Browsing by Author "Kozan, Hatice"

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Is there a relationship between resistin levels and left ventricular end-diastolic pressure?
(2018) Yildirir, Aylin; Yildirim, Ozge Turgay; Sade, Leyla Elif; Hasirci, Senem Has; Kozan, Hatice; Ozcalik, Emre; Okyay, Kaan; Bal, Ugur Abbas; Aydinalp, Alp; Muderrisoglu, Haldun; 0000-0002-9635-6313; 0000-0002-6731-4958; 29615544; AAK-7355-2020; AAG-8233-2020
Objective: Resistin, a cysteine-rich peptide, is associated with atherosclerosis and diabetes. Resistin levels increase corresponding to coronary artery disease (CAD) and heart failure severity. Since resistin level tends to elevate with symptomatic heart failure, it is expected to be associated with left ventricular end-diastolic pressure (LVEDP). However, there is no relevant literature on the relationship between resistin levels and LVEDP. We aimed to evaluate the association between resistin levels and LVEDP, severity of CAD, carotid intima-media thickness (CIMT), and echocardiographic diastolic dysfunction parameters. Methods: For this study, 128 euvolemic patients with creatinine clearance >50 mg/dL and without acute coronary syndrome, who had typical chest pain or were stress test positive, were enrolled. Resistin level was measured by Enzyme-linked immunosorbent assays (ELISA) method. Severe CAD is defined as >= 50% stenosis in one of the major coronary arteries. LVEDP was measured during left heart catheterization. Results: After coronary angiography, 60 patients (46.9%) had severe CAD. The mean LVEDPs were similar for patients with and without severe CAD (p=0.480). The resistin levels did not differ between the groups (p=0.154). The resistin levels did not correlate with LVEDP (r=-0.045, p=0.627), ejection fraction (EF; r=0.110, p=0.228), the Gensini score (r=-0.091, p=0.328), and CIMT (r=0.082, p=0.457). No significant correlation was found between the echocardiographic diastolic dysfunction parameters and resistin levels. Conclusion: There was no significant correlation between resistin level and LVEDP, CAD severity, echocardiographic diastolic dysfunction parameters, and CIMT. Further studies are warranted to determine the efficacy of resistin in clinical use.
Koroner arter hastalığını öngörmede ekokardiyografik strain analizi ve efor testinin birlikte kullanımı
(Başkent Üniversitesi Tıp Fakültesi, 2016) Kozan, Hatice; Sade, Leyla Elif
Efor testinin koroner arter hastalığını saptamada duyarlılığı %68, özgüllüğü %77 dolayındadır. Dolayısıyla yanlış pozitif sonuçlar azımsanmayacak düzeydedir. Ekokardiyografi ile koroner arter hastalığı tanısı için, duvar hareketleri ve duvar kalınlaşması görsel olarak değerlendirilerek global ve bölgesel kasılma hakkında karar verilmektedir. Ancak son yıllarda bölgesel ve global sol ventrikül kontraksiyonunu sayısal olarak değerlendirmeye yarayan yeni metotlar geliştirilmiştir ki strain görüntüleme bunların başında gelmekte ve görsel değerlendirmenin doğruluğunu artırmaktadır. Bu çalışma, efor testine strain görüntülemeyi eklemek suretiyle yapılacak non-invazif değerlendirmenin, koroner anjiyografiye gönderilecek hastalarda seçiciliği artırılabileceği hipotezini test etmek amacıyla planlanmıştır. Çalışmaya efor testi pozitif olan ve koroner anjiografi (KAG) endikasyonu konulan 77 hasta dahil edilmiştir. Çalışmaya alınan hastalar ciddi KAH olan ve ciddi KAH olmayan hastalar olmak üzere 2 gruba ayrılmıştır. Hafif KAH; normal koroner arterler ya da en az bir koroner arterde <%50 darlık, orta KAH; en az bir koroner arterde %50-70 arasında darlık ve ciddi KAH; en az bir koroner arterde %70 ve üzeri ya da sol ana koronerde %50 ve üzeri darlık saptanması olarak belirlenmiştir. KAH yaygınlığı Gensini skoru kullanılarak hesaplanmıştır. Ekokardiyografi değerlendirmesi KAG uygulamasının ±12 saat zaman aralığında yapılmıştır. Strain analizi, EchoPac BT 13.0 (GE, Horten Norveç) yazılımı ile benek takibi yöntemi kullanılarak yapılmıştır. Çalışmaya alınan hastaların yaş ortalaması 56.4±10.8’dir. KAG sonucuna göre 56 hasta (%73) ciddi KAH, 21 hasta (%27) ciddi olmayan KAH grubuna ayrılmıştır. Epikart, endokart ve miyokart strain parametreleri ciddi KAH grubunda, ciddi olmayan KAH grubundaki hastalara göre istatistiksel olarak daha düşük saptanmıştır (Ciddi KAH olan ve olmayan hastalarda sırasıyla GLSendokart: -20.6±2.4 ve -26.3±3.1, p<0.001; GLSmiyokart: -17.5±2.1 ve -22.1±2.5, p<0.001; GLSepikart: -14.9±1.9 ve -18.7±2.2, p<0.001). GLS değeri Gensini skoru ile de pozitif korelasyon göstermiştir. Efor testi pozitif olup strain değeri korunmuş hastaların önemli bir bölümünde ciddi KAH saptanmamıştır (%73). Pozitif efor testine ek olarak strain değerlendirmesi yaklaşımının duyarlılığı %81, özgüllüğü %89 olarak hesaplanmıştır. Sonuç olarak, pozitif efor testine ek olarak strain değerlendirilmesinin tek başına efor testine göre ciddi KAH saptamada daha yüksek duyarlılık ve özgüllüğe sahip olduğu saptanmıştır. Bu sonuçlar efor testi pozitif ancak straini korunmuş olan hastaların anjiyografi kararı vermeden önce ileri non-invazif anatomik ya da fonksiyonel görüntüleme yöntemleriyle değerlendirilmesinin daha iyi olacağını düşündürmektedir. The sensitiviy and specificity of treadmill exercise test in the detection of coronary artery disease (CAD) are 68% and 77% respectively. As a result false-positive results occure in a considerable number of patients. Traditionally, wall motion and wall thickening are evaluated visually with echocardiography to decide about global and regional contraction. However, in recent years new methods have been developed for accurate quantification of regional and global left ventricular contractions, and strain imaging is one of them. This study is planned to test the hypothesis that a combined non-invasive approach with concommitent use of strain imaging and treadmill exercise testing could increase the accuracy of patient selection for coronary angiography. A total of 77 patients with positive treadmill stress testing who were assigned to coronary angiography (CAG) were included in the study. Patients were devided into 2 groups: Those having mild-moderate CAD vs severe CAD. Mild CAD was defined as; normal coronary arteries or at least one coronary artery with < 50% stenosis, moderate CAD as; at least one coronary artery with 50-70% stenosis and severe CAD as; at least one coronary artery with 70% stenosis or more or left main coronary artery stenosis 50% or more. The extent of CAD was assessed by using the Gensini score. Echocardiographic evaluation was performed within ±12 hours from the time of CAG. Strain analysis were made with speckle tracking method by using the EchoPac BT 13.0 (GE, Horten Norway) software. The average age of the patients was 56.4±10.8 years. According to the CAG results 56 patients (73%) had severe CAD, 21 patients (27%) had non-severe CAD. Epicardial, endocardial and myocardial strain measurements were significantly lower in patients with severe CAD than patients without severe CAD (Patients with and without severe CAD, respectively GLS endocardial: -20.6±2.4 ve -26.3±3.1, p<0.001; GLSmyocardial: -17.5±2.1 ve -22.1±2.5, p<0.001; GLSepicardial: -14.9±1.9 ve -18.7±2.2, p<0.001). GLS also positively correlated with the Gensini score. Significant percentage of the patients with preserved strain despite a positive exercise test had non-severe CAD (73%). The approach of adding strain evaluation to positive exercise stress test reached a sensitivity of 81% and a specificity of 89%. As a result, the addition of the strain evaluation to the positive stress test had a higher sensitivity and specificity in detecting significant CAD compared to the exercise stress test alone. These results suggest that patients with positive exercise stres test and preserved strain are rather be tested with advanced non-invasive anatomical or functional imaging modalities before deciding about coronary angiography.
T1 Mapping by Cardiac Magnetic Resonance and Multidimensional Speckle-Tracking Strain by Echocardiography for the Detection of Acute Cellular Rejection in Cardiac Allograft Recipients
(2019) Sade, Leyla Elif; Hazirolan, Tuncay; Kozan, Hatice; Ozdemir, Handan; Hayran, Mutlu; Eroglu, Serpil; Pirat, Bahar; Sezgin, Atilla; Muderrisoglu, Haldun; 29680337; X-8540-2019
OBJECTIVES The aim of this study was to test the hypothesis that echocardiographic strain imaging, by tracking subtle alterations in myocardial function, and cardiac magnetic resonance T1 mapping, by quantifying tissue properties, are useful and complement each other to detect acute cellular rejection in heart transplant recipients. BACKGROUND Noninvasive alternatives to endomyocardial biopsy are highly desirable to monitor acute cellular rejection. METHODS Surveillance endomyocardial biopsies, catheterizations, and echocardiograms performed serially according to institutional protocol since transplantation were retrospectively reviewed. Sixteen-segment global longitudinal strain (GLS) and circumferential strain were measured before, during, and after the first rejection and at 2 time points for patients without rejection using Velocity Vector Imaging for the first part of the study. The second part, with cardiac magnetic resonance added to the protocol, served to validate previously derived strain cutoffs, examine the progression of strain over time, and to determine the accuracy of strain and T1 measurements to define acute cellular rejection. All tests were performed within 48 h. RESULTS Median time to first rejection (16 grade 1 rejection, 15 grade >= 2 rejection) was 3 months (interquartile range: 3 to 36 months) in 49 patients. GLS and global circumferential strain worsened significantly during grade 1 rejection and >= 2 rejection and were independent predictors of any rejection. In the second part of the study, T1 time >= 1,090 ms, extracellutar volume GLS >= 32%, GLS >-14%, and global circumferential strain >=-24% had 100% sensitivity and 100% negative predictive value to define grade >= 2 rejection with 70%, 63%, 55%, and 35% positive predictive values, respectively. The combination of GLS > 16% and T1 time >= 1,060 ms defined grade 1 rejection with 91% sensitivity and 92% negative predictive value. After successful treatment, T1 times decreased significantly. CONCLUSIONS T1 mapping and echocardiographic GLS can serve to guide endomyocardial biopsy selectively. (C) 2019 by the American College of Cardiology Foundation.
Three-Dimensional Right Ventricular Strain Versus Volume Quantification in Heart Transplant Recipients in Relation to Pulmonary Artery Pressure
(2017) Sade, Leyla Elif; Kozan, Hatice; Eroglu, Serpil; Pirat, Bahar; Aydinalp, Alp; Sezgin, Atilla; Muderrisoglu, Haldun; 0000-0003-3737-8595; 0000-0003-4576-8630; 0000-0002-9635-6313; 0000-0002-3761-8782; 0000-0003-3055-7953; 28260474; ABG-1582-2021; AAQ-7583-2021; AAI-8897-2021; AAG-8233-2020; AAD-5841-2021
Objectives: Residual pulmonary hypertension challenges the right ventricular function and worsens the prognosis in heart transplant recipients. The complex geometry of the right ventricle complicates estimation of its function with conventional transthoracic echo cardiography. We evaluated right ventricular function in heart transplant recipients with the use of 3-dimensional echocardiography in relation to systolic pulmonary artery pressure. Materials and Methods: We performed 32 studies in 26 heart transplant patients, with 6 patients having 2 studies at different time points with different pressures and thus included. Right atrial volume, tricuspid annular plane systolic excursion, peak systolic annular velocity, fractional area change, and 2-dimensional speckle tracking longitudinal strain were obtained by 2-dimensional and tissue Doppler imaging. Three-dimensional right ventricular volumes, ejection fraction, and 3-dimensional right ventricular strain were obtained from the 3-dimensional data set by echocardiographers. Systolic pulmonary artery pressure was obtained during right heart catheterization. Results: Overall mean systolic pulmonary artery pressure was 26 +/- 7 mm Hg (range, 14-44 mmHg). Three-dimensional end-diastolic (r = 0.75; P <.001) and end-systolic volumes (r = 0.55; P = .001) correlated well with systolic pulmonary artery pressure. Right ventricular ejection fraction and right atrium volume also significantly correlated with systolic pulmonary artery pressure (r = 0.49 and P = .01 for both). However, right ventricular 2-and 3-dimensional strain, tricuspid annular plane systolic excursion, and tricuspid annular velocity did not. Conclusions: The effects of pulmonary hemodynamic burden on right ventricular function are better estimated by a 3-dimensional volume evaluation than with 3-dimensional longitudinal strain and other 2-dimensional and tissue Doppler measurements. These results suggest that the peculiar anatomy of the right ventricle necessitates 3-dimensional volume quantification in heart transplant recipients in relation to residual pulmonary hypertension.