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        Relationship between Pulmonary Artery Stiffness and Functional Capacity in Patients with Heart Failure with Reduced Ejection Fraction

        Erkan Yildirim,Murat Celik,Uygar Cagdas Yuksel,Mutlu Gungor,Baris Bugan,Deniz Dogan,Yalcin Gokoglan,Hasan Kutsi Kabul,Suat Gormel,Salim Yasar,Mustafa Koklu,Cem Barcin 대한심장학회 2017 Korean Circulation Journal Vol.47 No.6

        Background and Objectives: Functional capacity varies significantly among patients with heart failure with reduced ejection fraction (HFrEF), and it remains unclear why functional capacity is severely compromised in some patients with HFrEF while it is preserved in others. In this study, we aimed to evaluate the role of pulmonary artery stiffness (PAS) in the functional status of patients with HFrEF. Methods: A total of 46 heart failure (HF) patients without overt pulmonary hypertension or right HF and 52 controls were enrolled in the study. PAS was assessed on parasternal short-axis view using pulsed-wave Doppler recording of pulmonary flow one centimeter distal to the pulmonic valve annulus at a speed of 100 mm/sec. PAS was calculated according to the following formula: the ratio of maximum flow velocity shift of pulmonary flow to pulmonary acceleration time. Results: PAS was significantly increased in the HFrEF group compared to the control group (10.53±2.40 vs. 7.41±1.32, p<0.001). In sub-group analysis of patients with HFrEF, PAS was significantly associated with the functional class of the patients. HFrEF patients with poor New York Heart Association (NYHA) functional capacity had higher PAS compared those with good functional capacity. In multivariate regression analysis, NYHA class was independently correlated with PAS. Conclusion: PAS is associated with functional status and should be taken into consideration as an underlying pathophysiological mechanism of dyspnea in patients with HFrEF.

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        The Relationship between Vitamin D and Coronary Artery Ectasia in Subjects with a Normal C-Reactive Protein Level

        Goksel Cagirci,Selcuk Kucukseymen,Isa Oner Yuksel,Nermin Bayar,Erkan Koklu,Ramazan Guven,Sakir Arslan 대한심장학회 2017 Korean Circulation Journal Vol.47 No.2

        Background and Objectives: Vitamin D is generally known to be closely related to inflammation. The effects of vitamin D on coronary artery disease (CAD) are not fully explained. Nowadays, coronary artery ectasia (CAE) cases are common and are regarded as being a kind of CAD. We aimed to investigate, in a case-control study, the relationship between vitamin D and CAE without an associated inflammatory process. Subject and Methods: This study population included 201 patients (CAE group, 121 males; mean age, 61.2±6.4 years) with isolated CAE; and 197 healthy individuals (control group, 119 males; mean age, 62.4±5.8 years), comprising the control group, who had normal coronary arteries. These participants concurrently underwent routine biochemical tests, tests for inflammatory markers, and tests for 25-OH vitamin D in whole-blood draws. These parameters were compared. Results: There are no statistical significance differences among the groups for basic clinical characteristics (p>0.05). Inflammatory markers were recorded and compared to exclude any inflammatory process. All of them were similar, and no statistical significance difference was found. The average parathyroid hormone (PTH) level of patients was higher than the average PTH level in controls (41.8±15.1 pg/mL vs. 19.1±5.81 pg/mL; p<0.001). Also, the average 25-OH vitamin D level of patients was lower than the average 25-OH vitamin D level of controls (14.5±6.3 ng/mL vs. 24.6±9.3 ng/mL; p<0.001). In receiver operating characteristic curve analysis, the observed cut-off value for vitamin D between the control group and patients was 10.8 and 85.6% sensitivity and 75.2% specificity (area under the curve: 0.854, 95% confidence interval: 0.678-0.863). Conclusion: We found that there is an association between vitamin D and CAE in patients who had no inflammatory processes. Our study may provide evidence for the role of vitamin D as a non-inflammatory factor in the pathophysiology of CAE.

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        An Unusual Pattern of All Three Coronary Arteries Originating from a Single Coronary Artery Arising from the Right Sinus of Valsalva

        Isa Oner Yuksel,Sakir Arslan,Nermin Bayar,Selcuk Kucukseymen,Erkan Koklu,Bekir Erol 대한심장학회 2014 Korean Circulation Journal Vol.44 No.2

        Anomalous origin of coronary arteries is generally asymptomatic and a rare disease. However, some cases can cause severe life-threateningevents such as myocardial ischemia, arrhythmia, and acute myocardial infarction. We describe a case of a single coronary artery arisingfrom the right sinus of Valsalva in a 48-year-old female patient with a complaint of stable angina pectoris and palpitations. Coronary an-giography revealed that all three coronary arteries arose from the right sinus. Coronary CT angiography confirmed that there was ananomalous origin of the left coronary artery arising from the right sinus of Valsalva. The patient was managed with conservative treatment.

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