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    Does carvedilol therapy reduce QT dispersion in patients with heart failure?
    (Termedia Publishing House Ltd, 2008) Tatli, Ersan; Aktoz, Meryern; Gul, Cetin; Buyuklu, Mutlu; Kurum, Turhan
    Introduction: Carvedilol therapy increases left ventricular ejection fraction, and reduces mortality and morbidity rates. However, there are very limited data relating to the effect of carvedilol on QT dispersion (QTd). In this study, we investigated the effect of carvedilol therapy on QTd in patients with heart failure. Material and methods: Fifty-six patients with heart failure and a left ventricular ejection fraction less than 40% were prospectively included in the study. Clinical examination, determinations of plasma levels of tumour necrosis factor-alpha (TNF-alpha), interleukin 2 (IL-2) and IL-6, electrocardiography and radionuclide study were performed at baseline and repeated at the end of the 4(th) month of carvedilol therapy. From standard 12-lead electrocardiograms the maximum and minimum QT intervals, corrected QT intervals and corrected QTd values were calculated at baseline, and after the 4(th) month of carvedilol therapy. Results: At the end of the 4(th) month, IL-6 (from 9.8 +/- 6.4 to 5.4 +/- 0.7 pg/ml) and TNF-a (from 10.9 +/- 4.6 to 6.0 +/- 4.9 pg/ml) levels, QTd, corrected QTd, resting heart rate, and Systolic blood pressure were significantly decreased, and left ventricular ejection fraction and NYHA functional class were improved by carvedilol therapy (QTd from 66 +/- 22 to 28 +/- 13 ms, P<0.001, corrected QTd from 72 +/- 23 to 30 +/- 14 ms, P<0.001). However, maximum corrected QT and maximum QT values did not change significantly, while minimum QT and minimum corrected QT values significantly increased. Conclusions: Carvedilol therapy for 4 months resulted in a significant reduction in QTd.
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    Effects of carvedilol on plasma levels of pro-inflammatory cytokines - in patients with ischemic and nonischemic dilated cardiomyopathy
    (Texas Heart Inst, 2007) Kurum, Turhan; Tatli, Ersan; Yuksel, Mahmut
    We prospectively investigated the effects of adding carvedilol to the standard treatment of ischemic and nonischemic dilated cardiomyopathy (DCM), by measuring the plasma levels of pro-inflammatory cytokines. Sixty patients with DCM (35 ischemic and 25 nonischemic) were divided into 2 subgroups: patients on standard therapy alone (digoxin, angiotensin-converting enzyme inhibitors, and diuretics) and patients on standard therapy plus carvedilol. Study participants' serum levels of tumor necrosis factor-alpha (TNF-alpha), interleukin-2 (IL-2), and interleukin-6 (IL-6) were measured at the beginning and again at the end of the study. Left ventricular ejection fraction and left ventricular diastolic function were evaluated by means of radionuclide ventriculography In ischemic patients on carvedilol, levels of IL-6 and TNF-alpha dropped significantly (P= 0.028 and P=0.034, respectively). In ischemic patients on standard treatment plasma IL-2 levels were elevated after treatment (P=0.047). No significant differences occurred in IL-6 levels, while TNF-alpha levels were elevated (P=0.008). In nonischemic patients on carvedilol, IL-6 and TNF-alpha levels dropped significantly (P=0.018 and P=0.004, respectively). The left ventricular ejection fraction increased significantly (P=0.006). In nonischemic patients on standard treatment, no significant change occurred in any value. Carvedilol suppressed the plasma levels of TNF-alpha and IL-6 in both ischemic and nonischemic patients. The carvedilol effect was more pronounced in patients with nonischemic dilated cardiomyopathy than in those with ischemic disease.
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    Effects of carvedilol on right ventricular ejection fraction and cytokines levels in patients with systolic heart failure
    (Elsevier Ireland Ltd, 2008) Tatli, Ersan; Kurum, Turhan; Aktoz, Meryem; Buyuklu, Mutlu
    Background: Right ventricular (RV) dysfunction frequently complicates advanced left ventricular (LV) heart failure and contributes to an unfavorable prognosis. It is known that carvedilol increases left ventricular ejection fraction (LVEF) significantly, and carvedilol reduces mortality by associating with improvement in LV function. However, the effect of carvedilol on RV function in heart failure has not adequately been studied, so far. The objective is to establish whether the addition of carvedilol has an additive beneficial effect on RVEF and cytokines levels in patients with heart failure who are already receiving treatment with angiotensin-converting enzyme (ACE) inhibitors, digoxin and diuretics. Methods: In this single-centre, prospective, randomized study, 74 patients with heart failure with an LVEF less than 40% and already receiving digoxin, ACE inhibitors and diuretics for 6 months as the standard therapy were randomly assigned to receive either carvedilol (n= 44) or placebo (n= 30). Patients received an initial dosage of 6.25 mg carvedilol or placebo twice daily for 2 weeks, which was then increased at 2-week intervals (if tolerated), first to 12.5 mg and, finally, to a target dosage of 25 mg twice daily. Clinical examinations, radionuclide studies, and determinations of plasma levels of tumour necrosis factor-alpha (TNF-alpha), interleukin (IL)-2 and IL-6 were performed at baseline and repeated 4 months after random assignment. Primary end points were New York Heart Association functional class, RVEF and plasma cytokines levels. Results: Patients treated with carvedilol had a significant improvement in functional class compared with the baseline values (P = 0.001), with a decrease in the levels of cytokines (IL-6 [P=0.02] and TNF-alpha [P= 0.02]). LVEF increased from 21.4 +/- 8.8% to 27.8 +/- 10.8% and RVEF increased from 28.8 +/- 4.2% to 36.3 +/- 2.6% in the carvedilol group (P= 0.003). Conclusions: Carvedilol treatment for 4 months resulted in a significant improvement of RVEF, which paralleled the improvement of LVEF and the decreasing of TNF-alpha and IL-6 levels in patients with systolic HF. Published by Elsevier Ireland Ltd.
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    The effects of nebivolol on fibrinolytic parameters in mild and moderate hypertensive patients
    (Pulsus Group Inc, 2007) Tarighi, Bahman; Kurum, Turhan; Demir, Muzaffer; Azcan, Sen Nur
    BACKGROUND: The aim of the present study was to investigate the effects of nebivolol (5 mg daily) on plasma levels of hemostatic and fibrinolytic endothelial function markers in mild or moderate hypertensive patients. METHODS AND RESULTS: Thirty-five (22 female, 13 male; mean +/- SD 54.7 +/- 11.3 years of age) mild and moderate hypertensive patients were included the study. The mean systolic blood pressure [BP] was 160 mmHg (range 150 mmHg to 165 mmHg) and the mean diastolic BP was 100 mmHg (range 90 mmHg to 100 mmHg). Plasma tissue plasminogen activator antigen (tPA-Ag), plasminogen activator inhibitor type 1 antigen (PAI-1-Ag), PAI-1-activity, tPA-Ag/PAI-1-Ag index, fibrinogen and euglobulin lysis time were determined before and after two months of therapy. tPA-Ag and PAI-Ag levels were measured by ELISA. After this period, treatment with nebivolol (5 mg/day) in all patients was associated with a significant decrease in systolic BP and diastolic BP (P < 0.001 for each), heart rate (P < 0.01), fibrinogen (P < 0.005) and euglobutin lysis time (P < 0.01). The tPA-Ag and tPA-Ag/PAI-1-Ag index levels were increased significantly (P < 0.001 for each) in all patients, but the PAI-1-Ag (P > 0.05) and PAI-1 activity (P > 0.05) did not show significant change. In the present study, there was no correlation between decreases in arterial BP and decreases in fibrinolytic parameters (P > 0.05), but there was a positive, statistically significant correlation between fibrinogen and body mass index (P < 0.001). CONCLUSIONS: The results indicated that, compared with no treatment, a two-month treatment trial with nebivolol was associated with a more favourable modification of hemostatic and fibrinolytic status in addition to antihypertensive effects.
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    Incidence of antiheparin-platelet factor 4 antibodies and heparin-induced thrombocytopenia in Turkish patients undergoing cardiac surgery
    (Sage Publications Inc, 2007) Demir, Muzaffer; Duran, Enver; Yigitbasi, Omer; Vural, Ozden; Kurum, Turhan; Yuksel, Mahmut; Turgut, Burhan
    The frequency of antiheparin-platelet factor 4 antibodies by means of antigenic and functional assays (C-14-serotonin release assay and citrated plasma platelet aggregation) was determined in 115 Turkish patients undergoing cardiac surgery. Blood samples were taken immediately before surgery and on days 5 and 10 +/- 2. Platelet counts were recorded and thrombotic events were determined by clinical methods. Antibody generation measured by enzyme-linked immunosorbent assay before surgery (n = 44) and on days 5 (n = 44) and 10 (n = 115) was 15.9%, 34.1%, and 65.2%, respectively. Positive samples from functional assays were 4.4% on day 0 and 7.0% on day 10. All positive samples had been negative on day 0. A high frequency of antiheparin-platelet factor 4 antibody generation and a low frequency of clinical heparin-induced thrombocytopenia were determined in these patients. These results obtained for Turkish patients are similar to those of other studies of heparin-induced thrombocytopenia.
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    Right coronary artery aneurysm: Possible relation with obesity?
    (Elsevier Ireland Ltd, 2008) Tatli, Ersan; Buyuklu, Mutlu; Onal, Baris; Yel, Mesih; Kurum, Turhan
    Aneurysms of the coronary arteries are uncommon occurrences that usually develop secondary to atherosclerosis and are often asymptomatic. We present a 57-year-old male patient who presented with the diagnosis of an inferior wall acute myocardial infarction with a large aneurysm of the right coronary artery and with morbid obesity. To the best of our knowledge, a relationship between body mass index and coronary artery aneurysm has not been reported in the literature so far. We speculated that there is a relationship between coronary artery aneurysm and body mass index. (C) 2007 Published by Elsevier Ireland Ltd.
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    Spontaneous coronary artery dissection after heavy lifting in a 25-year-old man with coronary risk factors
    (Lippincott Williams & Wilkins, 2006) Kurum, Turhan; Aktoz, Meryem
    Spontaneous coronary artery dissection (SCAD) is a clinical condition rarely leading to acute myocardial infarction (AMI). We report the case of SCAD presenting AMI in a 25-year-old man with coronary risk factors after strenuous exercise, who was successfully treated with systemic thrombolysis. Coronary angiography revealed spiral dissection of the proximal part of the left anterior descending artery. The present case supports the occurrence of SCAD as a cause of AMI in young male patients who have coronary risk factors, after heavy lifting. J Cardiovasc Med 7:68-70 (C) 2006 Italian Federation of Cardiology.