Person: KEPEZ, ALPER
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KEPEZ
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ALPER
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Publication Open Access Successful Treatment of Myocardial Bridge with Alcohol Septal Ablation in Hypertrophic Obstructive Cardiomyopathy(2014-02-17) KEPEZ, ALPER; Sunbul, Murat; Kepez, Alper; Tigen, Kursat; Erdogan, Okan; Mutlu, BulentPublication Metadata only THE EFFECT OF GLOBAL LONGITUDINAL STRAIN ON IMPAIRED SIX-MINUTE WALK TEST PERFORMANCE IN PATIENTS WITH SARCOIDOSIS(MATTIOLI 1885, 2020) KEPEZ, ALPER; Ozen, Deniz Kaptan; Mutlu, Bulent; Kocakaya, Derya; Turan, Burak; Sekerci, Sena Sert; Ceyhan, Berrin; Kepez, Alper; Erdogan, OkanBackground: Sarcoidosis is a multisystem and granulomatous disease associated with impaired functional capacity as a result of pulmonary and cardiac involvement. Factors adversely effecting functional capacity in patients with sarcoidosis have not been systematically assessed including myocardial strain imaging on echocardiography which enable to diagnose subclinical cardiac dysfunction. We aimed to evaluate the effect of left and right ventricular global longitudinal strain (GLS) on submaximal exercise capacity in patients with sarcoidosis who do not have clinically manifest cardiac involvement. Methods: Extracardiac biopsy proven 56 patients with sarcoidosis and 26 controls were included consecutively. Submaximal exercise capacity of the subjects was assessed with six-minute walk test (6 MWT). Pulmonary function tests and standard transthoracic and two-dimensional speckle tracking echocardiography were performed to the all subjects. Linear regression analysis was performed to find independent predictors of 6 MWT. Results: Fifty-six patients (18% male) with a mean age of 52.5 +/- 10.7 years were included. Patients with sarcoidosis had low 6 MWT performance and higher New York Heart Association classes and NT-proBNP levels. There were no significant differences between controls and patients with sarcoidosis in parameters of pulmonary function test. Biventricular GLS levels and biatrial reservoir and conduit function values were lower and systolic pulmonary artery pressure (SPAP) was significantly higher in patients with sarcoidosis as compared with controls. Older age and higher SPAP were found as independent predictors of poor 6 MWT performance. Conclusion: Although biventricular GLS levels were lower in the patients with sarcoidosis, only age and SPAP elevations were independent predictors of the submaximal exercise capacity.Publication Open Access Acute effect of zoledronic acid infusion on atrial fibrillation development in patients with osteoporosis(AVES, 2015-04-09) ÇİNÇİN, AHMET ALTUĞ; Ilgezdi, Zeynep Demet; Aktas, Ilknur; Metin, Fatma Dogan; Kepez, Alper; Ozkan, Feyza Unlu; Silte, Ayse Duygu; Kaysin, Meryem Yilmaz; Kivrak, Tarik; Cincin, Altug; Erdogan, OkanObjective: There is ongoing controversy related to the relationship between bisphosphonates and atrial fibrillation (AF). Our aim in this study was to evaluate the potential acute effect of zoledronic acid (ZA) infusion on AF development by using 24-hour Holter recordings. Methods: The study was designed to be a self-controlled case series study, and 33 consecutive patients with osteoporosis (29 females, age: 62.3 +/- 9.0 years) who were scheduled to receive ZA infusion constituted the study population. Patients underwent 24-hour Holter rhythm recordings at two different times; the first one was 48 hours before the planned ZA infusion, and the second one was on the morning of the infusion day. Heart rate, frequency and type of arrhythmias, as well as heart rate variability (HRV) from the two recordings were compared. Results: There were no episodes of AF greater than 30 sec in any of the 24-hour Holter recordings obtained before and on the day of drug infusion. Holter recordings before drug infusion showed that only 1 patient had an atrial run of 3 beats long. Holter recordings obtained on the day of drug infusion revealed that 5 patients (15.2%) had atrial runs with lengths ranging between 3 and 12 beats (p=0.046). Regarding HRV variables, SDANN values were found to be significantly depressed on the day of ZA infusion (113.6 +/- 26.9 vs. 98.2 +/- 29.9, p=0.007). Conclusion: None of the patients developed AF during or early after ZA infusion. However, there was an increase in atrial ectopy in some patients, which might be due to alterations in cardiac autonomic activity.Publication Open Access Arrhythmogenic epilepsy and pacing need: A matter of controversy(BAISHIDENG PUBLISHING GROUP INC, 2015) KEPEZ, ALPER; Kepez, Alper; Erdogan, OkanThere is increasing awareness among the cardiology community regarding ictal bradyarrhythmias as a cause of loss of consciousness. A high degree of suspicion is necessary when diagnosing ictal bradyarrhythmias, and delay in diagnosing this condition may lead to morbidity associated with falls and trauma. Ictal bradyarrhythmias have also been suggested to be associated with sudden unexplained death in epilepsy, although evidence related to this association is limited. There is no guidelinedirected therapy for symptomatic ictal bradyarrhythmias due to a lack of randomized, controlled trials. Cardiac pacemaker therapy is commonly used for these patientsPublication Metadata only Left bundle branch block type wide QRS tachycardia: what is the most likely diagnosis derived from the ECG?(BMJ PUBLISHING GROUP, 2015) KEPEZ, ALPER; Erdogan, Okan; Kepez, Alper; Atas, HalilPublication Metadata only The anatomical relationship between the axillary artery and vein investigated by radial coronary angiography(WILEY, 2018) KEPEZ, ALPER; Sert, Sena; Kepez, Alper; Atas, Halil; Mutlu, Bulent; Erdogan, OkanAimsTo reduce the risk of inadvertent arterial puncture and bleeding, we aimed to define a safe puncture site by demonstrating the relation of the axillary artery and vein. MethodsThe anatomical course and relation as well as crossover sites of the axillary artery and vein, the presence of small arterial bridges over the axillary vein, and validation of commonly preferred axillary venous puncture sites were determined by simultaneous ipsilateral venography in patients (n=111; 80 men, age 60 10 years) who underwent coronary angiography by radial artery access. ResultsThe axillary vein was detected at the first costa-clavicular intersection in 62% and at the second anterior and third posterior costal intersection in 60% of the patients. Small arterial bridges over the axillary vein were observed in 77% of the patients and more frequently in females and body mass index 25kg/m(2) (P=0.034 and P=0.03, respectively). The axillary artery crossed the vein in 24% of the patients and almost always within the region close to the first costa-clavicular intersection site. ConclusionOur study demonstrated a high crossover rate (24%) of axillary artery and vein and a high degree of variation in the course of axillary vein. Small arterial bridges over the axillary vein were observed in 77% of the patients.Publication Metadata only Anticoagulation for non-valvular atrial fibrillation: new anticoagulant agents(TURKISH SOC CARDIOLOGY, 2013) KEPEZ, ALPER; Kepez, Alper; Erdogan, OkanAtrial fibrillation (AF) is a common cardiac arrhythmia and it is associated with systemic thromboembolism. Until recently, vitamin K antagonists (VKA) such as warfarin were the only available oral anticoagulant therapy for prevention of stroke and systemic embolism in AF. Limitations of VKA therapy have prompted researchers to search for novel anticoagulant drugs, which do not necessitate coagulation monitoring due to their more predictable pharmacokinetic profile. Large-scale phase III trials have been completed for some of these drugs and 'U.S. Food and Drug Administration (FDA) approved dabigatran and rivaroxaban for prevention of systemic embolism in non-valvular AF patients. In this review, we will first focus on pharmacodynamic and pharmacokinetic profiles of these medications and then try to overview clinical trial results. We will also try to mention the current controversies regarding the clinical application of these drugs.Publication Open Access Prevalence of Brugada-type electrocardiogram pattern by recording right precordial leads at higher intercostal spaces(OXFORD UNIV PRESS, 2013-04) KEPEZ, ALPER; Hunuk, Burak; Kepez, Alper; Erdogan, OkanRecording electrocardiograms (ECGs) by placing the right precordial leads at higher intercostal spaces (ICSs) increases the sensitivity for detecting Brugada-type ECG pattern (BTEP). Published studies unfortunately used standard lead positions for recording ECGs and underestimated the true prevalence of BTEP. Therefore, by placing right precordial leads at higher ICS, we aimed to find out the true prevalence of BTEP in our population. Healthy male volunteers (n 504) between 18 and 55 years of age (37.3 10.7 years) without known cardiac or metabolic disorders were enrolled into the study. After the standard ECG recording, two other recordings were obtained by placing the right precordial leads to the third and second ICS. Electrocardiograms were stratified by two independent reviewers for the presence of BTEP. There were 15 subjects (3) who displayed BTEP on their standard ECG recordings. Number of cases displaying BTEP increased to 25 (5) and 38 (7.5) when the right precordial leads were moved to third and second ICS, respectively. Although none of the subjects displayed type 1 BTEP on their standard ECGs, three subjects displayed type 1 BTEP on the third and four subjects displayed type 1 BTEP on the second ICS. Our study revealed that the prevalence of BTEP in healthy male subjects was 7.5 by placing the right precordial leads to higher ICS. Instead of standard lead locations that are not sensitive enough for detection of BTEP we recommend high right ICS recording in further prevalence studies.Publication Metadata only Horizontal ECG in acute anterolateral myocardial infarction(SPRINGER WIEN, 2016) KEPEZ, ALPER; Erdogan, Okan; Dalkilic, Bahar; Kepez, AlperThe present study aims to compare the amount of ST segment changes recorded by horizontal electrocardiography (hECG) with standard ECG (sECG) in patients with acute anterior and/or lateral ST segment elevation myocardial infarction (STEMI). Consecutive eligible patients (n = 58) who were diagnosed with acute anterior and/or lateral STEMI were included in the study. After recording simultaneous sECG and hECG by placing precordial leads (V3-6) horizontally on the left 4th intercostal space, ST segment changes were compared. The mean ST segment changes (mV) on hECG were significantly higher than sECG in V-4 (0.27 +/- 0.2 vs. 0.21 +/- 0.21, p = 0.001), V-5 (0.21 +/- 0.17 vs. 0.12 +/- 0.16, p < 0.001) and V-6 (0.09 +/- 0.1 vs. 0.04 +/- 0.12, p < 0.001), respectively. When hECG and sECG were compared in patients with BMI < 30 kg/m(2), mean ST segment changes (mV) on hECG were significantly higher than sECG in V-4 (0.29 +/- 0.21 vs. 0.21 +/- 0.24, p = 0.004), V-5 (0.22 +/- 0.19 vs. 0.13 +/- 0.17, p < 0.001) and V-6 (0.11 +/- 0.11 vs. 0.04 +/- 0.11, p < 0.001), respectively. Mean ST segment changes in patients with anterior and/or lateral STEMI were significantly higher and easily detectable on hECG compared with sECG. We suggest that hECG be used in conjunction with sECG to diagnose anterior and lateral wall STEMI in cases of diagnostic doubt.Publication Metadata only The prevalence of early repolarization variant in Turkish male subjects: a clinical single center study(2012) KEPEZ, ALPER; Hünük, Burak; Kepez, Alper; Erdoğan, OkanOBJECTIVES: Early repolarization variant (ERV) detected in surface ECG has traditionally been considered a benign finding, but the presence of this pattern has recently been associated with vulnerability to ventricular fibrillation in many case reports and case-control studies. There is no information regarding the prevalence of ERV within the Turkish population. The aim of this study was to evaluate the prevalence of ERV within a sample group of the healthy Turkish male population. STUDY DESIGN: We assessed the prevalence of ERV within a community-based general population of 504 healthy male subjects (mean age 37.3±10.7 years; range 18 to 55 years) using 12-lead electrocardiography. ERV was stratified by two independent cardiologists according to the J-point elevation (≥0.1 mV) in the inferior, lateral or both leads with QRS slurring or notching. RESULTS: The ERV pattern was present in 34 subjects (6.7%): 19 subjects (3.8%) displayed ERV in the lateral leads, 7 (1.4%) in the inferior leads, and 8 (1.6%) in both the lateral and inferior leads. CONCLUSION: The prevalence of ERV within the healthy Turkish male population seems to be similar to the findings of previous population-based studies.