Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Previous Gestational Diabetes History is Associated with Impaired Coronary Flow Reserve(2015) Caliskan, Mustafa; Turan, Yasar; Caliskan, Zuhal; Gullu, Hakan; Ciftci, Faika Ceylan; Avci, Enver; Duran, Cevdet; Kostek, Osman; Caklili, Ozge Telci; Koca, Harun; Kulaksizoglu, Mustafa; 0000-0003-2579-9755; 26555575; IXD-5147-2023Background Gestational diabetes mellitus (GDM) is a prediabetic state that is known to increase the risk of cardiovascular diseases. We have investigated coronary flow velocity reserve (CFVR) and epicardial fat thickness (EFT), and left ventricular diastolic function in patients with a history of previous GDM (p-GDM). Methods Ninety-three women with GDM history and 95 healthy women without GDM history were recruited. We used transthoracic Doppler echocardiography to assess CFVR, EFT, and left ventricular diastolic function. Insulin resistance of each subject was assessed with homeostasis model assessment insulin resistance (HOMA-IR). Hemoglobin A1c and high-sensitivity C-reactive protein (hsCRP) were also measured in all patients. Results CFVR values were significantly lower (2.34 +/- 0.39 versus 2.80 +/- 0.24, p<0.001) and EFT values were significantly higher in patients with p-GDM than the control group (5.5 +/- 1.3 versus 4.3 +/- 1.1, p<0.001). E/E' ratio (7.21 +/- 1.77 versus 6.53 +/- 1.38, p = 0.003), hemoglobin A1c (5.2 +/- 0.4 and 5.0 +/- 0.3, p = 0.001), HOMA-IR (2.8 +/- 1.4 versus 1.7 +/- 0.9, p = 0.04), and hsCRP levels were significantly higher in the p-GDM group than the control group. Multivariate analysis revealed that gestational diabetes history is independently associated with CFVR. Conclusion Women with a GDM history may be at more risk regarding coronary microvascular dysfunction compared to the healthy ones.Item Impaired Coronary Microvascular and Left Ventricular Diastolic Function in Patients with Inflammatory Bowel Disease(2015) Caliskan, Zuhal; Gokturk, Huseyin Savas; Caliskan, Mustafa; Gullu, Hakan; Ciftci, Ozgur; Ozgur, Gulsum Teke; Guven, Aytekin; Selcuk, Haldun; 0000-0003-2579-9755; 0000-0002-8445-6413; 0000-0002-6463-6070; 25128749; AAJ-8546-2021; JYO-9455-2024; IXD-5147-2023; AAJ-6976-2021; A-7318-2017Background and aim: Increased incidence of coronary vascular events in patients with inflammatory bowel disease (IBD) is known. However, the association between coronary microvascular function and IBD has not been fully defined. We aimed to investigate whether coronary flow reserve (CFR) and left ventricular diastolic function were impaired in IBD patients. Methods: Seventy-two patients with IBD (36 patients with ulcerative colitis [UC] and 36 Crohn's disease [CD]) were registered. Each subject was evaluated after a minimum 15-day attack-free period. For the control group, 36 age- and sex-matched healthy volunteers were included into the study. IBD clinical disease activity in UC was assessed by the Truelove-Witts Index (TWAS) and in CD by the Crohn's Disease Activity Index (CDAI). In each subject, CFR was measured through transthoracic Doppler echocardiography. Results: Compared to the controls, the CD group and UC group had significantly higher high-sensitivity C-reactive protein (hs-CRP) and erythrocyte sedimentation rate. Baseline diastolic peak flow velocity (DPFV) of the left anterior descending artery (LAD) was significantly higher in the IBD group (24.1 +/- 3.9 vs. 22.4 +/- 2.9, p < 0.05), and hyperemic DPFV (56.1 +/- 12.5 vs. 70.6 +/- 15.3, p < 0.05) and CFR (2.34 +/- 0.44 vs. 3.14 +/- 0.54, p < 0.05) were significantly lower in the IBD group than in the control group. In stepwise linear regression analysis, hs-CRP and lateral Em/Am ratio were independently correlated with CFR. Conclusion: CFR, reflecting coronary microvascular function, is impaired in patients with IBD. CFR and left ventricular diastolic function parameters are well correlated with hs-CRP. (C) 2014 Published by Elsevier Inc.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 Increased Morning Blood Pressure Surge and Coronary Microvascular Dysfunction in Patient with Early Stage Hypertension(2014) Caliskan, Mustafa; Caliskan, Zuhal; Gullu, Hakan; Keles, Nursen; Bulur, Serkan; Turan, Yasar; Kostek, Osman; Ciftci, Ozgur; Guven, Aytekin; Aung, Soe Moe; Muderrisoglu, Haldun; https://orcid.org/0000-0003-2579-9755; https://orcid.org/0000-0002-6463-6070; https://orcid.org/0000-0002-9635-6313; 25224866; IXD-5147-2023; A-7318-2017; AAJ-8546-2021; AAG-8233-2020Morning blood pressure surge (MBPS) is defined as an excessive increase in blood pressure (BP) in the morning from the lowest systolic BP during sleep, and it has been reported as a risk factor for cardiovascular events in current clinical studies. In this study, we evaluated the association between the rate of BP variation derived from ambulatory BP monitoring data analysis and coronary microvascular function in patients with early stage hypertension. One hundred seventy patients with prehypertension and Stage 1 hypertension who fulfilled the inclusion and exclusion criteria were included in the study. We divided our study population into two subgroups according to the median value of coronary flow reserve (CFR). Patients with CFR values <2.5 were defined as the impaired CFR group, and patients with CFR values >= 2.5 were defined as the preserved CFR group, and we compared the MBPS measurements of these two subgroups. CFR was measured using transthoracic Doppler echocardiography (TTDE). Ambulatory 24-hour systolic and diastolic BP, uric acid, systolic MBPS amplitude, diastolic MBPS amplitude, high-sensitivity C-reactive protein, and mitral flow E/A ratio were statistically significant. These predictors were included in age- and gender-adjusted multivariate analysis; ambulatory 24-hour systolic BP (beta = 0.077, P <.001; odds ratio [OR] = 1.080; 95% confidence interval [CI] [1.037-1.1241) and systolic MBPS amplitude (beta = 0.043, P =.022; OR = 1.044; 95% CI [1.006-1.0841) were determined to be independent predictors of impaired CFR (Hosmer-Lemeshow test, P=.165, Nagelkerke's R-2 = 0.320). We found that increased changes in MBPS values in patients with prehypertension and Stage 1 hypertension seemed to cause microvascular dysfunction in the absence of obstructive coronary artery disease. (C) 2014 American Society of Hypertension. All rights reserved.Item Is Activation in Inflammatory Bowel Diseases Associated with Further Impairment of Coronary Microcirculation?(2016) Caliskan, Zuhal; Keles, Nursen; Gokturk, Huseyin Savas; Ozdil, Kamil; Aksu, Feyza; Ozturk, Oguzhan; Kahraman, Resul; Kostek, Osman; Tekin, Ahmet S.; Ozgur, Gulsum Teke; 27541650Background: Inflammatory bowel disease [IBD] includes a number of chronic relapsing diseases. In IBD intestinal microvascular endothelial cells are damaged by an abnormal immune response. Several studies have shown that IBD may cause increment in risk of developing atherosclerosis. IBD in activation was related to enhanced risks of worse cardiovascular [CV] outcome, on the other hand no risk increment was seen in remission comparing to control group in those studies. Coronary FlowReserve [CFR] reflects coronary microvascular circulation. Coronary microvascular dysfunction may be defined as a predictor of CV outcome combined with previous described atherosclerotic risk factors. The present study was purposed to further evaluate whether or not CFR in the left anterior descending artery [LAD] is disturbed in IBD patients with activation in comparison to remission and healthy subjects. Methods: 62 patients with IBD and 39 healthy volunteers were enrolled into the study. Patients' demographics were recorded. CFR evaluation of patients with IBD in both activation and remission period and control group were performed with transthoracic echocardiography. Results: CFR was significantly lowest in the active period of the IBD [2.26 [2.08-2.55] vs. 2.55 [2.18-3.00] and 3.10 [2.85-3.29] p < 0.001]. CFR is negatively correlated with disease activity scores of IBD. Conclusion: This study showed that CFR is more prominently disturbed in patients with IBD in activation. The activation of disease may have a major role in the progression of coronary microcirculatory dysfunction and future cardiovascular events. (C) 2016 Elsevier Ireland Ltd. All rights reserved.Item Combined past preeclampsia and gestational diabetes is associated with a very high frequency of coronary microvascular dysfunction(2021) Kul, Seref; Guvenc, Tolga Sinan; Baycan, Omer Faruk; Celik, Fatma Betul; Caliskan, Zuhal; Guvenc, Rengin Cetin; Ciftci, Faika Ceylan; Caliskan, Mustafa; 33189732Background: A history of preeclampsia (pPE) and gestational diabetes (pGDM) are female-specific risk markers for atherosclerosis and future cardiovascular risk. In addition to increasing the risk of established risk factors for atherosclerosis, such as hypertension or diabetes, evidence suggests that pregnancy-related complications can also directly accelerate atherosclerosis by inducing endothelial dysfunction. A combination of both conditions is seen in a subset of patients with pregnancy, though it is not known whether this combination increases the overall risk for cardiovascular events. Aims: Present study aimed to find the impact of combined pPE/pGDM on the prevalence of coronary micro vascular dysfunction (CMD). Methods: A total of 24 patients with combined pPE/pGDM, 19 patients with isolated pPE and 63 patients with pGDM were included to the present study and a further 36 healthy women with no previous pregnancy-related complications served as controls. Coronary flow reserve was measured using echocardiography and CMD was defined as a coronary flow reserve <= 2.5. Results: Patients with combined pPE/pGDM had a high prevalence of CMD (91%), which was significantly higher than controls (5.6%, p < 0.001) and patients with pGDM (55%, p = 0.01). A history of pPE on top of pGDM was associated with an increased risk of CMD (HR:6.28, 95%CI:1.69-23.37, p = 0.006) after multivariate adjustment, but pGDM did not increase the odds for CMD in those with pPE. Conclusions: Combined pPE/pDM is associated with a very high prevalence of CMD, which may indicate an increased risk for future cardiovascular events.