Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Arrhythmogenic Evidence for Epicardial Adipose Tissue: Heart Rate Variability and Turbulence are Influenced by Epicardial Fat Thickness(2015) Balcioglu, Akif Serhat; Cicek, Davran; Akinci, Sinan; Eldem, Halil Olcay; Bal, Ugur Abbas; Okyay, Kaan; Muderrisoglu, Haldun; 0000-0002-9635-6313; 0000-0001-6134-8826; 0000-0001-5250-5404; 0000-0002-9446-2518; 25224491; AAC-8036-2020; AAG-8233-2020; AAK-7355-2020; AAD-5564-2021; AAK-4322-2021BackgroundEpicardial adipose tissue (EAT) is a local source of various hormones, cytokines, and vasoactive substances affecting the myocardium. EAT contains abundant ganglionic plexi that interact with the autonomic nervous system. Evidence of the association between EAT and arrhythmia is limited, with the exception of atrial fibrillation. This study aimed to investigate the relation between EAT and cardiac autonomic function using heart rate variability (HRV) and heart rate turbulence (HRT) parameters. MethodsAll subjects underwent a 24-hour Holter recording to assess HRV and HRT parameters and a transthoracic echocardiography to measure EAT thickness. Patients were divided into two groups according to the median EAT thickness (3.9 mm). The higher EAT group consisted of 111 patients with a >3.9-mm thickness and the lower EAT group 113 patients with a 3.9-mm EAT thickness. ResultsHRV and HRT parameters were significantly influenced in the higher EAT group. Moreover, we observed significant correlations between EAT thickness and Holter findings (standard deviation of all NN intervals [SDNN]: r = -0.462, P < 0.001; SDNN index: r = -0.349, P < 0.001; standard deviation of the average NN intervals: r = -0.465, P < 0.001; root mean square of successive differences: r = -0.251, P < 0.001; pNN50: r = -0.354, P < 0.001; turbulence onset: r = 0.172, P = 0.010; turbulence slope: r = -0.279, P < 0.001, HRT category: r = 0.169, P = 0.011). In multivariate regression analysis, EAT thickness was independently associated with all measures of HRV and HRT, with the exception of turbulence onset. ConclusionsSympathovagal imbalance, detected by HRV and HRT parameters, is related to EAT thickness. As sympathovagal imbalance is a predictor of arrhythmic events, EAT may play an important arrhythmogenic role not limited to atrial fibrillation.Item Chronic Aortic Dissection and Recoarctation As A Late Complication of Aortic Coarctation Surgery(2015) Coner, Ali; Balcioglu, Serhat; Akinci, Sinan; Cicek, Davran; Muderrisoglu, Haldun; 0000-0001-5250-5404; 0000-0002-9635-6313; 0000-0002-5711-8873; 26717344; AAC-8036-2020; AAD-5564-2021; AAG-8233-2020; ABD-7321-2021Item Acquired Aneurysm of Sinus of Valsalva(2017) Coner, Ali; Akinci, Sinan; Cicek, Davran; Saba, Tonguc; Muderrisoglu, Haldun; 0000-0002-9635-6313; 0000-0001-5250-5404; 0000-0002-5711-8873; AAG-8233-2020; AAC-8036-2020; AAD-5564-2021; ABD-7321-2021Item Which Is Responsible for Cardiac Autonomic Dysfunction in Non-Diabetic Patients with Metabolic Syndrome: Prediabetes or the Syndrome Itself(2016) Balcioglu, Akif Serhat; Akinci, Sinan; Cicek, Davran; Eldem, Halil Olcay; Coner, Ali; Bal, Ugur Abbas; Muderrisoglu, Haldun; https://orcid.org/0000-0001-5250-5404; https://orcid.org/0000-0002-5711-8873; https://orcid.org/0000-0002-9446-2518; 26610403; AAD-5564-2021; ABD-7321-2021; AAK-4322-2021Aims: Cardiac autonomic dysfunction (CAD) is associated with both prediabetes and metabolic syndrome (MS). Heart rate variability (HRV) and heart rate turbulence (HRT) are reliable 24-h Holter-ECG findings of cardiac autonomic function. This study aimed to investigate the relation between MS and its components and CAD using HRV and HRT. Materials and methods: The study included 80 non-diabetic patients with MS and 70 control subjects. All study population and the patients with MS were further analyzed for each diagnostic component of MS to investigate which criteria impaired HRV and HRT. Results: HRV and HRT parameters were disturbed in patients in the MS group. While impairment in HRV and HRT was significantly related to the presence of the fasting plasma glucose (FPG) criterion, there were no differences between groups in terms of the other 4 MS criteria. Moreover, FPG level was significantly correlated with SDNN (r = -0.352, p < 0.001), SDNN index (r = -0.423, p < 0.001), SDANN (r = -0.301, p < 0.001), RMSSD (r = -0.237, p < 0.001), pNN50 (r = -0.237, p < 0.001), turbulence onset (TO) (r = 0.365, p < 0.001) and turbulence slope (TS) (r = -0.365, p < 0.001). Among the MS diagnostic criteria, only FPG level was an independent determinant of all HRV and HRT parameters. Conclusions: This study confirms the relation between MS and CAD. Increased FPG alone appears to be responsible for the mentioned findings among the 5 diagnostic criteria. Accordingly, CAD may be the result of prediabetes, not MS in patients with MS. (C) 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.Item Effect of Dobutamine Stress Echocardiography on Serum Heart Fatty Acid Binding Protein Levels(2017) Akinci, Sinan; Balcioglu, Akif Serhat; Tacoy, Gulten; Tavil, Yusuf; Guslbahar, Ozlem; Ozdemir, Murat; https://orcid.org/0000-0001-5250-5404; 28597800; AAD-5564-2021Objective Heart fatty acid binding protein (HFABP) is a low-molecular-weight free protein that is abundant in the intracytoplasmic space of myocytes. Due to its unique features, serum HFABP levels may increase in myocardial ischaemia. The aim of this study was to evaluate the effect of myocardial ischaemia induced by dobutamine stress echocardiography (DSE) on serum HFABP levels. Methods and results A total of 30 consecutive patients with suspected myocardial ischaemia underwent DSE examination. HFABP levels were measured immediately before and 1 hour after DSE. HFABP rose significantly in individuals in the DSE positive group (1.66 +/- 1.18 ng/ml vs 2.65 +/- 1.34 ng/ml, P = 0.004), but remained unchanged in the DSE negative group (1.61 +/- 0.77 ng/ml vs 1.85 +/- 0.76 ng/ml, P = 0.066). Conclusion Serum HFABP levels increased significantly at 1 hour in the presence of ischaemia induced by DSE in patients with stable clinical coronary syndromes. No such increase was evident in the absence of ischaemia.Item In-Hospital Bleeding and Mortality in Acute Coronary Syndrome Patients Treated with Tirofiban and Potent P2Y12 Inhibitors(2022) Akinci, Sinan; Coner, Ali; Akbay, Ertan; Adar, Adem; Muderrisoglu, Haldun; 35860883Objective: In this study, we aimed to determine whether potent agents affect in-hospital bleeding and mortality compared to clopidogrel in patients with the acute coronary syndrome in whom tirofiban and P2Y12 inhibitor are used together. Methods: Patients who were treated interventionally between 2015 and 2020 and were using tirofiban were retrospectively screened. Clinical, laboratory, and angiographic findings were obtained from the hospital database. Patients were analyzed by dividing them into clopidogrel and prasugrel/ticagrelor groups. Results: Acute coronary syndrome patients (n = 227) who were treated interventionally were included in this retrospective study. Clopidogrel was given to 93 (41%), ticagrelor to 112 (49.3%), and prasugrel to 22 of the patients (9.7%). Compared to the ticagrelor/prasugrel group, the clopidogrel group was older and more were women, and the history of hypertension and previous coronary artery disease was higher (P, respectively: <.001; .001; .008; .0045). The creatinine value was higher, the basal hemoglobin was lower, and the GRACE (Global Registry of Acute Coronary Events) and CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines) scores were higher (P, respectively:.026; .002;.002; <.001). The in-hospital bleeding rate was significantly higher in the clopidogrel group (P <.001). Although the in-hospital mortality rate was higher, it was not statistically significant (P = .07). Regression analysis showed that GRACE score and gender were associated with in-hospital mortality (P <.001; P = .031, respectively), and only age was associated with in-hospital bleeding (P <.001). No relationship was found with P2Y12 inhibitor. Conclusion: In our study, we found that the combined use of potent P2Y12 inhibitor with tirofiban in acute coronary syndrome patients treated interventionally was not different from the use of clopidogrel in terms of in-hospital bleeding and mortality.Item Association of Morning Surge and Postexercise Heart Rate and Blood Pressure Recovery(2022) Akbay, Ertan; Akinci, Sinan; Adar, Adem; https://orcid.org/0000-0002-9146-0621; https://orcid.org/0000-0001-5250-5404; 35325411; AAD-5479-2021; AAD-5564-2021Introduction The autonomic nervous system plays an active role in the regulation of early morning blood pressure (BP) and BP/pulse regulation in the treadmill exercise test (TET). Aim We evaluated the relationship between BP/pulse changes during TET and morning blood pressure surge (MS). Methods Patients who underwent ambulatory blood pressure measurement (ABPM) and TET in the same visit between 2017 and 2020 were evaluated retrospectively. Patients with previously diagnosed hypertension and/or using antihypertensives and office BP >= 140/90 were excluded from the study.MS values and dipping percentage were calculated from ABPM data. The patients were analyzed by dividing them into two groups according to the MS median, and BP/pulse values during exercise and recovery periods were compared in these groups. Results 202 patients [median age 45 (39-51), male 134 (66.3%)] were included in the study. MS median was 18.5 (10.75-27) mmHg. TET recovery period 3rd-min systolic blood pressure (RSBP) was higher in the group with high MS (p: 0.017). Systolic and diastolic dipping percentages were higher in the group with higher MS (p: 0.015, p: 0.040, respectively). Peak systolic and diastolic BP, RSBP, and recovery 3rd min diastolic BP were positively correlated with MS (p < 0.05, for all). Additionally, an independent relationship was observed between RSBP and MS (beta: 0.205, p: 0.028). Conclusion We found an independent association between RSBP and MS. Increased RSBP may be associated with target organ damage and cardiovascular events such as MS.Item A New And Simple Parameter For Diagnosis Pulmonary Edema: Expiratory Air Humidity(2022) Adar, Adem; Can, Emine Yilmaz; Elma, Yusuf; Ferah, Meryem Akpolat; Kececi, Mete; Muderrisoglu, Haldun; Akbay, Ertan; Akinci, Sinan; Coner, Ali; Haberal, Cevahir; Cakan, Fahri; Onalan, Orhan; https://orcid.org/0000-0002-9146-0621; https://orcid.org/0000-0001-5250-5404; 35092906; AAD-5479-2021; AAD-5564-2021Purpose: Acute pulmonary edema is characterized by increased levels of fluid in the interstitial and alveolar space of the lung and requires emergency treatment. In acute pulmonary edema, the amount of fluid in the intra-alveolar, interstitial space, and pleural space vary considerably and this fluid will evaporate in different amounts compared to the physiological fluid. The aim of this study was to compare the humidity rates of expiratory air measured before and after pulmonary edema induced by alpha-naphthylthiourea (ANTU) in rats. Methods: The study included twenty healthy adult rats divided equally into a healthy control group and a pulmonary edema group. Pulmonary edema was induced by administering ANTU intraperitoneally in the rats in the study group. Humidity, temperature, lung weight, pleural effusion, and histopathological changes in the respiratory system due to pulmonary edema were examined in the ANTU group. Control measurments were taken before administration of ANTU and again 4 h after administration of ANTU when lung damage was considred to be at maximum levels. Results: Mean expiratory air humidity was 71.22 +/- 3.59% before ANTU and 56.28 +/- 3.94% after administration of ANTU. The mean humidity difference of -14.94 +/- 5.96% was considered statistically different (p = 0.01). Conclusion: Humidity rate in expiratory air was significantly lower in rats with acute pulmonary edema compared to healthy rats. This result supports the hypothesis that humidity in expiratory air can be considered an important parameter in patients during clinical are follow-up for pulmonary edema. (C) 2022 Elsevier Inc. All rights reserved.Item Answer Regarding: Potent P2Y12 Inhibitors and Bleeding Complications(2022) Akinci, Sinan; Coner, Ali; Akbay, Ertan; Adar, Adem; Muderrisoglu, Haldun; 36200724Item Which is responsible for target organ damage in masked hypertension? Is it an increase in blood pressure or a disruption of the circadian rhythm?(2021) Akbay, Ertan; Coner, Ali; Akinci, Sinan; Demir, Ali Riza; Toktamis, Aydin; 0000-0002-9146-0621; 0000-0002-5711-8873; 0000-0001-5250-5404; 33870802; AAD-5479-2021; ABD-7321-2021; AAD-5564-2021Masked hypertension (MH) and non-dipping pattern are conditions associated with target organ damage and cardiovascular risk, which are frequently observed together. We aimed to show the relationship between the target organ damage observed in MH and the deterioration in the dipping pattern. Methods Patients who underwent ambulatory blood pressure monitoring (ABPM) and office blood pressure (BP) <140/90 mmHg were retrospectively screened. In ABPM data, those with daytime BP >= 135/85 mmHg and night BP >= 120/70 mmHg were included in the MH group, while the others were included in the normotensive group. The patients were grouped as dipper, non-dipper and reverse-dipper according to ABPM results. Left ventricular mass index (LVMI), glomerular filtration rate (GFR) and serum creatinine levels were used to determine target organ damage. Results 289 patients [mean age 46.6 +/- 12.4 years, 136 (47.1%) males], 154 (53.3%) of whom had MH were included in our study. GFR value was found to be significantly lower, serum creatinine levels and LVMI were significantly higher in patients with MH compared to normotensives (p < .05, for all). When the subgroups were examined, it was found that this difference was associated with the disruption in the dipping pattern. In patients with MH, dipping pattern disruption without change in systolic BP was independently associated with an increase in LVMI (p < .05, for both). Conclusion Target organ damage seen in MH may be due to the deterioration of the dipping pattern.