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Öğe Comparison of ventricular escape rates after administration of atropine, dopamine, and aminophylline in stable patients with chronic, high-grade atrioventricular block: An open-label, crossover pilot study in Turkish patients(Excerpta Medica Inc, 2002) Altun, A; Akdemir, O; Erdogan, O; Kirdar, C; Birsin, A; Tatli, E; Ozbay, GBackground: Bradyasystolic episodes are frequently observed in patients who present with presyncope, syncope, or sudden cardiac death to emergency departments. Current therapeutic modalities in treating patients with bradyasystolic episodes include pharmacotherapeutic agents (eg, atropine, epinephrine, and dopamine) and cardiac pacing. Objective: The aim of this open-label, crossover, prospective, sequential, pilot study was to compare the effects of 3 agents-atropine, dopamine, and aminophylline-on ventricular escape rate in Turkish patients. Methods: Eligible patients were stable and had chronic, symptomatic, second-degree 2:1 or third-degree atrioventricular (AV) block with a narrow complex escape rhythm. Patients who were receiving a pharmacotherapeutic regimen or who presented with a wide QRS complex escape rhythm, severely disturbed hemodynamic status, an electrolyte disturbance, previous heart surgery, myocarditis, or a reversible underlying cause (eg, acute ischemia) were excluded from the study. Study drugs were given in the same sequential order to all patients, without a washout period, until the ventricular escape rate returned to the initial level. Atropine (1 mg), dopamine (7.5 and 15 mug/kg/min), and aminophylline (240 mg, twice) were sequentially given to each patient. Results: Twelve consecutive patients (5 women, 7 men; mean age, 69 +/- 14 years) were enrolled. Compared with the baseline rate, a significantly improved ventricular escape rate was found after the beta-mimetic dose of dopamine (44 +/- 6 beats/min vs 49 +/- 10 beats/min; P = 0.005). Improvement in ventricular escape rate was also shown after the alpha-mimetic dose of dopamine, but it was not as dramatic as with the beta-mimetic dose (49 +/- 10 beats/min vs 52 +/- 13 beats/min; P = NS). Compared with the baseline rate, the ventricular escape rate was significantly increased after the second dose of aminophylline (45 +/- 10 beats/min vs 50 +/- 8 beats/min; P = 0.04). Conclusions: This study revealed that, in this patient population, significant acceleration of the ventricular escape rate was found after both the betamimetic dose of dopamine and high-dose aminophylline. This study may have been limited by its small sample size and short duration. Additional studies with larger sample sizes and of longer duration are needed to prove that dopamine and high-dose aminophylline can be used as therapy for patients with high-grade AV block and a slow escape rate.Öğe Dobutamine induced dynamic left ventricular outflow tract obstruction in patients with hypertrophic nonobstructive cardiomyopathy(Tohoku Univ Medical Press, 2002) Bolca, O; Özer, N; Eren, M; Dagdeviren, B; Norgaz, T; Akdemir, O; Tezel, TSome patients with hypertrophic nonobstructive cardiomyopathy (HNCM) suffer symptoms resembling those in obstructive type despite no left ventricular outflow tract (LVOT) gradient could be detected on resting echocardiography. To investigate the value of dobutamine stress echocardiography (DSE) in determining the dynamic left ventricular (LV) obstruction of patients with HNCM. The study was conducted on 31 patients who were diagnosed HNCM on resting echocardiography and 9 healthy person as a control group. Intraventricular flow acceleration of > 3 m/sec on DSE was accepted as dynamic LVOT obstruction. Group I and 2 included patients without and with dynamic LVOT obstruction, respectively. The occurrence of chest pain and dyspnea seen during DSE was more frequent in group 2 than group 1 and control group. The frequency of SAM was significantly higher (p < 0.05) and the septal angle was significantly lower (p < 0.001) in Group 2. The presence of SAM significantly correlated with the peak gradient (r = 0.61, p < 0.001). The septal angle had significant negative correlations with the peak gradient (r = .-0.77, p < 0.001) reached at DSE. The relative risk for peak gradient was highest when septal angle was less than or equal to 100degrees, with a sensitivity of 93%, specificity of 80%, positive predictive value of 82%, negative predictive value of 92%, and predictive accuracy of 87%. DSE is a reliable tool for the diagnosis of dynamic LV obstruction in patients with HNCM. The presence of SAM together with a low septal angle is highly predictive for the presence of a dynamic LVOT obstruction detected by DSE. (C) 2002 Tohoku University Medical Press.Öğe Echocardiographic prediction of long-term response to biventricular pacemaker in severe heart failure(Elsevier Science Bv, 2002) Oguz, E; Dagdeviren, B; Bilsel, T; Akdemir, O; Erdinler, I; Akyol, A; Ulufer, TBackground: Biventricular pacing substantially improves LV systolic function and symptom status in some patients with dilated cardiomyopathy. Aims: To assess whether the long-term benefit could be predicted from the echocardiographic parameters. Methods and Results: Sixteen patients with dilated cardiomyopathy who underwent atrio-biventricular pacemaker implantation were analyzed in two groups: the responders (n = 11) were those with a symptomatic improvement of one or more NYHA functional class; the non-responders (n = 5) failed to improve at follow-up (7.6 +/- 5 months). Echocardiography was performed at baseline, the day after the implantation and then every 3 months. Besides the conventional parameters, the following variables were included: LV diastolic filling time (DFT); the duration of mitral regurgitation (dMR); and LV dP/dt obtained from the continuous wave mitral regurgitation curve. While the baseline DFT and dP/dt were not significantly different between non-responders and responders (256 +/- 105 vs. 358 +/- 115, P = 0.14 and 564 +/- 199 vs. 468 +/- 117, P = 0.44, respectively), the QRS width (149 +/- 15 vs. 175 +/- 24 ms, P = 0.05) and the dMR (343 +/- 70 vs. 443 +/- 49 ms, P = 0.007) were higher in the responders. The changes of dMR, DFT and QRS width by pacing were not significantly different between groups (P = 0.18, 0.30 and 0.77, respectively). However, the change of LV dP/dt by pacing in the responders was significantly different than for non-responders (from 468 +/- 117 to 676 +/- 216 mmHg/s vs. from 564 +/- 199 to 483 +/- 94, P = 0.002). An acute increase in LV dP/dt over 22% by pacing yielded only two false negatives and no false positives in predicting the long-term responsiveness. Conclusion: Patients with longer QRS and dMR are more likely to benefit from atrio-biventricular stimulation. The acute changes of Doppler derived LV dP/dt may provide valuable information in predicting the long-term response to biventricular pacing. (C) 2002 European Society of Cardiology. All rights reserved.Öğe The effect of glucose-insulin-potassium solution on ventricular late potentials and heart rate variability in acute myocardial infarction(Lippincott Williams & Wilkins, 2001) Ulgen, MS; Alan, S; Akdemir, O; Toprak, NBackground Blunted heart rate variability (HRV) and presence of ventricular late potentials (VLPs) are known to correlate with an increased risk of ventricular tachycardia and sudden cardiac death in acute myocardial infarction (AMI), In the present study, we investigated the effect of glucose-insulin-potassium (GIK) solution on the VLPs and HRV in AMI. Methods Seventy-two consecutive patients with first Q wave AMI were randomized to GIK solution and placebo. HRV analysis and ambulatory electrocardiographic recordings were taken in all patients between 24 and 48 h. Sub-maximal exercise testing and echocardiography were performed and signal-averaged electrocardiography (SAECG) was recorded before discharge. Results Total filtered QRS duration (FORS: 102 +/- 7 versus 108 +/- 11 ms; P < 0.05), low-amplitude signal (LAS: 25 +/- 8 versus 32 +/- 11 ms; P < 0.01) and frequency of VLPs (21 versus 45%; P < 0.05) were found to be significantly lower while root-mean-square voltage of the terminal 40 ms. of QRS (RMS-40: 45 +/- 18 versus 36 +/- 20 V; P < 0.05), and left ventricular ejection fraction (EF: 55 +/- 6 versus 48 +/- 7; P < 0.05) were significantly higher in the GIK group when compared to placebo. During the hospital period, the presence and frequency of post-myocardial infarction angina were significantly lower in the GIK group (15 versus 29%, P < 0.05), whereas an insignificant decrease in frequency of ventricular arrhythmias was observed in these patients. On HRV analysis, there was no significant difference between two groups in either time domain (SID, SDNN, RMS-SD) or frequency domain (HF, LF, LF/HF ratio) parameters. Conclusion GIK solution may be beneficial to VLPs, ischaemic events, and left ventricular systolic performance in the early period of AMI. This therapy has no significant effect on HRV in AM] patients. Coron Artery Dis 12:507-512 (C) 2001 Lippincott Williams &Lippincott Wilkins.Öğe The effects of trimetazidine on heart rate variability and signal-averaged electrocardiography in early period of acute myocardial infarction(Elsevier Ireland Ltd, 2001) Ulgen, MS; Akdemir, O; Toprak, NBackground: Acute myocardial infarction (AMI) is accompanied by electrophysiological changes in cardiovascular system as well as those in autonomic cardiac control. Heart rate variability (HRV) is depressed due to increased sympathetic activity and/or decreased parasympathetic activity following AMI. Moreover, the frequency of ventricular late potentials (VLP) is increased due to the electrophysiological changes. Based on the hypothesis that the treatments increasing HRV and decreasing the frequency of VLP can improve the prognosis of AMI, we investigated the short-term effects of trimetazidine (TMZ) on HRV and VLP in patients with AMI. Methods: The study group consisted of 64 patients (men 49, mean age 55 +/- 12 years, range 26-70) suffering from first Q-wave AMI. Thirty-one of them were treated with conventional therapy (thrombolytic therapy, aspirin, beta-blocker, heparin and intravenous nitroglycerin) plus TMZ 20 mg tid. The remaining 33 patients served as controls. Holter monitorization between 24 and 48 h, echocardiography at average day 6 (range 4-7 days) and SAECG and sub-maximal exercise at average day 7 (range 6-9 days) were performed to all patients. Results: While HRV parameters reflecting parasympathetic activity (SDSD: 43 +/- 16 ms-35 +/- 13 ms, RMSSD: 34 +/- 14 ms-27 +/- 8 ms, HF: 7.8 +/- 5 ms(2) -4.3 +/- 4 ms(2), P < 0.05) were of significantly higher levels in TMZ group, the low frequency component mainly reflecting sympathetic activity (LF: 10 6 ms(2)-10 +/- 5 ms(2), P > 0.05) was similar in both groups. In addition, LF/HF ratio showing sympatho-vagal balance was significantly decreased in TMZ group (1.5-3.0, P = 0.005). About VLP, the mean FQRS (105 +/- 8 ms-107 +/- 10 ms), LAS (28 +/- 10 ms-30 +/- 11 ms:) and RMS-40 (34 +/- 15 muV-41 +/- 12 muV) were not different in both two groups (P > 0.05). Conclusion: Our results suggest that TMZ treatment causes changes in sympatho-vagal balance in favor of vagal activity by increasing parasympathetic activity in AMI at early period; however, no effect on VLP was observed. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.Öğe Hypercoagulopathy in stroke patients with nonvalvular atrial fibrillation(Westminster Publ Inc, 2006) Turgut, N; Akdemir, O; Turgut, B; Demir, M; Ekuklu, G; Vural, Ö; Özbay, GThe coagulation system is activated and coagulation activation markers are elevated in acute ischemic stroke with nonvalvular atrial fibrillation (NVAF). The etiology, severity, and prognosis of the ischemic stroke might be estimated with the level of the activation of the coagulation system. In this study, prothrombin F1+2 (F1+2), D-dimer, and fibrinogen levels were measured in patients with acute ischemic stroke with and without NVAF, and stroke severity was compared with these hemostatic parameters. Of 55 patients, 29 had sinus rhythm (group I), 26 had NVAF (group II); 20 healthy subjects (group III) were included in the study. Subtypes of cerebral infarction were classified. The patients underwent stroke severity, electrocardiography, echocardiography, cranial computed tomography, cervical duplex ultrasonography, and hemostatic parameter studies. In group II, F1+2 level (2.83 +/- 0.89) was significantly higher than in group I (2.33 +/- 0.80) and III (1.94 +/- 0.64) (p values: group I-II, 0.036; groups II-III, 0.001; groups I-III, 0.104). In group III, fibrinogen level (251.64 +/- 60.96) was significantly lower than that in groups I (347.97 +/- 111.49) and II (364.04 +/- 86.20) (p = 0.001). D-dimer was not significantly different between groups. In group I, lacunar syndrome (LACS), and in group II, partial and total anterior circulation syndrome (PACS + TAGS) were more common (p = 0.013, p = 0.001, respectively). In group II, Scandinavian Stroke Scale scores were lower than those in group I (group I = 45.2 +/- 14, group II = 35.4 +/- 18.9, p = 0.02). In conclusion, activation of coagulation, demonstrated by increment F1+2, is more abundant in the stroke patients with NVAF than in the stroke patients with sinus rhythm. Our results also showed that activation of the hemostatic system might be related to stroke subtype and stroke severity. It is suggested that the oral anticoagulation treatment as prophylaxis is important in the prevention of stroke in patients with NVAFÖğe Incidental detection of a quadricuspid aortic valve by transesophageal echocardiography in a patient with ruptured mitral valve chorda(I C R Publishers, 2002) Akdemir, O; Sürücü, H; Özbay, GQuadricuspid aortic valve is a rare congenital cardiac abnormality which is frequently detected at necropsy or surgery. Here, a young, asymptomatic patient with mild aortic. and mitral regurgitations is described in whom a quadricuspid aortic valve was detected incidentally on transesophageal echocardiography performed initially to diagnose ruptured mitral chordae tendineae.Öğe An interesting diagnostic dilemma: Double right coronary artery or high take off of a large right ventricular branch(Elsevier Sci Ireland Ltd, 2002) Altun, A; Akdemir, O; Erdogan, O; Ozbay, GWe would like to present and discuss the dilemma of an unusual right coronary artery anomaly in two cases. Double right coronary artery or a high take off of a large right ventricular branch are two diagnostic possibilities that may provide difficulty in differentiating such an unusual orientation of coronary arteries based on angiographic views. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.Öğe Left atrial maximum volume is a recurrence predictor in lone-atrial fibrillation - An acoustic quantification study(Japan Heart Journal, Second Dept Of Internal Med, 2002) Bolca, O; Akdemir, O; Eren, M; Dagdeviren, B; Yildirim, A; Tezel, TPredictors of recurrence in lone atrial fibrillation have not been clearly identified. Acoustic quantification (AQ) is a promising method in the assessment of left atrial (LA) volumes. The purpose of the present study was to investigate the potential of LA volumes obtained by standard manual tracing and AQ methods in predicting AF-recurrence after restoring the sinus rhythm in patients with lone AF, and to test the agreement between the two approaches. Standard echocardiography combined with AQ was performed in 28 patients with lone AF one hour after the sinus rhythm was regained, and in 10 controls. LA volumes were determined by conventional manual tracing and AQ methods. AQ waveforms of LA were obtained by drawing a region of interest around the LA border. The agreement of the two methods was tested by Bland-Altman analysis. Patients were followed up for 6 months for the occurrence of AF recurrence. A good correlation was observed between AQ and manual tracing methods in determining both minimal (r = 0.59) and maximal (r = 0.88) LA volumes. Patients with AF recurrence had a significantly larger maximum LA volume as assessed with both methods (P < 0.05 for both). M-mode derived LA dimension and isovolumic relaxation time were additional predictors of recurrence in patients with lone AF. In lone AF, patients prone to recurrence could be predicted by determining LA maximum volume assessed either by AQ or manual tracing methods. AQ provides on-line, accurate estimation of LA volumes.Öğe Left ventricular pacemaker lead insertion through the foramen ovale - A case report(Westminster Publ Inc, 2002) Altun, A; Akdemir, O; Erdogan, O; Aslan, O; Ozbay, GThis report describes a patient with a 6-year-old pacemaker lead in the left ventricle, Both transthoracic and transesophageal echocardiography unequivocally showed that the lead enters the left ventricle via the foramen ovale and the mitral valve. The patient did not suffer from a thromboembolic event; therefore, we did not proceed with extraction. The importance of this case report is to emphasize the conditions and precautions of proper pacemaker implantation.Öğe Mitral valve vegetation and cerebral emboli in a primary antiphospholipid syndrome patient who had hepatitis C virus infection(Springer-Verlag, 2003) Pamuk, ÖN; Çakir, N; Soy, M; Aktoz, M; Çelik, Y; Akdemir, OWe report the case of 36-year-old woman who came to us with a history of recurrent miscarriages and who was later diagnosed as having primary antiphospholipid syndrome (PAPS) and chronic hepatitis C virus (HCV) infection. The patient was referred to us with generalised seizures; cranial MRI revealed multiple embolic infarcts in both frontal lobes and a focal cortical infarct in the left frontoparietal lobe. Her echocardiography showed mitral valve vegetation and insufficiency. The patient was put on oral anticoagulant therapy and during her 8-month follow-up period no thrombotic events occurred. We report this case because it was the first in which PAPS, valvular disease, a cerebral embolic event and HCV infection were coexistent in the same patient. We also review other cases in which there was valvular vegetation and a cerebral ischaemic event associated with PAPS.Öğe Myocardial texture analysis in idiopathic dilated cardiomyopathy(Mosby, Inc, 2002) Dagdeviren, B; Akdemir, O; Bolca, O; Eren, M; Gürlertop, Y; Tezel, TConventional resting echocardiography is not able to predict contractile reserve (CR) of patients with idiopathic dilated cardiomyopathy. The aim of this study was to investigate whether the videodensito-metric myocardial texture analysis could predict the CR of these patients. Myocardial texture analysis was performed on echocardiographic digitized images of 27 patients with IDC through a calibrated 256 gray level digitization system. Cyclic variation (CV) index of myocardial mean gray level (MGL) was calculated according to the formula: (MGL(diast) - MGL(syst))/ MGL(diast) x 100. CR was defined as the %-change of ejection fraction by 10 mug/kg per minute dobutamine infusion. A clinical follow-up was also performed for all patients for an average of 8 3 months. CR ranged from. -1.8% to 50.3%. CV index of both septum and posterior wall (PW) was the single parameter significantly correlated to CR (r = 0.69 and r = 0.77, respectively, P <.0001 for both). The mean resting CV index of septum and PW were significantly lower in patients with CR less than 17%--median value of all subjects-(5.7 +/- 5.6 vs 16.9 +/- 7.9 and 5.4 +/- 5.9 vs 16.1 +/- 6.4, respectively, P <.0001 for both). A CV index of 10% for both septum and PW yielded a sensitivity of 77% and 84%, and a specificity of 84% and 84% for predicting diminished CR, respectively. The event-free survival rate was significantly lower in patients with CR less than 17% (61.5% vs 92.8%, P <.05). The CV index of both septum and PW were also significantly lower in patients with cardiac events (13.6 +/- 8 vs 4.3 +/- 6, P <.05 and 14.7 +/- 7 vs 4.1 +/- 7, P <.01, respectively). Ultrasonic myocardial texture analysis in idiopathic dilated cardiomyopathy has a high ability to discriminate the patients with and without preserved CR, and patients with unfavorable outcome as well.Öğe Prediction of infarct-related coronary artery of patients with acute inferior myocardial infarction by a predischarge exercise test index(Westminster Publ Inc, 2004) Bolca, O; Eren, M; Akdemir, O; Yildirim, A; Dagdeviren, B; Tezel, TThe predictive accuracy of electrocardiographic markers in identifying the infarct-related artery of myocardial infarctions has been a subject of extensive investigation. The present study was designed to test whether the index L II/L III ratio adapted to exercise electrocardiograms could be utilized as a marker to distinguish right coronary and left circumflex arteries as culprit coronaries in acute inferior myocardial infarctions. For this purpose, 82 patients with a positive-symptom-limited and/or submaximal treadmill exercise test with modified Bruce protocol after an acute inferior myocardial infarction were studied. Those patients with ST segment elevation during the stress test were included in the study. ST segment index was defined as the ratio of exercise-induced ST elevation amplitude in L II/L III. Patients were classified as having an index > 1 (n = 24) and < 1 (n = 58), and the findings were compared with the findings on coronary angiography. The groups were comparable with respect to age, gender, peak exercise level, and double products achieved. Circumflex artery was the infarct-related one in the majority (21/24; 88%) of patients with an index > 1, whereas most (51/58; 88%) patients with an index < 1 had the culprit lesion in their right coronary artery (p < 0.001). The ratio of exercise-induced ST elevations in leads L II and L III has a significantly high ability to discriminate the infarct-related coronary artery in patients with uncomplicated inferior myocardial infarction. Considering the prognostic importance of the type of coronary involvement, this index could be a part of predischarge evaluation in this patient group.Öğe Prognostic implication of myocardial texture analysis in idiopathic dilated cardiomyopathy(Elsevier Science Bv, 2002) Dagdeviren, B; Akdemir, O; Eren, M; Bolca, O; Oguz, E; Gürlertop, Y; Tezel, TBackground and aim: Abnormal myocardial acoustic properties have been reported in patients with idiopathic dilated cardiomyopathy (IDC). The aim of this study was to investigate the relationship between quantitative ultrasonic textural alterations of myocardium and clinical outcome in IDC. Methods: Baseline clinical and echocardiographic variables were obtained from 28 patients with IDC. By using a videodensitometric approach, quantitative myocardial texture analysis was performed on images obtained from septum and posterior wall (PW). Cyclic variation (CV) index of mean gray level (MGL) was calculated according to the formula: (MGLdiast - MGLsyst)/MGLdiast x 100. All patients were followed for an average of 11 5 months for the occurrence of cardiac death or repeated hospitalization due to worsening of heart failure. Results: During follow-up, 10 patients experienced cardiac events (6 cardiac deaths and 4 heart failure events). The CV indexes of both septum and PW were significantly lower in patients with cardiac events than those of event free patients (6.8 +/- 9.6% vs. 13.6 +/- 8.2%, P < 0.05 and 5.3 +/- 6.4% vs.15.7 +/- 7.2% P < 0.001, respectively). Univariate analysis defined the following variables as predictors of outcome: PW-CV index (chi(2) = 13.0, P = 0.0003), transmitral E/A ratio (chi(2) = 12.5, P = 0.0004), symptom status (chi(2) = 8.7, P = 0.003), and septum-CV index (chi(2) = 4.7, P = 0.03). Multivariate stepwise regression analysis showed that the PW-CV index (chi(2) = 7.5, P = 0.006) and E/A ratio (chi(2) = 6.5, P = 0.01) were the independent predictors of outcome. The event-free survival rate of patients with PW-CV index < 11% was significantly lower than those with an index greater than or equal to 11 (35.7% vs. 92.8%, P = 0,001). Conclusion: The assessment of severely depressed CV index provides valuable prognostic information in patients with IDC. (C) 2002 European Society of Cardiology. All rights reserved.Öğe Right ventricular aneurysm complicating right ventricular infarction(Acta Cardiologica, 2001) Akdemir, O; Gül, Ç; Özbay, GRight ventricular (RV) involvement commonly occurs in patients with acute inferior myocardial infarction and is associated with high mortality and morbidity. RV dysfunction and dilatation commonly recover in survivors; chronic RV dyskinesia and failure are rare complications. This case report presents a patient in whom an isolated RV aneurysm complicates a RV involvement of acute inferior-posterior myocardial infarction.Öğe Right ventricular function in patients with acute anterior myocardial infarction(Acta Cardiologica, 2002) Akdemir, O; Yildiz, M; Sürücü, H; Dagdeviren, B; Erdogan, O; Ozbay, GObjective - Our purpose was to investigate the right ventricular (RV) performance of patients with a first acute anterior myocardial infarction (AAMI) by using pulsed wave Doppler tissue (PWDT) samplings of tricuspid annulus and RV free wall. Methods and results - The study group included 31 patients with AAMI and 20 age-matched controls. Conventional indexes of RV functions were the magnitude of tricuspid annular plane systolic excursion (TAPSE), and the transpulmonary and transtricuspid Doppler parameters. PWDT velocities were obtained by placing the sample volume at the lateral tricuspid annulus and the mid-segment of RV free wall; the peak systolic (S), early (E) and late (A) diastolic PWDT velocities and time intervals from ECG-Q wave to their peaks were analysed. Standard indexes were comparable except TAPSE that was significantly lower in AAMI-patients (p < 0.001). S velocities were similar; A of both regions (p = 0.0 18 and 0.0 12) and E of RV free wall (p = 0.0 11) were significantly increased in AAMI-group. Q-Sa intervals in both regions (p = 0.007 and 0.0 IS) and Q-Ea of tricuspid annulus (p = 0.045) were significantly shorter in patients with AAMI. TAPSE and E of RV free wall had significant negative correlations with left ventricular systolic volume index and right atrial filling fraction (AFF), respectively (r -0.46, p = 0.0 1 for both). A of tricuspid annulus had a positive correlation with left AFF (r = 0.42, p 0.02). Conclusion - PWDT imaging of tricuspid annulus and RV free wall is capable to sensitively detect the adaptive mechanisms and unfavourable diastolic properties of RV dynamics in patients with AAMI.Öğe Specific tissue Doppler predictors of preserved systolic and diastolic left ventricular function after an acute anterior myocardial infarction(Japan Heart Journal, Second Dept Of Internal Med, 2003) Akdemir, O; Dagdeviren, B; Yildiz, M; Gül, Ç; Sürücü, H; Özbay, GThe degree of left ventricular (LV) dysfunction determines the outcome of patients suffering an acute anterior myocardial infarction (AAMI). Many recent studies have utilized tissue Doppler echocardiography (TDE) parameters in the assessment of LV function. We sought to investigate whether some variables easily obtained from TDE profiles of mitral annulus corners would predict a relatively preserved LV global function traditionally assessed with ejection fraction (EF) and deceleration time (DT), within the acute phase of AAMI Included were 50 consecutive patients with a first AAMI. Standard echocardiography and TDE of mitral annulus were performed within 36 hours of admission Pulsed wave sample volumes were set at the septal, lateral, anterior, and inferior corners of the mitral annulus. Preserved LV function was defined as an EF > 40% together with a DT greater than or equal to 140 ms and < 220 ms. An inferior annular systolic velocity of > 7.5 cm/s predicts preserved global left ventricular function with a sensitivity of 81% and specificity of 71%. An anterior mitral annular early diastolic velocity of > 8cm/s had a sensitivity of 69% and specificity of 85%. When these two velocities both exceed the limits above, such a combined index yielded a sensitivity of 69%, specificity of 94%, and an overall diagnostic accuracy of 86% for the estimation of preserved LV global function. The parameters derived from TDE profiles of inferior and anterior mitral annulus corners provide valuable information to predict preserved global left ventricular function during the early period of AAMI.Öğe Specific tissue Doppler predictors of preserved systolic and diastolic left ventricular function after an acute anterior myocardial infarction [Meeting Abstract](W B Saunders Co Ltd, 2002) Akdemir, O; Dagdeviren, B; Yildiz, M; Gul, C; Surucu, H; Ozbay, G[Abstract Not Available]Öğe Technetium-99m sestamibi cavity/myocardium count ratio in the detection of left ventricular hypertrophy(Clinical Cardiology Publ Co, 2003) Altun, GD; Akdemir, O; Ustun, F; Altun, A; Sarikaya, A; Berkarda, SBackground and hypothesis: Left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular mortality and morbidity. This study was designed to assess whether technetium-99m (Tc-99m) sestamibi cavity-to-myocardium count (c/m) ratio would differentiate LVH from normal geometry, and discriminate between the two patterns-concentric and eccentric-of LVH. Methods: In all, 72 patients including 32 hypertensive patients with both normal Tc-99m sestamibi single-photon emission computed tomography imaging and good-quality echocardiographic recordings were studied retrospectively. Four different patterns of left ventricular (LV) geometry were defined: normal (n = 47), concentric remodeling (n = 3), eccentric LVH (n = 13), and concentric LVH (n = 9). Results: Left ventricular hypertrophy was detected in 22 of 32 hypertensive patients. The c/m ratio calculated on midventricular short-axis slices of dipyridamole-stress Tc-99m sestamibi images was significantly decreased in patients with LVH compared with subjects with normal geometry (0.05 +/- 0.02 vs. 0.17 +/- 0.08, p = 0.001). A c/m ratio of < 0.124 yielded a sensitivity of 86%, a specificity of 64%, and an overall diagnostic accuracy of 68% for detecting LVH. Negative correlations of c/m ratio were found to LV mass-index (r = -0.44, p = 0.004), septal width (r = -0.42, p = 0.008), posterior wall thickness (r = -0.39, p = 0.001), and relative wall thickness (r = -0.40, p = 0.001). Multiple linear regression analysis revealed that LV mass index was the single independent predictor of c/m ratio. Although both groups with concentric and eccentric LVH had a significantly lower mean c/m ratio than those with normal geometry (p = 0.01 and p = 0.01, respectively), no significant difference of c/m ratio was found between the two patterns of LVH. Conclusion: A new index, c/m ratio on Tc-99m sestamibi images, has a potential to discriminate between LVH and normal geometry in subjects free of myocardial ischemia.Öğe Transient ST segment changes mimicking early repolarisation phenomenon in a patient with angina at rest -: Coronary artery spasm.(Bmj Publishing Group, 2001) Altun, A; Akdemir, O; Tath, E; Özbay, G[Abstract Not Available]
