Browsing by Author "Atar, Ilyas"

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Comparison of application of 2013 ACC/AHA guideline and 2011 European Society of Cardiology guideline for the management of dyslipidemias for primary prevention in a Turkish cohort
(2017) Yilmaz, Mustafa; Atar, Ilyas; Hasirci, Senem; Akyol, Kadirhan; Tekin, Abdullah; Karacaglar, Emir; Ciftci, Orcun; Muderrisoglu, Haldun; 0000-0002-9635-6313; 0000-0002-2538-1642; 0000-0001-8926-9142; 0000-0002-8342-679X; 0000-0002-5658-870X; 0000-0002-2557-9579; 27684519; AAG-8233-2020; ABI-6723-2020; W-5233-2018; AAK-7805-2021; ABD-7304-2021; S-6973-2016
OBJECTIVE: Atherosclerotic cardiovascular disease is a major global cause of death. The common approach in primary prevention of cardiovascular disease is to identify patients at high risk for cardiovascular disease. This article analyzes and compares the application of 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline and the 2011 European Society of Cardiology (ESC) guideline for the management of dyslipidemias for primary prevention in Turkish population. METHODS: The study included 833 patients (482 women and 351 men). Risk scores were calculated according to both guidelines and indications for statin treatment were determined according to sex and age group. Variables are presented as mean +/- SD or median with interquartile range for continuous data and as proportions for categorical data. Variables were analyzed by unpaired t-test, Mann-Whitney U test, chi-square or Fischer's exact test as appropriate. RESULTS: The ACC/AHA would suggest statin treatment in 415 patients out of 833 (49.5%), while ESC would recommend statin for 193 patients out of 833 (23.1%)(p<0.001). Statins would be recommended for 40.4% of women and 62.6% of men for primary prevention by the ACC/AHA, while this figure was 12% for women and 38.4% for men according to the ESC guideline (p<0.001 for both). CONCLUSION: When compared to the ESC guideline, the ACC/AHA guideline suggests augmented statin treatment for primary prevention in Turkish population
Coronary Artery Disease Detected by Coronary Computed Tomography Angiography is Associated with Red Cell Distribution Width
(2016) Karacaglar, Emir; Bal, Ugur; Hasirci, Senem; Yilmaz, Mustafa; Doganozu, Ersin; Coskun, Mehmet; Atar, Ilyas; Yildirir, Aylin; Muderrisoglu, Haldun; 0000-0002-2538-1642; 0000-0002-9446-2518; 0000-0002-8342-679X; 0000-0002-2557-9579; 0000-0001-8750-5287; 0000-0002-9635-6313; 27774965; ABI-6723-2020; AAK-4322-2021; AAK-7805-2021; S-6973-2016; A-4947-2018; AAG-8233-2020
Objective: Increased red blood cell distribution width (RDW) is associated with severity of coronary artery disease (CAD). The aim of the present study was to retrospectively evaluate the relationship between CAD detected by coronary computed tomography angiography (CCTA) and RDW. Methods: Records of 291 patients who underwent 16-slice CCTA due to the presence of angina-like chest pain were retrospectively evaluated. Exclusion criteria were applied. Clinical characteristics, risk factors for CAD, and RDW values on CCTA were noted. Results: RDW levels in patients with CAD were significantly higher than in those with normal coronary arteries (NCAs) (15.50 +/- 1.57 compared to 14.80 +/- 1.41, p=0.001). Diabetes mellitus, hypertension, and history of smoking were significantly more common in the CAD group (p=0.018, p=0.007, and p=0.013, respectively). On multivariate logistic regression analysis, RDW (p=0.009 [odds ratio (OR): 1.352; 95% confidence interval (CI): 1.081-1.683]), age (p<0.001 [OR: 1.063; 95% CI 1.031-1.090]), and history of smoking (p=0.003 [OR: 2.672; 95% CI: 1.360-5.232]) were shown to be independent predictors for CAD detected by CCTA. Conclusion: The present results suggest that higher RDW levels are independently associated with presence of CAD detected by CCTA in patients without known CAD. Further studies are warranted to clarify the exact role of RDW in risk stratification.
Determinants of New-Onset Atrial Fibrillation in Patients Receiving CRT Mechanistic Insights From Speckle Tracking Imaging
(2016) Sade, Leyla Elif; Atar, Ilyas; Ozin, Bulent; Yuce, Deniz; Muderrisoglu, Haldun; 26684972
OBJECTIVES The aim of this study was to investigate the factors associated with the development of atrial fibrillation (AF) and to examine the impact of these factors for long-term outcome after cardiac resynchronization therapy (CRT). BACKGROUND The effect of CRT on the development of new AF is under debate. METHODS Clinical assessment, 12-lead electrocardiogram, echocardiography with speckle tracking strain imaging, and device interrogation before implantation and every 6 months thereafter were performed regularly over a 5-year follow-up. The primary endpoint was new-onset AF. Pre-specified outcome events were transplantation, assist device implantation, and death. RESULTS During follow-up, AF occurred in 29 of 106 patients. Parameters of left atrial (LA) mechanics including mitral annular (A') velocity, left atrial volume index (LAVI), LA ejection fraction, active emptying fraction, LA mean systolic strain (Ss) and late diastolic strain (Sa) improved at 6 months only in patients who remained free of AF. The change in LA Ss and Sa from baseline to 6 months after CRT had the highest accuracy to predict new-onset AF (area under the curve [AUC] = 0.793, 0.815, respectively, p < 0.0001 for both vs. left ventricular [LV] reverse remodeling AUC = 0.531; p < 0.01 for both). In addition, the change in LA Ss and Sa predicted outcome events independently from new-onset AF and LV volume response. CONCLUSIONS LA functional improvement is essential for AF-free survival after CRT and is an independent predictor of AF-free survival. The improvement in LA Ss and Sa as a means of LA mechanical reserve also predicts long-term event-free survival after CRT independently from LV volume response and new-onset AF. (C) 2016 by the American College of Cardiology Foundation.
The effect of raloxifene on left ventricular hypertrophy in postmenopausal women: A prospective, randomized, and controlled study
(2015) Bal, Ugur Abbas; Atar, Ilyas; Oktem, Mesut; Zeyneloglu, Hulusi Bulent; Yildirir, Aylin; Kuscu, Esra; Muderrisoglu, Haldun; 25430415
Objective: In healthy women, there is a progressive age-related increase in myocardial mass that is not seen in their male counterparts and occurs primarily in postmenopausal women. Raloxifene is a selective estrogen receptor modulator that has estrogenic actions on bone and the cardiovascular system. The aim of this study was to investigate the effect of raloxifene on myocardial hypertrophy in postmenopausal patients. Methods: A total of 22 postmenopausal osteoporotic women were included in this open-label, randomized, prospective, controlled study. Patients were randomized into two groups: 11 of the patients (group 1) were treated with raloxifene 60 mg/day, and the other 11 patients (group 2) were defined as the control group. Quantitative 2-dimensional and M-mode echocardiographic examination was performed in all patients at the beginning and repeated at the end of the 6-month follow-up period. Left ventricle mass (LVM) and left ventricle mass index (LVMI) were calculated for all patients. Results: The mean age of the patients was 57.2 +/- 3.9 years, and baseline clinical characteristics and echocardiographic parameters were similar between the two groups. After 6 months of raloxifene treatment, there was no difference in echocardiographic parameters of LVM and LVMI compared with the control group (201.2 +/- 25.9 gr vs. 169.7 +/- 46.2 gr, p=0.14 and 120.4 +/- 25.9 gr/m(2) vs. 105.5 +/- 26.3 gr/m(2), p=0.195, respectively). There was also no significant difference in LVM and LVMI in the within-group analysis of both groups. Conclusion: Raloxifene therapy does not affect myocardial hypertrophy in postmenopausal women after 6 months of treatment.
The effects of a low international normalized ratio on thromboembolic and bleeding complications in patients with mechanical mitral valve replacement
(2014) Bal, Ugur; Aydinalp, Alp; Yilmaz, Kerem; Ozcalik, Emre; Hasirci, Senem; Atar, Ilyas; Gultekin, Bahadir; Sezgin, Atilla; Muderrisoglu, Haldun
Background: Mechanical heart valve replacement has an inherent risk of thromboembolic events (TEs). Current guidelines recommend an international normalized ratio (INR) of at least 2.5 after mechanical mitral valve replacement (MVR). This study aimed to evaluate the effects of a low INR (2.0-2.5) on thromboembolic and bleeding complications in patients with mechanical MVR on warfarin therapy. Methods: One hundred and thirty-five patients who underwent mechanical MVR were enrolled in this study. The end points of this study were defined as TEs (valve thrombosis, transient ischemic attack, stroke) and bleeding (all minor and major bleeding) complications. Patients were followed up for a mean of 39.6 months and the mean INR of the patients was calculated. After data collection, patients were divided into 3 groups according to their mean INR, as follows: group 1 (n = 34), INR < 2.0; group 2 (n = 49), INR 2.0-2.5; and group 3 (n = 52), INR > 2.5. Results: A total of 22 events (10 [7.4%] thromboembolic and 12 [8.8%] bleeding events) occurred in the follow-up period. The mean INR was an independent risk factor for the development of TEs. Mean INR and neurological dysfunction were independent risk factors for the development of bleeding events. A statistically significant positive correlation was found between the log mean INR and all bleeding events, and a negative correlation was found between the log mean INR and all TEs. The total number of events was significantly lower in group 2 than in groups 1 and 3 (P = 0.036). Conclusions: This study showed that a target INRs of 2.0-2.5 are acceptable for preventing TEs and safe in terms of bleeding complications in patients with mechanical MVR.
Effects of Carvedilol Compared to Nebivolol on Insulin Resistance and Lipid Profile in Patients With Essential Hypertension
(2017) Ozyildiz, Ali Gokhan; Eroglu, Serpil; Bal, Ugur; Atar, Ilyas; Okyay, Kaan; Muderrisoglu, Haldun; 0000-0001-6134-8826; 0000-0002-9635-6313; 0000-0002-9446-2518; 0000-0003-0679-9434; 0000-0003-3055-7953; 27093951; AAK-7355-2020; AAG-8233-2020; AAK-4322-2021; ABG-1582-2021; D-2856-2015
Background and aim: Beta-blockers have unfavorable effects on metabolic parameters in hypertensive treatment. New generation beta-blockers with vasodilatory capabilities are superior to traditional beta-blockers, but studies examining their effects on metabolic parameters are still lacking. This study aimed to compare the effects of 2 new generation beta-blockers, carvedilol and nebivolol, on insulin resistance (IR) and lipid profiles in patients with essential hypertension. Methods: This was a prospective, randomized, open-label, single-center clinical trial. A total of 80 patients were randomized into 2 groups: the carvedilol group (n = 40, 25 mg of carvedilol daily) and the nebivolol group (n = 40, 5 mg of nebivolol daily). Follow-up was performed for 4 months. Fasting plasma glucose, insulin levels, and the lipid profile (high-density lipoprotein [HDL], low-density lipoprotein [LDL], total cholesterol, triglyceride, apolipoprotein AI, and apolipoprotein B levels) were measured and IR was calculated by the homeostasis model assessment (HOMA) index. These variables were compared before and 4 months after treatment. Results: Blood pressure and heart rate were significantly and similarly reduced in the carvedilol and nebivolol groups after treatment compared to those before treatment (both P < .001). Serum glucose (P < .001), insulin (P < .01), HOMA-IR (P < .01), HDL (P < .001), LDL (P < .001), total cholesterol (P < .001), and apolipoprotein B (P < .05) levels decreased in a similar manner in the carvedilol and nebivolol groups after treatment compared to those before treatment. Serum triglyceride and apolipoprotein AI levels did not change after treatment with both drugs. Conclusion: New generation beta-blockers, carvedilol and nebivolol, efficiently and similarly decrease blood pressure. They have similar favorable effects on glucose, insulin, IR, and the lipid profile.
The Effects of Niacin on Inflammation in Patients with Non-ST Elevated Acute Coronary Syndrome
(2015) Karacaglar, Emir; Atar, Ilyas; Altin, Cihan; Yetis, Begum; Cakmak, Abdulkadir; Bayraktar, Nilufer; Coner, Ali; Ozin, Bulent; Muderrisoglu, Haldun; 0000-0002-2538-1642; 0000-0002-5711-8873; 0000-0003-3821-412X; 0000-0002-7886-3688; 0000-0002-9635-6313; 27122858; ABI-6723-2020; ABD-7321-2021; AAD-9938-2021; Y-8758-2018; AAG-8233-2020
Background: In this study, we aimed to evaluate the effects of niacin on high sensitivity C reactive protein (hs-CRP) and cholesterol levels in non-ST elevated acute coronary syndrome (NSTE-ACS) patients. Methods: In this prospective, open label study, 48 NSTE-ACS were randomized to niacin or control group. Patients continued their optimal medical therapy in the control group. In the niacin group patients were assigned to receive extended-release niacin 500 mg/day. Patients were contacted 1 month later to assess compliance and side effects. Blood samples for hs-CRP were obtained upon admittance to the coronary care unit, in the third day and in the first month of the treatment. Fasting blood samples for cholesterol levels were obtained before and 30 days after the treatment. The primary end point of the study was to evaluate changes in hs-CRP, cholesterol levels, short-term cardiovascular events, and the safety of niacin in NSTE-ACS. Results: Baseline demographic, clinical and laboratory characteristics were similar between the two groups. Logarithmic transformation of baseline and 3rd day hs-CRP levels were similar between the groups; but 1 month later, logarithmic transformation of hs-CRP level was significantly lower in the niacin group (0.43 +/- 0.39 to 0.83 +/- 0.91, p = 0.04). HDL-C level was significantly increased in the niacin group during follow-up. Drug related side effects were seen in 7 patients in the niacin group but no patients discontinued niacin. Conclusions: Our findings demonstrate that lower dose extended release niacin can be used safely and decreases hs-CRP and lipid parameters successfully in NSTE-ACS patients.
Implantation of A Cardiac Resynchronization Therapy-Defibrillator Device in A Patient with Persistent Left Superior Vena Cava
(2015) Atar, Ilyas; Karacaglar, Emir; Ozcalik, Emre; Ozin, Bulent; Muderrisoglu, Haldun; 0000-0002-9635-6313; 0000-0002-2538-1642; 0000-0003-3821-412X; 26142791; AAG-8233-2020; ABI-6723-2020; AAD-9938-2021
Presence of a persistent left superior vena cava (PLSVC) is generally clinically asymptomatic and discovered incidentally during central venous catheterization. However, PLSVC may cause technical difficulties during cardiac device implantation. An 82-year-old man with heart failure symptoms and an ejection fraction (EF) of 20% was scheduled for resynchronization therapy-defibrillator device (CRT-D) implantation. A PLSVC draining via a dilated coronary sinus into an enlarged right atrium was diagnosed. First, an active-fixation right ventricular lead was inserted into the right atrium through the PLSVC. The stylet was preshaped to facilitate its passage to the right ventricular apex. An atrial lead was positioned on the right atrium free wall, and an overthe- wire coronary sinus lead deployed to a stable position. CRT-D implantation procedure was successfully completed.
Inappropriate Shock and Battery Switching to "End of Life" in A Patient with Biventricular ICD During Magnetic Resonance Imaging
(2016) Atar, Ilyas; Bal, Ugur; Ertan, Cagatay; Ozin, Bulent; Muderrisoglu, Haldun; https://orcid.org/0000-0002-9446-2518; https://orcid.org/0000-0003-3821-412X; https://orcid.org/0000-0002-9635-6313; 26875136; AAK-4322-2021; AAD-9938-2021; AAG-8233-2020
Presence of a cardiac pacemaker or implantable cardioverter defibrillator (ICD) is a relative contraindication to magnetic resonance imaging (MRI). Biventricular ICDs are often used in the treatment of advanced heart failure; however, reports on experience with biventricular ICDs are lacking in the literature. In this case report, we describe a pacemaker-dependent patient with a biventricular ICD on whom an MRI of the lumbar spine was performed without having realized the presence of the ICD.
Predictive Value of Hematologic Parameters for Detecting Asymptomatic Graft Rejection After Heart Transplant: Preliminary Results
(2015) Karacaglar, Emir; Bal, Ugur; Ciftci, Orcun; Turgay, Ozge; Yilmaz, Mustafa; Sade, Elif; Aydinalp, Alp; Sezgin, Atilla; Atar, Ilyas; Muderrisoglu, Haldun; 0000-0002-2557-9579; 0000-0002-9446-2518; 0000-0001-8926-9142; 0000-0002-2538-1642; 0000-0002-3761-8782; 0000-0002-9635-6313; 0000-0002-6731-4958; 0000-0003-3737-8595; 26640937; S-6973-2016; AAK-4322-2021; W-5233-2018; ABI-6723-2020; GPX-1387-2022; AAD-5841-2021; AAG-8233-2020; AAQ-7583-2021
Objectives: Hematologic parameters, such as mean platelet volume, red-cell distribution width, and neutrophil-to-lymphocyte ratio, have prognostic value in multiple cardiac conditions such as stable angina pectoris, acute coronary syndromes, and heart failure. However, no previous studies have evaluated the association between hematologic parameters and asymptomatic graft rejection after heart transplant. We evaluated the role of hematologic parameters for detecting asymptomatic graft rejection after heart transplant. Materials and Methods: We retrospectively evaluated medical records of 47 adult patients who underwent orthotopic heart transplant between February 25, 2005, and July 6, 2014, in our hospital, noting their hematologic parameters before each biopsy. Two groups were created according to biopsy results: rejection and no-rejection. Results: We excluded 4 patients who died during the first month posttransplant owing to early complications. We evaluated 422 endomyocardial biopsy results of 43 adult patients (mean age, 43.4 +/- 11.4 y; 14 women). Mean follow-up was 33 months. A total of 109 biopsies performed because of clinical suspicion of rejection were excluded. Redcell distribution width levels were similar between groups (17.2% +/- 2.6% in the rejection group and 17.1% +/- 2.5% in the no-rejection group; P=.856). Neutrophil-to-lymphocyte ratio was similar between groups (7.8 +/- 9.9 in the rejection group and 8.2 +/- 9.7 in the no-rejection group; P=.791). Mean platelet volume levels were significantly lower in the rejection group (8.3 +/- 1.3 fL) than in the no-rejection group (8.8 +/- 1.8 fL) (P=.037) (Table 1). Conclusions: According to our results, only lower mean platelet volume levels were significantly associated with asymptomatic graft rejection in patients with a transplanted heart. More detailed analyses are needed to exclude the effects of immunosuppressant drugs, and further studies are needed to clarify the exact role of hematologic parameters for detecting asymptomatic rejection after heart transplant.
A Report of Brugada Syndrome Presenting with Cardiac Arrest Triggered by Verapamil Intoxication
(2017) Erdogan, Ilkay; Yakut, Kahraman; Varan, Birgul; Atar, Ilyas; 0000-0001-6887-3033; 0000-0002-6719-8563; 29215340; ABB-2220-2021; AAJ-2305-2021; ABB-1767-2021
Background: Brugada syndrome is a disease characterized by a specific electrocardiographic pattern and an increased risk of sudden cardiac death. We present this case with the updated literature to emphasise the need to consider the diagnosis of Brugada syndrome in patients admitted to the emergency ward with sudden cardiac arrest. Case Report: A 16-year-old female patient was admitted to the emergency ward with complaints of weakness and abdominal pain, and she had four cardiac arrests during her evaluation period. She was referred to our clinic for permanent pacemaker implantation. She was on a temporary pace maker after having had C-reactive protein. Her physical exam was normal except for bilaterally decreased lung sounds. Lung x-ray and computed tomography, which were performed by another institution, revealed minimal pleural effusion and nothing else of significance. Blood and peritoneal fluid samples were sterile. Echocardiographic exam and cardiac enzymes were also in the normal ranges. Electrocardiographic showed incomplete right branch block in leads V1 and V2. An ajmaline test revealed specific electrocardiographic findings of the type I Brugada pattern. We proposed implanting an implantable cardioverter defibrillator to the patient as there were positive findings on the ajmaline test as well as a history of sudden cardiac arrest. After this treatment proposal, the patient's family admitted that she had taken a high dose of verapamil and thus, the encountered bradycardia was associated with verapamil overuse. The ajmaline test was repeated as it was contemplated that the previous positive ajmaline test had been associated with verapamil overuse. Implantable cardioverter defibrillator implantation was proposed again as there was a history of sudden cardiac arrest; however, the family did not consent to implantable cardioverter defibrillator, and the patient was discharged and followed up. Conclusion: Brugada syndrome should be considered for patients who are admitted to the emergency ward with sudden cardiac arrest though surface electrocardiographic is normal. If there is a suspicion of Brugada syndrome, repeated electrocardiographic should be performed on different occasions. Diagnosis can be clarified by upper costal electrocardiographic or by administering Na channel blockers during electrocardiographic performance.