Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 31
Filter
1.
North Clin Istanb ; 9(2): 93-101, 2022.
Article in English | MEDLINE | ID: mdl-35582509

ABSTRACT

Objective: Warfarin therapy has some difficulties in terms of close monitoring and dosage. This study aims to evaluate the effect of same-fixed versus different-variable physician-based monitoring of warfarin therapy on treatment quality and clinical end-points. Methods: A total of 625 consecutive patients requiring warfarin treatment were enrolled at seven centers. INR values of the patients measured at each visit and registered to hospital database were recorded. Time in therapeutic range (TTR) was calculated using linear interpolation method (Rosendaal's method). A TTR value of ≥65% was considered as effective warfarin treatment. If a patient was evaluated by the same-fixed physician at each INR visit, was categorized into the same-physician (SP) group. In contrast, if a patient was evaluated by different-variable physicians at each INR visit, was categorized into variable physician (VP) group. Enrolled patients were followed up for bleeding and embolic events. Results: One hundred and fifty-six patients (24.9%) were followed by SP group, 469 (75.1%) patients were followed by VP group. Median TTR value of the VP group was lower than that of SP group (56.2% vs. 65.1%, respectively, p=0.009). During median 25.5 months (9-36) of follow-up, minor bleeding, major bleeding and cerebral embolic event rates were higher in VP group compared to SP group (p<0.001, p=0.023, p<0.001, respectively). In multivariate analysis, INR monitoring by VP group was found to be an independent predictor of increased risk of bleeding events (OR 2.55, 95% CI 1.64-3.96, p<0.001) and embolism (OR 3.42, 95% CI 1.66-7.04, p=0.001). Conclusion: INR monitoring by same physician was associated with better TTR and lower rates of adverse events during follow-up. Hence, it is worth encouraging an SP-based outpatient follow-up system at least for where warfarin therapy is the only choice.

2.
J Innov Card Rhythm Manag ; 12(9): 4682-4684, 2021 Sep.
Article in English | MEDLINE | ID: mdl-34595052

ABSTRACT

In equivocal or suspected cases of Brugada syndrome (BrS), ajmaline testing is frequently used in the diagnostic approach. However, the administration of sodium channel blockers can not only elicit the coved ST-segment elevation characteristic of type 1 Brugada pattern but also induce right bundle branch block (RBBB), which can preclude the electrocardiographic manifestations of BrS. We describe a case report wherein RBBB posed a diagnostic challenge during the ajmaline test for suspected BrS.

3.
Turk Kardiyol Dern Ars ; 49(6): 463-473, 2021 Sep.
Article in English | MEDLINE | ID: mdl-34523594

ABSTRACT

OBJECTIVE: The time in therapeutic range (TTR) of international normalized ratio (INR) is essential for the safety and efficacy of warfarin treatment. In this study, we aimed to determine TTR and the factors that affect TTR in patients using warfarin. METHODS: Patients taking warfarin for valvular and nonvalvular atrial fibrillation (AF) or prosthetic heart valves who were admitted to our cardiology outpatient clinic were enrolled. TTR was calculated using the linear interpolation method. The patients were analyzed according to warfarin indications and TTR efficiency (TTR ≥60%). Weekly warfarin dose, the duration of warfarin use, the frequency of INR visits per year, and the awareness of patients regarding target INR were noted. RESULTS: The TTR of 248 patients (aged 57.21±12.45 years, 33.1% male) was 55.92±27.84%, and 48.0% patients exhibited efficient TTR. Clinical and demographic characteristics (age, sex, socioeconomic status, and comorbidities) exerted no effect on TTR and TTR efficiency. The frequency of INR visits per year was 10.02±3.80. TTR was related to the frequency of annual INR visits (r=0.131, p=0.039). Only one-third (30.2%) of patients were aware of their target INR. The literacy of the patients and duration of warfarin use exerted a positive effect on awareness (p=0.011 and p=0.024, respectively). CONCLUSION: The findings of our study demonstrated that TTR and TTR efficiency were low and not associated with the characteristics of patients or indications. Unfortunately, in patients with valvular AF and prosthetic valves, warfarin is the sole drug that can be used. Thus, awareness and knowledge regarding target INR are essential to overcome poor anticoagulation monitoring with frequent INR visits.


Subject(s)
Anticoagulants/administration & dosage , Atrial Fibrillation/drug therapy , Medication Adherence , Warfarin/administration & dosage , Aged , Drug Administration Schedule , Female , Humans , International Normalized Ratio , Male , Middle Aged
4.
Heart Rhythm ; 17(8): 1312-1319, 2020 08.
Article in English | MEDLINE | ID: mdl-32302704

ABSTRACT

BACKGROUND: Positive T wave in lead aVR (TaVR) has been associated with increased risk of adverse events in patients with various cardiovascular diseases. OBJECTIVE: The purpose of this study was to investigate the prevalence and prognostic significance of positive TaVR in patients with hypertrophic cardiomyopathy (HCM). METHODS: This study investigated 421 consecutive patients with HCM (177 women; age 51.1 ± 14.9 years). Admission electrocardiogram was examined for the presence of a positive TaVR. The primary endpoint was defined as a composite of major arrhythmic events (MAEs), which included sudden cardiac death, sustained ventricular tachycardia or fibrillation, or appropriate implantable cardioverter-defibrillator therapy. Cardiovascular mortality and all-cause death were evaluated as secondary endpoints. RESULTS: During median follow-up period of 6.0 years (interquartile range 4.0-11.6 years), 53 patients (12.6%) experienced the primary endpoint. On multivariable competing analysis, after adjusting for other confounding factors, the presence of positive TaVR was found to be an independent and strong predictor of the primary composite endpoint. Time-dependent receiver operating characteristic analysis, net reclassification index, and integrated discrimination improvement showed that the addition of positive TaVR to conventional HCM risk factors improved prediction of arrhythmic events. However, in subgroup analysis, a positive TaVR lost statistical significance in patients with apical HCM but remained significant in patients with all other hypertrophy patterns. CONCLUSION: Positive TaVR is associated with MAE in HCM patients, independent of and incremental to traditional risk factors.


Subject(s)
Cardiomyopathy, Hypertrophic/complications , Defibrillators, Implantable , Electrocardiography , Tachycardia, Ventricular/physiopathology , Cardiomyopathy, Hypertrophic/mortality , Cardiomyopathy, Hypertrophic/physiopathology , Female , Humans , Male , Middle Aged , Retrospective Studies , Survival Rate/trends , Tachycardia, Ventricular/etiology , Tachycardia, Ventricular/therapy , Turkey/epidemiology
5.
Medicine (Baltimore) ; 99(11): e19524, 2020 Mar.
Article in English | MEDLINE | ID: mdl-32176104

ABSTRACT

The clinical significance of poor nutritional status in patients with peripartum cardiomyopathy (PPCM) is not clearly understood. Prognostic nutritional index (PNI) is a simple nutritional assessment tool, which was first demonstrated to be valuable in patients with colorectal surgeries. We aimed to investigate the predictive value of PNI in patients with PPCM.A total of 92 patients diagnosed with PPCM were enrolled in this study. PNI was calculated using the following formula: 10 × serum albumin value (g/dL) + 0.005 × total lymphocyte count. The primary endpoint was defined as composite adverse cardiac events that included cardiac death or hospitalization due to worsening heart failure (HF). Cardiac death, hospitalization due to worsening HF, and persistent left ventricular (LV) systolic dysfunction were evaluated, respectively, as secondary endpoints.Primary composite endpoint was higher in the lower PNI group. After adjusting for other risk factors, PNI was found to be as an independent predictor of primary composite endpoint (odds ratio 0.805; 95% confidence interval 0.729-0.888; P < .001). In addition, PNI was significantly associated with secondary endpoints; persistent LV systolic dysfunction as well as cardiac death.This study identified nutritional status assessed by the PNI seems to be a novel predictor of adverse cardiovascular outcomes in patients with PPCM.


Subject(s)
Cardiomyopathies/diagnosis , Nutritional Status , Prenatal Diagnosis , Puerperal Disorders/diagnosis , Adult , Biomarkers , Cardiomyopathies/blood , Cardiomyopathies/mortality , Cardiomyopathies/physiopathology , Female , Humans , Predictive Value of Tests , Pregnancy , Puerperal Disorders/blood , Puerperal Disorders/mortality , Puerperal Disorders/physiopathology , Risk Factors , Survival Analysis
6.
Biomark Med ; 14(3): 201-210, 2020 02.
Article in English | MEDLINE | ID: mdl-31912743

ABSTRACT

Aim: This study sought to investigate the predictive value of whole blood viscosity (WBV) to identify high-risk patients who will develop an apical thrombus during the acute phase of anterior transmural infarction. Materials & methods: Consecutive 1726 patients with first acute anterior myocardial infarction were evaluated. WBV was calculated according to the Simone's formula. Results: Patients with an apical thrombus had prolonged pain to balloon time, higher rate of post-PCI thrombolysis in myocardial infarction flow ≤1 and significantly higher mean WBV values at both shear rates than those without an apical thrombus. Conclusion: WBV values at both shear rates were found to be significant and independent predictors for early LV apical thrombus formation complicating a first-ever anterior wall myocardial infarction.


Subject(s)
Anterior Wall Myocardial Infarction/blood , Anterior Wall Myocardial Infarction/complications , Blood Viscosity , Thrombosis/complications , Anterior Wall Myocardial Infarction/therapy , Cohort Studies , Female , Humans , Male , Middle Aged , Percutaneous Coronary Intervention , ROC Curve , Retrospective Studies
7.
Ann Noninvasive Electrocardiol ; 25(3): e12719, 2020 05.
Article in English | MEDLINE | ID: mdl-31609051

ABSTRACT

BACKGROUND: Noncompaction cardiomyopathy (NCCM) is a relatively rare cardiac abnormality with high rates of mortality and morbidity. T-wave amplitudes during ventricular repolarization in lead aVR (TaVR) have been reported to be associated with the prognosis of various cardiovascular diseases. This study sought to investigate the prevalence and prognostic role of positive TaVR in patients with NCCM. METHODS: We evaluated consecutive 161 patients with NCCM (65.8% men, mean age 42.5 ± 15.2 years old). Presentation electrocardiogram was assessed regarding classical parameters as well as T-wave amplitudes in lead aVR. The primary endpoint was defined as composite lethal arrhythmic events, including sudden cardiac death, ventricular fibrillation, or sustained ventricular tachycardia or appropriate implantable cardioverter-defibrillator shock. Heart failure requiring hospitalization, cardiovascular death, and all-cause mortality were also investigated as secondary endpoints. RESULTS: Patients with positive TaVR showed higher rates for arrhythmic events, hospitalization for heart failure, and death compared with patients without it. In multivariate Cox model, after adjusting for other known clinical and electrocardiographic risk factors, the positive TaVR was found to be a strong independent predictor of primary endpoint (HR: 4.8, 95% CI: 1.2-19.3; p = .025) and all-cause death (HR: 3.5, 95% CI: 1.0-12.1; p = .045). CONCLUSION: Our findings revealed that positive TaVR is significantly and independently associated with adverse outcomes in NCCM patients. This unique ECG criterion in the often ignored lead provides incremental information beyond what is available with other traditional risk factors.


Subject(s)
Cardiomyopathies/complications , Death, Sudden, Cardiac , Electrocardiography/methods , Heart Failure/diagnosis , Tachycardia, Ventricular/diagnosis , Ventricular Fibrillation/diagnosis , Adult , Cardiomyopathies/physiopathology , Defibrillators, Implantable , Electrocardiography/statistics & numerical data , Female , Heart/physiopathology , Heart Failure/complications , Heart Failure/physiopathology , Humans , Male , Retrospective Studies , Risk Assessment , Risk Factors , Tachycardia, Ventricular/complications , Tachycardia, Ventricular/physiopathology , Ventricular Fibrillation/complications , Ventricular Fibrillation/physiopathology
8.
Ann Noninvasive Electrocardiol ; 25(3): e12708, 2020 05.
Article in English | MEDLINE | ID: mdl-31587432

ABSTRACT

BACKGROUND: Fragmented QRS (fQRS) complex, with various morphology, has been recently described as a diagnostic criterion of several cardiac diseases. However, there are little data regarding the prognostic role of fQRS in peripartum cardiomyopathy (PPCM) patients. We aimed to investigate the effect of fQRS on predicting left ventricular (LV) nonrecovery in patients with peripartum cardiomyopathy (PPCM). METHODS: Ninety patients (mean age: 34.7 ± 6.5 years) with the diagnosis of PPCM were analyzed retrospectively. The median follow-up period of was 67.0 (12.0-192.0) months. Fragmented QRS was defined as the presence of various RSR' patterns (QRS duration < 120 ms) with or without Q wave, which include an additional R wave (R' prime) or notching of the R wave or S wave, or the presence of more than one R' (fragmentation) without typical bundle branch block. Recovery of LV function was defined as the presence of LV ejection fraction (EF) >45%. RESULTS: Of the patients, 54 (60%) did not recover LV function at the last follow-up visit (nonrecovery group), while 36 of the patients (40%) exhibited LV recovery (recovery group). LV ejection fraction (EF) and fQRS were identified as independent predictors of LV nonrecovery in patients with PPCM (odds ratio OR: 5.546, 95% confidence interval CI: 0.792-0.979, p = .019 and OR: 5.986, 95% CI: 1.313-11.787, p = .014, respectively). CONCLUSION: Our data firstly indicated that presence of fQRS was a significant predictor of LV nonrecovery in patients with PPCM. The fQRS might assist in identifying high-risk patients.


Subject(s)
Cardiomyopathies/diagnosis , Electrocardiography/methods , Pregnancy Complications, Cardiovascular/diagnosis , Puerperal Disorders/diagnosis , Ventricular Dysfunction, Left/diagnosis , Adult , Cardiomyopathies/physiopathology , Female , Follow-Up Studies , Heart Ventricles/physiopathology , Humans , Peripartum Period , Pregnancy , Pregnancy Complications, Cardiovascular/physiopathology , Puerperal Disorders/physiopathology , Retrospective Studies , Risk Assessment , Ventricular Dysfunction, Left/physiopathology
9.
Biomark Med ; 13(15): 1307-1320, 2019 10.
Article in English | MEDLINE | ID: mdl-31429589

ABSTRACT

Aim: This study sought to investigate the predictive value of estimated whole blood viscosity (WBV) for stent thrombosis (ST) in ST-elevation myocardial infarction (STEMI) patients who underwent percutaneous coronary intervention. Materials & methods: A total of 1720 STEMI patients treated with primary percutaneous coronary intervention were followed up for median 36.0 months. WBV was calculated according to the Simone's formula. Results: During follow-up period, 119 patients were diagnosed as 'definite' ST. The rate of ST was significantly higher in the high WBV group. In multivariate analysis, adjusted for other factors, higher WBV significantly increased risk of ST at both shear rates. Conclusion: Being an easily accessible and costless parameter, WBV seems to be an emerging predictor of ST in patients with STEMI.


Subject(s)
Blood Viscosity , ST Elevation Myocardial Infarction/therapy , Stents/adverse effects , Thrombosis/blood , Thrombosis/etiology , Female , Humans , Male , Middle Aged , Percutaneous Coronary Intervention/adverse effects , Prognosis , Thrombosis/diagnosis
10.
Biomark Med ; 13(14): 1175-1186, 2019 10.
Article in English | MEDLINE | ID: mdl-31364861

ABSTRACT

Aim: The aim of the study was to investigate the monocyte count to HDL cholesterol ratio (MHR) on the prognosis of patients with hypertrophic cardiomyopathy (HCM). Materials & methods: A total of 411 patients with HCM were assessed. The primary end point was cardiovascular death or malignant arrhythmic events. Results: During the follow-up, primary end point was developed in 54 (13.1%) patients. Receiver operating characteristic (ROC) analysis showed that using a cut-off level of 14.57, MHR predicted the occurrence of primary end point with a sensitivity of 72% and specificity of 72%. In the multivariate model, high MHR was the only significant predictor of the primary end point. Conclusion: This study showed that higher MHR level is an independent predictor of malignant arrhythmia and death in patients with HCM.


Subject(s)
Cardiomyopathy, Hypertrophic/diagnosis , Cholesterol, HDL/blood , Monocytes/cytology , Cardiomyopathy, Hypertrophic/blood , Cardiomyopathy, Hypertrophic/immunology , Cell Count , Female , Humans , Male , Middle Aged , Prognosis
11.
Ann Noninvasive Electrocardiol ; 24(3): e12631, 2019 05.
Article in English | MEDLINE | ID: mdl-30653267

ABSTRACT

BACKGROUND: Peripartum cardiomyopathy (PPCM) is an uncommon complication of pregnancy. Clinical courses of PPCM are markedly heterogeneous. Positive T waves in lead aVR (TaVR) are shown to be associated with adverse cardiac events in several cardiovascular diseases. We aimed to investigate the prevalence and prognostic role of positive TaVR in patients with PPCM. METHODS: A total of 82 patients (mean age 29.1 ± 6.3 years) with the diagnosis of PPCM were enrolled. Presentation electrocardiogram (ECG) was investigated for presence of a positive TaVR. The median follow-up duration was 67.0 months. The primary endpoint was defined as composite cardiac events, including cardiac death, arrhythmic events, or persistent left ventricular systolic dysfunction. RESULTS: Patients with positive T wave in lead aVR showed higher rates for persistent left ventricular systolic dysfunction, arrhythmic events, and cardiac death compared to patients without it. In multivariate logistic regression analysis, after adjusting for other confounding factors, the presence of positive TaVR was found to be as an independent and strong predictor of primary composite endpoint (odds ratio 6.21, 95% CI 1.45-26.51; p = 0.014). In Kaplan-Meier survival analysis, both primary and secondary endpoints occurred more frequently in the positive TaVR group. Using the cut-off level of 0.25 mV, T-wave amplitude in lead aVR predicted primary endpoint with a sensitivity of 100% and specificity of 100%. CONCLUSION: Positive T wave in lead aVR, as a simple and feasible electrocardiographic marker, seems to be a novel predictor of adverse cardiovascular outcomes in patients with PPCM.


Subject(s)
Cardiomyopathies/diagnostic imaging , Echocardiography/methods , Electrocardiography/methods , Peripartum Period , Pregnancy Complications, Cardiovascular/diagnostic imaging , Ventricular Dysfunction, Left/diagnostic imaging , Adult , Cardiomyopathies/epidemiology , Cardiomyopathies/physiopathology , Cohort Studies , Female , Humans , Kaplan-Meier Estimate , Logistic Models , Pregnancy , Prognosis , ROC Curve , Retrospective Studies , Severity of Illness Index , Statistics, Nonparametric , Stroke Volume , Survival Rate , Ventricular Dysfunction, Left/epidemiology , Ventricular Dysfunction, Left/physiopathology , Young Adult
12.
Cardiovasc J Afr ; 29(5): 278-282, 2018.
Article in English | MEDLINE | ID: mdl-30395141

ABSTRACT

OBJECTIVE: Since visual estimation of the extent of vessel stenosis may vary between operators, we aimed in this study to investigate both inter-observer variability and consistency between the estimation of an operator and quantitative coronary analysis (QCA) measurements. METHODS: A total of 147 elective percutaneous coronary intervention patients with 155 lesions between them were consecutively enrolled in the study. These patients were evaluated for visual estimation of lesion severity by three operators. The lesions were also evaluated with QCA by an operator who was blinded to the visual assessments. Reference diameter, minimal lumen diameter, percentage diameter of stenosis, percentage area of stenosis and diameter of lesion length from the proximal lesion-free segment to the distal lesion-free segment were calculated using a computerised QCA software program. RESULTS: There was a moderate degree of concordance in the categories 70-89% (κ: 0.406) and 90-99% (κ: 0.5813), whereas in the categories < 50% and 50-69% there was a low degree of concordance between the visual operators (κ: 0.323 and κ: 0.261, respectively). There was a low to moderate grade of concordance between visual estimation and percentage area of stenosis by QCA (κ: 0.30) but there was no concordance between visual estimation and percentage diameter of stenosis by QCA (κ: -0.061). Also, there was a statistically significant difference between QCA parameters of percentage diameter of stenosis and percentage area of stenosis (58.4 ± 14.5 vs 80.6 ± 11.2 %, p < 0.001). CONCLUSIONS: Visual estimation may overestimate a coronary lesion and may lead to unnecessary coronary intervention. There was low concordance in the categories < 50% and 50-69% between the visual operators. Percentage area of stenosis by QCA had a low to moderate grade of concordance with visual estimation. Percentage area of stenosis by QCA more closely reflected the visual estimation of lesion severity than percentage diameter of stenosis.


Subject(s)
Coronary Angiography/methods , Coronary Artery Disease/diagnostic imaging , Coronary Stenosis/diagnostic imaging , Coronary Vessels/diagnostic imaging , Radiographic Image Interpretation, Computer-Assisted/methods , Visual Perception , Adult , Aged , Aged, 80 and over , Coronary Artery Disease/surgery , Coronary Stenosis/surgery , Coronary Vessels/surgery , Female , Humans , Judgment , Male , Middle Aged , Observer Variation , Percutaneous Coronary Intervention , Predictive Value of Tests , Reproducibility of Results , Retrospective Studies , Severity of Illness Index
13.
Angiology ; 69(5): 400-405, 2018 May.
Article in English | MEDLINE | ID: mdl-28893082

ABSTRACT

We evaluated the efficacy and safety of the fixed dose of 5000 IU unfractionated heparin (UFH) represented as peak activated clotting time (ACT) according to the body mass index (BMI) tertiles in patients undergoing diagnostic transradial coronary angiography (TRCA). A total of 422 patients were included in the present study, 84 in the normal weight group, 218 in the overweight group, and the 120 in the grades 1 and 2 obesity groups. Radial artery occlusion (RAO) was observed in 29 (6.8%) patients and the hematoma was observed in 43 (10.1%) patients. The rate of RAO and hematoma did not differ across the BMI tertiles ( P = .749 and P = .066). Also, peak ACT and procedure duration did not differ between the study groups ( P = .703 and P = .999). The only independent predictor of hematoma was sheath/radial artery diameter ( P = .011) and the independent predictors for RAO were peak ACT, sheath/radial artery diameter, and procedure duration ( P = .001, P = .028, and P < .001, respectively). In conclusion, a fixed dose of 5000 IU UFH is safe and effective regardless of the BMI in diagnostic TRCA procedure.


Subject(s)
Arterial Occlusive Diseases/etiology , Coronary Angiography/adverse effects , Hematoma/etiology , Obesity/complications , Radial Artery , Whole Blood Coagulation Time , Adult , Aged , Aged, 80 and over , Arterial Occlusive Diseases/diagnosis , Body Mass Index , Female , Fibrinolytic Agents/therapeutic use , Hematoma/diagnosis , Heparin/therapeutic use , Humans , Male , Middle Aged , Sensitivity and Specificity
14.
Indian Heart J ; 69(3): 355-356, 2017.
Article in English | MEDLINE | ID: mdl-28648433

ABSTRACT

Atrial septal defect closure is now routinely performed using a percutaneous approach under echocardiographic guidance. Since some echocardiographic features play an important role in the assessment of the defect and safety of the procedure, the salient features of the anatomical variations seen in adults undergoing transcatheter device closure should be well known to prevent inadvertent adverse effect or complications. It has been reported that the valve of the inferior vena cava, Eustachian valve, could be mistaken as the atrial septum thus ending in a wrong diagnosis and causing inadvertent surgical or percutaneous closure of an Eustachian valve to interatrial septum. We present a concise article that brings out a practical issue encountered during device closure of atrial septal defects.


Subject(s)
Atrial Septum/diagnostic imaging , Echocardiography, Transesophageal/methods , Heart Atria/diagnostic imaging , Heart Septal Defects, Atrial/diagnosis , Vena Cava, Inferior/diagnostic imaging , Cardiac Catheterization/methods , Diagnosis, Differential , Humans , Preoperative Period
15.
J Infect Public Health ; 10(6): 721-724, 2017.
Article in English | MEDLINE | ID: mdl-28162963

ABSTRACT

The relationship between atrial fibrillation and human immunodeficiency virus (HIV) infection was evaluated. Electro-echocardiographic methods can be used to predict the development of atrial fibrillation (AF). In this study, we aimed to investigate the atrial electromechanical delay (AEMD) parameters of HIV (+) patients. Forty-two HIV (+) patients and 40 HIV (-) healthy volunteers were prospectively enrolled in this study. The electromechanical properties of the subjects' atria were evaluated with tissue Doppler imaging. The left-AEMD, right-AEMD and inter-AEMD were increased in the HIV (+) patients relative to the controls (p=0.003, p<0.001, and p<0.001, respectively). The CD4 count was inversely correlated with the inter-AEMD (r=-0.428, p<0.001). The CD4 count was an independent predictor of the inter-AEMD (ß=0.523, p=0.007). Our study demonstrated that both the inter- and intra-atrial electromechanical delays were prolonged in the patients with HIV. This non-invasive and simple technique may provide significant contributions to the assessment of the risk of atrial arrhythmia in patients with HIV.


Subject(s)
Atrial Fibrillation/epidemiology , Electrophysiological Phenomena , HIV Infections/complications , Mechanical Phenomena , Adult , Atrial Fibrillation/diagnostic imaging , Echocardiography, Doppler , Female , Humans , Male , Prospective Studies , Risk Assessment
17.
Pharmacology ; 99(1-2): 19-26, 2017.
Article in English | MEDLINE | ID: mdl-27654487

ABSTRACT

AIM: We aimed to evaluate the effect of echocardiographically demonstrated right ventricular dysfunction (RVD) on time in therapeutic range (TTR) in heart failure (HF) patients receiving warfarin therapy. METHODS: A total of 893 consecutive HF patients were included and classified into 4 different subgroups: HF with preserved ejection fraction (HFpEF) without RVD (n = 373), HF with reduced EF (HFrEF) without RVD (n = 215), HFpEF with RVD (n = 106) and HFrEF with RVD (n = 199). Groups were compared according to baseline, demographic and clinical data and the characteristics of warfarin therapy. RESULTS: Presence of RVD yielded lower median TTR values both in HFpEF and HFrEF patients. RVD, current smoking, New York Heart Association functional class III/IV, hypertension, diabetes mellitus, pulmonary disease, prior transient ischemic attack or stroke, chronic kidney disease (CKD) stage 4/5 and CKD stage 3 were found to be independent predictors of poor anticoagulation control in multivariate logistic regression analysis. CONCLUSIONS: The present study demonstrated that presence of RVD in HF increases the risk for poor anticoagulation.


Subject(s)
Anticoagulants/therapeutic use , Heart Failure/diagnostic imaging , Heart Failure/drug therapy , Ventricular Dysfunction, Right/diagnostic imaging , Ventricular Dysfunction, Right/drug therapy , Warfarin/therapeutic use , Adult , Aged , Cross-Sectional Studies , Female , Heart Failure/physiopathology , Humans , Male , Middle Aged , Time Factors , Ventricular Dysfunction, Right/physiopathology
18.
Indian Heart J ; 68 Suppl 2: S226-S227, 2016 Sep.
Article in English | MEDLINE | ID: mdl-27751297

ABSTRACT

Prediction of left main coronary artery (LMCA) or equivalent disease is important with regard to selecting the appropriate treatment strategy. The classical electrocardiographic pattern of LMCA disease includes ST elevation (STE) in lead aVR in the presence of extensive ST depression (most prominent in leads I, II, and V4-6) with the STE in aVR≥V1. Patients with these findings may potentially require early coronary angiography and coronary bypass surgery; therefore selected patients with these findings on exercise testing might benefit from more urgent or expedited angiography.


Subject(s)
Coronary Stenosis/diagnosis , Coronary Vessels/physiopathology , Electrocardiography/methods , Coronary Angiography , Coronary Stenosis/physiopathology , Coronary Vessels/diagnostic imaging , Exercise Test , Humans
19.
Am J Cardiol ; 118(10): 1455-1459, 2016 Nov 15.
Article in English | MEDLINE | ID: mdl-27645762

ABSTRACT

Although heparin administration has reduced the incidence of radial artery occlusion (RAO) during the transradial coronary angiography (TRCA), the effective activated clotting time (ACT) value for guiding unfractionated heparin dosing in patients undergoing TRCA is unknown. Four hundred thirty-two patients who were scheduled for elective TRCA were enrolled in our prospective study. All the patients received a standard dose of 5,000 IU unfractionated heparin. Anticoagulation level was assessed by ACT measurements that were taken at the end of the procedure just before the sheath removal. The day after TRCA, all patients were evaluated by color Doppler ultrasound to detect RAO. RAO was found in 29 patients (6.7%). A median ACT of 205 seconds in the RAO group and 265 seconds in the radial artery patent group were detected (p <0.001). Mean procedure duration was significantly longer in the RAO group than in the radial artery patent group (18.55 ± 9.80 vs 11.24 ± 7.07 minutes, p <0.001). There was a negative correlation between end-procedural ACT and procedure duration (r = -0.117, p = 0.015). In multivariate analysis, end-procedural ACT (odds ratio 0.981, 95% confidence interval [CI] 0.972 to 0.989, p <0.001), procedure duration (odds ratio 1.076, 95% CI, 1.037 to 1.116, p <0.001), and radial artery diameter (odds ratio 0.240, 95% CI 0.063 to 0.907, p = 0.035) were found as independent predictors of RAO. In conclusion, shorter end-procedural ACT levels, longer procedural duration, and smaller radial arterial diameter were independently associated with RAOs after TRCA with standard-dose heparin. In prolonged procedures, ACT-based heparin dosing may be useful to overcome RAO.


Subject(s)
Arterial Occlusive Diseases/diagnosis , Blood Coagulation/drug effects , Cardiac Catheterization/methods , Coronary Angiography/methods , Heparin/administration & dosage , Adolescent , Adult , Aged , Aged, 80 and over , Arterial Occlusive Diseases/epidemiology , Arterial Occlusive Diseases/prevention & control , Coronary Artery Disease/diagnosis , Cross-Sectional Studies , Dose-Response Relationship, Drug , Follow-Up Studies , Humans , Incidence , Middle Aged , Prognosis , Prospective Studies , Radial Artery , Time Factors , Turkey/epidemiology , Ultrasonography, Doppler, Color , Young Adult
20.
Indian Heart J ; 68 Suppl 1: S10-4, 2016 Apr.
Article in English | MEDLINE | ID: mdl-27056647

ABSTRACT

BACKGROUND: Heart failure (HF) is a common, progressive, complex clinical syndrome and a subset of HF patients has symptoms out of proportion to the resting hemodynamics and left ventricular ejection fraction (LVEF). Right ventricular (RV) function is a powerful prognostic factor in HF, but assessing it is a challenge because of the right ventricle's complex geometry. OBJECTIVE: The aim of this study was to investigate the clinical application value of RV outflow tract (RVOT) function measured by transthoracic echocardiography in HF patients. METHOD: We prospectively investigated 36 chronic HF patients with dilated heart and LV systolic dysfunction and 21 healthy control subjects (normal ventricular function and ECG, and no cardiac risk factors). In addition to clinical and conventional echocardiographic parameters, RVOT size and fractional shortening (RVOT-FS) parameters were analyzed. RESULTS: The RVOT-FS was less in HF patients than healthy controls (18.8±15.7 vs 55.8±6.7, p<0.001) and correlated positively with TAPSE (r=0.814, p<0.001) and inversely with SPAP (r=-0.728, p<0.001) and functional capacity (r=-0.842, p<0.001). There was a statistically significant difference in RVOT-FS among the HF subgroups with regard to NYHA functional capacity (p<0.001), although there was no statistically significant difference with regard to LVEF. CONCLUSION: Although the apparent discordance between LVEF and the degree of functional impairment in HF is not well understood, it may be explained in part by alterations in RV function. We found that the RVOT-FS was a noninvasive and easily applicable measure of RV function and might be used for a comprehensive evaluation and follow-up of HF patients with a combined assessment of RV by other RV parameters.


Subject(s)
Heart Failure/physiopathology , Ventricular Dysfunction, Right/physiopathology , Ventricular Function, Right/physiology , Ventricular Outflow Obstruction/complications , Echocardiography , Heart Failure/diagnosis , Heart Failure/etiology , Heart Ventricles/physiopathology , Humans , Stroke Volume , Ventricular Dysfunction, Right/diagnosis , Ventricular Dysfunction, Right/etiology , Ventricular Outflow Obstruction/diagnosis , Ventricular Outflow Obstruction/physiopathology
SELECTION OF CITATIONS
SEARCH DETAIL