Browsing by Author "Balcioglu, Akif Serhat"

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Arrhythmogenic Evidence for Epicardial Adipose Tissue: Heart Rate Variability and Turbulence are Influenced by Epicardial Fat Thickness
(2015) Balcioglu, Akif Serhat; Cicek, Davran; Akinci, Sinan; Eldem, Halil Olcay; Bal, Ugur Abbas; Okyay, Kaan; Muderrisoglu, Haldun; 0000-0002-9635-6313; 0000-0001-6134-8826; 0000-0001-5250-5404; 0000-0002-9446-2518; 25224491; AAC-8036-2020; AAG-8233-2020; AAK-7355-2020; AAD-5564-2021; AAK-4322-2021
BackgroundEpicardial adipose tissue (EAT) is a local source of various hormones, cytokines, and vasoactive substances affecting the myocardium. EAT contains abundant ganglionic plexi that interact with the autonomic nervous system. Evidence of the association between EAT and arrhythmia is limited, with the exception of atrial fibrillation. This study aimed to investigate the relation between EAT and cardiac autonomic function using heart rate variability (HRV) and heart rate turbulence (HRT) parameters. MethodsAll subjects underwent a 24-hour Holter recording to assess HRV and HRT parameters and a transthoracic echocardiography to measure EAT thickness. Patients were divided into two groups according to the median EAT thickness (3.9 mm). The higher EAT group consisted of 111 patients with a >3.9-mm thickness and the lower EAT group 113 patients with a 3.9-mm EAT thickness. ResultsHRV and HRT parameters were significantly influenced in the higher EAT group. Moreover, we observed significant correlations between EAT thickness and Holter findings (standard deviation of all NN intervals [SDNN]: r = -0.462, P < 0.001; SDNN index: r = -0.349, P < 0.001; standard deviation of the average NN intervals: r = -0.465, P < 0.001; root mean square of successive differences: r = -0.251, P < 0.001; pNN50: r = -0.354, P < 0.001; turbulence onset: r = 0.172, P = 0.010; turbulence slope: r = -0.279, P < 0.001, HRT category: r = 0.169, P = 0.011). In multivariate regression analysis, EAT thickness was independently associated with all measures of HRV and HRT, with the exception of turbulence onset. ConclusionsSympathovagal imbalance, detected by HRV and HRT parameters, is related to EAT thickness. As sympathovagal imbalance is a predictor of arrhythmic events, EAT may play an important arrhythmogenic role not limited to atrial fibrillation.
Cardiac autonomic nervous dysfunction detected by both heart rate variability and heart rate turbulence in prediabetic patients with isolated impaired fasting glucose
(2016) Balcioglu, Akif Serhat; Akinci, Sinan; Cicek, Davran; Coner, Ali; Bal, Ugur Abbas; Muderrisoglu, Ibrahim Haldun; 0000-0002-9446-2518; 0000-0002-5711-8873; 0000-0001-5250-5404; 27025199; AAK-4322-2021; ABD-7321-2021; AAD-5564-2021; AAC-8036-2020
Objective: Cardiac autonomic nervous dysfunction (CAND), a severe complication of diabetes, has also been shown to affect prediabetic patients. The role of isolated impaired fasting plasma glucose (IFG), a subtype of prediabetes, is not clear in the pathogenesis of CAND. The aim of this study was to examine the relationship between isolated IFG and cardiac autonomic function using heart rate variability (HRV) and heart rate turbulence (HRT) indices derived from 24-h Holter-electrocardiogram recordings. Methods: This observational, prospective, cross-sectional study examined 400 consecutive subjects divided into three groups according to oral glucose tolerance test results: the control group [Group I, fasting plasma glucose (FPG) <100 mg/dL and normal glucose tolerance, n=193], the isolated IFG group (Group II, FPG >= 100 and <126 mg/dL, n=134), and the isolated impaired glucose tolerance (IGT), both IFG and IGT, or newly diagnosed diabetes' group (Group III, n=73). Patients with non-sinus rhythm, known diabetes mellitus, coronary artery disease, heart failure, severe valvular disease, or receiving medical therapy that may affect HRV and HRT indices were excluded. Time domain HRV parameters, turbulence onset (TO), turbulence slope (TS), and HRT category were examined. Chi-square, one-way analysis of variance, Kruskal-Wallis H, and Mann-Whitney U tests were used to compare variables where appropriate. The correlation between Holter data and FPG levels was analyzed using the Spearman's test. Multiple linear regression analysis was performed to identify independent predictors of the HRV and HRT parameters. Results: Median (interquartile range 25-75) FPG levels in Groups I, II, and III were 89 (83/93) mg/dL, 109 (104/116) mg/dL, and 174 (150.5/197) mg/dL, respectively. There were significant differences in HRV and HRT parameters between and among all groups. While HRV parameters and TS decreased from Group I to Group III, TO and HRT category gradually increased. Additionally, FPG level was significantly correlated with SDNN, r=-0.220; SDNN index, r=-0.192; SDANN, r=-0.207; RMSSD, r=-0.228; pNN50, r=-0.226; TO, r=0.354; and TS, r=-0.331 (all p<0.001). Conclusion: CAND, as detected by both HRV and HRT, appear to be present in the isolated IFG subtype of prediabetes.
Characterization of Echocardiographic Measures of Cardiac Structure and Function in Healthy Octogenarians
(2014) Balcioglu, Akif Serhat; Durakoglugil, Murtaza Emre; Okyay, Kaan; Tavil, Yusuf; Abaci, Adnan; https://orcid.org/0000-0001-6134-8826; https://orcid.org/0000-0001-5268-4262; 24506515; Q-3547-2019; AAK-7355-2020
Background: Currently, there is not enough echocardiographic information regarding aging-associated changes in the octogenarian population. We aimed to characterize echocardiographic measures of structure and function among a group of healthy octogenarians. Methods: Approximately 350 octogenarians, residing in nursing homes, were screened in Ankara, Turkey. According to inclusion criteria, 40 octogenarians were enrolled. These subjects underwent conventional and tissue Doppler echocardiography according to the guidelines of the American Society of Echocardiography (ASE). The population was also separated into various groups according to gender, body mass index (BMI, <25 vs. 25-29.9), and blood pressure (<80/120 mmHg vs. 80-89/120-139 mmHg). All measurements were indexed by dividing to body surface area (BSA) for standardization. Results: Left ventricular mass (LVM), posterior wall thickness, right ventricular diameter, tricuspid E/A ratio, and septal e'-wave velocity were significantly higher in men, which lost significance after adjusting for BSA. There was no significant difference between groups formed by BMI and blood pressure. Moreover, mild global left and right ventricular dysfunction including a prominent diastolic counterpart, however, with normal ejection fraction was revealed using conventional and tissue Doppler techniques. Finally, we checked our results with the current reference values of the ASE and observed the following differences: ventricular septum, relative wall thickness, LVM, and mass index values were above ASE reference range, posterior wall measurements were close to upper range. On the contrary, left ventricular diameters and volumes were below ASE reference range. Conclusions: We described echocardiographic measures of structure and function in a group of healthy octogenarians.
Diabetes and cardiac autonomic neuropathy: Clinical manifestations, cardiovascular consequences, diagnosis and treatment
(2015) Balcioglu, Akif Serhat; Muderrisoglu, Haldun; 25685280
Cardiac autonomic neuropathy (CAN) is a frequent chronic complication of diabetes mellitus with potentially life-threatening outcomes. CAN is caused by the impairment of the autonomic nerve fibers regulating heart rate, cardiac output, myocardial contractility, cardiac electrophysiology and blood vessel constriction and dilatation. It causes a wide range of cardiac disorders, including resting tachycardia, arrhythmias, intraoperative cardiovascular instability, asymptomatic myocardial ischemia and infarction and increased rate of mortality after myocardial infarction. Etiological factors associated with autonomic neuropathy include insufficient glycemic control, a longer period since the onset of diabetes, increased age, female sex and greater body mass index. The most commonly used methods for the diagnosis of CAN are based upon the assessment of heart rate variability (the physiological variation in the time interval between heartbeats), as it is one of the first findings in both clinically asymptomatic and symptomatic patients. Clinical symptoms associated with CAN generally occur late in the disease process and include early fatigue and exhaustion during exercise, orthostatic hypotension, dizziness, presyncope and syncope. Treatment is based on early diagnosis, life style changes, optimization of glycemic control and management of cardiovascular risk factors. Medical therapies, including aldose reductase inhibitors, angiotensin-converting enzyme inhibitors, prostoglandin analogs and alpha-lipoic acid, have been found to be effective in randomized controlled trials. The following article includes the epidemiology, clinical findings and cardiovascular consequences, diagnosis, and approaches to prevention and treatment of CAN.
Effect of Dobutamine Stress Echocardiography on Serum Heart Fatty Acid Binding Protein Levels
(2017) Akinci, Sinan; Balcioglu, Akif Serhat; Tacoy, Gulten; Tavil, Yusuf; Guslbahar, Ozlem; Ozdemir, Murat; https://orcid.org/0000-0001-5250-5404; 28597800; AAD-5564-2021
Objective Heart fatty acid binding protein (HFABP) is a low-molecular-weight free protein that is abundant in the intracytoplasmic space of myocytes. Due to its unique features, serum HFABP levels may increase in myocardial ischaemia. The aim of this study was to evaluate the effect of myocardial ischaemia induced by dobutamine stress echocardiography (DSE) on serum HFABP levels. Methods and results A total of 30 consecutive patients with suspected myocardial ischaemia underwent DSE examination. HFABP levels were measured immediately before and 1 hour after DSE. HFABP rose significantly in individuals in the DSE positive group (1.66 +/- 1.18 ng/ml vs 2.65 +/- 1.34 ng/ml, P = 0.004), but remained unchanged in the DSE negative group (1.61 +/- 0.77 ng/ml vs 1.85 +/- 0.76 ng/ml, P = 0.066). Conclusion Serum HFABP levels increased significantly at 1 hour in the presence of ischaemia induced by DSE in patients with stable clinical coronary syndromes. No such increase was evident in the absence of ischaemia.
The Effect of Epicardial Adipose Tissue Thickness with İrritable Bowel Syndrome
(2018) Cicek, Yuksel; Durakoglugil, Murtaza Emre; Duman, Hakan; Erdogan, Turan; Rakici, Halil; Balcioglu, Akif Serhat; 30317341
Objective: To investigate the association of epicardial adipose tissue thickness with irritable bowel syndrome. Methods: This case-control and observational study was conducted in Recep Tayyip Erdogan University between January and December 2014, and comprised patients of irritable bowel syndrome and healthy controls who underwent a complete transthoracic echocardiographic examination as well as measurements of epicardial adipose tissue. They were screened for psychiatric or organic bowel diseases for the sake of precise diagnosis. Epicardial fat thickness was measured perpendicularly in front of the right ventricular free wall at end-diastole.SPSS 15 was used to analyse the data. Results: Of the 75 subjects, 44(59%) were patients and 31(41%) were controls. There was no statistically significant difference between the groups except epicardial adipose tissue thickness, which was significantly elevated in patients (p<0.001). C-reactive protein was significantly higher in patients (p=0.002). Epicardial adipose tissue (p<0.001) and haematocrit (p<0.05) were independent predictors of irritable bowel syndrome. Conclusion: Increased epicardial adipose tissue thickness, and accompanying low-grade inflammation appeared to be involved in irritable bowel syndrome pathogenesis.
Effects of Three Month Nasal Continuous Positive Airway Pressure Treatment on Electrocardiographic, Echocardiographic and Overnight Polysomnographic Parameters in Newly Diagnosed Moderate/Severe Obstructive Sleep Apnea Patients
(2015) Cicek, Davran; Balcioglu, Akif Serhat; Lakadamyali, Huseyin; Muderrisoglu, Haldun; 25503651
The objective of the study was to determine the effects of nasal continuous positive airway pressure (nCPAP) therapy on left ventricular (LV) function and electrocardiographic parameters in newly diagnosed moderate/severe obstructive sleep apnea (USA) patients without cardiovascular comorbidities and medical treatments. We examined 44 patients who underwent overnight polysomnography together with 24-hour Ho lter electrocardiography, cardiopulmonary exercise testing including heart rate recovery at 1 minute (HRR-1), echocardiography, surface electrocardiography, and those who were diagnosed with moderate/severe USA apnea-hypopnea index >= 15. After 3 months of nCPAP treatment, the above-mentioned examinations were repeated. Forty-four patients completed the treatment period. Twelve weeks on effective nCPAP induced a significant increase in the mitral E/A ratio (P = 0.001), as well as reductions in isovolumic relaxation time (P = 0.001) and mitral deceleration time (DT) (P = 0.002). There were no significant differences in LV ejection fraction, LV mass index, and pulsed wave Doppler parameters. Mean heart rate was 79.2 +/- 12.5 pulses/minute, maximum P-wave duration 117.5 +/- 8.6 msec, P-wave dispersion (PWd) 54.6 +/- 10.2 msec, corrected QT interval (QTc) 436.5 +/- 40.5 msec, and QT dispersion (QTd) 46.3 +/- 7.1 msec, which significantly decreased to 70.4 +/- 9.6 pulses/minute (P <0.001), 111.5 +/- 8.7 msec (P <0.001), 51.6 +/- 8.9 msec (P <0.001), 418.4 +/- 31.2 msec (P <0.001), and 33.8 +/- 3.4 msec (P < 0.001), respectively. Exercise capacity at baseline determined as 10.5 +/- 2.2 metabolic equivalents (METS) and HRR-1 (20.6 +/- 11.7 bpm) significantly increased (12.1 +/- 1.5 METS and 27.4 +/- 8.6 bpm). There was no significant difference in aortic root parameters. Three-month nCPAP therapy significantly increased LV shortening fraction, with no effect on systolic function or aortic root diameters and a positive effect on heart rate, PWd, HRR-1, QTc and QTd time following nCPAP therapy.
Epicardial adipose tissue thickness and plasma homocysteine in patients with metabolic syndrome and normal coronary arteries
(2014) Balcioglu, Akif Serhat; Durakoglugil, Murtaza Emre; Cicek, Davran; Bal, Ugur Abbas; Boyaci, Bulent; Muderrisoglu, Haldun
Background: Increased epicardial adipose tissue thickness and plasma homocysteine levels are associated with Metabolic Syndrome (MS) and coronary artery disease. The majority of patients with MS have subclinical or manifest coronary artery disease. The aim of this study was to evaluate the relationship between MS and plasma homocysteine levels and epicardial adipose tissue thickness in subjects without epicardial coronary artery disease. Methods: Patients who underwent coronary angiography due to angina or equivocal symptoms and/or abnormal stress test results and were found to have normal coronary arteries were evaluated for the presence of MS. The study group comprised 75 patients with normal coronary arteries and MS, and the control group included 75 age-gender matched subjects without coronary artery disease or MS. Results: Epicardial adipose tissue thickness (5.8 +/- 1.9 mm vs. 4.3 +/- 1.6 mm, p <0.001) and plasma homocysteine levels (21.6 +/- 6.1 mu mol/L vs. 15.1 +/- 5.8 mu mol/L, p <0.001) were significantly higher in the MS group. Body mass index, triglyceride level, weight, age and waist circumference were positively and HDL cholesterol level were negatively correlated with both epicardial adipose tissue thickness and plasma homocysteine level. Epicardial adipose tissue thickness had the strongest correlation with plasma homocysteine level (r = 0.584, p < 0.001). For each 1 mm increase in epicardial adipose tissue thickness, an increase of 3.51 mu mol/L (95% CI: 2.24-4.79) in plasma homocysteine level was expected. Conclusions: We observed a close relationship between MS and epicardial adipose tissue thickness and plasma homocysteine levels, even in the absence of overt coronary artery disease.
Which Is Responsible for Cardiac Autonomic Dysfunction in Non-Diabetic Patients with Metabolic Syndrome: Prediabetes or the Syndrome Itself
(2016) Balcioglu, Akif Serhat; Akinci, Sinan; Cicek, Davran; Eldem, Halil Olcay; Coner, Ali; Bal, Ugur Abbas; Muderrisoglu, Haldun; https://orcid.org/0000-0001-5250-5404; https://orcid.org/0000-0002-5711-8873; https://orcid.org/0000-0002-9446-2518; 26610403; AAD-5564-2021; ABD-7321-2021; AAK-4322-2021
Aims: Cardiac autonomic dysfunction (CAD) is associated with both prediabetes and metabolic syndrome (MS). Heart rate variability (HRV) and heart rate turbulence (HRT) are reliable 24-h Holter-ECG findings of cardiac autonomic function. This study aimed to investigate the relation between MS and its components and CAD using HRV and HRT. Materials and methods: The study included 80 non-diabetic patients with MS and 70 control subjects. All study population and the patients with MS were further analyzed for each diagnostic component of MS to investigate which criteria impaired HRV and HRT. Results: HRV and HRT parameters were disturbed in patients in the MS group. While impairment in HRV and HRT was significantly related to the presence of the fasting plasma glucose (FPG) criterion, there were no differences between groups in terms of the other 4 MS criteria. Moreover, FPG level was significantly correlated with SDNN (r = -0.352, p < 0.001), SDNN index (r = -0.423, p < 0.001), SDANN (r = -0.301, p < 0.001), RMSSD (r = -0.237, p < 0.001), pNN50 (r = -0.237, p < 0.001), turbulence onset (TO) (r = 0.365, p < 0.001) and turbulence slope (TS) (r = -0.365, p < 0.001). Among the MS diagnostic criteria, only FPG level was an independent determinant of all HRV and HRT parameters. Conclusions: This study confirms the relation between MS and CAD. Increased FPG alone appears to be responsible for the mentioned findings among the 5 diagnostic criteria. Accordingly, CAD may be the result of prediabetes, not MS in patients with MS. (C) 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.