Browsing by Author "Sade, Elif"

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Analysis of right ventricle function with strain imaging before and after pulmonary valve replacement
(2016) Gursu, Hazim Alper; Varan, Birgul; Sade, Elif; Erdogan, Ilkay; Ozkan, Murat; 26779972
Background: Pulmonary valve insufficiency may develop after surgical treatment of tetralogy of Fallot (ToF). Severe pulmonary valve insufficiency may result in right ventricular dysfunction. We aimed to compare cardiac magnetic resonance (CMR), with echocardiography. Methods: Patients who developed severe pulmonary valve insufficiency after total correction for ToF, were included in the study. CMR was used to measure end-diastolic, end-systolic volumes and ejection fraction of the right ventricle before and 6 months after replacement, and echocardiographic strain imaging was obtained before, and 1, 3, and 6 months after replacement. Results: There were significant differences between pre- and post-replacement QRS durations, and right ventricle end-diastolic and end-systolic volumes measured with CMR (p < 0.05). However, right ventricular ejection fraction (RVEF) did not change. Therefore, CMR determined that right ventricle size and volume increased, and right ventricular function deteriorated before replacement. After replacement, no significant improvement was seen in RVEF. Lower-than-normal right ventricle strain and strain rate before replacement indicated that healthy and dysfunctional myocardium could be differentiated by this method. Pre-replacement strain and strain rate of asymptomatic and symptomatic patients were similar. Strain and strain rate values increased 6 months after replacement (p < 0.05). Conclusions: We suppose that increased experience with strain imaging, and further studies on a larger patient group with a longer follow-up period would show that this method is quite advantageous, and it will take its place in the literature as a non-invasive technique that may be used instead of magnetic resonance.
Characterization of Responder Profiles for Cardiac Resynchronization Therapy through Unsupervised Clustering of Clinical and Strain Data
(2021) Gallard, Alban; Bidaut, Auriane; Hubert, Arnaud; Sade, Elif; Marechaux, Sylvestre; Sitges, Martha; Separovic-Hanzevacki, Jadranka; Le Rolle, Virginie; Galli, Elena; Hernandez, Alfredo; 33524492
Background: The mechanisms of improvement of left ventricular (LV) function with cardiac resynchronization therapy (CRT) are not yet elucidated. The aim of this study was to characterize CRT responder profiles through clustering analysis, on the basis of clinical and echocardiographic preimplantation data, integrating automatic quantification of longitudinal strain signals. Methods: This was a multicenter observational study of 250 patients with chronic heart failure evaluated before CRT device implantation and followed up to 4 years. Clinical, electrocardiographic, and echocardiographic data were collected. Regional longitudinal strain signals were also analyzed with custom-made algorithms in addition to existing approaches, including myocardial work indices. Response was defined as a decrease of $15% in LV end-systolic volume. Death and hospitalization for heart failure at 4 years were considered adverse events. Seventy features were analyzed using a clustering approach (k-means clustering). Results: Five clusters were identified, with response rates between 50% in cluster 1 and 92.7% in cluster 5. These five clusters differed mainly by the characteristics of LV mechanics, evaluated using strain integrals. There was a significant difference in event-free survival at 4 years between cluster 1 and the other clusters. The quantitative analysis of strain curves, especially in the lateral wall, was more discriminative than apical rocking, septal flash, or myocardial work in most phenogroups. Conclusions: Five clusters are described, defining groups of below-average to excellent responders to CRT. These clusters demonstrate the complexity of LV mechanics and prediction of response to CRT. Automatic quantitative analysis of longitudinal strain curves appears to be a promising tool to improve the understanding of LV mechanics, patient characterization, and selection for CRT.
Detection of Donor-Specific Antibodies Both in Serum and Cardiac Allograft Biopsy in Heart Transplant Patients: Tissue DSA is More Predictive than Serum DSA
(2018) Basturk, Bilkay; Sezgin, Atilla; Sade, Elif; Ozdemir, B. Handan; Terzi, Aysen; Kantaroglu, Bircan; Haberal, Mehmet; 0000-0002-8784-1974; 0000-0002-7528-3557; 0000-0002-1225-1320; 0000-0002-3462-7632; AAD-6918-2021; X-8540-2019; F-7546-2013; AAJ-8097-2021
EACVI appropriateness criteria for the use of transthoracic echocardiography in adults: a report of literature and current practice review
(2017) Sade, Elif; Steeds, Richard P.; Garbi, Madalina; Cardim, Nuno; Kasprzak, Jaroslaw D.; Nihoyannopoulos, Petros; Popescu, Bogdan Alexandru; Stefanidis, Alexandros; Cosyns, Bernard; Monaghan, Mark; Aakhus, Svend; Edvardsen, Thor; Flachskampf, Frank; Galiuto, Leonarda; Athanassopoulos, George; Lancellotti, Patrizio; 28329307
The European Association for Cardiovascular Imaging (EACVI) has outlined the rationale for setting appropriate use criteria (AUC) in cardiovascular (CV) imaging. Transthoracic echocardiography (TTE) is the most common imaging modality in CV disease and is a central tool in diagnosis, follow-up, management planning and intervention. The purpose of AUC is to inform referrers, both to avoid under-use, which may result in incomplete or incorrect diagnosis and treatment, and also over-use, which may delay correct diagnosis, lead to 'treatment cascade', and wastes resources. The first step in defining AUC for TTE in the adult has been for a panel of experts in echocardiography to review the evidence, guidelines, recommendations, and position papers from the European Society of Cardiology, EACVI and other specialist societies, and current state-of-the-art clinical practice. The attached document summarizes this work, which will be used to under-pin the development of AUC.
Evaluation of Acute Rejection by Measuring Strain and Strain Rate in Children With Heart Transplant: A Preliminary Report
(2017) Gursu, Hazim Alper; Varan, Birgul; Sade, Elif; Erdogan, Ilkay; Sezgin, Atilla; Aslamaci, Sait; 0000-0002-0707-2678; 0000-0002-6719-8563; 0000-0001-6887-3033; 27310367; AHI-4502-2022; ABB-1767-2021; ABB-2220-2021
Objectives: Asymptomatic rejection after heart transplant is difficult to detect by noninvasive methods. The present study investigated the efficacy of echocardiographic strain and the strain rate imaging method in detecting rejection after pediatric heart transplant. Materials and Methods: Fourteen pediatric patients with heart transplant were examined both with endomyocardial biopsy and strain imaging. Patients were divided into 2 groups: group 1 included patients with rejection, and group 2 included patients without rejection. Patients underwent endomyocardial biopsy at regular intervals. Regional systolic function was evaluated by longitudinal myocardial peak systolic values of strain and of strain rate. Differences between the 2 groups were assessed with unpaired t test or Mann-Whitney U test. Results: Acute rejection was detected in 7 patients (4 were female patients). Cardiac diagnosis was restrictive cardiomyopathy in 3 patients, dilated cardiomyopathy in 3 patients, and complex congenital heart disease in 1 patient. After heart transplant, 6 patients had rejection once and 1 patient had rejection twice. Evaluation of biopsy samples revealed grade IB rejection in all patients in group 1. Systolic functions of the 6 patients were determined as normal in standard echocardiographic examination. There were no significant differences in deformation and deformation rates between group 1 and 2 except in midseptal region (P<.05). Conclusions: One of the most significant complications in patients with heart transplant is rejection. Our results suggested that myocardial strain imaging may be valuable in defining low-grade rejection.
Future of Advanced Heart Failure and Mechanical Support Devices: A Cardiology-Cardiovascular Surgery Consensus Report
(2016) Yilmaz, Mehmet Birhan; Akar, Ahmet Ruchan; Ekmekci, Ahmet; Nalbantgil, Sanem; Sade, Elif; Eren, Mehmet; Orhan, Gokcen; Ozbaran, Mustafa; Yagdi, Tahir; Kucuker, Seref Alp; Gurbuz, Ali; Tokgozoglu, Lale; https://orcid.org/0000-0003-3737-8595; 27111324; AAQ-7583-2021
Heart failure is a progressive disease. A considerable number of patients eventually reach an advanced or terminal phase, in spite of developments in diagnostic procedure, alternative treatments that can slow progression, management, and follow-up. In addition to palliative care of patients in the terminal phase, accurate recognition of advanced disease is vital in the determination of therapeutic options. Overall management of patients with heart failure requires the collaboration of professionals from multiple disciplines. Still, patients with advanced heart failure should be managed by a "heart team," as indicated by guidelines; communication and collaboration among cardiologists, cardiovascular surgeons, and other medical staff responsible for patient care is necessary. While our country has physicians experienced in the management of patients with advanced heart failure, these professionals are not distributed evenly across the country, and equitable access to therapeutic options is not provided. Hence, progress has yet to be made regarding appropriate referrals and patient circulation. The aims of the present consensus report are to strengthen the connection between certified, experienced centers and those that care for patients irrespective of disease phase and healthcare staff, as well as to raise awareness and provide information regarding conditions in Turkey.
The Importance of the Histopathological Findings of Surveillance Biopsies in the Monitoring Of Acute Antibody-Mediated Rejection (AMR) In Cardiac Allograft Recipients with or Without Clinical Symptoms: Single Center Experience
(2018) Terzi, Aysen; Tunca, Zeynep; Ozdemir, B. Handan; Sezgin, Atilla; Basturk, Bilkay; Sade, Elif; Haberal, Mehmet; https://orcid.org/0000-0002-1225-1320; https://orcid.org/0000-0002-7528-3557; https://orcid.org/0000-0002-8784-1974; https://orcid.org/0000-0002-3462-7632; F-7546-2013; X-8540-2019; AAD-6918-2021; AAJ-8097-2021
Left atrial strain is a predictor of left ventricular systolic and diastolic reverse remodelling in CRT candidates
(2021) Galli, Elena; Oger, Emmanuel; Aalen, John M.; Duchenne, Jurgen; Larsen, Camilla K.; Sade, Elif; Hubert, Arnaud; Gallard, Aban; Penicka, Martin; Linde, Cecilia; Le Rolle, Virginie; Hernandez, Alfredo; Leclercq, Christophe; Voig, Jens-Uwe; Smiseth, Otto A.; Donal, Erwan; 34432006
Aims The left atrium (LA) has a pivotal role in cardiac performance and LA deformation is a well-known prognostic predictor in several clinical conditions including heart failure with reduced ejection fraction. The aim of this study is to investigate the effect of cardiac resynchronization therapy (CRT) on both LA morphology and function and to assess the impact of LA reservoir strain (LARS) on left ventricular (LV) systolic and diastolic remodelling after CRT. Methods and results Two hundred and twenty-one CRT-candidates were prospectively included in the study in four tertiary centres and underwent echocardiography before CRT-implantation and at 6-month follow-up (FU). CRT-response was defined by a 15% reduction in LV end-systolic volume. LV systolic and diastolic remodelling were defined as the percent reduction in LV end-systolic and end-diastolic volume at FU. Indexed LA volume (LAVI) and LV-global longitudinal (GLS) strain were the main parameters correlated with LARS, with LV-GLS being the strongest determinant of LARS (r = -0.59, P < 0.0001). CRT induced a significant improvement in LAVI and LARS in responders (both P < 0.0001). LARS was an independent predictor of both LV systolic and diastolic remodelling at follow-up (r = -0.14, P = 0.049 and r = -0.17, P = 0.002, respectively). Conclusion CRT induces a significant improvement in LAVI and LARS in responders. In CRT candidates, the evaluation of LARS before CRT delivery is an independent predictor of LV systolic and diastolic remodelling at FU.
Left Ventricular Assist Device Management Strategy
(2018) Ersoy, Ozgur; Gultekin, Bahadir; Beyazpinar, Sarp; Sade, Elif; Sezgin, Atilla; Aslamaci, Sait; ABA-7388-2021
Predictive Value of Hematologic Parameters for Detecting Asymptomatic Graft Rejection After Heart Transplant: Preliminary Results
(2015) Karacaglar, Emir; Bal, Ugur; Ciftci, Orcun; Turgay, Ozge; Yilmaz, Mustafa; Sade, Elif; Aydinalp, Alp; Sezgin, Atilla; Atar, Ilyas; Muderrisoglu, Haldun; 0000-0002-2557-9579; 0000-0002-9446-2518; 0000-0001-8926-9142; 0000-0002-2538-1642; 0000-0002-3761-8782; 0000-0002-9635-6313; 0000-0002-6731-4958; 0000-0003-3737-8595; 26640937; S-6973-2016; AAK-4322-2021; W-5233-2018; ABI-6723-2020; GPX-1387-2022; AAD-5841-2021; AAG-8233-2020; AAQ-7583-2021
Objectives: Hematologic parameters, such as mean platelet volume, red-cell distribution width, and neutrophil-to-lymphocyte ratio, have prognostic value in multiple cardiac conditions such as stable angina pectoris, acute coronary syndromes, and heart failure. However, no previous studies have evaluated the association between hematologic parameters and asymptomatic graft rejection after heart transplant. We evaluated the role of hematologic parameters for detecting asymptomatic graft rejection after heart transplant. Materials and Methods: We retrospectively evaluated medical records of 47 adult patients who underwent orthotopic heart transplant between February 25, 2005, and July 6, 2014, in our hospital, noting their hematologic parameters before each biopsy. Two groups were created according to biopsy results: rejection and no-rejection. Results: We excluded 4 patients who died during the first month posttransplant owing to early complications. We evaluated 422 endomyocardial biopsy results of 43 adult patients (mean age, 43.4 +/- 11.4 y; 14 women). Mean follow-up was 33 months. A total of 109 biopsies performed because of clinical suspicion of rejection were excluded. Redcell distribution width levels were similar between groups (17.2% +/- 2.6% in the rejection group and 17.1% +/- 2.5% in the no-rejection group; P=.856). Neutrophil-to-lymphocyte ratio was similar between groups (7.8 +/- 9.9 in the rejection group and 8.2 +/- 9.7 in the no-rejection group; P=.791). Mean platelet volume levels were significantly lower in the rejection group (8.3 +/- 1.3 fL) than in the no-rejection group (8.8 +/- 1.8 fL) (P=.037) (Table 1). Conclusions: According to our results, only lower mean platelet volume levels were significantly associated with asymptomatic graft rejection in patients with a transplanted heart. More detailed analyses are needed to exclude the effects of immunosuppressant drugs, and further studies are needed to clarify the exact role of hematologic parameters for detecting asymptomatic rejection after heart transplant.
Rational and design of EuroCRT: an international observational study on multi-modality imaging and cardiac resynchronization therapy
(2017) Sade, Elif; Donal, Erwan; Delgado, Victoria; Magne, Julien; Bucciarelli-Ducci, Chiara; Leclercq, Christophe; Cosyns, Bernard; Sitges, Marta; Edvardsen, Thor; Stankovic, Ivan; Agricola, Eustachio; Galderisi, Maurizio; Lancellotti, Patrizio; Hernandez, Alfredo; Plein, Sven; Muraru, Denisa; Schwammenthal, Ehud; Hindricks, Gerhard; Popescu, Bogdan A.; Habib, Gilbert; 28329299
Aims Assessment of left ventricular (LV) volumes and ejection fraction (LVEF) with cardiac imaging is important in the selection of patients for cardiac resynchronization therapy (CRT). Several observational studies have explored the role of imaging-derived LV dyssynchrony parameters to predict the response to CRT, but have yielded inconsistent results, precluding the inclusion of imaging-derived LV dyssynchrony parameters in current guidelines for selection of patients for CRT. Methods The EuroCRT is a large European multicentre prospective observational study led by the European Association of Cardiovascular Imaging. We aim to explore if combing the value of cardiac magnetic resonance (CMR) and echocardiography could be beneficial for selecting heart failure patients for CRT in terms of improvement in long-term survival, clinical symptoms, LV function, and volumes. Speckle tracking echocardiography will be used to assess LV dyssynchrony and wasted cardiac work whereas myocardial scar will be assessed with late gadolinium contrast enhanced CMR. All data will be measured in core laboratories. The study will be conducted in European centres with known expertise in both CRT and multimodality cardiac imaging.
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.