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    Comparison of different strategies of ivabradine premedication for heart rate reduction before coronary computed tomography angiography
    (ELSEVIER SCIENCE INC, 2014) Celik, Omer; Atasoy, Mehmet M.; Erturk, Mehmet; Yalcin, Arif A.; Aksu, Hale U.; Diker, Mustafa; Akturk, Faruk I.; Erkanli, Korhan; Atasoy, Isil; Kiris, Adem
    Objective: The aim of this study was to assess the effectiveness and safety of different strategies of ivabradine therapy by comparing the effects on heart rate (HR), blood pressure (BP), and image quality of coronary CT angiography (CTA). Methods: A total of 192 consecutive patients were randomly assigned to 3 groups of oral premedication with ivabradine 15 mg (single dose), 10 mg (single dose), and 5 mg twice daily for 5 days, prospectively. Patients using HR-lowering drugs and patients with beta-blockade contraindication were excluded. The target HR was 65 beats/thin. In addition 5 to 10 mg of intravenous metoprolol was administered to the patients at the CT unit, if required. The systolic and diastolic blood BP values and the HRs were recorded. Image quality was assessed for 8 of 15 coronary segments with a 4-point grading scale. Results were compared with the Kruskal-Wallis test, one-way ANOVA, and chi(2) test. Results: Reductions in mean HR after the treatment were 18 +/- 6, 14 +/- 4, and 17 +/- 7 beats/min for groups 1, 2, and 3, respectively. With the total additional therapies, 81.3%, 67.2%, and 84.3% of the patients achieved HR < 65 beats/min in groups 1, 2, and 3, respectively. The mean BP values before coronary CTA were not significantly changed except for patients in group 2. Unacceptable (score 0) image quality was obtained in only 4.5%, 10.2%, and 4.2% of all the coronary segments, in groups 1, 2, and 3, respectively. Conclusions: Our study indicates that coronary CTA with premedication with oral ivabradine in all 3 strategies is safe and effective in reducing HR, in particular with a beta-blockade combination. All 3 ivabraline regimes may be an alternative strategy for HR lowering in patients undergoing coronary CTA. Ivabradine 15 mg (single dose) and ivabradine 5 mg twice daily for 5 days are superior to the ivabradine 10-mg single-dose regime for HR lowering without adjunctive intravenous beta-blocker usage. (C) 2014 Society of Cardiovascular Computed Tomography. All rights reserved.
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    Interaction between Cardioverter Defibrillator and Enhanced External Counterpulsation Device
    (WILEY-BLACKWELL, 2013) Celik, Omer; Aydin, Alper; Yilmazer, Mustafa S.; Sarigul, Nedim U.; Gurol, Tayfun; Dagdeviren, Bahadir
    Background Potential interference between implanted cardiac devices and other medical instruments is an important concern. Therefore, we aimed to investigate the possible device interaction between implantable cardioverter defibrillators (ICDs) and external enhanced counterpulsation (EECP) treatment. Methods Twenty-one patients with an implanted ICD or cardiac resynchronization therapy with defibrillator (CRT-D) were enrolled into the study. EECP had applied as two sessions of 5 minutes. Data from device interrogations before and after the first EECP session and during second EECP session were recorded and analyzed for signs of possible device interaction. Results There was no sign of inappropriate sensing or noise during EECP session. There was no difference regarding electrode impedance, pacing, and sensing values before and after EECP. There was a statistically significant difference regarding heart rates during EECP therapy between rate response off and on modes (68.69 +/- 5.92 beats/min and 90.32 +/- 11.05 beats/min, respectively P = 0,001). In four patients with CRT-D and unipolar left ventricular pacing, counterpulsation could not be done because of QRS sensing problems. Conclusions EECP seems to be a safe treatment modality in patients with implanted ICD and CRT-D devices. It should be kept in mind that in those patients with CRT-D, rate responsive mode is on; inappropriate sinus tachycardia can be seen during EECP therapy. Also in patients with CRT-D using a unipolar sensing mode, problems of QRS complex sensing by the EECP may occur and, therefore, this effects synchronization and success of EECP therapy.
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    Nonsevere Acute Pulmonary Embolism: Prognostic CT Pulmonary Angiography Findings
    (LIPPINCOTT WILLIAMS & WILKINS, 2015) Atasoy, Mehmet Mahir; Sariman, Nesrin; Levent, Ender; Cubuk, Rahmi; Celik, Omer; Saygi, Attila; Atasoy, Isil; Sahin, Sinan
    Purpose: To retrospectively evaluate the prognostic parameters of computed tomography (CT) pulmonary angiographic findings in nonsevere (hemodynamically stable) pulmonary embolism(PE) patients and to assess the predictive value of these parameters for mortality within 1 month of the initial diagnosis. Materials and Methods: Retrospectively, 67 consecutive patients (28 men, 39 women; mean age, 63.25 +/- 18 years) from 2 centers with nonsevere PE diagnosed using CT and a clinical evaluation were included in the current study. Using consensus reading, 2 readers blinded to the patients' clinical outcomes quantified the right ventricle short axis to left ventricle short axis ratio in the axial plane, vascular measurements, reflux of contrast medium into the inferior vena cava and azygos vein, ventricular septal bowing, and clot load using the Qanadli scoring system. The Simplified Pulmonary Embolism Severity Index (sPESI) and pulmonary parenchymal findings were also evaluated. All CT pulmonary angiographic parameters were compared with the risk of death within 1 month using logistic regression analysis. Results: Fifty-nine patients survived (88.1%), and 8 patients (11.9%) died because of PE. The sPESI and 2 parenchymal findings (multiple wedge-shaped opacities or consolidation accompanied by a wedge-shaped opacity) were significantly related tomortality. In the univariate analysis, neither the cardiovascular CT parameters nor the clot burden was significant between the survivors and nonsurvivors (P > 0.05). Conclusions: In clinically nonsevere PE patients, the sPESI and significant parenchymal findings were the CT parameters related to 1-month mortality.
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    Ondansetron administration before transoesophageal echocardiography reduces the need for sedation and improves patient comfort during the procedure
    (OXFORD UNIV PRESS, 2010) Aydin, Alper; Yilmazer, Mustafa Serdar; Gurol, Tayfun; Celik, Omer; Dagdeviren, Bahadir
    Transoesophageal echocardiography (TEE) is an uncomfortable procedure for the majority of patients. In the current double-blind randomized prospective study, we sought to assess whether ondansetron would improve patient comfort, reduce the need for sedation, and increase tolerance during TEE, and we compared ondansetron, metoclopramide, and placebo. One hundred and fifty-six patients who underwent TEE were randomized into three groups receiving ondansetron HCl, metoclopramide, or placebo. Data concerning additional doses of midazolam, procedural time, recovery time in the outpatient ward, blood pressure values, percutaneous arterial oxygen saturation values, side effects of the medications used, and patient discomfort via a visual analogue scale (VAS) were collected and analysed. The ondansetron group received less additional midazolam than the metoclopramide and placebo groups (ondansetron group: 0.6 +/- 0.7 mg; metoclopramide group: 1.9 +/- 0.9 mg; and placebo group: 2.1 +/- 0.8 mg; P < 0,001). VAS was significantly lower in the ondansetron group than in the metoclopramide and placebo groups (4.0 +/- 1.6, 6.1 +/- 1.8, and 6.6 +/- 1.6, respectively; P < 0.001). Recovery time in the outpatient ward was shorter in the ondansetron group than in the metoclopramide and placebo groups (22.5 +/- 4.8, 30.9 +/- 6.6, and 30.4 +/- 5.0 min, respectively; P < 0.001). No adverse reaction to ondansetron was observed, whereas one patient developed mild spontaneously resolving dystonia due to metoclopramide. Ondansetron administration reduces the need for sedation during TEE and improves patient comfort.
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    The Relationship Between Gamma-Glutamyl Transferase Levels and Coronary Plaque Burdens and Plaque Structures in Young Adults With Coronary Atherosclerosis
    (WILEY, 2014) Celik, Omer; Cakmak, Huseyin Altug; Satilmis, Seckin; Gungor, Baris; Akin, Fatih; Ozturk, Derya; Yalcin, Ahmet Arif; Ayca, Burak; Erturk, Mehmet; Atasoy, Mehmet Mahir; Uslu, Nevzat
    Background: Elevated gamma-glutamyl transferase (GGT) levels have been demonstrated to be associated with poor prognoses in patients with coronary artery disease. Coronary computed tomography angiography (CCTA) is a noninvasive imaging modality that may differentiate the structure of coronary plaques. Elevated plaque burdens and noncalcified plaques, detected by CCTA, are important predictors of atherosclerosis in young adults. Hypothesis: The present study investigated the possible relationship between GGT levels and coronary plaque burdens/structures in young adults with coronary atherosclerosis. Methods: CCTA images of 259 subjects were retrospectively examined, and GGT levels were compared between patients with coronary plaques and individuals with normal coronary arteries. Coronary plaques, detected by CCTA, were categorized as noncalcified, calcified, and mixed, according to their structures. The significant independent predictors of coronary atherosclerosis were also analyzed using multivariate logistic regression analysis. Results: GGT levels were significantly higher in patients with coronary plaque formation than in controls (35.7 +/- 14.7 vs 19.6 +/- 10.0 U/L; P < 0.001). GGT levels were also positively correlated with the number of plaques; presence of noncalcified plaques; and levels of high-sensitivity C-reactive protein (hs-CRP), hemoglobin A1c, uric acid, and triglycerides. Moreover, smoking and levels of GGT, hs-CRP, uric acid, and low high-density lipoprotein cholesterol were independent predictors of coronary atherosclerosis. Conclusions: GGT is an inexpensive and readily available marker that provides additional risk stratification beyond that provided by conventional risk factors for predicting coronary plaque burdens and plaque structures in young adults.