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Öğe Association of P wave duration index with atrial fibrillation recurrence after cryoballoon catheter ablation(Churchill Livingstone Inc Medical Publishers, 2018) Kaypakli, Onur; Koca, Hasan; Sahin, Durmus Yildiray; Okar, Sefa; Karatas, Fadime; Koc, MevlutAim: We aimed to investigate the relationship between the recurrence of AF and P wave duration index (PWDI) in patients with nonvalvular PAF. Methods: We included 114 patients who underwent cryoballoon catheter ablation with the diagnosis of paroxysmal atrial fibrillation (PAF) (55 male, 59 female; mean age 55.5 +/- 10,9 years). PWDI was calculated by dividing the Pwd by the PR interval in DII lead of 1201ead ECG. Patients had regular follow-up visits with 12-lead ECG, medical history and clinical evaluation. 24 h Holter ECG monitoring had been recorded at least 12 months after ablation. Results: AF recurrence was detected in 24 patients after 1 year. Patients were divided into two groups according to the AF recurrence. All parameters were compared between the two groups. Age, DM, HT frequency, ACEI-ARB use, CHA2DS2VASc and HAS-BLED score, HsCRP, LA diameter, LA volume, LA volume index, Pwd and PWDI were related to AF recurrence. In binary logistic regression analysis, PWDI (OR = 1.143, p = 0.001) and HT (OR = 0.194, p = 0.020) were found to be independent parameters for predicting AF recurrence. Every 0,01 unit increase in PWDI was found to be associated with 14.3% increase in the risk of AF recurrence. The cut-off value of PWDI obtained by ROC curve analysis was 59,9 for prediction of AF recurrence (sensitivity: 75.0%, specificity: 69.0%). The area under the curve (AUC) was 0.760 (p < 0.001). Conclusion: Increased PWDI may help to identify those patients in whom electrical remodeling has already occurred and who will get less benefit from cryoablation. (C) 2017 Elsevier Inc. All rights reserved.Öğe Calculation of the Correct Angle of Bifurcation Predicts the Atherosclerotic Lesion Location More Accurately(Digital Commons Bepress, 2021) Ozgeyik, Mehmet; Kaypakli, Onur; Ozgeyik, Mufide Okay[Abstract Not Available]Öğe Decreased left atrial global longitudinal strain predicts the risk of atrial fibrillation recurrence after cryoablation in paroxysmal atrial fibrillation(Springer, 2020) Koca, Hasan; Demirtas, Abdullah Orhan; Kaypakli, Onur; Icen, Yahya Kemal; Sahin, Durmus Yildiray; Koca, Fadime; Koseoglu, ZikretPurpose We aimed to investigate the association of atrial fibrillation (AF) recurrence with left atrial (LA) strain in nonvalvular paroxysmal AF patients after cryoablation. Methods We included 190 patients who underwent successful cryoablation due to paroxysmal AF. In addition to classical echocardiographic data, LA apical 2-chamber (A2C) strain, LA apical 4-chamber (A4C) strain, and LA global longitudinal strain (LA-GLS) values were calculated by speckle tracking echocardiography. Forty-eight-hour Holter monitoring was performed to all patients no later than 6 months after ablation. Results AF recurrence was detected in 42 patients (22.1%). End-systolic diameter, LA end-systolic diameter, LA-volume, LA-volume index, interatrial septum thickness, coronary sinus diameter, epicardial fat thickness (EFT), and septal E/E & x2cb; ratio were significantly higher, LV-EF, IVRT, septal S and A & x2cb; wave, lateral S wave, LA-A2C strain, LA-A4C strain, and LA-GLS were significantly lower in patients with AF recurrence. LA-GLS, LA-volume index, and EFT were found to be independent parameters for predicting AF recurrence. Conclusions LA-GLS and LAVI should be included in routine evaluations to determine long-term AF recurrence preoperatively.Öğe Delta wave notching time is associated with accessory pathway localization in patients with Wolff-Parkinson-White syndrome(Springer, 2018) Icen, Yahya Kemal; Donmez, Yurdaer; Koca, Hasan; Kaypakli, Onur; Koc, MevlutPurposeOur aim was to investigate the relation between delta wave notching time (DwNt) and accessory pathway location in patients with Wolff-Parkinson-White (WPW) syndrome.MethodsThe retrospective study included 149 WPW patients who underwent ablation therapy. DwNt was defined as the duration between the initial point of QRS and the notching in the delta wave. DwNt was divided by QRS duration to obtain the delta wave index (Dwi).ResultsPatients with left-sided accessory pathway (AP) had significantly higher DwNt (p<0.001) and Dwi (p=0.027) values. The R wave voltage in lead I (p=0.037) and S wave voltage in lead V1 (p=0.005) values were significantly higher in patients with right-sided AP compared to patients with left-sided AP. When 27ms was taken as the DwNt cut-off value, higher durations determined the left-sided AP location with a sensitivity of 91% and a negative predictive value of 91.4%. Dwi cutoff values 0.29 were accepted to indicate a left-sided AP location with a sensitivity of 91.2% and a NPV of 91.4%.ConclusionsWPW patients with left-sided AP have longer DwNt values than patients with right-sided AP.Öğe The effect of heart rate and pulse pressure on mean arterial pressure: the combined formula for calculation of mean arterial pressure(Lippincott Williams & Wilkins, 2021) Kaypakli, Onur; Ozgeyik, MehmetBackground We demonstrate a new formula to predict mean arterial pressure (MAP) using corrections of the key factors associated with the inaccuracy of the standard formula: heart rate (HR) and pulse pressure (PP). Methods A total of 99 patients (50 men, 49 women; mean age 52.5 +/- 10.3 years), who underwent elective coronary angiography, were enrolled in our study. The arterial pressure was measured in the aortic root. MAP was measured digitally by the area-under-the-pressure-time curve method. We evaluated the accuracy of four different formulas: the standard formula, the formula of Razminia et al., the formula of Meaney et al. and the combined formula. Results PP coefficient deviation of the standard formula was negatively correlated with PP (R = -0,561, P < 0.001), and positively correlated with HR (R = 0,298, P = 0.003). Both R and R-2 values of the combined formula were higher than previous formulas. Accuracy parameters of the combined formula [root mean square error (RMSE): 1.801 mmHg, mean square residuals (MSR): 3.244 mmHg(2), Akaike information criterion (AIC): 401.4] were superior to the standard formula (RMSE: 1.902 mmHg, MSR: 3.620 mmHg(2), AIC: 412.3), the formula of Razminia et al. (RMSE: 2.022 mmHg, MSR: 4.089 mmHg(2), AIC: 424.3) and the formula of Meaney et al. (RMSE: 2.137 mmHg, MSR: 4.568 mmHg(2), AIC: 435.3). In the multivariate linear regression analysis, the combined formula was the only method that independently predicts the measured MAP (beta = 0,990, P < 0.001). Conclusion The combined formula is superior to previous formulas for accurately predicting MAP.Öğe Effect of Modified Global Risk Classification on Prognosis at Patients Undergoing Bypass Surgery and Percutaneous Coronary Intervention with Multi-vessel Disease(Aves Press Ltd, 2018) Kaypakli, Onur; Sahin, Durmus Yildiray; Deniz, Ali; Aktas, Halil; Akilli, Rabia Eker; Icen, Yahya Kemal; Caglayan, Caglar EmreObjective: The aim of this study was to compare mortality and myocardial infarction in patients with multi-vessel disease using Modified Global Risk Classification (mGRC). Methods: We divided 579 patients into low, intermediate risk with a high EuroSCORE (IE), intermediate risk with a high SYNTAX score (IS), and high Modified Global Risk groups. Patients were evaluated for death, myocardial infarction, cerebrovascular events, need for re intervention, and a primary endpoint, which denotes the occurrence of any one of the four events. Results: Comparing the bypass surgery and percutaneous coronary intervention groups using mGRC showed significantly better prognostic results in the bypass surgery patients for the rate of the occurrence of the myocardial infarction for the IS group (p=0.047). In terms of the primary endpoint, the EuroSCORE, SYNTAX score, and Global Risk Classification (GRC) were found to be independent risk factors in logistic regression analysis. The ability of GRC to discriminate for the 1-year mortality was found to be better than that of the EuroSCORE and SYNTAX score. Conclusion: With the evaluation of the EuroSCORE and SYNTAX score together, the modified GRC, which includes both anatomical and clinical risk factors, provides an additional benefit for predicting the prognosis and decision of treatment in patients with multi-vessel disease.Öğe Effectiveness of Device-Guided Breathing in Chronic Coronary Syndrome: A Randomized Controlled Study(Taiwan Soc Cardiology, 2023) Akkus, Oguz; Huzmeli, Irem; Seker, Taner; Bekler, Ozkan; Sen, Fatih; Kaypakli, Onur; Ozer, Aysel YildizBackground: Chronic coronary syndrome (CCS) is one of the most life-restricting coronary artery diseases, and symptom relief is the main goal in CCS patients who suffer from angina.Objectives: To assess the potential benefits of device-guided breathing in CCS patients with angina in this randomized, controlled, single-blinded study.Methods: Fifty-one patients with CCS received device-guided breathing for 7 days/8 weeks. Exercise capacity [exercise stress test], cardiac function [transthoracic echocardiography], and angina severity [Canadian Cardiovascular Society Classification] were evaluated initially and after the training. Device-guided breathing was performed at the lowest resistance of the device (POWERbreathe (R) Classic LR) for the control group (n = 17). The low load training group (LLTG; n = 18) and high load training group (HLTG; n = 16) were trained at 30% and 50% of maximal inspiratory pressure. Baseline characteristics were compared using one-way ANOVA and Kruskal-Wallis test. Categorical data were compared using the chi-square test. ANCOVA was performed to compare changes between three groups. A p value < 0.05 was considered statistically significant.Results: Metabolic equivalent values were significantly improved in both HLTG and LLTG groups (p < 0.001, p = 0.003). The Duke treadmill score significantly improved and shifted to low-risk both in the HLTG (p < 0.001) and LLTG (p < 0.001) groups. Angina severity significantly alleviated after the training in both HLTG and LLTG groups (p < 0.001, p = 0.002).Conclusions: An 8-week long program of short-term respiratory muscle training provided positive gains in exercise capacity and angina severity in CCS patients with angina. The effects of long-term training programs on CCS patients should be investigated clinically because of the possibility of helping to decrease the need for invasive treatments.Öğe Fibrosis Marker Soluble ST2 Predicts Atrial Fibrillation Recurrence after Cryoballoon Catheter Ablation of Nonvalvular Paroxysmal Atria Fibrillation(Korean Soc Cardiology, 2018) Okar, Sefa; Kaypakli, Onur; Sahin, Durmus Yildiray; Koc, MevlutBackground and Objectives: We aimed to investigate the relationship between the recurrence of atrial fibrillation (AF) and fibrosis marker soluble ST2 (sST2) in patients with nonvalvular paroxysmal AF (PAF). Methods: We prospectively included 100 consecutive patients with PAF diagnosis and scheduled for cryoballoon catheter ablation for AF (47 males, 53 females; mean age 55.1 +/- 10.8 years). sST2 plasma levels were determined using the ASPECT-PLUS assay on ASPECT Reader device (Critical Diagnostics). The measurement range of these measurements was 12.5-250 ng/mL. Patients had regular follow-up visits with 12-lead electrocardiogram (ECG), medical history, and clinical evaluation. Twenty-four hours Hotter ECG monitoring had been recorded 12 months after ablation. Results: AF recurrence was detected in 22 patients after 1 year. Age, smoking history, diabetes mellitus,hypertension frequency, angiotensin converting enzyme inhibitor-angiotensin receptor blocker use, CHA(2)DS(2)VASc and HAS-BLED scores, serum sST2 level, left atrium (LA) end-diastolic diameter, LA volume and LA volume index were related to AF recurrence. In multivariable logistic regression analysis, sST2 was found to be only independent parameter for predicting AF recurrence (odds ratio, 1.085; p=0.001). Every 10-unit increase in sST2 was found to be associated with 2.103-fold increase in the risk of AF recurrence. The cut-off value of sST2 obtained by receiver operating characteristic curve analysis was 30.6 ng/mL for prediction of AF recurrence (sensitivity: 77.3%, specificity: 79.5%). The area under the curve was 0.831 (p<0.001). Conclusions: sST2, which is associated with atrial fibrosis, can be thought to be a useful marker for detection of patients with high-grade fibrosis who will get less benefit from cryoablation.Öğe Impact of catheter ablation procedure on optical coherence tomography angiography findings in patients with ventricular arrhythmia(Assoc Medica Brasileira, 2023) Kurtul, Bengi Ece; Kurtul, Alparslan; Kaypakli, OnurOBJECTIVE: Catheter ablation procedure may cause retinal complications associated with the risk of thromboembolism. We aimed to evaluate retina and optic disc microvascularity with optical coherence tomography angiography before and after the catheter ablation process in patients with ventricular arrhythmia. METHODS: A total of 40 eyes of 21 ventricular arrhythmia patients were included in this cross-sectional study. Demographic characteristics and ophthalmic examination findings of patients were recorded. optical coherence tomography angiography measurements were evaluated before (group 1) and after (group 2) catheter ablation. Optical coherence tomography angiography was applied to all eyes with 6x6 mm sections for the macula and 4.5x4.5 mm sections for the optic nerve head. Foveal retinal thickness, peripapillary retinal nerve fiber layer thickness, vessel density in different parts of the retina, and optic disc were analyzed. RESULTS: The mean age of ventricular arrhythmia patients was 53.48 +/- 13.02 years. In all, 13 (61.9%) of the patients were males and 8 (38.1%) were females. There was no significant difference between the groups in terms of average, inferior, superior, and temporal retinal nerve fiber layer thicknesses, foveal avascular area, flow areas, superficial and deep vessel densities, and optic disc capillary densities of the optic disc. However, when compared with group 1, significantly lower values in foveal retinal thickness and higher values in nasal retinal nerve fiber layer thickness were observed in group 2 (248.42 +/- 20.50 vs. 247.20 +/- 20.44, p<0.001 and 94.22 +/- 18.43 vs. 96.12 +/- 20.18, p=0.044, respectively). CONCLUSION: Although foveal retinal thickness and nasal retinal nerve fiber layer thickness are affected in patients undergoing catheter ablation for ventricular arrhythmia, the stable retinal and optic disc vessel densities can be explained by the administration of effective anticoagulants during the procedure.Öğe Increased Rates of Coronary Artery Calcium Score in Patients with Non- Functioning Adrenal Incidentaloma(Bentham Science Publ Ltd, 2021) Akkus, Oguz; Akkus, Gamze; Kaypakli, Onur; Ozturk, Fatma Keles; Gurkan, Eren; Bekler, Ozkan; Sen, FatihAim: We evaluated cardiovascular (CV) risk stratification for nonfunctioning adrenal in-cidentalomas (NFAIs) via the coronary-artery-calcium (CAC) score. Materials and Methods: The participants were patients with NFAI (n = 55). They were compared to patients with chest pain, a low-intermediate Framingham-risk score, and a non-diagnostic tread-mill-exercise test, which served as the control group (n = 49). Subsequently, the NFAI group was subdivided according to a CAC score of <100 Agatston units - mild coronary-artery calcification (n = 40) - and >100 Agatston units - moderate-to-severe calcification (n = 15). Results: Similar rates of traditional risk factors were observed between the NFAI and control groups, and lower low-density lipoprotein cholesterol rates were observed in the NFAI group. The CAC score was significantly higher for the NFAI group than the control group. Glucose, potassi-um, adrenocorticotropic-hormone, and basal-cortisol levels were higher in those with a CAC score of >100. High-density-lipoprotein cholesterol estimated glomerular filtration rate and ejection frac-tion (EF) were higher in those with a CAC score of <100. Adenoma size and location were similar between the groups. Age, EF, and glucose were the most significant variables related to CAC score in patients with NFAI, at >100 Agatston units. Discussion: Patients with a low-intermediate CV risk profile and NFAI have a higher risk of atherosclerosis when compared to patients with a low-intermediate CV risk profile, but no NFAI. Conclusion: In patients with NFAI, CAC score evaluation may be used to predict increased atherosclerosis, especially in patients of an older age with higher glucose and decreased EF.Öğe Morning blood pressure surge is associated independently with orthostatic hypotension in hypertensive patients under treatment(Lippincott Williams & Wilkins, 2018) Caf, Hakan; Donmez, Yurdaer; Guler, Emel Celiker; Kaypakli, Onur; Icen, Yahya Kemal; Koc, MevluetObjective Morning blood pressure surge (MBPS) and orthostatic hypotension (OH) play a role in the occurrence of cardiovascular events. We aimed to investigate the association between MBPS and OH in hypertensive patients under treatment. Patients and methods We prospectively included 297 patients (mean age: 53.8 +/- 10.7 years, male/female: 101/196) with essential hypertension. Tilt table testing was performed for the diagnosis of OH. OH was classified into three groups as initial OH (0-15s), classical OH (15s to 3 min), and delayed OH (3-30 min). Patients were categorized into two main groups: patient with OH or without OH. We used sleep-through MBPS. The MBPS was calculated as the difference between the average blood pressure (BP) during the 2 h after awakening and the lowest night-time BP. Results We detected initial OH in two patients, classic OH in seven patients, delayed OH in 20 patients, and delayed OH with syncope in two patients. MBPS, thiazide diuretic, and alpha-blocker treatments were found to be associated independently with the occurrence of OH. Every 10 mmHg increase in MBPS was found to increase the rate of development of OH by 29.6%. The cut-off value of MBPS obtained by the receiver operator characteristic curve analysis was 35mmHg for the prediction of OH occurrence (sensitivity: 58.0%, specificity: 68.0%). The area under the curve was 0.657 (95% confidence interval: 0.553-0.771, P=0.004). Conclusion OH is a major problem in hypertensive patients. Increased MBPS, which can be detected easily by 24-h ambulatory BP monitor, predicts the occurrence of OH independently. Copyright (C) 2018 Wolters Kluwer Health, Inc. All rights reserved.Öğe Morning blood pressure surge is associated with the severity of stable coronary artery disease in hypertensive patients(Taylor & Francis Inc, 2021) Harbalioglu, Hazar; Kaypakli, OnurBackground: We aimed to investigate the association between morning surge (MS) of blood pressure (BP) and SYNTAX score (SS) which gives information regarding the complexity and extent of coronary artery disease (CAD) in hypertensive patients. Methods: We included 187 hypertensive patients (134 males, 53 females; mean age: 62.5 +/- 10.9 years) who underwent elective coronary angiography. Patients with the acute coronary syndrome and a history of coronary intervention were excluded from the study. The MBPS was calculated as the difference between the average BP during the 2 hours after awakening (four BP readings) and the lowest nighttime BP. The severity of coronary lesions was evaluated based on the SS assessed by coronary angiography. Patients were classified into two groups according to SS: low SS (SS <= 22) and intermediate-to-high SS (>22). Results: Patients in the intermediate-to-high SS group were found to be older, have higher uric acid levels, average daytime systolic BP (SBP), nighttime SBP, morning SBP, MS of BP and have higher rates of diabetes (DM) and female gender. There was no significant difference in terms of hypertensive treatment. In multivariate analysis, MS of BP (OR: 2.151, p: 0.005) and DM (OR: 0.014, p: 0.015) were independent parameters for predicting intermediate-to-high SS. The cutoff value of MS of BP obtained by ROC curve analysis was 18,5 mmHg for prediction of intermediate-high SS (sensitivity: 76.5%, specificity: 71.2%). The area under the curve was 0.762 (p < .001). Conclusion: MS of BP significantly correlates with the severity of coronary stenosis in hypertensive patients, suggesting that it could be a potential predictive marker of CAD.Öğe A new criterion to differentiate atrioventricular nodal reentrant tachycardia from atrioventricular reciprocating tachycardia: Combined AVR criterion(Churchill Livingstone Inc Medical Publishers, 2018) Demirtas, Abdullah Orhan; Icen, Yahya Kemal; Kaypakli, Onur; Koca, Hasan; Unal, Ilker; Koseoglu, Zikret; Sahin, Durmus YildirayAim: A combined aVR criterion is described as the presence of a pseudo r' wave in aVR during tachycardia in patients without r' wave in aVR in sinus rhythm and/or a >= 50% increase in r' wave amplitude compared to sinus rhythm in patients with r' wave in the basal aVR lead. We aimed to investigate the use of combined aVR criterion in differential diagnosis of atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reciprocating tachycardia (AVRT). Methods: In this prospective study, 480 patients with inducible narrow QRS supraventricular tachycardia (SVT) were included. Twelve-lead electrocardiogram (ECG) was conducted during tachycardia and sinus rhythm. The patients were divided into two groups according to the arrhythmia mechanism that determined via EPS, AVNRT, and AVRT. Criteria of narrow QRS complex tachycardia were compared between the two groups. Results: AVNRT was present in 370 (77%) patients and AVRT in 110 (23%) patients. Combined aVR criterion was found to be more frequent in patients with AVNRT (84.1% and 9.1%, p < 0.001). In logistic regression analysis, combined aVR criterion and classical ECG criterion were found to be the most important predictors of AVNRT (p < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of the combined aVR criterion for AVNRT were 84.1%, 90.9%, 96.9%, and 62.9%, respectively. Conclusion: In the differential diagnosis of patients with SVT, the combined aVR criterion identifies the presence of AVNRT with an independent and acceptable diagnostic value. In addition to classical ECG criteria for AVNRT, it is necessary to evaluate the combined aVR criterion in daily practice. (C) 2018 Elsevier Inc. All rights reserved.Öğe New genetic risk factors for myocardial infarction at young patients in Southern Turkey(Cukurova Univ, Fac Medicine, 2020) Akilli, Rabia Eker; Cagliyan, Caglar Emre; Kaypakli, Onur; Kanadasi, Mehmet; Demirtas, MustafaPurpose: Genetic predisposition plays an important role in the development of atherosclerosis in young patients. The aim of this study was to determine the relationship between myocardial infarction and HLA antigens in young patients who had myocardial infarction in southern region of Turkey. Materials and Methods: We enrolled 50 patients (36 male, 14 female, mean age 45.0 +/- 7.1) who had myocardial infarction before 45 years old in men and 55 years old in women and 50 healthy subjects (31 male, 19 female, mean age 51.5 +/- 5.5) as a control group into the study. Venous blood samples were collected for HLA tissue typing and determining trombogenic factors. Histocompatibility antigens (HLA-A,B,C,-DQ,-DR) were studied with Polymerase Chain Reaction (PCR)-Sequance Spesific Oligonucleotide typing (SSO) method. Results: Frequency of HLA antigens in patients and controls were 38% and 10% for HLA-A24, 40% and 10% for HLA-DQB2, 26% and 6% for HLA-DRB1-7 and 52% and 26% for HLA-DRB4-1. Chi square test revealed a significant relation with the disease and the presence of these antigens. In the logistic regression analysis, smoking, Lp(a), homocysteine and HLA-DQB1 subtype were independently associated with development of MI in young patients. Conclusion: The presence of HLA-A24, HLA-DQB2, HLA-DRB1-7 and HLA-DRB4-1 may be used as genetic markers for the tendency to coronary artery disease in southern region of Turkey.Öğe Paced Corrected QT Interval is Associated with Lv Diastolic Dysfunction in Patients With Permanent Pacemakers and Preserved Left Ventricular Ejection Fraction(Aves Press Ltd, 2018) Kaypakli, OnurObjective: Although chronic right ventricular apex (RVA) pacing is usually well tolerated in patients with normal cardiac function, recent studies report that not only left ventricular (LV) systolic function but also diastolic function is adversely affected. The aim of the present study was to detect the relationship between paced QRS, paced corrected QT (pQTc) duration, and echocardiographic parameters of LV diastolic dysfunction to examine the effects of RVA pacing in patients with preserved LV ejection fraction (LVEF). Methods: We included 74 patients with LVEF>50% and DDD(R) pacemakers implanted for atrioventricular block (45 men and 29 women; mean age 64.9 +/- 11.6 years). Patients were included to the study at least 6 months after battery implantation. Patients with RVA pacing rate <70% were excluded from the study. Patients were classified into two groups according to the left atrial (LA) volume index. Results: pQTc was associated with LA volume index, LA volume, LA end-diastolic diameter, E-wave deceleration time, septal annular e' velocity, and mitral E/e' ratio in bivariate analysis. The cut-off value of pQTc obtained by receiver operating characteristic curve analysis was 512 ms for prediction of increased (>34 mL/m(2)) LA volume index (sensitivity: 88.0% and specificity: 79.6%). The area under the curve was 0.848 (p<0.001). Conclusion: pQTc duration was found to be significantly associated with the echocardiographic parameters of LV diastolic dysfunction. We suggest that pQTc be used as a marker to predict the risk of diastolic dysfunction after permanent pacemaker implantation in patients with preserved LVEF. It can also be used to optimize the RV pacing area with intraoperative measurements.Öğe The Possible Effects of Dapagliflozin on 12-derived Electrocardiogram in Patients with Type 2 Diabetes Mellitus(Bentham Science Publ Ltd, 2019) Akkus, Oguz; Akkus, Gamze; Kaypakli, OnurBackground: Dapagliflozin, sodium glucose cotransporter 2 inhibitor, has potential side effects on electrolyte imbalance as it has diuretic effects which include decreasing glucose reabsorption, increasing glucosuria and natriuresis. We aimed to determine the possible effects of dapagliflozin on electrocardiogram (ECG) in patients with type 2 DM. Material and Methods: This retrospective study consisted of 49 patients (25 female, 24 male). Patients who had inadequate glycemic control besides using several oral antidiabetics, subsequently endorsed with dapagliflozin, were included in the current study. Results: Meantime interval from treatment initiation to control was 10.5 +/- 5.03 weeks. Body mass index, glucose, HbAlC, eGFR, LDL-C, heart rate, systolic and diastolic blood pressures were found to be significantly lower at control admission (p<0.05). Creatinine and QT interval were significantly higher at control admission (p<0.05). Baseline Tpe duration and baseline Tpe/QT ratio were found to be significantly correlated with Tpe/QT difference (p<0.05). In linear regression analysis, baseline Tpe/QT ratio was found to be the sole independent predictor of Tpe/QT difference (p<0.05). Conclusion: Initiation of dapagliflozin treatment seems to be safe, up to several months, in terms of serum electrolytes and ECG findings in patients with type 2 DM with a probable improvement.Öğe Prognostic Value of High Sensitive Troponin T in Patients with Chronic Ischemic Heart Disease Undergoing Percutaneous Coronary Intervention(Czech Soc Cardiology & Czech Soc Cardiovascular Surgery, 2021) Aktas, Halil; Kaypakli, Onur; Ozmen, Caglar; Gul, Murat; Yildirim, Oguz; Inci, Sinan; Deniz, AliObjective: Several studies have investigated different cardiac biomarkers as predictors of the prognosis after percutaneous coronary interventions (PCI) in patients with chronic ischemic heart disease; nevertheless, the results of these studies are conflicting. High sensitive troponin T (Hs-TnT) measurement is a novel and sensitive method. The aim of this study was to investigate if Hs-TnT levels are a predictor of major adverse cardiovascular events (MACE) in the first year after a successful elective PCI in patients with stable angina pectoris (SAP). Material and methods: 100 patients who presented with SAP and underwent successfully elective PCI were included in the study. Patients with elevated troponin I levels (>0.1 ng/mL) before the procedure excluded from the study. Hs-TnT levels were measured before the procedure and at 3-4 hours (h) (early period) and 12-24 hours (late period) after the procedure and Hs-TnT level >14 pg/mL was considered positive. The incidence of MACE during the first year was recorded. Results: Hs-TnT levels were positive in 36% of the patients in the early period and in 54% of the patients in the late period. The incidence rate of MACE for the first year was significantly higher in the patients with positive Hs-TnT levels in the early period but not the late period (36.1% vs. 15.6%; p = 0.026) and logistic regression analysis yielded an odds ratio of 3.36. Conclusion: Hs-TnT levels measured 3-4 h after a successful elective PCI in patients with SAP can predict the incidence of MACE within the first year. Nonetheless, these results must be corroborated by other larger studies.Öğe The relationship between low thiol levels and major adverse cardiovascular events after primary percutaneous coronary intervention in patients with STEMI(Turkish Soc Cardiology, 2018) Akkus, Oguz; Topuz, Mustafa; Koca, Hasan; Harbalioglu, Hazar; Kaypakli, Onur; Kaplan, Mehmet; Sen, OmerOjective: The aim of this study was to investigate whether low thiol levels are associated with peri-procedural factors during primary percutaneous coronary intervention (pPCI) upon admission with ST-segment elevation myocardial infarction (STEMI), and the prognostic value at 6-month follow-up. Methods: A total of 241 consecutive acute STEMI patients who underwent pPCI and a control group of 67 individuals with a normal coronary angiography were enrolled in the study. Result: While age, contrast-induced nephropathy, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), stent length, and creatinine were related to native thiol, NT-proBNP, contrast-induced nephropathy, and creatinine were related to total thiol. NT-proBNP was also related to the disulphide level. The left ventricular ejection fraction (LVEF) and the levels of native thiol, total thiol, low-density lipoprotein, and serum albumin were found to be independent predictors of major adverse cardiovascular events (MACEs) during 6 months of follow-up. Conclusion: Initial lower native thiol, total thiol, LVEF, LDL, and serum albumin may be used to identify patients with an increased long-term risk of unfavorable cardiac events in case of STEMI.Öğe S-R difference in V1-V2 is a novel criterion for differentiating the left from right ventricular outflow tract arrhythmias(Wiley, 2018) Kaypakli, Onur; Koca, Hasan; Sahin, Durmus Yildiray; Karatas, Fadime; Ozbicer, Suleyman; Koc, MevluetAimThe correct estimation of the VA origin as RVOT or LVOT results in reduced ablation duration reduced radiation exposure and decreased number of vascular access. In our study, we aimed to detect the predictive value of S-R difference in V1-V2 for differentiating the left from right ventricular outflow tract arrhythmias. MethodsWe included 123 patients with symptomatic frequent premature ventricular outflow tract contractions who underwent successful catheter ablation (70 male, 53 female; mean age 46.213.9years, 61 RVOT, 62 LVOT origins). S-R difference in V1-V2 was calculated with this formula on the 12-lead surface ECG: (V1S+V2S) - (V1R+V2R). Conventional ablation was performed in 101 (82.1%) patients, CARTO electroanatomic mapping system was used in 22 (17.9%) patients. ResultsV1-2 SRd was found to be significantly lower for LVOT origins than RVOT origins (p<.001). The cutoff value of V1-2 SRd obtained by ROC curve analysis was 1.625 mV for prediction of RVOT origin (sensitivity: 95.1%, specificity: 85.5%, positive predictive value: 86.5%, negative predictive value: 94.5%). The area under the curve (AUC) was 0.929 (p<.001). ConclusionS-R difference in V1-V2 is a novel and simple electrocardiographic criterion for accurately differentiating RVOT from LVOT sites of ventricular arrhythmia origins. The use of this simple ECG measurement could improve the accuracy of OTVA localization, could be beneficial for decreasing ablation duration and radiation exposure. Further studies with larger patient population are needed to verify the results of this study.Öğe Subclinical atrial fibrillation frequency and associated parameters in patients with cardiac resynchronization therapy(Springer, 2018) Ugurlu, Mehmet; Kaypakli, Onur; Sahin, Durmus Yildiray; Icen, Yahya Kemal; Kurt, Ibrahim Halil; Koc, MevlutThe presence of subclinical atrial fibrillation (SCAF) is relevant to issues such as the risk of stroke and the necessity of anticoagulant use in patients with cardiac resynchronization therapy (CRT). Our study aimed to investigate SCAF frequency and associated parameters in patients with CRT. One hundred ninety-one patients with CRT (77 females, 114 males, mean age 65.9 +/- 9.8) were included in the study. Atrial high-rate episodes detected by the device, atrial electrode impedance, P-wave sense amplitude, and atrial lead threshold values were measured during pacemaker controls. SCAF was defined as asymptomatic atrial high-rate episodes (AHRE) longer than 6 min and shorter than 24 h. Patients were divided into two groups as with and without SCAF. SCAF was detected in 44 (23.2%) of 191 patients with CRT. Age, sex, weight, aortic end-systolic diameter, left atrium (LA) diameter, left bundle branch block morphology, CHA(2)DS(2)-VASc score, and right atrium thresholds were associated with SCAF. In multivariate regression analysis, CHA(2)DS(2)-VASc score, LA diameter, and atrial threshold values were found to be independent predictors of SCAF occurrence. According to this analysis, every 1 point increase in CHA(2)DS(2)-VASc score, every 1 mm increase in LA diameter, and every 0.1 V increase in atrial threshold increased the risk of SCAF by 32.5, 59.6, and 14.6%, respectively. In the ROC analysis, the area under the curve (AUC) was 0.870, 0.638, and 0,652 for LA diameter, CHA2DS2-VASc score, and atrial lead threshold, respectively (p < 0.05, for all). The cut-off values were 34 mm, 3, and 0.6 V for LA diameter, CHA2DS2-VASc score, and atrial lead threshold, respectively. Patients with CRT have significantly higher frequency of SCAF than the normal population. CHA(2)DS(2)-VASc score, LA diameter, and atrial threshold values were considered to be useful and easily applicable parameters in identifying the patients to develop SCAF.
