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Öğe Acute myocarditis mimicking acute myocardial infarction associated with pandemic 2009 (H1N1) influenza A virus(Via Medica, 2011) Erden, İsmail; Erden, Emine Çakcak; Özhan, Hakan; Başar, CengizThe prevalence of myocardial involvement in influenza infection ranges from 0% to 11% depending on the diagnostic criteria used to define myocarditis. Whether such an association holds for the novel influenza A strain, pandemic-2009-H1N1, remains unknown. The clinical presentation of myocarditis varies and often mimics myocardial infarction. Although history, physical examination, laboratory data points, and electrocardiogram are helpful in distinguishing myocarditis from myocardial infarction, differential diagnosis can sometimes be difficult. Here, we present the first known report of acute myocarditis mimicking acute myocardial infarction associated with the pandemic influenza A virus (H1N1) infection. (Cardiol J 2011; 18, 5: 552-555)Öğe Amount of ST wave resolution in patients with and without spontaneous coronary reperfusion in the infarct -related artery after primary PCI: an observational study(Turkish Soc Cardiology, 2012) Erden, Emine Çakcak; Erden, İsmail; Türker, Yasin; Aslantaş, Yusuf; Yalçın, Sübhan; Karabacak, AhmetObjective: In patients with ST-elevation myocardial infarction (STEN) undergoing primary percutaneous coronary intervention (PCI), a patent infarct-related artery (IRA) on initial angiography was associated with better angiographic results and improved prognosis compared with patients without spontaneous reflow. The role of systematic emergency PCI in patients with spontaneous reperfusion during myocardial infarction is debated. We compared the amount of ST wave resolution (STR) in patients with and without spontaneous coronary reperfusion (SCR) in the infarct related artery. Methods: This study was designed as an observational cohort study. One hundred sixty-one consecutive patients (121 males, 40 females, with a mean age of 56 10 years) who had STEMI and treated with primary PCI without previous thrombolytic therapy were included in the study. All patients were treated with primary PCI within 12 hours from the onset of the symptoms and had stent implantation in the culprit lesion. ST wave resolution was measured as percent resolution of ST segment elevation from electrocardiogram (ECG), before and after PCI, classified as complete (>70%), partial (30% to 70%), or absent (<30%). SCR was defined as a TIMI grade III flow in the IRA on baseline coronary angiogram. The amount of ST wave resolution (STR) in patients with and without SCR in the IRA was compared. We used Chi-square test, Student's t-test and the Mann-Whitney U test for statistical analysis. Results: At the baseline coronary angiography 40(25%) patients had SCR and 121 patients (75%) had TIMI flow grade 0, 1 or 2 (non-SCR group). ST segment resolution amount was significantly higher in patients without SCR (53 +/- 17 versus 13 +/- 23 mm; p<0.001). In fact; in five patients whom had patent infarct related artery in initial angiography, ST segment elevation increased according to pre-PCI ECG. Conclusion: Mean ST wave resolution was lower in patients with spontaneous coronary reperfusion who were treated with primary PCI compared to their counterparts who did not have spontaneous coronary reperfusion on initial coronary angiography. (Anadolu Kardiyol Derg 2012; 12:30-4)Öğe Association between restless leg syndrom and slow coronary flow(Turkish Soc Cardiology, 2014) Erden, İsmail; Erden, Emine Çakcak; Durmuş, Hacer; Tibilli, Hakan; Tabakçı, Mustafa; Kalkan, Mehmet Emin; Akçakoyun, MustafaObjective: Restless legs syndrome (RLS) is a common sleep disorder in which patients feel unpleasent leg sensations and urge to move the legs during rest, especially at night, and symptoms are improved by leg movement. Prior studies analyzing the associations between cardiovascular disease and restless legs syndrome has shown controversial results. The goal of the study was to estimate the relationship between restless legs syndrome and slow coronary flow (SCF). Methods: The present study was cross-sectional and observational and consists of 176 individuals who underwent coronary angiography and had angiographically normal coronary arteries of varying coronary flow rates. The study included 86 patients with isolated SCF and 90 control participants with normal coronary flow (NCF). RLS was assessed the day after the coronry flow was evaluated, using a self-administered questionnaire based on the International Restless Legs Study Group criteria. The following question was asked: "Do you have unpleasant leg sensations (like crawling, paraesthesia, or pain) combined with motor restlessness and an urge to move?" The possible responses were as follows: no, less than once/month, 2-4 times/month, 5-14 times/month, and 15 or more times per month. Those who answered that they had these feelings were asked the following two more questions: 1) "Do these symptoms occur only at rest and does moving improve them?" and 2) "Are these symptoms worsen in the evening/at night compared with the morning?" RLS is considered to be probable if the participant has answered "yes" for all three of the above questions, and has a frequency of >= 5 times/month. Student's t-test, Mann-Whitney U test, multiple logistic regression analysis were used for statistical analysis. Results: The prevalence of restless legs syndrome was 48 (27%) and increased significantly with age. Patients with SCF have more likely had RLS than the control group (p<0.001). The age-adjusted prevalence odds of SCF were 3.11 times higher (95% CI: 1.54-6.29; P<0.001) among patients with RLS symptoms. Significant associations between RLS and SCF did not materially change after further adjustment for other potential covariates, such as sex, BMI, BMI squared, smoking. Conclusion: Our study concluded that there is a strong link between SCF and RLSÖğe Cor triatriatum sinister with significant pressure gradient in an adult patient(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2013) Erden, Emine Çakcak; Erden, İsmail; Kayapınar, OsmanCor triatriatum sinistrum is rare congenital cardiac malformation. It accounts for approximately 0.1-0.4% of all patients with congenital heart disease. Most cases are diagnosed in childhood, while adult cases are very rare. The condition is characterized by the presence of a fibromuscular membrane dividing the left atrium into two chambers a superior posterior chamber and an inferior anterior chamber. A 30-year-old male presenting with progressive exertional dyspnea for the past two years was admitted to our clinic. Color Doppler ultrasonography revealed an eccentric, mosaic pattern of continuous turbulent flow near the interatrial septum across the membrane. The peak velocity of the flow across the membrane was 2.70 m/s, indicating that the pressure gradient between two chamber was 11.5 mmHg. Surgical correction of the membrane was recommended. The membrane was excised and all symptoms resolved in the scheduled visit at one month following surgery. In this article, we report an adult case of incomplete cor triatriatum sinister with a significant pressure drop.Öğe Echocardiographic manifestations of pandemic 2009 (H1N1) influenza a virus infection(W B Saunders Co Ltd, 2010) Erden, İsmail; Erden, Emine Çakcak; Özhan, Hakan; Başar, Cengiz; Yıldırım, Mustafa; Yalçın, Sübhan; Dumlu, TalhaAim: The prevalence of myocardial involvement in influenza infection ranges from 0% to 12% depending on the diagnostic criteria used to define myocarditis. Whether such an association holds for the novel influenza A strain, pandemic-2009-H1N1, remains unknown. The aim of this present study is to evaluate the cardiovascular manifestations of pandemic (H1N1) 2009 influenza A (pH1N1) by using standard echocardiography and tissue Doppler imaging (TDI). Methods: Twenty-eight young patients who had been hospitalized for at least 24 h due to an influenza-like illness and tested positive for pH1N1 by real-time polymerase chain reaction were included in the study. All patients underwent echocardiographic studies during the first 72 h of admission. Echocardiographic studies of thirty gender and age matched control subjects were performed and the results were compared. Results: Heart rate was significantly higher in patients infected with pH1N1 virus. Other clinical variables were similar between the two groups (p > 0.05). Echocardiographic variables were also similar except left ventricular end-systolic dimension, which was significantly increased in the patient group (P = 0.042). Left ventricular tissue Doppler assessment at mitral annulus showed that mean systolic velocities of pH1N1 infected patients and control group were statistically similar. However, early diastolic velocity was decreased and late diastolic velocity was increased in the patient group. Therefore early diastolic/late diastolic velocity ratio was significantly decreased in pH1N1 infected patients. Also, isovolumetric contraction time and isovolumetric relaxation time were prolonged and ejection time was significantly shortened in pH1N1 infected patients. As a result, global myocardial performance index was significantly higher in pH1N1 infected patients (p < 0.001). Right ventricular tissue Doppler assessment at tricuspid annulus showed similar results with the left ventricular measurements. Conclusion: The results of the study suggest an association between hospitalized pH1N1 and subclinical cardiac dysfunction as measured by tissue Doppler echocardiography. (c) 2010 The British Infection Society. Published by Elsevier Ltd. All rights reserved.Öğe Effect of dipping status on QRS morphology in patients with hypertension(Lippincott Williams & Wilkins, 2010) Erden, İsmail; Erden, Emine Çakcak; Özhan, Hakan; Yalçın, Sübhan; Başar, Cengiz; Aydın, MesutBackground Prolongation of the QRS complex on the surface electrocardiogram (ECG) has been shown to be predictive of cardiovascular outcomes in selected populations. A 'nondipper' blood pressure (BP) profile is currently regarded as a risk factor in its own right for cardiovascular events and target organ damage. The predictive value of ECG parameters in hypertensives with nondipper profile has not been established. Methods A total of 750 consecutive patients with hypertension who had been evaluated with ambulatory BP monitoring were screened for this study. One hundred and thirty-six patients who had fulfilled the inclusion and exclusion criteria were included in the final analysis. Dipper and nondipper patterns were detected and the maximum QRS duration (QRSd) measured on a 12-lead ECG was recorded. Results There were 70 nondipper and 66 dipper hypertensives. There was no significant difference between the two groups regarding the daytime systolic and diastolic mean BPs, number of medications taken, and the proportion of each class of antihypertensive medications. Other variables were similar between the two groups. QRSd was significantly higher in nondippers than dippers (P = 0.006). Correlation analysis revealed that the systolic BP fall at night was inversely and significantly related with QRSd (r = -0.482, P < 0.001). Regression analysis further showed that the systolic BP fall at night and age were independent correlates of QRSd. Conclusion QRSd on the standard-surface 12-lead ECG was increased in patients with nondipper pattern and furthermore the systolic BP fall at night was independent correlate of QRSd in patients with hypertension. Blood Press Monit 15:247-250 (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.Öğe Incremental effects of restless legs syndrome (RLS) on nocturnal blood pressure in relatively young untreated hypertensive patients and normotensive individuals(Oxford Univ Press, 2012) Erden, İsmail; Erden, Emine Çakcak; Türker, Yasin; Aslantaş, Y.; Tibilli, Hakan…Öğe Incremental effects of restless legs syndrome on nocturnal blood pressure in hypertensive patients and normotensive individuals(Lippincott Williams & Wilkins, 2012) Erden, Emine Çakcak; Erden, İsmail; Türker, Yasin; Sivri, Nasır; Dikici, Süber; Özşahin, MustafaBackground Few studies have evaluated the role of restless legs syndrome (RLS) in the development of nondipping 24 h blood pressure (BP) patterning/sleep-time hypertension, which has been shown to be an independent predictor of cardiovascular risk. These were indirect studies that had reported the relation between BP and RLS attacks during polysomnographic investigations in the lab. The aim of the present study was to assess the relationship between RLS, which was diagnosed clinically, and night-time BP patterns in a relatively large young cohort who had not been treated before. Patients and methods After applying the exclusion criteria, this cross-sectional study included 230 consecutive patients with never-treated hypertension who presented to our institution for initial evaluation of hypertension. RLS was assessed using a self-administered questionnaire based on the International Restless Legs Study Group criteria. The questions on RLS were completed by 214 patients and ambulatory BP monitoring was carried out for all patients. Results In the study group, 133 patients were diagnosed as hypertensive (53.4% nondippings) and 81 patients as normotensives (54.3% nondippings). RLS was present in 61 patients (28.5%) in the total sample. The prevalence of RLS, overall, was significantly higher in nondippings compared with dippings (34.7 vs. 21.2%, respectively; P = 0.028). Logistic regression analysis showed that the RLS is an independent determinant for both hypertension (odds ratio = 0.43, 95% confidence interval = 0.21-0.83; P = 0.013) and the nondipping BP patterns (odds ratio = 1.96, 95% confidence interval = 1.05-3.67; P = 0.035). Conclusion We have shown that clinically diagnosed RLS was associated with the nondipping pattern, which has been shown to be an independent predictor of cardiovascular risk. Blood Press Monit 17:231-234 (C) 2012 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins. Blood Pressure Monitoring 2012, 17:231-234Öğe The levels of asymmetric dimethylarginine in patients with isolated coronary artery ectasia(2010) Erden, İsmail; Erden, Emine Çakcak; Sözen, Serhat Bahadır; Kayapınar, Osman; Çağlar, Sabri Onur; Başar, CengizAim: Although underlying mechanisms of coronary artery ectasia (CAE) are clearly unknown, endothelial dysfunction may be responsible for the coronary ectasia. Asymmetric dimethylarginine (ADMA) is the principal endogenous inhibitor of nitric oxide synthase and elevated levels of ADMA is considered to be a marker of endothelial dysfunction and increased risk of cardiovascular disease. Accordingly, we investigated serum ADMA levels in patients with CAE in comparison with participants having normal coronary artery. Method: This study consisted of 41 consecutive patients with angiographically proven normal coronary arteries with CAE and 48 controls with normal coronary arteries without coronary artery ectasia undergoing cardiac catheterization. Serum levels of ADMA were measured by Enzyme Linked Immunosorbent Assay. Result: Serum level of ADMA was significantly higher in CAE patients compared with controls (1.9±0.9 ?mol/l vs. 1.1±0.7 ?mol/l, respectively, p= 0.01). Serum ADMA levels was an independent predictor for CAE (OR= 1.486 [95% confidence interval (CI): 0.978-2.054; p= 0.03]). ADMA levels correlated with diffuse ectasia (p= 0.04). Conclusion: Our findings provide evidence to support the hypothesis that endothelial dysfunction may be an important factor in the pathogenesis of CAE.Öğe Outcome of Primary Percutaneous Intervention in Patients With Infarct-Related Coronary Artery Ectasia(Sage Publications Inc, 2010) Erden, İsmail; Erden, Emine Çakcak; Özhan, Hakan; Karabulut, Ahmet; Ordu, Serkan; Yazıcı, MehmetData related to the incidence and clinical outcome of acute myocardial infarction (AMI) in patients with preexisting coronary artery ectasia (CAE) are limited. We assessed whether infarct-related artery ectasia (EIRA) indicates an untoward clinical outcome in patients with AMI undergoing primary percutaneous coronary intervention (pPCI). Consecutive patients (n = 643) who presented with AMI and were treated with pPCI were analyzed retrospectively; 3 I patients (4.8%) had EIRA. Patients who had EIRA were significantly younger and had higher incidence of hypertension, previous stroke, smoking, inferior wall AMI, and Killip score >1. Infarct-related artery ectasia was more frequent in the right coronary artery (RCA). Impaired epicardial arterial flow, thrombus burden score of infarct-related artery (IRA), impaired Thrombolysis in Myocardial Infarction (TIMI) Myocardial Perfusion Grade, and distal embolization were significantly higher whereas ST-segment resolution and collateral vascular development were significantly lower in patients with EIRA. Infarct-related artery ectasia was an independent predictor of adverse outcome (odds ratio: 0.197; 95% confidence interval [CI]: 0.062-0.633; P = .006).Öğe Poor-quality sleep score is an independent predictor of nondipping hypertension(Lippincott Williams & Wilkins, 2010) Erden, İsmail; Erden, Emine Çakcak; Özhan, Hakan; Başar, Cengiz; Aydın, Mesut; Dumlu, Talha; Alemdar, RecaiObjective We aimed to investigate whether there was any association between the nondipping status and sleep quality in relatively young patients with an initial diagnosis of hypertension. Methods One hundred and thirty-three consecutive patients, diagnosed to have stage 1 hypertension by their primary physicians, were referred to our study. Patients with a history of use of any antihypertensive medication were excluded. Eligible patients underwent the Pittsburgh Sleep Quality Index (PSQI) survey, which has an established role in evaluating sleep disturbances. All patients underwent ambulatory blood pressure monitoring. Results There were 71 nondipper patients (mean age 44.3 +/- 5.3 years, 33 male/38 female) and 62 dipper hypertensive patients (mean age 43.3 +/- 6.3 years, 27 male/35 female). The PSQI scores, globally, were significantly higher in the nondippers compared with the dippers. It was noticed that all the components of the PSQI (sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleep medication, and daytime dysfunction) were significantly higher in the nondippers. Correlation analysis showed that systolic blood pressure fall at night was inversely and significantly related with the PSQI (r = -0.46, P < 0.001). Logistic regression analysis showed that the PSQI score is an independent determinant for nondipping hypertension (HT) {odds ratio = 0.842 [95% confidence interval (CI) = 0.748-0.947; P = 0.004]}. Conclusion We showed that poor sleep quality was related with a nondipping pattern, and furthermore, it was an independent predictor of nondipping in newly diagnosed stage 1 hypertensive patients Blood Press Monit 15:184-187 (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.Öğe The relationship between the level of serum uric acid and no-reflow phenomenon after primary percutaneous coronary intervention in patients with St segment elevated myocardial infarction(2010) Erden, İsmail; Erden, Emine Çakcak; Sözen, Serhat Bahadır; Kayapınar, Osman; Çağlar, Sabri Onur; Başar, CengizNo-reflow phenomenon is the absence of myocardial perfusion despite adequate dilatation of the infarct related coronary artery during percutaneous coronary intervention. Uric acid (UA) release during ischemia and washout from the ischemic zone during reperfusion is adenine nucleotide breakdown product. Therefore uric acid may play reperfusion injury and no-reflow. İn this study, we aimed to compare serum uric acid value of ST segment elevated Mİ patients groups whith no-reflow phenomenon and normal miyocardial perfusion after primary coronary intervention. 47 patients was enrolled consecutively to this study. During hospital admission, patients blood samples were taken for serum uric acid value. Patients was grouped as no reflow and normal perfusion groups according to myocardial blush grades (MBG). Patient with myocardial blush grades 0-1 were accepted as no-reflow group, patients with MBG 2-3 normal perfusion group. When the serum uric acid value of no-reflow and normal perfusion groups was compared, there was statistificaly significant difference (respectively 6,680±1,11 mg/dl versus 5,066±0,68 mg/dl. p<0,05). A significant correlation was found between the serum uric acid level and the presence of no-reflow phenomenon (r=0.598; p<0.025). Multivariate logistic regression analysis showed an independent relationship between no-reflow phenomenon and serum uric acid level (OR 1.815; 95% CI 1.098-1.493; p<0.031). In ST segment elevated Mİ patients with higher serum uric acid value before primary coronary intervention, no-reflow phenomenon is developed more frequently. Uric acid may play important role in mechanism of no-reflow phenomenon. © 2010 Düzce Medical Journal.Öğe St elevasyonlu miyokard infarktüslü hastalarda primer perkütan girişim sonrası no-reflow fenomeni gelişimi ile serum ürik asit düzeyleri arasındaki ilişki(2010) Erden, İsmail; Erden, Emine Çakcak; Sözen, Serhat Bahadır; Kayapınar, Osman; Çağlar, Sabri Onur; Başar, CengizPerkütan koroner girişimlerde, sorumlu arterin açılmasına rağmen, miyokardial perfüzyonun sağlanamaması “no-reflow” fenomeni olarak tanımlanır. Adenin nükleotit metabolitlerinden biri olan ürik asidin hem iskemi sırasında, hem de reperfüzyon sırasında iskemik dokulardan salındığı gösterilmiş ve iskemik hasar ile reperfüzyon hasarında rol oynayabileceği düşünülmüştür. Biz çalışmamızda ST elevasyonlu akut miyokard infarktüsü tanısı alıp, primer perkütan girişim uygulanan hastalarımızda, işlem sonrası anjiyografik olarak no-reflow fenomeni gelişen ve gelişmeyen gruplarda ürik asit değerlerini karşılaştırdık. Çalışmaya 47 hasta alındı. Olguların hastaneye gelişinde kan örnekleri alınarak ürik asit sayımı yapıldı. Hastalar primer perkütan girişim sonrası Miyokardial Blush Grade (MBG) derecelerine göre iki gruba ayrıldı. Buna göre MBG 0 ve 1 olan olgular no-reflow fenomeni var, MBG 2 ve 3 olan olgular no-reflow fenomeni yok, olarak kabul edildi. İki grup mutlak ürik asit değerleri açısından karşılaştırıldı ve no-reflow fenomeni gözlenen hastaların ürik asit değerleri ortalaması 6,6801,11 mg/dl iken, no-reflow gözlenmeyen grupta 5,0660,68 mg/dl idi. İki değer arasındaki fark istatistiksel olarak anlamlı kabul edildi. (p0,013). Ayrıca, no-reflow fenomeni gelişimi ile serum ürik asit düzeyi arasında anlamlı pozitif ilişki bulundu (r0.598; p0.025). Çok değişkenli lojistik regresyon analizinde, no-reflow fenomeni ile serum ürik asid düzeyi arasında bağımsız ilişki belirlendi (odds oranı 1.815; %95 güven aralığı 1.098- 1.493; p0.031). Akut miyokard infarktüslü hastalarda daha yüksek ürik asit değerlerine sahip olmanın, daha sık no-reflow fenomeni gelişimine neden olduğu sonucuna vardıkÖğe Thrombus formation on angioplasty equipment during primary Percutaneous coronary intervention for acute st elevation myocardial infarction despite intravenous Enoxaparin use: Case report(2013) Erden, İsmail; Erden, Emine Çakcak; Albayrak, Enver Sinan; Türker, YasinABS TRACT Unfractionated heparin (UFH) has been traditionally used as the choice of antithrombin treatment during percutaneous coronary intervention. Increasing evidence suggests that treatment with the low molecular weight heparin enoxaparin during percutaneous coronary intervention (PCI) is safe and effective. Insufficient anticoagulation increases the risk of catheter thrombus formation during PCI. We report here a case with acute ST elevation myocardial infarction that periprocedural macroscopic thrombus formation on PCI equipment following antithrombin therapy with 0.75 mg/kg intravenously enoxaparin. All PCI equipments were removed and a bolus of intravenous UFH 100 U/kg was administered. New PCI equipments were inserted and the procedure was completed with stent implantation. Low molecular- weight heparin enoxaparin in the absence of a glycoprotein IIb/IIIa receptor blocker may be insufficient during percutaneous coronary intervention. Copyright © 2013 by Türkiye Klinik leri.
