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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 Differentiating the infarct-related artery on initial electrocardiogram in single or multi-vessel disease in acute inferior myocardial infarction and evaluating involvement of vessels using correspondence analysis(Westminster Publ Inc, 2005) Kürüm, T; Birsin, A; Özbay, G; Türe, MInitial electrocardiography changes were compared prospectively with the findings of coronary angiography to predict the infarct-related artery (IRA) in cases of single- and multi-vessel disease and to demonstrate the relationship between other coexisting coronary involvements and IRA in patients who presented with acute inferior myocardial infarction (AMI). ST elevations or depressions of at least 1 mm (0.1 mV) were evaluated in the leads 1, aVL, and V-1-V-6. Of the 160 patients hospitalized due to inferior AMI, 153 (96%) underwent coronary angiography using standard methods. The angiograms were screened for stenotic lesions using quantitative coronary angiography to confirm significance, which was considered > 50% vessel lumen diameter reduction. Among single-vessel involvements, the IRA was either the circumflex artery (Cx) or right coronary artery (RCA). In conditions in which IRA was detected as either Cx or RCA, 1-, 2-, and 3-vessel involvements were also detected. Correspondence analysis was performed to show the vessel involvements accompanying IRA. Compared with patients with IRA as RCA, the presence of ST depressions in the leads V-1 or V-2 and aVL were more frequently seen in patients with IRA as Cx (p = 0.000, p = 0.015, respectively). Among all vessel involvements in which IRA was either Cx or RCA, a ST-segment depression in leads V-1 or V-2 (P = 0-000) and aVL (p = 0.000) and a ST-segment elevation in lead 1 (p = 0.005) were considered to be significant for Cx, and a ST-segment depression in lead I for RCA involvement (p=0.010). According to correspondence analysis, the most frequent single-vessel involvement seen in inferior AM] was RCA; when IRA was RCA, a multi-vessel involvement included RCA and Cx; and when IRA was Cx, a single-vessel involvement included the left anterior descending (LAD) artery most frequently, and RCA+LAD less frequently (p = 0.000). In inferior AMI, RCA was the most common IRA; however, the possibility of multi-vessel disease is increased when Cx is found to be the IRA. In patients presenting with inferior AM], the presence of ST-depression in the leads aVL and V1-2 is a sensitive finding that indicates Cx stenosis rather than RCA stenosis and is not affected by coexisting other coronary artery involvements.Öğe Effect of obesity on coronary collateral vessel development in patients with coronary artery disease(Sage Publications Inc, 2005) Tath, E; Yildiz, M; Gül, E; Birsin, A; Karahasanoglu, E; Özçelik, F; Özbay, GThe purpose of this study was to compare coronary collateral circulation and with other risk factors in patients with coronary artery disease and different body mass index. Between January 1999 and December 2001, of 867 patients who underwent angiography for the first time, 90 patients (24 women and 66 men), with occlusion in only I coronary artery participated in the study. Information regarding age, body mass index, sex, smoking, hypertension, diabetes mellitus, hyperlipidemia, preinfarction angina, and use of oral beta blockers and nitrates were recorded for all patients. The patients were separated into 2 groups in accordance with development of their coronary collateral circulation; those with insufficient (Rentrop 0, 1, and 2) and those with sufficient coronary collateral circulation. They were also divided into 3 groups on the basis of body mass index as follows: (1) 18.0-24.9 kg/m(2), (11) 25.0-29.9 kg/m(2), and (111) more than 30 kg/ml. In the obesity and overweight groups, hyperlipidemia, diabetes mellitus, and nitrate use were identified more frequently than in the other groups (p < 0.05). Use of oral nitrates more than 6 months before the myocardial infarction and existence of preinfarction angina affected collateral coronary vessel development in the positive direction (p=0.01, p = 0.03, respectively). There was no correlation between coronary artery disease and coronary collateral vessel development in the obese patients (p = 0.6). Although it has been shown that coronary collateral vessel development was affected negatively in obese patients with coronary artery disease, no statistical significance was identified.Öğe Normalization of negative T waves in the chronic stage of Q wave anterior myocardial infarction as a predictor of myocardial viability(Karger, 2005) Altun, A; Durmus-Altun, G; Birsin, A; Gultekin, A; Tatli, E; Ozbay, GWe investigated whether spontaneous normalization of negative T waves ( TWN) on infarct-related ECG leads ( IRLs) in the chronic phase of Q wave anterior myocardial infarction ( MI) could be a predictor of residual viability in infarct areas. We prospectively studied 35 patients ( age 60 +/- 8.6 years) in the chronic phase of Q wave anterior MI. Spontaneous TWN ( group A, n = 23) were defined as negative T waves that became upright ( greater than or equal to0.15 mV) in 62 IRLs. The presence of negative T waves ( group B, n = 12) was defined as symmetric or biphasic negative T wave of greater than or equal to0.15 mV. All patients underwent same-day rest Tl-201-stress Tc-99m sestamibi dual-isotope myocardial perfusion SPECT and 24-hour Tl-201 reinjection imaging for ischemia and viability analysis. On scintigraphic examination, ischemic or viable myocardial segments were found in 18 patients ( 78%) with TWN and 4 patients ( 33%) of group B ( p = 0.013). The use of TWN as a parameter had a marked influence on the sensitivity ( 82%), specificity ( 62%), positive ( 78%) and negative ( 67%) predictive values and accuracy ( 74%) of the diagnosis of viable smyocardium. If we add the criterion of positive T waves in aVR with negative T waves to our criteria, we found that sensitivity ( 90%), positive ( 80%) and negative ( 80%) predictive values and accuracy ( 80%) increased. The results of our study suggest that analysis of TWN on IRLs is an accurate marker of residual viability and/or persistent peri-infarct ischemia in patients in the chronic stage of Q wave anterior MI, and therefore optimizes the diagnostic and therapeutic strategies after MI. Copyright (C) 2005 S. Karger AG, Basel.Öğe Ventricular repolarization changes during thyrotropin releasing hormone test(Elsevier Sci Ireland Ltd, 2001) Altun, A; Ugur, B; Akdemir, O; Altun, GD; Öztekin, E; Birsin, A; Özbay, GWe investigated the ventricular repolarization changes during thyrotropin-releasing hormone (TRH) test in 20 euthyroid healthy subjects. TSH elevation was observed in 14 subjects (age: 29 +/- 5 years). TSH increased at 20 min (baseline: 1.91 +/- 1.18 muU/ml vs. 20 min: 13.7 +/- 7.2 muU/ml, P < 0.0001) and slightly decreased at 40 min (baseline vs. 40 min: 11.6 6.7 muU/ml P < 0.0001). Many dispersions prolonged at 20 and 40 min (P < 0.05). At baseline, 20 and 40 min, positive linear correlations were observed between TSH levels and TTd and TTcd, These data shows: that ventricular repolarization and regional inhomogeneity of ventricular repolarization increase during the TRH test. Neural and receptor-mediated mechanisms on repolarization kinetics of myocardial cells may act on this effect. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.
