Browsing by Author "Colak, Ayse"

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Approach To Optimal Assessment Of Right Ventricular Remodelling In Heart Transplant Recipients: Insights From Myocardial Work Index, T1 Mapping, And Endomyocardial Biopsy
(2023) Colak, Ayse; Duzgun, Selin Ardali; Hazirolan, Tuncay; Sezgin, Atilla; Donal, Erwan; Butcher, Steele C.; Ozdemir, Handan; Pirat, Bahar; Eroglu, Serpil; Muderrisoglu, Haldun; Sade, Leyla Elif; https://orcid.org/0000-0002-7528-3557; https://orcid.org/0000-0003-3737-8595; 35666833; X-8540-2019; AAQ-7583-2021
Aims Right ventricular (RV) dysfunction is an important cause of graft failure after heart transplantation (HTx). We sought to investigate relative merits of echocardiographic tools and cardiac magnetic resonance (CMR) with T1 mapping for the assessment of functional adaptation and remodelling of the RV in HTx recipients. Methods and results Sixty-one complete data set of echocardiography, CMR, right heart catheterization, and biopsy were obtained. Myocardial work index (MWI) was quantified by integrating longitudinal strain (LS) with invasively measured pulmonary artery pressure. CMR derived RV volumes, T1 time, and extracellular volume (ECV) were quantified. Endomyocardial biopsy findings were used as the reference standard for myocardial microstructural changes. In HTx recipients who never had a previous allograft rejection, longitudinal function parameters were lower than healthy organ donors, while ejection fraction (EF) (52.0 +/- 8.7%) and MWI (403.2 +/- 77.2 mmHg%) were preserved. Rejection was characterized by significantly reduced LS, MWI, longer T1 time, and increased ECV that improved after recovery, whereas RV volumes and EF did not change MWI was the strongest determinant of rejection related myocardial damage (area under curve: 0.812, P < 0.0001, 95% CI: 0.69-0.94) with good specificity (77%), albeit modest sensitivity. In contrast, T1 time and ECV were sensitive (84%, both) but not specific to detect subclinical RV damage. Conclusion Subclinical adaptive RV remodelling is characterized by preserved RV EF despite longitudinal function abnormalities, except for MWI. While ultrastructural damage is reflected by MWI, ECV, and T1 time, only MWI has the capability to discriminate functional adaptation from transition to subclinical structural damage.
Left Atrial Mechanics For Secondary Prevention From Embolic Stroke Of Undetermined Source
(2022) Sade, Leyla Elif; Keskin, Suzan; Can, Ufuk; Colak, Ayse; Yuce, Deniz; Ciftci, Orcun; Ozin, Bulent; Muderrisoglu, Haldun; https://orcid.org/0000-0003-3737-8595; 33206942; AAQ-7583-2021
Aims Anticoagulation is not justified unless atrial fibrillation (AF) is detected in cryptogenic stroke (CS) patients. We sought to explore whether left atrial (LA) remodelling is associated with embolic stroke of undetermined source (ESUS). Methods and results In this prospective study, we evaluated consecutively 186 patients in sinus rhythm who presented with an acute ischaemic stroke (embolic and non-embolic) and sex- and age-matched controls. We performed continuous electrocardiogram (ECG) monitoring to capture paroxysmal AF episodes as recommended by the guidelines. After 12 months of follow-up, continuous ECG monitoring was repeated in patients with undetected AF episodes. We quantified LA reservoir and contraction strain (LASr and LASct) by speckle-tracking, LA volumes by 3D echocardiography. Out of 186 patients, 149 were enrolled after comprehensive investigation for the source of ischaemic stroke and divided into other cause (OC) (n = 52) and CS (n = 97) groups. CS patients were also subdivided into AF (n = 39) and ESUS (n = 58) groups. Among CS patients, LA strain predicted AF independently from CHARGE-AF score and LA volume indices. ESUS group, despite no captured AF, had significantly worse LA metrics than OC and control groups. AF group had the worst LA metrics. Moreover, LASr predicted both CS (embolic stroke with and without AF) and ESUS (embolic stroke with no detected AF) independently from LAVImax and CHA(2)DS(2)-VASc score. LASr >26% yielded 86% sensitivity, 92% specificity, 92% positive, and 86% negative predictive values for the identification of ESUS (areas under curve: 0.915, P < 0.0001, 95% confidence interval: 0.86-0.97). Conclusion Echocardiographic quantification of LA remodelling has great potential for secondary prevention from ESUS.
Longitudinal Strain and Strain Rate for Estimating Left Ventricular Filling Pressure in Heart Transplant Recipients
(2020) Colak, Ayse; Muderrisoglu, Haldun; Pirat, Bahar; Eroglu, Serpil; Aydinalp, Alp; Sezgin, Atilla; Sade, Leyla Elif; 0000-0002-3761-8782; 0000-0003-4576-8630; 32998008; AAD-5841-2021; AAI-8897-2021
Traditional parameters have limited value to estimate left ventricular filling pressure (LVFP) in orthotropic heart transplant (OHT) recipients. We hypothesized that global longitudinal strain (GLS), diastolic, and systolic strain rate (SR) would be depressed in OHT recipients with elevated LVFP and could overcome the limitations of traditional parameters. We studied consecutively OHT patients at the time of endomyocardial biopsies and retrospectively pretransplantation studies conforming to the same protocol. Comprehensive echocardiography with strain measurements was performed. Results were compared with pulmonary capillary wedge pressure (PCWP) obtained from right heart catheterization that was performed just after the echocardiography study. In all, 74 studies were performed in 50 OHT recipients. Mean PWCP was 11.8 +/- 4.3 mm Hg (range: 4 to 25 mm Hg). Several parameters, but not left atrial volume index, mitral inflow velocities, annular velocities, and their ratio (E/e'), were different between studies with normal (n = 47) and elevated PCWP (n = 27). Area Under Curve for GLS (0.932*), E/e'SR (0.849*), and systolic SR (0.848*) (*p 0.0001) were more accurate than traditional parameters for predicting PCWP 12 mm Hg. GLS, systolic SR and E/e'SR remained accurate regardless of LV ejection fraction and allograft vasculopathy. Meanwhile, E/e' was accurate to predict PWCP in native failing hearts before transplantation. Changes in GLS and E/e'SR tracked accurately changes in PCWP. In conclusion, traditional indices of diastolic function perform poorly in OHT recipients, whereas GLS and E/e'SR provide reliable means of LVFP, irrespective of ejection fraction and allograft vasculopathy. These parameters also track reasonably well the changes in LVFP. (c) 2020 Elsevier Inc. All rights reserved.
Multiparametric Assessment of Right Ventricular Function in Heart Transplant Recipients by Echocardiography and Relations with Pulmonary Hemodynamics
(2023) Colak, Ayse; Erdemir, Ahmet Gurkan; Hazirolan, Tuncay; Pirat, Bahar; Eroglu, Serpil; Aydinalp, Alp; Muderrisoglu, Haldun; Sade, Leyla Elif; 0000-0002-1958-6158; 0000-0002-3761-8782; 37955614
Objective: Right ventricular (RV) dilatation and dysfunction are usually present in heart transplant (HTx) patients and worsened with residual pulmonary hypertension (PH). We aimed to determine the ability of different echocardiographic modalities to evaluate RV function in comparison with cardiac magnetic resonance (CMR) and their relations with pulmonary hemodynamics in HTx patients.Methods: A total of 62 data sets [echocardiographic, hemodynamic, and CMR] were acquired from 35 HTx patients. Comprehensive echocardiography, including two-dimensional (2D) transthoracic echocardiography, speckle tracking echocardiography, and three-dimensional (3D) echocardiography, was performed. Mean pulmonary artery pressure (mPAP) was obtained invasively from right heart catheterization. The correlations between all echocardiographic parameters and CMR imaging data and the differences between patients with and without residual PH were evaluated.Results: Diastolic and systolic RV volumes and RV ejection fraction (RVEF) by 3D echocardiography correlated strongly with CMR-derived volumes and RVEF (r = .91, r = .79, r = .64; p < .0001 for each, respectively). Among other parameters, RV fractional area change (r = .439; p < .001) and RV free wall longitudinal strain (RVFW-LS) (r = -.34; p < .05) correlated moderately with CMR-RVEF, whereas tricuspid annulus S' velocity (r = .29; p < .05) and tricuspid annular systolic plane excursion (r = .27; p < .05) correlated weakly with CMR-RVEF. Additionally, 3D-RVEF and RVFW-LS were significantly decreased in studies with mPAP >= 20 mm Hg in comparison to those with mPAP < 20 mm Hg (47.7 +/- 3.7 vs. 50.9 +/- 5.3, p = .04 and -15.5 +/- 3.1 vs. -17.5 +/- 3, p = .03, respectively).Conclusion: The best method for the evaluation of RV function in HTx recipients is 3D echocardiography. Besides, the subclinical impact of residual PH on RV function can be best determined by RVFW-LS and 3D-RVEF in these patients.
Pulmonary Artery Distensibility is Worsened in Obstructive Sleep Apnea Syndrome
(2019) Karacaglar, Emir; Bal, Ugur; Eroglu, Serpil; Colak, Ayse; Bozbas, Serife; Muderrisoglu, Hadun; 0000-0003-3055-7953; 31571799
Background: Obstructive sleep apnea syndrome (OSAS) leads to right ventricular (RV) dysfunction and pulmonary hypertension (PH) in the later stages. Early determination of these conditions is very important. Objectives: We aimed to evaluate the correlations of pulmonary artery distensibility, right pulmonary artery fractional shortening (RPA-FS), and pulmonary artery stiffness (PAS) with PH among newly diagnosed OSAS patients. Methods: We prospectively evaluated 34 newly diagnosed OSAS patients and 28 controls. The study subgroups were determined according to the apnea-hypopnea index (AHI). All patients underwent a transthoracic echocardiographic examination. Conventional RV parameters, PAS, and RPA-FS parameters were measured. Results: RPA-FS was significantly lower in the OSAS group (p < 0.001) and positively correlated with tricuspid annular systolic excursion (TAPSE) (p = 0.047) and pulmonary acceleration time (PAT) (p = 0.006), and inversely correlated with systolic pulmonary artery pressure (sPAP) (p = 0.013), and PAS (p < 0.001). Consistent with this result, PAS was significantly worse in the patients with OSAS compared to the controls (27.1 +/- 3.5 to 15.8 +/- 2.7, p < 0.001), and inversely correlated with RPA-FS (p < 0.001), PAT (p = 0.001), and TAPSE (p = 0.035). PAS was positively correlated with sPAP (p = 0.001). There were statistically significant differences for both PAS and RPA-FS among the OSAS subgroups with regards to the severity of disease (p < 0.001). The correlation analyses showed a significantly positive correlation between RPA-FS and mean O2 saturation. RPA-FS was also inversely correlated with AHI. Similarly, PAS was positively correlated with AHI and arousal index. Conclusions: PAS and RPA-FS are worsened in patients with OSAS, and are correlated with PH and severity of OSAS.