Browsing by Author "Pirat, Bahar"

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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.
Assessment of Myocardial Mechanics in Patients with End-Stage Renal Disease and Renal Transplant Recipients Using Speckle Tracking Echocardiography
(2015) Pirat, Bahar; Bozbas, Huseyin; Simsek, Vahide; Sade, L. Elif; Sayin, Burak; Muderrisoglu, Haldun; Haberal, Mehmet; 0000-0002-9635-6313; 0000-0003-4576-8630; 0000-0003-3737-8595; 0000-0002-3462-7632; 0000-0001-8287-6572; 25894162; AAG-8233-2020; AAI-8897-2021; AAQ-7583-2021; AAJ-8097-2021; J-3707-2015
Objectives: Velocity vector imaging allows quantitation of myocardial strain and strain rate from 2-dimensional images based on speckle tracking echocardiography. The aim of this study was to analyze the changes in myocardial strain and strain rate patterns in patients with end-stage renal disease and renal transplant recipients. Materials and Methods: We studied 33 patients with end-stage renal disease on hemodialysis (19 men; mean age, 36 +/- 8 y), 24 renal transplant recipients with functional grafts (21 men; mean age, 36 +/- 7 y) and 26 age- and sex-matched control subjects. Longitudinal peak systolic strain and strain rate for basal, mid, and apical segments of the left ventricular wall were determined by velocity vector imaging from apical 4- and 2-chamber views. The average longitudinal strain and strain rate for the left ventricle were noted. From short-axis views at the level of papillary muscles, average circumferential, and radial strain, and strain rate were assessed. Results: Mean heart rate and systolic and diastolic blood pressure during imaging were similar between the groups. Longitudinal peak systolic strain and strain rate at basal and mid-segments of the lateral wall were significantly higher in renal transplant recipients and control groups than end-stage renal disease patients. Average longitudinal systolic strain from the 4-chamber view was highest in control subjects (-14.5% +/- 2.9%) and was higher in renal transplant recipients (-12.5% +/- 3.0%) than end-stage renal disease patients (-10.2% +/- 1.6%; P <= .001). Radial and circumferential strain and strain rate at the level of the papillary muscle were lower in patients with end-stage renal disease than other groups. Conclusions: Differences in myocardial function in patients with end-stage renal disease, renal transplant recipients, and normal controls can be quantified by strain imaging. Myocardial function is improved in renal transplant recipients compared with end-stage renal disease patients.
The Effect of Positive End Expiratory Pressure on Right Ventricular Functions in Coronary Artery Bypass Graft Surgery
(2017) Turker, Melis; Firat, Aynur Camkiran; Pirat, Bahar; Sezgin, Atilla; Pirat, Arash; https://orcid.org/0000-0003-4576-8630; AAI-8897-2021
Background: This study aims to investigate the effect of positive end-expiratory pressure on the right ventricular functions by speckle tracking method in patients undergoing coronary artery bypass grafting. Methods: This prospective study included a total of 20 patients (17 males, 3 females; mean age 59.7 +/- 10.5 years; range 42 to 77 years) who underwent coronary artery bypass grafting between May 2013 and September 2013. After initiation of 5 cmH(2)O positive end-expiratory pressure during mechanical ventilation before sternotomy, 10 and 20 cmH(2)O of positive end-expiratory pressure were applied in five-min intervals, respectively. Four-chamber and two-chamber views of the right ventricle were recorded at each pressure level using transesophageal echocardiography. The right ventricle diameter and velocity, longitudinal strain and strain rate, and right ventricle fractional area change were calculated. Results: Intraoperative systolic, diastolic, and mean blood pressures and mean heart rate were similar at the three positive end-expiratory pressure levels. The mean right ventricle strain value was significantly lower at 20 cmH(2)O pressure (p<0.001 for both). The mean strain rate was significantly lower at 20 cmH(2)O pressure, compared to 5 cmH(2)O pressure (p=0.03). The right ventricle velocity was found to significantly decreased with increasing positive end-expiratory pressure (p<0.05). The mean right ventricle fractional area change was similar at 5 and 10 cmH(2)O pressures (p=0.063), while it was significantly lower at 20 cmH(2)O pressure (p=0.001). The mean right ventricle diameter decreased with increasing positive end-expiratory pressure, while this decrease was significant at 20 cmH(2)O pressure (p=0.01). Conclusion: Our study results show that 5, 10, and 20 cmH(2)O positive end-expiratory pressures does not significantly change hemodynamic data in patients undergoing coronary artery bypass grafting with normal right ventricular functions; however, 20 cmH(2)O positive end-expiratory pressure leads to decreased right ventricular functions, as assessed by transesophageal echocardiography.
Follow-Up of Heart Transplant Recipients with Serial Echocardiographic Coronary Flow Reserve and Dobutamine Stress Echocardiography to Detect Cardiac Allograft Vasculopathy
(2014) Sade, Leyla Elif; Eroglu, Serpil; Yuce, Deniz; Bircan, Asli; Pirat, Bahar; Sezgin, Atilla; Aydinalp, Alp; Muderrisoglu, Haldun; https://orcid.org/0000-0003-3737-8595; https://orcid.org/0000-0003-3055-7953; https://orcid.org/0000-0003-4576-8630; https://orcid.org/0000-0002-3761-8782; https://orcid.org/0000-0002-9635-6313; 24613313; AAQ-7583-2021; ABG-1582-2021; AAI-8897-2021; AAD-5841-2021; AAG-8233-2020
Background: Implementation of reliable noninvasive testing for screening cardiac allograft vasculopathy (CAV) is of critical importance. The most widely used modality, dobutamine stress echocardiography (DSE), has moderate sensitivity and specificity. The aim of this study was to assess the potential role of serial coronary flow reserve (CFR) assessment together with DSE for predicting CAV. Methods: A total of 90 studies were performed prospectively over 5 years in 23 consecutive heart transplant recipients who survived > 1 year after transplantation. Assessment of CFR with transthoracic Doppler echocardiography, DSE, coronary angiography, and endomyocardial biopsy was performed annually. Results of CFR assessment and DSE were compared with angiographic findings of CAV. Results: Acute cellular rejections were excluded by endomyocardial biopsies. CAV was detected in 17 of 90 angiograms. Mean CFR was similarly lower in both mild (CAV grade 1) and more severe (CAV grades 2 and 3) vasculopathy, but wall motion score index became higher in parallel with increasing grades of vasculopathy. Any CAV by angiography was detected either simultaneously with or later than CFR impairment, yielding 100% sensitivity for CFR. The combination of CFR and DSE increased the specificity of the latter from 64.3% to 87.2% without compromising sensitivity (77.8%). Conclusions: CFR is very sensitive for detecting CAV and increases the diagnostic accuracy of DSE, raising the potential for patient management tailored to risk modification and to avoid unnecessary angiographic procedures.
Head to Head Comparison of Speckle Tracking Strain Echocardiography with Invasive Hemodynamic Assessment for the Detection of Acute Cellular Rejection in Cardiac Allograft Recipients
(2018) Sade, Leyla Elif; Eroglu, Serpil; Pirat, Bahar; Sezgin, Atilla; Aydinalp, Alp; Ozdemir, Handan; Muderrisoglu, Haldun; 0000-0003-3737-8595; 0000-0003-4576-8630; 0000-0002-3761-8782; 0000-0002-7528-3557; AAQ-7583-2021; ABG-1582-2021; AAI-8897-2021; AAD-5841-2021; X-8540-2019
How to Assess Right Ventricular Function with Echocardiography ?
(2014) Pirat, Bahar; https://orcid.org/0000-0003-4576-8630; 24643157; AAI-8897-2021
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.
Mekanik protez aort kapağı olan hastalarda protez kapak darlığını öngörmede miyokardiyal gerilme (strain) ve rotasyon rolü
(Başkent Üniversitesi Tıp Fakültesi, 2016) Özyıldız, Afag; Pirat, Bahar
Mekanik protez aort kapağı bulunan hastaların takibinde protez kapak işlevi değerlendirilmesi esas olarak transtorasik ekokardiyografi ile yapılmaktadır. Bu amaçla, transtorasik ekokardiyografi dışında kullanılabilen pratik ve yaygın bir yöntem bulunmamaktadır. Miyokardiyal gerilme (strain) görüntüleme ve sol ventrikül rotasyonu ölçümü son yıllarda klinik kullanım alanı gittikçe yaygınlaşan yeni ekokardiyografik yöntemlerdir. Strain görüntüleme ile miyokart işlevindeki subklinik değişiklikler dahi belirlenebilir. Bu çalışmada, mekanik protez aort kapağı olan hastalarda protez kapak darlığını öngörmede miyokardiyal strain ve rotasyonun rolünün belirlenmesi amaçlanmıştır. Çalışmaya mekanik protez aort kapağı olan 60 hasta ve yapısal kalp hastalığı olmayan 30 kontrol grubu olmak üzere 90 hasta alındı. Protez aort kapağı olan hastalar ortalama aort kapak gradyanı < 20 mmHg olan (normal gradyanlı grup, 27 hasta) ve ortalama gradyanı ≥ 20 mmHg olan (yüksek gradyanlı grup, 33 hasta) hastalar olmak üzere 2 gruba ayrıldı. Tüm hastalara ayrıntılı 2-boyutlu ve Doppler ekokardiyografi uygulandı. EchoPAC analiz paketi (General Electric, Horten, Norway) ile benek takibi yöntemi kullanılarak, apikal dört boşluk (4B), iki boşluk (2B) ve apikal uzun eksen pencerelerden global ve segmental longitudinal tepe sistolik strain analizleri yapıldı. Parasternal kısa eksen görüntülerden sirkumferensiyal strain, radyal strain, apikal ve bazal rotasyon, burulma değerleri belirlendi. Tüm hastalardan ekokardiyografi ile aynı gün alınan venöz kan örneklerinden fluorescence immunoassay yöntemi ile BNP düzeyi ölçüldü. Çalışmaya alınan protez aort kapak hastalarının yaş ortalaması 46 ± 20 yıl, kontrol grubunun yaş ortalaması 45 ± 17 yıl idi. Yüksek gradyan (Y ) grubunda, normal gradyan (N ) grubu ile karşılaştırıldığında Doppler velosite indeksi (DVİ) daha düşük (p<0.001), akselerasyon zamanı (AZ) daha uzun (p=0.001) ve ejeksiyon zamanına (EZ) oranı daha yüksekti (p=0.009). Etkin kapak alanı (EKA) ve vücut yüzey alanına indekslenmiş etkin kapak alanı (İEKA), YG grubunda, NG grubu ile karşılaştırıldığında anlamlı olarak daha düşüktü (p<0.001). Dört boşluk ve 2B global longitudinal strain (GLS), kontrol grubunda hasta grubuna göre daha yüksek saptandı (p<0.001 ve p=0.008). N ve Y grupları arasında 4B ve 2B LS değerleri açısından anlamlı fark saptanmadı (sırasıyla p=0.096, p=0.355). Apikal uzun eksen LS değerleri açısından gruplar arasında anlamlı fark yoktu (p=0.957). Ortalama LS, Y grubunda kontrol ve N grubuna göre anlamlı olarak düşük bulundu (sırasıyla p<0.001 ve p=0.022). Lateral duvar bazal ve mid segmentleri longitudinal strain (LS) değerleri kontrol grubuna göre N ve Y grubunda daha düşüktü (sırasıyla p=0.003, p=0.008). Bazal rotasyonun Y grubunda kontrol grubuna göre daha düşük olduğu saptanırken (p=0.048), apikal rotasyon ve burulma açısından gruplar arasında fark anlamı değildi (sırasıyla p=0.452, p=0.07). BNP düzeyi kontrol grubunda ortalama 17.1 ± 9.6 pg/ml, NG grubunda ortalama 24.1 ± 15.6 pg/ml, YG grubunda ortalama 36.5 ± 42 pg/ml olarak bulundu. Üç grup arasındaki fark anlamlıydı (p=0.048). Hasta grubunda yapılan korelasyon analizinde aort kapak ortalama gradyanı ile BNP, LS, bazal rotasyon arasında anlamlı ilişki saptanmazken, DVİ, AZ, AZ/EZ, EKA, İEKA arasında istatiksel anlamlı ilişki saptandı. Çok değişkenli regresyon analizinde sadece DVİ, aort kapağı ortalama gradyanını tahmin etmede kullanılabilecek bağımsız bir parametre olarak bulundu. Sonuç olarak; geleneksel yöntemlere ek olarak sol ventrikül longitudinal strain ölçümü ve sol ventrikül rotasyon değerlendirmesi mekanik aort protez gradyan artışında yardımcı parametreler olarak bulunmamıştır. Bu parametrelerin protez kapak darlığı tanısı koymadaki güvenilirlikleri daha fazla sayıda protez aort kapak darlığı olan hasta gruplarında araştırılmalıdır. eleneksel Doppler ekokardiyografi yöntemleri bu hastaların değerlendirilmesinde halen vazgeçilmez ve güvenilir yöntemlerdir. Evaluation of mechanical prosthetic aortic valve function is mainly done by transthoracic echocardiography. For this purpose, no practical common method is used except transthoracic echocardiography. Myocardial strain imaging and measurement of left ventricular rotation are new echocardiographic methods, and these methods are widespread in clinical use recently. By strain imaging, even subclinical changes in myocardial function can be identified. In this study, we aimed to determine the role of myocardial strain and rotation in predicting prosthetic valve stenosis in patients with mechanical prosthetic aortic valve. The study included 90 subjects; 60 patients with mechanical prosthetic aortic valve and 30 individuals who have no structural heart disease as the control group. Patients with prosthetic aortic valve were divided into 2 groups; aortic valve mean gradient < 20 mmHg (27 patients with normal gradient) and  20 mmHg (33 patients with high gradient). Detailed 2-dimensional and Doppler echocardiography were performed to all patients. Global and segmental peak systolic longitudinal strain analysis were performed by speckle tracking method using EchoPAC analysis package (General Electric, Horten, Norway), from apical four-chamber (4C), two-chamber (2C) and apical long-axis views. Circumferential strain, radial strain, apical and basal rotation and twist values were determined from parasternal short-axis views. Venous blood sample were taken on the same day with echocardiographic examination for BNP measurements using fluorescence immunoassay. Mean age of patients with aortic valve prosthesis and controls were 46 ± 20 and 45 ± 17 years, respectively. Doppler velocity index (DVI) was lower in high gradient (HG) group compared with normal gradient (NG) group, (p<0.001); acceleration time (AT) was longer (p=0.001) and ratio of AT to ejection time (ET) was higher (p=0.009) HG group than NG group. Effective valve area (EVA) and indexed effective orifice area (IEVA) were lower in HG group compared with NG group (p<0.001). Four-chamber global longitudinal strain (GLS) and 2C GLS was higher in the control group compared to patients (p<0.001 and p=0.008, respectively). No significant difference was detected in terms of 4C and 2C GLS values between the NG and HG groups (p=0.096 and p=0.355, respectively). There was no significant difference between the groups in terms of apical long axis GLS levels (p=0.957). Mean GLS was lower in HG group compared to control and NG groups (p<0.001 and p=0.022 respectively). Longitudinal strain levels of basal and mid segments of the lateral wall were lower in NG and HG groups compared to control group (p=0.003 and p=0.008, respectively). While basal rotation was lower in HG group compared to control group (p=0.048), there was no significant difference between the groups in terms of apical rotation and twist (p=0.452 and p=0.07, respectively). BNP levels were; 17.1 ± 9.6 pg/ml in control group; 24.1 ± 15.6 pg/ml in N group; and 36.5 ± 42 pg/ml in HG group, and the difference was significant between 3 groups (p=0.048). While no significant relationship was found in the correlation analysis carried out in the patient group between aortic valve mean gradient and BNP, GLS, basal rotation; there was statistically significant correlation between aortic valve mean gradient and DVI, AT, AT/ET, EVA, and IEVA values. In the multivariate regression analysis, only DVI was found to be an independent parameter that can estimate the aortic valve mean gradient. As a result, in addition to traditional methods, left ventricular longitudinal strain measurement and assessment of left ventricular rotation are not found as auxiliary parameters in aortic prosthesis gradient increment. Reliability of these parameters in the diagnosis of prosthetic valve stenosis should be investigated in larger studies with greater number of patients with prosthetic aortic valve stenosis. In evaluating these patients, traditional measurements with Doppler echocardiography are still indispensable and reliable methods.
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.
Opere fallot tetralojili hastalarda pulmoner kapak yetersizliğinin sağ ventrikül işlevi üzerine etkisinin farklı ekokardiyografik teknikler ve galectin-3 düzeyi ile değerlendirilmesi
(Başkent Üniversitesi Tıp Fakültesi, 2015) Has Hasırcı, Senem; Pirat, Bahar
Tam düzeltme ameliyatı yapılmış Fallot Tetraloji (ToF) hastalarında uzun dönem izlemde pulmoner yetmezlik (PY) çoğunlukla gelişmektedir. Pulmoner yetmezliğe bağlı sağ ventrikülde (SğV) hacim yüklenmesi, SğV dilatasyonu ve fonksiyon bozukluğu gelişmesine yol açmaktadır. Bu hastalarda pulmoner kapak replasmanı endikasyonları ve zamanlaması net değildir. Çalışmamızda amaç, PY’nin SğV fonksiyonları üzerine etkisinin farklı ekokardiyografik yöntemlerle değerlendirilmesi ve SğV fonksiyonu ile fibrozisten sorumlu olduğu bilinen galektin-3 düzeyi arasındaki ilişkinin belirlenmesidir. Çalışmamıza tam düzeltme ameliyatı yapılmış 42 ToF hastası ve yaş, cinsiyet olarak benzer 31 sağlıklı birey olmak üzere toplam 73 kişi alındı. Hastaların boy ve kilo ölçümleri kaydedildi, vücut kitle indeksleri hesaplandı. Elektrokardiyografilerindeki QRS süreleri kaydedildi. Ekokardiyografik değerlendirme ile aynı gün hastalardan galektin-3 düzeyi için venöz kan örneği alındı ve çalışma sonunda ELISA yöntemiyle galektin-3 düzeyleri ölçüldü. İki boyutlu (2B) ekokardiyografi (EKO) ile hastaların SğV diyastol sonu çapı, diyastol sonu alanı (DSA), sistol sonu alan (SSA), fraksiyonel alan değişimi (FAD), M-mod ile triküspit kapak anüler düzlem (TAPSE) ölçümleri yapıldı, doku doppler (DD) ile SğV serbest duvar S hızı ölçüldü. Benek takibi yöntemiyle SğV serbest duvar ve interventriküler septum (İVS) strain analizleri yapıldı, global strain hesaplandı. Üç boyutlu (3B) EKO ile SğV diyastol sonu hacim (DSH), sistol sonu hacim (SSH) ve ejeksiyon fraksiyonu (EF) ölçüldü. Hasta grubundan son 6 ay içerisinde kardiyak manyetik rezonans görüntüleme (MRG) yapılmış olanların MRG ile değerlendirilen SğV DSH, SSH, EF ile sağ kalp kateterizasyonu (SKK) yapılmış hastaların SğV sistolik basınçları (SB) kaydedildi. Hasta ve kontrol gruplarının yaş ortalaması sırasıyla 22.3 ± 4.2 ve 22.9 ± 2.5 idi (p=0.479). Her iki grup arasında cinsiyet dağılımı, boy, kilo, vücut kitle indeksleri açısından fark yoktu. Tüm bireylerin EKG’leri sinüs ritminde olup, hasta grubunun QRS süresi, kontrol grubuna göre belirgin uzundu (p≤0.001). Gruplar arasında galektin-3 düzeyleri açısından fark saptanmadı (hasta grubunda ortalama 3.22 ± 2.76 ng/ml, kontrol grubunda ortalama 3.23 ± 2.70 ng/ml, p=0.993). Hasta grubunda galektin-3 düzeyi ile SğV diyastol sonu çapı, FAD, TAPSE, SğV serbest duvar S hızı, global strain ve 3B EF arasında ilişki saptanmadı. Hasta grubunda QRS süreleri ile galektin-3 düzeyleri arasında istatistiksel olarak anlamlı, ancak zayıf, pozitif yönde bir ilişki saptandı (p=0.046, r=0.350). Hasta grubunda SğV diyastol sonu çapları kontrol grubuna göre anlamlı olarak geniş bulundu (p<0.001). Aynı zamanda hasta grubunda SğV DSA ve SğV SSA anlamlı olarak daha geniş (p<0.001), FAD ve TAPSE anlamlı olarak daha düşük saptandı (p<0.001). Sağ ventrikül serbest duvar S hızı ve global strain hasta grubunda anlamlı olarak düşük bulundu (p<0.001). 3B SğV EF hasta grubunda % 46.5 ± 5.5, kontrol grubunda % 59.09 ± 2.0 bulundu (p<0.001). Korelasyon analizi sonucunda hasta grubunda 3B SğV EF ile TAPSE, FAD, SğV serbest duvar S hızı ve global strain arasında anlamlı korelasyon saptandı. Hasta grubunda çoklu regresyon analizi ile FAD ve SğV serbest duvar S hızı, 3B SğV EF’yi tahmin etmekte kullanılabilecek bağımsız belirteçler olarak bulundu. Alt grup analizinde MRG ile değerlendirilen SğV EF ile galektin-3 düzeyi arasında ilişki saptanmazken (p=0.552, r=0.161), SKK ile ölçülen SğVSB arasında galektin-3 düzeyi arasında istatistiksel anlama ulaşmayan zayıf bir ilişki saptandı (p=0.059, r=0.535). Hasta grubu PVR yapılmış olanlar ve yapılmamış olanlar olarak ayrıldığında TAPSE ve SğV serbest duvar S hızının PVR yapılmış grupta PVR yapılmamış olan gruba göre anlamlı olarak düşük olduğu bulundu. 3B SğV EF ve global strain değeri de PVR yapılmış grupta PVR yapılmamış gruba göre anlamlı olarak daha düşüktü. Kontrol, PVR yapılmış ve PVR yapılmamış grupta galektin-3 düzeyleri açısından istatistiksel olarak anlamlı fark izlenmedi. Sonuç olarak, tam düzeltme ameliyatı yapılmış ToF hastalarında galektin-3 düzeyi ile SğV fonksiyonlarını değerlendirmekte kullanılan konvansiyonel ve ileri EKO parametreleri arasında anlamlı ilişki saptanmamıştır. Bu EKO parametreleri kontrol grubu ile karşılaştırıldığında hasta grubunda anlamlı olarak düşüktür. Sağ ventrikül serbest duvar S hızı ve FAD, 3B EKO ile ölçülen SğV EF’yi tahmin etmekte kullanılabilecek bağımsız parametreler olarak bulunmuştur. Pulmonary regurgitation is a common problem after surgical repair of tetralogy of Fallot (ToF). Chronic volume overload leads to progressive right ventricle (RV) dilation and dysfunction. In these patients, indications and optimal timing of pulmonary valve replacement (PVR) is uncertain. In this study we aimed to assess effect of pulmonary regurgitation on RV function using different echocardiographic techniques and to identify the relationship between RV function and galectin-3, which is a mediator of fibrosis. Forty-two patients with repaired TOF, and thirty-one healthy controls were prospectively studied. Height and weight measurements of patients were recorded, body mass indexes were calculated. Electrocardiographic QRS duration of each patient were recorded. Venous blood samples were taken for galectin-3 analysis from patients on the same day with echocardiographic assessment and galectin-3 levels were analyzed by ELISA method at the end of the enrollment of patients. RV end-diastolic diameter, enddiastolic area, end-systolic area and fractional area change (FAC) were measured by using two-dimensional echocardiography. Tricuspid annular peak systolic excursion (TAPSE) was measured using M-mode echocardiography. Tissue Doppler imaging was used to determine annular RV tissue Doppler S wave. RV lateral free wall and interventricular septum (IVS) strain and peak systolic global RV strain was determined using speckle tracking. RV end-diastolic and end-systolic volumes and ejection fraction (EF) were assessed by 3-dimensional (3D) echocardiography. RV end-diastolic volume, end-systolic volume and EF measurements were recorded in patients who underwent cardiac magnetic resonance imaging (MRI) and systolic right ventricle pressure was recorded in patients who underwent right heart catheterization. Mean age of the patients and controls were 22.3 ± 4.2 and 22.9 ± 2.5 years, respectively (p=0.479). There were no differences in sex distribution, height, weight and body mass index between the two groups. All participants were in sinus rhythm and QRS duration was significantly longer in patients when compared with the control group. Galectin-3 concentration were similar between the groups (3.22 ± 2.76 ng/ml for patients vii and 3.23 ± 2.70 ng/ml for controls, p=0.993). There was no significant relation between galectin-3 concentration and RV end diastolic diameter, FAC, TAPSE, RV tissue Doppler S wave, global strain and 3D RVEF in patients with ToF. There was a significant but weak positive correlation between galectin-3 levels and QRS duration (p=0.046, r=0.350). RV end-diastolic diameter, end-diastolic area, and end-systolic area were significantly higher in patients than controls (p<0.001 for all). FAC and TAPSE were significantly lower in patients than controls (p<0.001 for both). RV tissue Doppler S wave and global strain were significantly lower in patients than controls (p<0.001). RVEF with 3D echocardiography was 46.5 ± 5.5 % in patients and 59.09 ± 2.0 % in controls (p<0.001). 3D RVEF was significantly correlated to TAPSE, FAC, RV tissue Doppler S wave and global strain. On multivariate analysis FAC and RV tissue Doppler S wave were independent parameters to predict 3D RVEF. In subgroup analysis of patients who underwent cardiac MRI, there was no significant relation between galectin-3 levels and RVEF measured by MRI (p=0.552, r= - 0.161). Within patients who underwent RHC, there was only a weak correlation between galectin-3 levels and RV systolic pressure (p=0.059, r=0.535). When patients with and without PVR were compared; TAPSE, RV tissue Doppler S wave, RV 3D EF and global strain were significantly lower in patients who underwent PVR. Galectin-3 concentrations were similar between controls and patients with and without PVR. In conclusion, in patients with repaired ToF, no significant relation was detected between galectin-3 levels and echocardiography parameters which indicates right ventricular function. Both conventional and advanced echocardiography parameters were significantly worse in patients when compared with the control group. Tissue Doppler S velocity and FAC can be used to predict RVEF determined by 3D echocardiography.
Risk factors for left atrial appendage thrombus
(2020) Yilmaz, Kerem Can; Akgun, Arzu Neslihan; Ciftci, Orcun; Eroglu, Serpil; Pirat, Bahar; Sade, Elif; Ulucam, Melek; Ozin, Bulent; Muderrisoglu, Haldun; 0000-0002-9635-6313; 0000-0001-8926-9142; 0000-0003-4576-8630; 0000-0003-3055-7953; 32342731; AAD-9938-2021; AAG-8233-2020; W-5233-2018; AAI-8897-2021; AAJ-1331-2021
Background: Atrial fibrillation (AF) is the most common persistent rhythm disorder that has been shown to be associated with a significant increase in stroke risk. Left atrial appendage (LAA) thrombi are responsible for most of strokes of cardiac origin. CHA(2)DS(2)-VASc is a risk scoring system to identify patients' indications for anticoagulation in nonvalvular AF patients. The aim of our study was to investigate CHA(2)DS(2)-VASc score, the other risk factors, echocardiographic data and blood parameters for LAA thrombus. Methods: Two hundred and sixty-four patients who were admitted to our adult cardiology outpatient clinic and who underwent a transesophageal echocardiography procedure between June 2017 and June 2019 included in our study. Patient's demographic data, transthoracic echocardiographic examinations, and laboratory results were recorded retrospectively. Results: LAA thrombus was detected in 39 (14.7%) patients. The rates of coronary artery disease and systolic dysfunction were significantly higher in patients with LAA thrombus (p = .017, p = .016, respectively). When AF subtypes were examined in detail, thrombus rate was significantly higher in persistent AF (51 vs. 25.7%, p = .002). Although the CHA(2)DS(2)-VASc score was slightly higher in the thrombus group, there was no statistically significant difference between the two groups (3.0 +/- 1.65 vs. 2.78 +/- 1.66). Conclusions: In conclusion, CHA(2)DS(2)-VASc score system itself was not informative about LAA thrombus formation although some of its components were related with LAA thrombus formation. According to a multiple regression analysis, the independent determinants of LAA thrombus were the presence of AF and coronary artery disease.
Role of myocardial strain and rotation for predicting prosthetic aortic valve stenosis
(2021) Ozyildiz, Afag; Pirat, Bahar; Ozyildiz, Ali Gokhan; Muderrisoglu, Haldun; 0000-0003-0679-9434; 34626295; D-2856-2015
Pressure overload due to aortic stenosis leads to subclinical left ventricular (LV) dysfunction and global longitudinal strain (GLS) impairment even if ejection fraction is preserved. However, little is known about LV mechanics in aortic prosthetic valve (APV) stenosis. The study aimed to determine the role of myocardial strain and rotation in predicting prosthetic valve stenosis in mechanical APV patients. 60 patients with mechanical APV and 30 healthy individuals were evaluated. APV patients were analyzed in two groups; aortic valve mean gradient < 20 mmHg (27 normal gradient patients) and >= 20 mmHg (33 high gradient patients). Strain, rotation, and twist values were assessed using the speckle tracking method, and brain natriuretic peptide (BNP) levels were measured. Four-chamber (p < 0.001) and two-chamber (p = 0.008) longitudinal strain (LS) were higher in the control group. GLS was lower in the high gradient group than control and normal gradient groups (p < 0.001, p = 0.022). LS of lateral wall's basal and mid segments were lower in normal and high gradient groups than the control group (p = 0.003, p = 0.008). While basal rotation was lower in the high gradient group than the control group (p = 0.048), there was no difference between the groups in terms of apical rotation, and twist. BNP levels were significantly different between the groups (p = 0.048). No correlation was found between aortic valve mean gradient and GLS, basal rotation, and BNP. In conclusions, LV GLS and basal rotation are depressed in high APV gradient patients; however, these parameters are not independent predictors of gradient increment.
Speckle Tracking Imaging For Evaluation of Effects of Peep Level on Right Ventricular Function
(2014) Turker, Melis; Firat, Aynur Camkiran; Pirat, Bahar; Sezgin, Atilla; Arslan, Gulnaz; Pirat, Arash; https://orcid.org/0000-0003-4576-8630; AAI-8897-2021
Subclinical myocardial dysfunction in liver transplant candidates determined using speckle-tracking imaging
(2019) Inci, Saadet Demirtas; Sade, Leyla Elif; Altin, Cihan; Pirat, Bahar; Pamukcu, Hilal Erken; Yilmaz, Sabriye; Muderrisoglu, Haldun; 31802775
Objective: There are various cardiovascular abnormalities in end-stage liver disease (ESLD). In these patients, left ventricular (LV) systolic function is normal at rest but deteriorates during stress. This deterioration may be due to subclinical myocardial dysfunction. This study evaluated global LV and right ventricular (RV) functions using 2-dimensional (2D) speckle tracking in patients with ESLD. Methods: Forty liver transplant candidates with ESLD and 26 healthy individuals were included in the study. All of the patients underwent conventional echocardiographic measurement. Longitudinal, circumferential, and radial strain measurements, as well as apical and parasternal short-axis image recordings were obtained. All 2D strain measurements were measured with offline analysis using velocity vector imaging (VVI) software. Results: In the apical 4- and 2-chamber measurements, the LV mean longitudinal strain was significantly lower in the patient group compared with that of the control group (-16.0 +/- 3.2% versus -17.6 +/- 2.2%, -16.7 +/- 3.3% versus -18.7 +/- 2.1 +/- 2.1 %; p=0.002, respectively). The LV mean circumferential strain did not differ between groups. The LV mean radial strain and RV longitudinal strain were significantly lower in the patient group (45.4 +/- 10.7 vs. 52.7 +/- 10.8%; p=0.01 and -19.2 +/- 3.5% versus -21.5 +/- 3.6%; p=0.03, respectively). Conclusions: Subclinical impairment of global LV and RV systolic functions was determined in liver transplantation candidates using VVI. This deterioration was detected in longitudinal and radial deformation rather than circumferential deformation mechanics, which is consistent with early-stage LV myocardial dysfunction.
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.
Treatment-associated change in apelin concentration in patients with hypertension and its relationship with left ventricular diastolic function
(2017) Pirat, Bahar; Baysal, Sadettin Selcuk; Okay, Kaan; Bal, Ugur Abbas; Ulucam, Melek Zekiye; Oztuna, Derya; Muderrisoglu, Haldun; 0000-0003-4576-8630; 0000-0002-9635-6313; 0000-0002-9446-2518; 0000-0002-4107-3500; 0000-0001-6134-8826; 27599667; AAI-8897-2021; AAG-8233-2020; AAK-4322-2021; ABD-7240-2021; AAK-7355-2020
OBJECTIVE: We examined the change in apelin concentration and its relationship with left ventricular diastolic function in patients treated for hypertension. METHODS: Ninety treatment-naive patients with newly diagnosed hypertension and 33 age- and sex-matched control subjects were prospectively enrolled. Patients with hypertension were randomized to treatment either with telmisartan 80 mg or amlodipine 10 mg. Apelin concentration was measured and echocardiography was performed at baseline and after 1 month of treatment. RESULTS: The data of 77 patients and 33 controls were analyzed. Mean age, gender, baseline blood pressure, apelin levels, and echocardiographic measurements were similar between the treatment groups (p>0.05 for all). Apelin concentration was significantly lower in patients with hypertension than in controls. There was a significant increase in apelin level after 1 month of treatment in both groups (0.32 +/- 0.17 vs. 0.38 +/- 0.17 ng/dL in telmisartan group, p=0.009, and 0.27 +/- 0.13 vs. 0.34 +/- 0.18 ng/dL in amlodipine group, p=0.013). Diastolic function improved significantly in both groups (p<0.05) but was not significantly associated with change in apelin concentration. CONCLUSION: Apelin concentration increased significantly after 1 month of effective treatment with telmisartan or amlodipine to a similar extent. Change in apelin concentration was not associated with improvement in diastolic function
Yeni tanı hpertansiyonda tedavi ile apelin düzeyi değişimi ve sol ventrikül diyastolik işlevi ile ilişki
(Başkent Üniversitesi Tıp Fakültesi, 2014) Baysal, Sadettin Selçuk; Pirat, Bahar
Apelin kardiyovasküler sistem üzerine çeşitli etkileri saptanmış olan yeni bir endojen peptiddir. Bu çalışmada hipertansiyon tanısı konan ve yeni ilaç tedavisi başlanan hastalarda apelin düzeyindeki değişimin saptanması ve tedavi sonrası apelin düzeyi ile diyastolik işlev parametrelerindeki iyileşme arasındaki ilişkinin araştırılması amaçlandı. Avrupa Kardiyoloji Derneği (ESC) kılavuzuna göre evre 1 ve 2 hipertansiyon tanısı konulmuş 90 hasta (50 erkek, 40 kadın) çalışmaya alındı. Koroner arter hastalığı , diabetes mellitus , ciddi kapak hastalığı, sol ventrikül ejeksiyon fraksiyonu % 45’ in altında olan, vücut kitle indeksi 30 kg/ m2’ nin üstünde olan ve kreatinin düzeyi 1,6 mg/dl’ den yüksek olan hastalar çalışmadan çıkarıldı. Hastaların yarısına 80 mg telmisartan, diğer yarısına da 10 mg amlodipin tedavisi rastgele olarak verildi. Tedavi öncesi apelin düzeyi için kan alınıp, transtorasik ekokardiyografi uygulandı. Rutin ekokardiyografik ölçümlerin yanında doku doppler ekokardiyografileri yapıldı. Doku doppler ekokardiyografi ile anüler septal ve lateral e’ dalgaları kaydedilip, analizlerde ikisinin ortalaması kullanıldı. Ayrıca M-mod ekokardiyografi ile mitral propagasyon velositeleri (Vp) ölçüldü. Bir aylık tedavi sonrası plazma apelin düzeyi ölçümü ve ekokardiyografi tekrarlandı. Onüç hasta kontrole gelmediği için çalışmadan çıkarıldı. Yaş ortalaması 48 ± 10 olan 77 hastanın verileri analiz edildi. Her iki grup yaş, cinsiyet dağılımı, bazal kan basıncı ölçümleri, bazal apelin düzeyleri ve bazal ekokardiyografik ölçümleri açısından birbirine benzerdi (p>0,05). 1 aylık tedavi sonrasında hem amlodipin hem de telmisartan grubu beraber değerlendirildiğinde apelin düzeylerinde anlamlı artış izlendi (sırasıyla 0,32±0,02’e karşın 0,38±0,02 ng/dl ve 0,27±0,02’e karşın 0,34±0,02 ng/dl; p<0,001). Bu artış miktarı her iki grupta birbirine benzerdi (p=0,671). Yine hem amlodipin hem de telmisartan grubu beraber değerlendirildiğinde sistolik kan basıncında (sırasıyla 154±11’e karşın 123±10 mmHg ve155±7’e karşın 122±9 mmHg) ve diyastolik kan basıncında (sırasıyla 96±9’a karşın 76±8 mmHg ve 92±6’ya karşın 74±9 mmHg) anlamlı azalma izlendi (p<0,001). Bu azalma miktarı her iki grupta birbirine benzerdi (p=0,628). Her iki grupta diyastolik işlevin değerlendirilmesinde kullanılan ekokardiyografik parametrelerde gelişme izlendi (p<0,05). Spearman korelasyon testlerinde, apelin düzeyindeki artış ile ekokardiyografik diyastolik işlev parametrelerindeki gelişme arasında istatistiksel olarak anlamlı bir ilişki saptanmadı. Bu çalışmanın sonucunda, yeni tanı hipertansiyon hastalarında 1 aylık antihipertansif tedavi altında etkin kan basıncı kontrolü ile apelin düzeylerinde anlamlı artış saptandı. Apelin düzeyindeki artış ile diyastolik işlevdeki iyileşme arasında anlamlı bir ilişki saptanmadı. Apelin is a novel endogenous peptide which has different functions in cardiovascular system. In this study we aimed to investigate the change in apelin levels in patients with newly diagnosed hypertension after one month of drug therapy and identify the relation between apelin level and improvement in left ventricular diastolic function. Ninety patients (50 men, 40 women) were enrolled who were diagnosed as stage 1 and 2 hypertension based on Eurepean Society of Cardiology guidelines. Patients who had coronary artery disease, diabetes mellitus, severe valvular disease, body mass index above 30 kg/ m2, left ventricle ejection fraction below 45 % and creatinine level above 1.6 mg/dl were excluded. Patients were randomized to treatment groups of 80 mg telmisartan and 10 mg amlodipine. At baseline, blood samples for apelin level were obtained and transthoracic echocardiography was performed. In addition to routine echocardiographic measurements, lateral and septal annular e’ wave velocities were measured using tissue Doppler method. Transmitral flow propagation velocity (Vp) was measured by M-mode echocardiography. After 1 month of treatment, ambulatory blood pressure monitoring was performed and plasma apelin level measurement and echocardiography were repeated. Thirteen patients were excluded due to incomplete follow-up. Data from 77 patients with a mean age of 48 ± 10 were analyzed. Mean age, gender, baseline blood pressure, apelin levels and echocardiographic measurements were similar between the groups (p > 0,05 for all). When both amlodipin and telmisartan group evaluated together, there was a significant increase in apelin levels after one month of treatment (0,32±0,02 vs 0,38±0,02 ng/dl and 0,27±0,02 vs 0,34±0,02 ng/dl respectively; p<0,001). This increase was similar between both groups (p=0,671). In both amlodipin and telmisartan groups, there was a significant decrease in systolic (154±11 vs 123±10 mmHg and 155±7 vs 122±9 mmHg respectively) and diastolic blood pressure values (96±9 vs 76±8 mmHg and 92±6 vs 74±9 mmHg respectively)(p<0,001). This decrease was similar between both groups (p=0,628). Parameters indicating diastolic function were improved in both telmisartan and amlodipine groups (p<0,05). On spearman rank correlation test analysis, diastolic function indices which were improved with treatment were not significantly related to follow-up apelin level. Apelin levels were significantly increased in newly diagnosed hypertensive patients after one month of treatment and effective blood pressure control either with telmisartan or amlodipine. Change in apelin level was not related to improvement in diastolic function.