Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Effects of Paclitaxel and Carboplatin Combination on Mechanical Myocardial and Microvascular Functions: A Transthoracic Doppler Echocardiography and Two-Dimensional Strain Imaging Study(2015) Altin, Cihan; Elif Sade, Leyla; Demirtas, Saadet; Karacaglar, Emir; Kanyilmaz, Suleyman; Simsek, Vahide; Ayhan, Ali; Muderrisoglu, Haldun; 24814007AimPaclitaxel and carboplatin are frequently used chemotherapy drugs in the treatment of gynecologic malignancies. Little is known about their effects on left ventricular mechanical and coronary microvascular functions. MethodsThirty consecutive patients were prospectively enrolled. Patients underwent transthoracic echocardiography (TTE) before and after chemotherapy, to evaluate left ventricular mechanical functions and coronary flow reserve (CFR). A comprehensive TTE, tissue Doppler and two-dimensional (2D) strain imaging were performed and coronary flow velocity was measured at baseline and after dipyridamole infusion. CFR was calculated as the ratio of hyperemic to baseline diastolic peak flow velocities. Mitral annular velocities by tissue Doppler, peak strain, and systolic strain rate by velocity vector imaging (VVI) were measured. Baseline measurements were compared with healthy controls (n=26). ResultsNo patient developed heart failure (HF) symptoms, no significant change occurred in left ventricular ejection fraction or cardiac output and no significant difference was observed in CFR after chemotherapy. Baseline mean longitudinal peak strain and systolic stain rate were similar between patients and controls: -17.52.6% versus -17.6 +/- 2.2% (P=NS) and -1.04 +/- 0.14/sec versus -1.05 +/- 0.12/sec (P=NS). Peak strain and systolic strain rate decreased significantly after chemotherapy (from -17.5 +/- 2.6% to -16.2 +/- 2.5%, P<0.02; and from -1.05 +/- 0.12/sec to -0.96 +/- 0.11/sec, P=0.01, respectively). However, mean longitudinal velocity did not change significantly. ConclusionPaclitaxel and carboplatin combination did not impair CFR; however, this chemotherapy combination could induce subtle impairment in myocardial mechanical function which can be detected by advanced deformation imaging techniques rather than by tissue Doppler imaging or conventional 2D and Doppler echocardiography.Item The Effects of Niacin on Inflammation in Patients with Non-ST Elevated Acute Coronary Syndrome(2015) Karacaglar, Emir; Atar, Ilyas; Altin, Cihan; Yetis, Begum; Cakmak, Abdulkadir; Bayraktar, Nilufer; Coner, Ali; Ozin, Bulent; Muderrisoglu, Haldun; 0000-0002-2538-1642; 0000-0002-5711-8873; 0000-0003-3821-412X; 0000-0002-7886-3688; 0000-0002-9635-6313; 27122858; ABI-6723-2020; ABD-7321-2021; AAD-9938-2021; Y-8758-2018; AAG-8233-2020Background: In this study, we aimed to evaluate the effects of niacin on high sensitivity C reactive protein (hs-CRP) and cholesterol levels in non-ST elevated acute coronary syndrome (NSTE-ACS) patients. Methods: In this prospective, open label study, 48 NSTE-ACS were randomized to niacin or control group. Patients continued their optimal medical therapy in the control group. In the niacin group patients were assigned to receive extended-release niacin 500 mg/day. Patients were contacted 1 month later to assess compliance and side effects. Blood samples for hs-CRP were obtained upon admittance to the coronary care unit, in the third day and in the first month of the treatment. Fasting blood samples for cholesterol levels were obtained before and 30 days after the treatment. The primary end point of the study was to evaluate changes in hs-CRP, cholesterol levels, short-term cardiovascular events, and the safety of niacin in NSTE-ACS. Results: Baseline demographic, clinical and laboratory characteristics were similar between the two groups. Logarithmic transformation of baseline and 3rd day hs-CRP levels were similar between the groups; but 1 month later, logarithmic transformation of hs-CRP level was significantly lower in the niacin group (0.43 +/- 0.39 to 0.83 +/- 0.91, p = 0.04). HDL-C level was significantly increased in the niacin group during follow-up. Drug related side effects were seen in 7 patients in the niacin group but no patients discontinued niacin. Conclusions: Our findings demonstrate that lower dose extended release niacin can be used safely and decreases hs-CRP and lipid parameters successfully in NSTE-ACS patients.Item Implantation of A Cardiac Resynchronization Therapy-Defibrillator Device in A Patient with Persistent Left Superior Vena Cava(2015) Atar, Ilyas; Karacaglar, Emir; Ozcalik, Emre; Ozin, Bulent; Muderrisoglu, Haldun; 0000-0002-9635-6313; 0000-0002-2538-1642; 0000-0003-3821-412X; 26142791; AAG-8233-2020; ABI-6723-2020; AAD-9938-2021Presence of a persistent left superior vena cava (PLSVC) is generally clinically asymptomatic and discovered incidentally during central venous catheterization. However, PLSVC may cause technical difficulties during cardiac device implantation. An 82-year-old man with heart failure symptoms and an ejection fraction (EF) of 20% was scheduled for resynchronization therapy-defibrillator device (CRT-D) implantation. A PLSVC draining via a dilated coronary sinus into an enlarged right atrium was diagnosed. First, an active-fixation right ventricular lead was inserted into the right atrium through the PLSVC. The stylet was preshaped to facilitate its passage to the right ventricular apex. An atrial lead was positioned on the right atrium free wall, and an overthe- wire coronary sinus lead deployed to a stable position. CRT-D implantation procedure was successfully completed.Item 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-7583-2021Objectives: 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.Item Significant Improvement of Cardiac Dysfunction After Kidney Transplant: A Case Report(2022) Sayin, Begum Yetis; Karacaglar, Emir; Ozin, Bulent; 36377806Kidney transplant is known to reverse cardiac dysfunction in patients with end-stage renal disease, and low ejection fraction in kidney transplant candidates is considered to be a contraindication for transplant. We present a significant improvement in cardiac dysfunction after successful kidney transplant in a 21-year- old male recipient. Kidney transplant may be beneficial for cardiac function in transplant recipients who have impaired cardiac function prior to the procedure and caused by uremic toxins.Item Plasma Osteopontin Concentration is Elevated in Patients with Coronary Bare Metal Stent Restenosis(2018) Yilmaz, Kerem Can; Bal, Ugur Abbas; Karacaglar, Emir; Okyay, Kaan; Aydinalp, Alp; Yildirir, Aylin; Muderrisoglu, Haldun; 0000-0002-2538-1642; 0000-0002-9446-2518; 0000-0002-9635-6313; 0000-0002-3761-8782; 0000-0001-8750-5287; 0000-0001-6134-8826; 0000-0003-3320-9508; 28841817; ABI-6723-2020; AAJ-1331-2021; AAK-4322-2021; AAG-8233-2020; AAD-5841-2021; A-4947-2018; AAK-7355-2020Objective: Osteopontin is a component of atherosclerotic lesions, secreted by monocytes, macrophages and endothelial and vascular smooth muscle cells, which together are responsible for neointimal proliferation. We examined whether elevated plasma osteopontin concentration was associated with in-stent restenosis in patients with coronary artery disease. Subjects and methods: We enrolled 91 patients who underwent coronary artery stenting, and 60 control patients with normal findings on coronary angiography, between June 2012 and September 2013. For patients with stents, we measured plasma osteopontin concentration at the first follow-up coronary angiogram. For controls, plasma osteopontin concentration was measured at the time of angiography. Results: Of the 91 patients who had undergone coronary artery stenting, 31 (34.1%) had developed in-stent restenosis and the mean time passed to control coronary angiography was 36.7 months (+/- SD 35.1 months). Mean plasma osteopontin concentration in this group was 2721.4 +/- 1787.8 pg/ml, significantly higher than the 60 patients (65.9%) with no in-stent restenosis (1770.4 +/- 1208.2 pg/ml, p = .011) and the 60 patients with a normal coronary angiogram (1572.4 +/- 904.8 pg/ml, p = .002). There was no significant difference in mean osteopontin concentration between the patients with no in-stent restenosis and the control group (p = .312). Conclusions: Elevated plasma osteopontin concentration is associated with in-stent stenosis in patients with coronary artery disease. Further studies will be needed to establish whether osteopontin can predict in-stent restenosis and guide clinical management strategies.Item Predictors of Obstructive Coronary Artery Disease vs Non-obstructive Lesions on Coronary Angiography in Patients with Non-ST Elevation Myocardial Infarction. A Retrospective Analysis from a University Hospital(2017) Ciftci, Orcun; Kayipmaz, Afsin Emre; Karacaglar, Emir; Yilmaz, Kerem Can; Muderrisoglu, Ibrahim Haldun; 0000-0001-8926-9142; 0000-0002-2538-1642; AAC-2597-2020; AAJ-1331-2021; W-5233-2018; ABI-6723-2020Item Chronic Renal Disease and hypertension are Significant Predictors of Severe Coronary Artery Disease Among Patients Presenting to Emergency Department with Atrial Fibrillation and Undergoing Coronary Angiography for Presumed Acute Coronary Syndrome(2017) Ciftci, Orcun; Karacaglar, Emir; Yilmaz, Keremcan; Muderssioglu, Ibrahim Haldun; 0000-0002-2538-1642; 0000-0001-8926-9142; ABI-6723-2020; W-5233-2018Item Neutrophil/Lymphocyte Ratio in Coronary Bare Metal Stent Restenosis(2017) Yilmaz, Kerem Can; Ciftci, Orcun; Karacaglar, Emir; Bal, Ugur Abbas; Okyay, Kaan; Aydinalp, Alp; Yildirir, Aylin; Muderrisoglu, Ibrahim Haldun; 0000-0002-9446-2518; 0000-0002-2538-1642; 0000-0002-3761-8782; 0000-0001-8926-9142; 0000-0001-8750-5287; 0000-0001-6134-8826; 0000-0003-3320-9508; AAK-4322-2021; ABI-6723-2020; AAJ-1331-2021; AAD-5841-2021; W-5233-2018; A-4947-2018; AAK-7355-2020Item Preoperative Cardiac Risk Assessment in Patients Undergoing Liver Transplant Due to Hepatocellular Carcinoma: Should It Be Different?(2017) Muderrisoglu, Haldun; Yilmaz, Kerem Can; Karacaglar, Emir; Bal, Ugur; Aydinalp, Alp; Moray, Gokhan; Haberal, Mehmet; 0000-0002-2538-1642; 0000-0002-9446-2518; 0000-0002-3761-8782; 0000-0002-3462-7632; 0000-0002-9635-6313; 0000-0003-2498-7287; 0000-0003-3320-9508; 28302002; ABI-6723-2020; AAK-4322-2021; AAJ-1331-2021; AAD-5841-2021; AAJ-8097-2021; AAG-8233-2020; AAE-1041-2021Objectives: Liver transplant is a high-risk surgery for cardiac events. The risk of 30-day major cardiac adverse events is estimated at more than 5%. In this retrospective study, we evaluated our preoperative cardiac risk assessment approach. Materials and Methods: We evaluated 58 adult patients who underwent liver transplant between May 2011 and May 2015. Preoperative cardiac risk factors and results of diagnostic tests were noted. Patients were divided into 2 groups: patients with or without hepatocellular carcinoma. Electrocardiogram, echo cardiogram, and treadmill tests were performed for preoperative cardiac evaluation in all candidates for liver transplant. Results of these tests showed our preference for myocardial perfusion scintigraphy and/or coronary angiography and heart catheterization. Results: Mean age of patients was 46.5 +/- 14.5 years. The most common cardiovascular risk factor was family history of coronary artery disease (24.1%) in all patients. Diabetes mellitus (15.5%) was the most common risk factor in the patient group without hepatocellular carcinoma. Three patients had already known coronary artery disease (5.2%). Of 16 patients (27.6%) who underwent coronary angiography, 4 were in the hepatocellular carcinoma group. Coronary revascularization by stent implantation was necessary for 1 patient in the hepatocellular carcinoma group; 1 patient in the group without hepatocellular carcinoma underwent preoperative coronary bypass surgery. Conclusions: No consensus exists for cardiovascular risk stratification and preoperative cardiovascular evaluation of liver transplant candidates. Noninvasive stress tests are not always feasible for all liver transplant candidates because of poor mobility and poor exercise capacity. With early diagnoses of cardiovascular conditions and preventive recom mendations, liver transplant can be performed safely before spread of the disease, which is essential for carcinoma patients. Angiographic evaluation of liver transplant candidates for hepatocellular carcinoma is strongly recommended.
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