehmet; Ülgen, Mehmet S.
Objectives: Although atrial fibrillation (AF) is one of the most common rhythm disorders observed in clinical practice, a multicenter epidemiological study has not been conducted in our country. This study aimed to assess our clinical approach to AF based upon the records of the first multicenter prospective Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER) study. Study design: Taking into consideration the distribution of the population in our country, 2242 consecutive patients with at least one AF attack determined by electrocardiographic examination in 17 different tertiary health care centers were included in the study. Inpatients and patients that were admitted to emergency departments were excluded from the study. Epidemiological data of the patients and the treatment administered were assessed. Results: The mean age of the patients was determined as 66.8±12.3 years with female patients representing 60% of the study population. While the most common AF type in the Turkish population was non-valvular AF (78%), persistent/permanent AF was determined in 81% of all patients. Hypertension (%67) was the most common comorbidity in patients with AF. While a stroke or transient ischemic attack or history of systemic thromboembolism was detected in 15.3% of the patients, bleeding history was recorded in 11.2%. Also, 50% of the patients were on warfarin treatment and 53% were on aspirin treatment at the time of the study. The effective INR level was detected in 41.3% of the patients. The most frequent cause of not receiving anticoagulant therapy was physician neglect. Conclusion: These results demonstrate the necessity for improved quality of physician care of patients with AF, especially with regards to antithrombotic therapy. © 2013 Turkish Society of Cardiology.

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