Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item 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; 37955614Objective: 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.Item Relation Between Carotid Intima-Media Thickness, Serum Paraoxonase Levels and Severity of Obstructive Sleep Apnea Syndrome(2023) Akkurt, Esma Sevil; Bozbas, Serife Savas; Eroglu, Serpil; Ozcalik, Emre; Ozer, Eda Ozturan; Ozyurek, Berna Akinci; Eyuboglu, Fusun Oner; 37983282INTRODUCTION: Obstructive sleep apnea (OSA) has a significant effect on the development of cardiovascular complications. The aim of this study was to evaluate the relationship between carotid intimamedia thickness (IMT), paraoxonase 1 (PON 1) enzyme levels and severity of OSA. MATERIAL AND METHODS: A total of 120 cases were included in the study with 30 cases in each group, as follows: Group 1 (AHI < 5/h), Group 2 (AHI 5-15/h), Group 3 (AHI 16-30/h) and Group 4 (AHI > 30/h). Blood samples of the patients were taken to measure serum PON1 activity. Carotid IMT of all patients included in the study was measured by means of echocardiography using vascular probe and results were recorded. RESULTS: With regard to carotid IMT, a statistically significant increase was detected as severity of OSA increased (p < 0.001). A positive relationship was detected between IMT level and total oxygen desaturation time, oxygen desaturation index and SpO2 time < 90 % (p < 0.01). When the groups were compared, a statistically significant decline was observed in serum PON 1 level as severity of OSA increased (p < 0.05). CONCLUSIONS: The findings of our study indicate that PON1 and carotid IMT might be used as indicators of vascular damage in patients with OSA. Depending on the severity of OSA, measurement of PON1 enzyme activity in conjunction with carotid IMT may help us in predicting the cardiovascular risk in patients with OSA (Tab. 4, Fig. 2, Ref. 27). Tex t in PDF www.elis.skItem 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-8233-2020Background: 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.Item Association Between Coronary Flow Reserve and Exercise Capacity(2015) Eroglu, Serpil; Sade, Leyla Elif; Polat, Ezgi; Bozbas, Huseyin; Muderrisoglu, Haldun; 0000-0003-3737-8595; 0000-0002-9635-6313; 0000-0003-3055-7953; 26021241; AAQ-7583-2021; AAG-8233-2020; ABG-1582-2021Introduction: Reduced exercise capacity is of clinical importance. Sometimes no corresponding cardiovascular disease can be found to explain this condition. We hypothesized that coronary microvascular dysfunction may have an effect on exercise capacity in patients without apparent cardiovascular disease. Methods: Fifty patients (33 female, mean age 46.8 +/- 12.4 years) without coronary artery or other cardiac disease were enrolled. Coronary microvascular function was evaluated by measurement of coronary flow reserve (CFR) during transthoracic pulsed-wave Doppler echocardiography with pharmacological stress. CFR was calculated as the ratio of hyperemic to baseline peak diastolic velocities after dipyridamole infusion. Exercise capacity was determined by treadmill exercise testing. Exercise time, metabolic equivalent (MET), and Duke treadmill score (DTS) were recorded and compared with the CFR data. Results: CFR was correlated with exercise time (r=0.376, p=0.007), MET (r=0.435, p=0.002) and DTS (r=0.458, p=0.001). Exercise time, MET, and DTS were lower in patients with impaired CFR (<2) than in those with normal CFR (2) (5.3 +/- 1.8 min vs. 8.6 +/- 2.7 min, p<0.001; 7.3 +/- 3.1 vs. 11.4 +/- 2.8, p=0.002; -1.75 (-5.9, 5.0) vs. 7.5 (5.2, 9.41), p<0.001; respectively). CFR was lower in patients with MET <= 7 as compared to patients with MET>7 (2.0 +/- 0.5 vs. 2.6 +/- 0.6, p=0.015). Conclusions: CFR is associated with exercise capacity. Thus coronary microvascular dysfunction may be a reason for reduced exercise capacity in patients who have no apparent cardiovascular disease.Item Relation Between Carotid Intima-Media Thickness, Serum Paraoxonase Levels and Severity of Obstructive Sleep Apnea Syndrome(2015) Akkurt, Esma Sevil; Bozbas, Serife Savas; Eroglu, Serpil; Ozcalik, Emre; Eyuboglu, Fusun Oner; 0000-0002-7230-202X; 0000-0002-5525-8207; AAI-8064-2021; AAR-4338-2020; ABG-1582-2021Item Pulmonary Hypertension Improves After Orthotopic Liver Transplant in Patients With Chronic Liver Disease(2015) Bozbas, Serife Savas; Eroglu, Serpil; Eyuboglu, Fusun Oner; Moray, Gokhan; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0003-2498-7287; 0000-0002-7230-202X; 0000-0002-5525-8207; 0000-0003-3055-7953; 26640929; ABG-1582-2021; AAJ-8097-2021; AAE-1041-2021; AAI-8064-2021; AAR-4338-2020Objectives: Pulmonary hypertension is a common finding in chronic liver disease patients that has prognostic significance. In this study, we aimed to evaluate the prevalence and severity of pulmonary hypertension in patients undergoing orthotopic liver transplant. We also evaluated pulmonary artery pressure changes after transplant surgery. Materials and Methods: The records of adult patients with chronic liver disease who underwent orthotopic liver transplant at our center between 2004 and 2015 were retrospectively evaluated. Clinical and demographic variables and laboratory data were noted. Transthoracic Doppler echo cardiographic examination reports were obtained. Using continuous-wave Doppler examination, systolic pulmonary artery pressure values were calculated. Pulmonary hypertension was defined as systolic pulmonary artery pressure >= 30 mm Hg. Among 208 adult patients who underwent orthotopic liver transplant, 203 who had Doppler echocardiographic examination were enrolled. Results: The mean age of patients was 42.1 +/- 14.1 years (range, 16-67 y), and 143 (70.4%) were men. During preoperative assessment, pulmonary hypertension was identified in 47 patients (23.2%), of whom 10 displayed systolic pulmonary artery pressure > 50 mm Hg. Compared with preoperative values of systolic pulmonary artery pressure (46.8 +/- 8.4 mm Hg), a significant reduction in mean values (to 39.3 +/- 13.3 mm Hg) was observed post operatively (P=.007). Conclusions: The findings of this study indicate that pulmonary hypertension is a common finding in adult chronic liver disease patients undergoing orthotopic liver transplant. A significant improve ment occurs in systolic pulmonary artery pressure values following transplant surgery. Regarding the prevalence and prognostic significance of pulmonary hypertension, all patients with chronic liver disease should be evaluated with transthoracic Doppler echocardiography before transplant.Item 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-5841-2021Objectives: 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.Item Effects of Carvedilol Compared to Nebivolol on Insulin Resistance and Lipid Profile in Patients With Essential Hypertension(2017) Ozyildiz, Ali Gokhan; Eroglu, Serpil; Bal, Ugur; Atar, Ilyas; Okyay, Kaan; Muderrisoglu, Haldun; 0000-0001-6134-8826; 0000-0002-9635-6313; 0000-0002-9446-2518; 0000-0003-0679-9434; 0000-0003-3055-7953; 27093951; AAK-7355-2020; AAG-8233-2020; AAK-4322-2021; ABG-1582-2021; D-2856-2015Background and aim: Beta-blockers have unfavorable effects on metabolic parameters in hypertensive treatment. New generation beta-blockers with vasodilatory capabilities are superior to traditional beta-blockers, but studies examining their effects on metabolic parameters are still lacking. This study aimed to compare the effects of 2 new generation beta-blockers, carvedilol and nebivolol, on insulin resistance (IR) and lipid profiles in patients with essential hypertension. Methods: This was a prospective, randomized, open-label, single-center clinical trial. A total of 80 patients were randomized into 2 groups: the carvedilol group (n = 40, 25 mg of carvedilol daily) and the nebivolol group (n = 40, 5 mg of nebivolol daily). Follow-up was performed for 4 months. Fasting plasma glucose, insulin levels, and the lipid profile (high-density lipoprotein [HDL], low-density lipoprotein [LDL], total cholesterol, triglyceride, apolipoprotein AI, and apolipoprotein B levels) were measured and IR was calculated by the homeostasis model assessment (HOMA) index. These variables were compared before and 4 months after treatment. Results: Blood pressure and heart rate were significantly and similarly reduced in the carvedilol and nebivolol groups after treatment compared to those before treatment (both P < .001). Serum glucose (P < .001), insulin (P < .01), HOMA-IR (P < .01), HDL (P < .001), LDL (P < .001), total cholesterol (P < .001), and apolipoprotein B (P < .05) levels decreased in a similar manner in the carvedilol and nebivolol groups after treatment compared to those before treatment. Serum triglyceride and apolipoprotein AI levels did not change after treatment with both drugs. Conclusion: New generation beta-blockers, carvedilol and nebivolol, efficiently and similarly decrease blood pressure. They have similar favorable effects on glucose, insulin, IR, and the lipid profile.Item Assessment of Subclinical Atherosclerosis by Carotid Intima-Media Thickness and Epicardial Adipose Tissue Thickness in Prediabetes(2016) Altin, Cihan; Sade, Leyla Elif; Gezmis, Esin; Ozen, Necmi; Duzceker, Ozkan; Bozbas, Huseyin; Eroglu, Serpil; Muderrisoglu, Haldun; 0000-0002-1001-6028; 0000-0003-3737-8595; 0000-0002-9635-6313; 0000-0003-3055-7953; 27069111; AAE-8301-2021; AAQ-7583-2021; ABG-1582-2021; AAG-8233-2020Impaired fasting glucose (IFG) and impaired glucose intolerance (IGT) are predictors of cardiovascular disease (CVD). We tested the hypothesis that epicardial fat thickness (EFT) and carotid intima-media thickness (cIMT), as markers of early atherosclerosis, are increased in patients with prediabetes. We prospectively enrolled 246 patients (162 with prediabetes and 84 controls). Prediabetes was defined according to American Diabetes Association criteria, and patients were divided into 3 groups: group 1IFG, group 2IGT, and group 3IFG + IGT. Both cIMT and EFT were significantly greater in patients with prediabetes compared with controls (0.81 +/- 0.20 mm vs 0.68 +/- 0.16 mm, P < .001 and 7.0 +/- 2.0 mm vs 5.6 +/- 1.6 mm, P < .001, respectively). This difference was mainly attributed to patients with IGT. Age, waist circumference, and 2-hour glucose independently predicted cIMT, while 2-hour glucose was the only independent predictor of EFT in multivariate analysis among other relevant parameters for cIMT and EFT. The cIMT and EFT (measured noninvasively) could be useful indicators of CVD risk in these patients. In order to prove this hypothesis, long-term prospective studies with greater patient numbers are required.Item 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