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1.
Turk Kardiyol Dern Ars ; 50(2): 117-123, 2022 03 01.
Article in English | MEDLINE | ID: mdl-35400633

ABSTRACT

OBJECTIVE: Safety and effectiveness of edoxaban was demonstrated in phase III, Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48 (ENGAGE-AF-TIMI 48) trial and is being confirmed in the post-authorization Edoxaban Treatment in routiNe clinical prActice for patients with Atrial Fibrillation in Europe (ETNA-AF-Europe) study in patients with atrial fibrillation. However, any post-authoriza tion safety study focusing on the safety of edoxaban treatment in Turkey with a prospective design has not been performed yet. The Evaluation of Treatment Safety in Patients with Atrial Fibrillation on Edoxaban Therapy in Real-Life in Turkey (ETAF-TR) study is designed to evaluate the safety and effectiveness of edoxaban treatment in atrial fibrillation in routine practice. The present article describes the design and rationale for the ETAF-TR Study. METHODS: The ETAF-TR (NCT04594915) is a national, multicenter, prospective, observational study that enrolled 858 patients from 32 centers. The primary outcome of the ETAF-TR study is any overt bleeding (consisting of major bleeding or clinically relevant nonmajor bleeding or any bleeding that does not meet this definition but is considered as overt bleeding by the par ticipating physician). Effectiveness, treatment persistence, and posology will also be evaluated in an explorative manner. The overall duration of follow-up will be 1 year; the first patient was enrolled in August 2020. CONCLUSIONS: Results of ETAF-TR will add data from clinical practice to those from ENGAGE-AF trial and also ETNA-AF study. Comparing their results will enable to test the external validity of ENGAGE-AF trial in the country conditions.


Subject(s)
Atrial Fibrillation , Stroke , Anticoagulants/adverse effects , Atrial Fibrillation/chemically induced , Atrial Fibrillation/drug therapy , Factor Xa Inhibitors/adverse effects , Humans , Prospective Studies , Pyridines , Stroke/drug therapy , Stroke/prevention & control , Thiazoles , Treatment Outcome , Turkey/epidemiology
2.
Turk Kardiyol Dern Ars ; 49(8): 630-640, 2021 Dec.
Article in English | MEDLINE | ID: mdl-34881702

ABSTRACT

OBJECTIVE: The D-SPIRIT registry is designed to investigate the safety and effectiveness of dabigatran etexilate in patients with atrial fibrillation in routine clinical practice. METHODS: D-SPIRIT is the first national, multicenter, prospective, observational, postmarketing registry that investigates the usage of dabigatran in real life. A total of 326 noveloral anticoagulant-eligible patients with atrial fibrillation who have been taking dabigatran etexilate therapy for stroke prevention at least 6 months from 9 different centers were enrolled into the registry. Patients were followed up for 2 years to evaluate the effectiveness and safety of the treatment. All adverse clinical events including bleeding, thromboembolic events, stroke, systemic embolism, transient ischemic attack, myocardial infarction, and all-cause death were recorded. RESULTS: The mean age was 71.1±9.6 years, and 57.4% of the study participants were female. The mean CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack [TIA], vascular disease, age 65-74 years, sex category) score was 3.4±1.6. The cumulative adverse clinical events rate was 6.30% per year. The rate for embolic events including TIA, ischemic stroke, and peripheral embolism was 1.26% per year. The rate for major bleeding was 2.20% per year, and the mortality rate was 0.94% per year. CONCLUSION: This registry obtained an important overview of the current safety and effectiveness of the dabigatran etexilate in Turkey. Our results indicate similar rates of thromboembolic and bleeding events with pivotal phase 3 trial and other real-life registries. However, rate of undertreatment usage of dabigatran etexilate in real life was found to be considerable.


Subject(s)
Antithrombins/therapeutic use , Atrial Fibrillation/complications , Dabigatran/therapeutic use , Stroke/prevention & control , Age Factors , Aged , Antithrombins/administration & dosage , Antithrombins/adverse effects , Cause of Death , Dabigatran/administration & dosage , Dabigatran/adverse effects , Diabetes Mellitus/epidemiology , Embolism/epidemiology , Female , Heart Failure/epidemiology , Hemorrhage/chemically induced , Humans , Hypertension/epidemiology , Ischemic Attack, Transient/epidemiology , Male , Myocardial Infarction/epidemiology , Product Surveillance, Postmarketing , Prospective Studies , Registries , Sex Factors , Stroke/epidemiology , Stroke/etiology , Thromboembolism/epidemiology , Turkey/epidemiology
4.
Turk Kardiyol Dern Ars ; 47(8): 662-668, 2019 Dec.
Article in English | MEDLINE | ID: mdl-31802765

ABSTRACT

OBJECTIVE: Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is a new term to define the syndrome of clinical evidence of MI occurring in the absence obstructive coronary artery disease. Given that there is believed to be a large number of MINOCA cases, effective diagnostic and therapeutic strategies are needed. Documentation of the demographic parameters and diagnostic methods used in existing cases is a first step. The purpose of this study is documentation of the prevalence, demographic details, and possible etiological causes, as well as inpatient and 1-year prognosis data of MINOCA patients in the Turkish population. METHODS: The MINOCA-TR Study is a national, multi-center, prospective, observational study. A sample of 1028 conse-cutive MI patients who undergo diagnostic angiography will be enrolled. This is a cohort study that will include patients from 32 different centers. After an initial screening/enrollment visit, follow-up will be performed at the time of hospital discharge for the overall MI study population. Patients diagnosed as MINOCA will be followed up with 3 prospective office or telephone visits as part of the Prospective MINOCA Registry. CONCLUSION: Demographic information, clinical characteristics, management strategies, and inpatient prognostic indicators will be documented in the cross-sectional portion of the registry. Additional diagnostic data, therapeutic strategies, and prognostic relevance will be recorded in the 12 months of the prospective research. The results are expected to inform future diagnostic and therapeutic strategies and enhance understanding of the condition by highlighting the national burden of the disease from a medical and a public health perspective, as well as stimulate future research focusing on the MINOCA population.


Subject(s)
Epidemiologic Research Design , Myocardial Infarction , Coronary Vessels/physiology , Humans , Myocardial Infarction/epidemiology , Myocardial Infarction/physiopathology , Prevalence , Prospective Studies , Turkey
5.
Turk Kardiyol Dern Ars ; 47(1): 53-56, 2019 01.
Article in English | MEDLINE | ID: mdl-30628901

ABSTRACT

Cardiac implantable electronic devices include remote monitoring tools intended to guide heart failure management. These tools allow for observation of some physiological functions, such as intrathoracic impedance (ITI), patient activity (PA), and heart rate variability (HRV). Sacubitril/valsartan is recommended in the current guidelines as foundational therapy for patients with heart failure and reduced ejection fraction. However, the effects of sacubitril/valsartan treatment on these physiological parameters remain unclear. To the best of our knowledge, this is the first case objectively documenting improvements in ITI, PA, and HRV values with sacubitril/valsartan treatment.


Subject(s)
Aminobutyrates/therapeutic use , Angiotensin Receptor Antagonists/therapeutic use , Defibrillators, Implantable , Drug Monitoring , Monitoring, Ambulatory , Tetrazoles/therapeutic use , Aminobutyrates/pharmacology , Angiotensin Receptor Antagonists/pharmacology , Biphenyl Compounds , Cardiography, Impedance/drug effects , Drug Combinations , Drug Monitoring/instrumentation , Drug Monitoring/methods , Heart Rate/drug effects , Humans , Male , Middle Aged , Monitoring, Ambulatory/instrumentation , Monitoring, Ambulatory/methods , Motor Activity/drug effects , Tetrazoles/pharmacology , Valsartan
7.
Turk Kardiyol Dern Ars ; 44(3): 221-7, 2016 Apr.
Article in English | MEDLINE | ID: mdl-27138311

ABSTRACT

OBJECTIVE: The D-SPIRIT registry is designed to investigate the safety and efficacy of dabigatran etexilate in patients with nonvalvular atrial fibrillation (NVAF) and to collect data on outcomes in clinical practice. METHODS: The D-SPIRIT is a national, prospective, observational, post-marketing registry involving patients with NVAF who have been taking dabigatran etexilate therapy for stroke prevention for a minimum of 6 months prior to enrollment. The registry will collect and analyze data from routine care, enrolling up to 600 patients in 9 centers. Patients will be followed up for 2 years to evaluate effectiveness and safety. A sample size of 600 subjects is proposed based on the following assumptions; Two-sided significance level of 0.05 (1-sided significance level of 0.025), ischemic stroke incidence rate of 0.768%-1.111%, hemorrhagic stroke incidence rate of 0.109%-0.130%, transient ischemic attack incidence rate of 0.722%-0.623%, therapy discontinuation incidence rate of 40% at day 730, and duration of enrollment period of 12 months with non-uniformed enrollment rate. Ethics approval was given by Dokuz Eylül University Ethics Committee of Clinical Research (2014/54) and approved by the Turkish Ministry of Health. CONCLUSION: Potential results of D-SPIRIT registry will add data from clinical practice to those from the RE-LY trial to expand knowledge of dabigatran etexilate treatment in patients with NVAF.


Subject(s)
Antithrombins/therapeutic use , Dabigatran/therapeutic use , Epidemiologic Research Design , Registries , Stroke , Adult , Female , Humans , Male , Middle Aged , Prospective Studies , Stroke/drug therapy , Stroke/epidemiology , Stroke/prevention & control , Turkey/epidemiology
8.
Cardiol J ; 22(5): 567-75, 2015.
Article in English | MEDLINE | ID: mdl-26100825

ABSTRACT

BACKGROUND: Warfarin is highly efficacious in reducing stroke risk in patients with atrial fibrillation (AF). However, its safety and efficacy in stroke prevention is markedly influenced by its time in therapeutic range (TTR). The quality of anticoagulant therapy varies considerably among countries. Representative data concerning the quality of anticoagulant therapy and its effects on clinical outcomes in Turkey are lacking. METHODS: Warfarin in Therapeutic Range (WATER) registry is a prospective, observational study which followed 572 AF patients (mean age 67.3 ± 12 years; females 60%; 71% non-valvular AF) treated with warfarin. RESULTS: At a median of 22-month follow-up, the mean TTR value was 42.3 ± 18% (median: 40%) for the whole population and lower in non-valvular AF su group than valvular AF subgroup (40.3 ± 18 vs. 46.9 ± 19, respectively, p < 0.001). Death, cardiac hospital-ization and minor bleeding rates were higher in the group with TTR value < 40% than the group with > 40% (3.4% vs. 5.9%; 28.6% vs. 35.4%; 36.5% vs. 41.7%, respectively, all of them p < 0.001). A correlation analysis showed a negative correlation between age and TTR value (r = -0.178, p < 0.001). Mean CHA2DS2VASc score was 3.63 ± 1.5 and mean HASBLED score was 2.38 ± 1.01 in the non-valvular AF group. A negative correlation was observed between TTR levels and CHA2DS2VASc score. CONCLUSIONS: WATER provides insight into the anticoagulation control status of AF patients in Turkey. The quality of anticoagulation was poor. Strategies should be undertaken by clinicians and patients to improve TTR. New oral anticoagulant agents may be perfect alternatives for non-valvular AF patients.


Subject(s)
Anticoagulants/therapeutic use , Atrial Fibrillation/drug therapy , Blood Coagulation/drug effects , Drug Monitoring/methods , International Normalized Ratio , Stroke/prevention & control , Warfarin/therapeutic use , Aged , Anticoagulants/adverse effects , Atrial Fibrillation/blood , Atrial Fibrillation/complications , Atrial Fibrillation/diagnosis , Atrial Fibrillation/mortality , Female , Hemorrhage/chemically induced , Hospitalization , Humans , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Quality Indicators, Health Care , Registries , Risk Factors , Stroke/etiology , Stroke/mortality , Time Factors , Treatment Outcome , Turkey , Warfarin/adverse effects
9.
Middle East Afr J Ophthalmol ; 22(2): 258-60, 2015.
Article in English | MEDLINE | ID: mdl-25949090

ABSTRACT

Amiodarone is an antiarrhythmic medication that can adversely effect various organs including lungs, thyroid gland, liver, eyes, skin, and nerves. The risk of adverse effects increases with high doses and prolonged use. We report a 54-year-old female who presented with multiorgan toxicity after 8 months of low dose (200 mg/day) amiodarone treatment. The findings of confocal microscopy due to amiodarone-induced keratopathy are described. Amiodarone may cause multiorgan toxicity even at lower doses and for shorter treatment periods.


Subject(s)
Amiodarone/toxicity , Anti-Arrhythmia Agents/toxicity , Corneal Diseases/chemically induced , Multiple Organ Failure/chemically induced , Atrial Fibrillation/drug therapy , Corneal Diseases/diagnosis , Female , Humans , Liver Function Tests , Microscopy, Confocal , Middle Aged , Multiple Organ Failure/diagnosis
10.
J Geriatr Cardiol ; 12(2): 187-8, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25870623

ABSTRACT

Percutaneous closure of a prosthetic paravalvular leak (PVL) is a challenging procedure. Operators must use devices constructed for other applications. We present the use of a device which is specifically designed for PVL closure. To the best of our knowledge, there is no publication in MEDLINE reporting the use of the device.

11.
Int Cardiovasc Res J ; 8(2): 71-3, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24936485

ABSTRACT

We report an asymptomatic patient in whom the intravenous pacemaker (PM) lead was inadvertently implanted in LV through the perforated interventricular septum. He had no embolic events during the last 9 years after the implantation. Possible explanation of the uncomplicated follow-up period is that the patient had been taking warfarin because of mechanical mitral valve prosthesis.

12.
Kardiol Pol ; 71(11): 1129-34, 2013.
Article in English | MEDLINE | ID: mdl-24297710

ABSTRACT

BACKGROUND: Platelets play a key role in the development and progression of cardiovascular disease. The degree of platelet activation may be assessed by platelet indices such as platelet count, mean platelet volume (MPV) and platelet distribution width (PDW). AIM: To evaluate the relationship between platelet indices and clinical features of coronary artery disease (CAD). METHODS: Our population is represented by a total of 441 consecutive patients undergoing coronary angiography. Patients were divided into three groups according to their clinical presentation: Patients with stable angina (Group I), with acute coronary syndrome (Group II), and with a normal coronary angiogram (Group III). All demographic and clinical features were collected retrospectively. Platelet indices were measured in all patients. RESULTS: There was no statistical difference for platelet count, MPV and PDW values among the groups. Correlation analysis showed a positive association between platelet count and Gensini scoring (Kendall's tau b, r = 0.312, p = 0.037, two-tailed)and also age (Kendall's tau b, r = 0.518, p = 0.001, two-tailed) in patients with CAD. However, there was no significant correlation between Gensini scoring and MPV or PDW values in these patients. CONCLUSIONS: PDW and MPV may not be related to the clinical features or presentation and extent of CAD. Our study findings add to the conflicting results of previous studies in this area. Prospective trials with longer follow-up periods and larger samples are warranted to conclusively define the role of platelet indices in CAD.


Subject(s)
Coronary Artery Disease/blood , Coronary Artery Disease/diagnosis , Coronary Angiography , Coronary Artery Disease/diagnostic imaging , Female , Humans , Male , Mean Platelet Volume , Middle Aged , Platelet Activation , Platelet Aggregation , Platelet Count , Retrospective Studies
13.
J Geriatr Cardiol ; 10(1): 110-2, 2013 Mar.
Article in English | MEDLINE | ID: mdl-23610581

ABSTRACT

Coronary aneurysms represent anomalies identified in 0.15%-4.9% of patients undergoing coronary angiography. At present, there is no uniform definition of this pathology. Aneurysms of the left main coronary artery (LMCA) are extremely uncommon, with an incidence of 0.1%. It has been demonstrated that atherosclerosis is the main cause of these anomalies in adults, and Kawasaki disease in children and adolescents. Other causes include connective tissue disorders, trauma, vasculitis, congenital, mycotic, and idiopathic. These dilated sections of the coronary artery are not benign pathology because they are subject to spasm, thrombosis, and subsequent distal embolism, spontaneous dissection and rupture. Treatment options include anticoagulation, custom-made covered stents, reconstruction, resection, and exclusion with bypass. Our report on an old case illustrates the giant saccular LMCA aneurysm leading to myocardial ischemia due to coronary steal phenomenon.

14.
Anadolu Kardiyol Derg ; 13(3): 221-6, 2013 May.
Article in English | MEDLINE | ID: mdl-23376650

ABSTRACT

OBJECTIVE: NT-pro-brain natriuretic peptide (NT-proBNP) has been shown to be an accurate diagnostic marker in patients with heart failure (HF). Adiponectin (Adp) levels are increased in HF but its diagnostic value is still uncertain in these patients. The study was designed to investigate the possible association of these markers in non-cachectic patients with newly diagnosed systolic heart failure. METHODS: Fifty-seven systolic HF patients and 20 matched controls were enrolled in an observational cross-sectional study. Physical and echocardiographic examinations were performed and serum Adp, NT-proBNP, tumor necrosis factor-alpha (TNF-α) levels were measured. Study variables were compared between the groups. Correlation analyses were done and the diagnostic validity of the markers was compared with ROC analysis. RESULTS: Adp and NT-proBNP levels were significantly higher in HF group (20.19±12.9 vs. 7.65±4.6 µg/mL; p<0.001 and 1051.74±606.2 vs. 222.53±65.6 pg/mL; p=0.002; respectively). TNF-α levels were similar between the groups (2.83±1.8 vs. 2.08±1.2 pg/mL; p=0.582). Correlation analysis showed significant association among Adp and NT-proBNP levels, (r=0.448; p<0.001), and left ventricular ejection fraction (LVEF) values (r=-0.466; p<0.001). The Adp and NT-proBNP showed comparable diagnostic performances with mean [95% confidence interval] areas under the curves of 0.857 (0.771-0.944) and 0.888 (0.815-0.960), respectively. CONCLUSION: There were significant correlation between Adp levels with NT-proBNP levels and LVEF values but no any association between Adp levels with body mass index values and TNF-α levels in patients with newly diagnosed systolic heart failure. The result may arouse suspicion about the hypothesis, which proposes that Adp levels simply reflects disease severity or cardiac cachexia in patients with HF.


Subject(s)
Biomarkers/blood , Heart Failure/physiopathology , Ventricular Dysfunction, Left/physiopathology , Adiponectin/blood , Cachexia , Case-Control Studies , Cross-Sectional Studies , Echocardiography , Female , Heart Failure/blood , Heart Failure/diagnostic imaging , Humans , Male , Middle Aged , Natriuretic Peptide, Brain/blood , Peptide Fragments/blood , Predictive Value of Tests , ROC Curve , Systole
15.
Cardiovasc Ther ; 31(3): 168-73, 2013 Jun.
Article in English | MEDLINE | ID: mdl-22212518

ABSTRACT

AIMS: Prophylactic oral N-acetylcysteine (NAC) has been widely used for prevention of contrast-induced nephropathy (CIN). However, clinical studies have not been demonstrating this effect consistently because of evidence that NAC can alter serum creatinine levels without affecting glomerular filtration rate (GFR). We investigated NAC for the prevention of CIN by monitoring creatinine and cystatin C. METHODS: We enrolled 113 patients (49 patients in NAC group and 64 patients in control group) with normal to subnormal GFR who were scheduled for cardiovascular procedures. Patients in NAC group receive acetylcysteine 600 mg twice a day, on the day before and on the day of cardiovascular procedure. All patients received a periprocedural intravenous infusion ("volume expansion") of 1 ml/kg/h with 0.45% saline for 24 h (12 h before and 12 h after exposure to contrast medium). Serum cystatin C and creatinine levels were measured before and at 12, 24, and 48 h after procedure. RESULTS: The incidence of cystatin C-based CIN was 28.5% (n = 14) in NAC and 23.4% (n = 15) in control group (p = 0.663) and serum creatinine-based CIN was 12.2% (n = 6) in NAC and 17.2% (n = 11) in control group (P= 0.468). In this study, oral NAC had no effect on the prevention of CIN in patients undergoing cardiovascular procedures. CONCLUSION: In this study, oral NAC administration does not reduce neither the incidence of cystatin C-based CIN nor serum creatinine-based CIN in patients undergoing cardiovascular procedures.


Subject(s)
Acetylcysteine/therapeutic use , Contrast Media/adverse effects , Cystatin C/blood , Kidney Diseases/prevention & control , Aged , Female , Glomerular Filtration Rate , Humans , Kidney Diseases/chemically induced , Male , Middle Aged
16.
Int Cardiovasc Res J ; 7(4): 150-1, 2013 Dec.
Article in English | MEDLINE | ID: mdl-24757641

ABSTRACT

Hydatid disease is a parasitic infection caused by larvae of Echinococcus granulosus. Cardiac involvement in hydatid disease is uncommon, constituting only 0.5 - 2% of all cases of hydatidosis. Most patients with cardiac echinococcosis are asymptomatic, and the disease is often latent because a hydatid cyst in the heart grows very slowly. Only approximately 10 % of patients, especially those with large hydatid cysts, have clinical manifestations. Precordial pain is the one of the common symptoms and is most often vague and does not resemble angina pectoris.

17.
J Geriatr Cardiol ; 9(3): 237-42, 2012 Sep.
Article in English | MEDLINE | ID: mdl-23097652

ABSTRACT

OBJECTIVES: Although development of new treatment modalities limited digoxin usage, digoxin intoxication is still an important issue which could be easily overlooked. In this report, we analyzed a case series definitively diagnosed as digoxin intoxication in the modern era. METHODS: We analyzed 71 patients hospitalized with digoxin intoxication confirmed by history, complaints, clinical and electrocardiograph (ECG) findings, and serum digoxin levels > 2.0 ng/mL, during a five year period. The demographic and clinical data, indications for digoxin use, digoxin dosage, concurrent medications, laboratory data, hospital monitoring, and ECG findings were obtained from all patients. RESULTS: Thirty-eight of 71 patients (53.5%) had symptoms of heart failure during admission or later. Sixty-four percent of patients were older than 75 years. The percentage of females was 67%. Atrial fibrillation, hypertension and gastrointestinal complaints were more frequent in the females (64% in females, 30% in males, P = 0.007; 81% in female, 52% in males, P = 0.01; 50% in female, 17.3% in males, P = 0.008, respectively). The mortality rate during the hospital course was 7%. CONCLUSIONS: This report demonstrated the reduced mortality rates in patients with digoxin intoxication over the study period. Gastrointestinal complaints are the most common symptoms in this population.

18.
Turk Kardiyol Dern Ars ; 40(3): 205-12, 2012 Apr.
Article in English | MEDLINE | ID: mdl-22864315

ABSTRACT

OBJECTIVES: We analyzed pentraxin 3 (PTX3) levels and the relation of PTX3 levels with GRACE risk scores in 39 patients with non-ST elevation acute coronary syndrome (ACS) and stabile angina after stenting. STUDY DESIGN: Seventeen patients with ACS and 22 patients with stabile angina who underwent coronary stenting were included in the study. PTX3 levels were measured serially at admission, at the 8th hour and at the 24th hour after stenting. RESULTS: While diabetes and hypertension were more frequent in the stabile angina group, leukocyte counts were significantly higher in the ACS group. PTX3 levels measured at the 8th hour were significantly higher in the ACS group compared to the stabile angina group (p=0.003). Strong correlations were observed between 24th hour PTX3 levels and GRACE scores calculated for risk of death and death/MI at admission (in-hospital/to 6 months), and for risk of death/MI at discharge to 6 months (R=0.571, p=0.01, R=0.564, p=0.01; R=0.558, p=0.02, R=0.512, p=0.03; R=0.653, p=0.004, respectively). CONCLUSION: The serum PTX3 levels may provide important information for the early risk stratification of patients with ACS who underwent coronary stenting.


Subject(s)
Acute Coronary Syndrome/diagnosis , Angina, Stable/diagnosis , C-Reactive Protein/analysis , Serum Amyloid P-Component/analysis , Stents , Acute Coronary Syndrome/blood , Adult , Aged , Angina, Stable/blood , Angina, Stable/therapy , Female , Humans , Linear Models , Male , Middle Aged , Percutaneous Coronary Intervention , Prognosis , Risk Assessment
19.
Turk Kardiyol Dern Ars ; 40(6): 481-90, 2012 Sep.
Article in Turkish | MEDLINE | ID: mdl-23363892

ABSTRACT

OBJECTIVES: The aim of the study is to evaluate hypertensive patients who are supposedly under control according to office blood pressure measurements with 24 hour ambulatuar blood pressure monitoring for determining their actual controlled hypertension rate. In addition, we investigate the adherence ratio of blood pressure measurements to current guidelines. STUDY DESIGN: Nine hundred-forty hypertensive patients supposedly under control according to office blood pressure measurements were enrolled in the study. Twenty-four hour ambulatuar blood pressure monitoring was performed on all of them. RESULTS: Actual controlled hypertension was determined in 617 (65.6%) patients whereas 323 (34.4%) patients had uncontrolled hypertension. The blood pressure measurements that were over threshold values were seen mostly at night and in the early morning during ambulatuar blood pressure monitoring. Nocturnal and early morning hypertension was determined in most of the patients who were supposedly under control according to office blood pressure measurements. This was especially true in patients with high cardiovascular risk such as diabetes mellitus, chronic kidney failure, and metabolic syndrome. CONCLUSION: Efficacy of antihypertensive therapy during 24 hour and the early morning period is essential for optimal risk modification.


Subject(s)
Blood Pressure Monitoring, Ambulatory , Blood Pressure , Antihypertensive Agents/therapeutic use , Cardiovascular Diseases , Cities , Humans , Hypertension , Prospective Studies , Risk Factors
20.
J Heart Valve Dis ; 20(4): 417-24, 2011 Jul.
Article in English | MEDLINE | ID: mdl-21863655

ABSTRACT

BACKGROUND AND AIM OF THE STUDY: The left atrial appendage (LAA) is a common source of cardiac thrombus formation associated with systemic embolism in patients with mitral stenosis (MS). Low flow velocities in the LAA are important factors in the development of thrombosis. Whilst oral anticoagulant therapy is used routinely in MS with atrial fibrillation (AF), the characteristics of LAA contractile functions and the protective role of oral anticoagulant treatment in patients with MS in sinus rhythm (SR) are unclear. The study aim was to compare LAA contractile functions in patients with MS who were either in SR or had AF. METHODS: The study population comprised 51 patients with MS, who had undergone both standard transthoracic and transesophageal echocardiography. The patients were allocated to two groups, according to the presence of AF or SR. Ten healthy, gender-matched subjects were included in the study as a control group. RESULTS: Except for age, the characteristics of the groups were similar. In patients with SR and AF, the LAA contractile functions were significantly lower than in controls. While the LAA contractile functions of the SR group were significantly lower than the AF group (LAA emptying/filling velocity: 26 +/- 7/24 +/- 8 versus 19 +/- 5/17 +/- 5 cm/s; p = 0.002 and p = 0.001, respectively, LAA maximum/minimum area: 5.4 +/- 1.2/3.2 +/- 0.9 versus 6.2 +/- 1.1/3.7 +/- 0.8 cm2, p = 0.02 and p =0.02, respectively), no statistically significant differences were observed between patients in SR with mitral valve area (MVA) <1.5 cm2 and patients in AF. Four SR patients (13%) and six AF patients (27%) had LAA thrombus. A strong correlation was observed between the MVA and LAA peak emptying/filling velocity in patients with MS in SR (r = 0.739, p = 0.0001 and r = 0.728, p = 0.0001, respectively). CONCLUSION: The study results showed that LAA contractile function is diminished in patients with moderate-severe MS in SR, and to a similar degree as patients in AF. It was concluded that patients with moderate-severe MS in SR have a higher risk for thromboembolic events than MS patients in AF.


Subject(s)
Atrial Appendage/physiopathology , Atrial Function, Left/physiology , Heart Rate/physiology , Mitral Valve Stenosis/physiopathology , Atrial Appendage/diagnostic imaging , Blood Flow Velocity/physiology , Diagnosis, Differential , Echocardiography, Transesophageal , Female , Follow-Up Studies , Humans , Male , Middle Aged , Mitral Valve Stenosis/diagnostic imaging , Severity of Illness Index
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