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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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    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.