Fakülteler / Faculties
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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 The Safety and Tolerability of Nebivolol in Hypertensive Patients with Coronary Artery Disease and Left Ventricular Ejection Fraction >= 40%: A Population-Based Cohort Study (Nebivolol-TR Study)(2022) Altin, Cihan; Okyay, Kaan; Kocaba, Umut; Coner, Ali; https://orcid.org/0000-0001-6134-8826; https://orcid.org/0000-0002-5711-8873; 36317659; AAK-7355-2020; ABD-7321-2021Background: This study aimed to assess the safety and tolerability of nebivolol in hypertensive patients with coronary artery disease and left ventricular ejection fraction >= 40% in a Turkish cohort. Methods: A total of 1015 hypertensive patients and coronary artery disease with left ventricular ejection fraction >= 40% were analyzed from 29 different centers in Turkey. Primary outcomes were the mean change in blood pressure and heart rate. Secondary outcomes were to assess the rate of reaching targeted blood pressure (<130/80 mmHg) and heart rate (<60 bpm) and the changes in the clinical symptoms (angina and dyspnea). Adverse clinical events and clinical outcomes including cardiovascular mortality, cardiovascular hospital admissions, or acute cardiac event were recorded. Results: The mean age of the study population was 60.3 +/- 11.5 years (male: 54.2%). During a mean follow-up of 6 months, the mean change in blood pressure was -11.2 +/- 23.5/-5.1 +/- 13.5 mmHg, and the resting heart rate was -12.1 +/- 3.5 bpm. Target blood pressure and heart rate were achieved in 76.5% and 37.7% of patients. Angina and functional classifications were improved by at least 1 or more categories in 31% and 23.2% of patients. No serious adverse events related to nebivolol were reported. The most common cardiovascular side effect was symptomatic hypotension (4.2%). The discontinuation rate was 1.7%. Cardiovascular hospital admission rate was 5% and hospitalization due to heart failure was 1.9% during 6 months' follow-up. Cardiovascular mortality rate was 0.1%. Conclusion: Nebivolol was well tolerated and safe for achieving blood pressure and heart rate control in hypertensive patients with coronary artery disease and heart failure with preserved or mildly reduced ejection fraction.Item Investigation of The Relationship Between Asthma and Subclinical Atherosclerosis by Carotid/Femoral Intima Media and Epicardial Fat Thickness Measurement(2018) Yilmaz, Mustafa; Yilmaz, Hatice Eylul Bozkurt; Sen, Nazan; Altin, Cihan; Tekin, Abdullah; Muderrisoglu, Haldun; https://orcid.org/0000-0002-2557-9579; https://orcid.org/0000-0002-4171-7484; https://orcid.org/0000-0002-5658-870X; https://orcid.org/0000-0002-9635-6313; 28453377; S-6973-2016; AAI-8947-2021; ABD-7304-2021; AAG-8233-2020Objective: Since asthma and atherosclerosis may share similar pathophysiological mechanism, this study is planned to investigate whether epicardial fat thickness (EFT), carotid and femoral intima media thicknesses, which are markers of subclinical atherosclerosis, are increased in patients with asthma. Methods: The study was designed as a cross-sectional study. A total of 154 participants (83 patients with asthma and 71 healthy volunteers) were enrolled into the study. Epicardial fat, carotid, and femoral intima media thicknesses were measured and recorded in both groups. The statistical difference between the two groups was examined. Results: Both carotid and femoral intima media thicknesses were significantly higher in patients with asthma compared to control group (5.52 +/- 0.4 mm vs. 5.36 +/- 0.4 mm; p = 0.038 and 5.64 +/- 0.4 mm vs. 5.46 +/- 0.5 mm; p = 0.036, respectively). However, there was not a significant difference in EFT between the groups [5.9 mm (5.3-6.6; IQR = 1.3) vs. 5.6 mm (4.7-6.5; IQR = 1.8); p = 0.1]. On comparison of control group and asthma subgroups (mild, moderate, and severe), there was a statistically significant difference among these four groups in terms of carotid and femoral intima media thicknesses (p = 0.002 and p < 0.001, respectively). Subgroup analyses showed that this difference was mainly due to patients with severe asthma. Conclusions: Carotid and femoral intima media thicknesses in asthmatic patients were found to be increased compared to the normal population. As a result, the risk of subclinical atherosclerosis in asthmatic patients may be high.Item Assessment of Atrial Fibrillation and Ventricular Arrhythmia Risk after Bariatric Surgery by P Wave/QT Interval Dispersion(2018) Yilmaz, Mustafa; Altin, Cihan; Tekin, Abdullah; Erol, Tansel; Arer, Ilker; Nursal, Tarik Zafer; Torer, Nurkan; Erol, Varlik; Muderrisoglu, Haldun; 0000-0002-3628-4661; 0000-0002-5658-870X; 0000-0002-2557-9579; 0000-0002-9635-6313; 28900850; AAN-5153-2021; ABD-7304-2021; IQV-1169-2023; S-6973-2016; AAG-8233-2020The association of obesity with atrial fibrillation (AF) and with ventricular arrhythmias is well documented. The aim of this study was to investigate whether weight reduction by a laparoscopic sleeve gastrectomy has any effect on P wave dispersion (PWD), a predictor of AF, and corrected QT interval dispersion (CQTD), a marker of ventricular arrhythmias, in obese individuals. In a prospective study, a total of 114 patients (79 females, 35 males) who underwent laparoscopic sleeve gastrectomy were examined. The patients were followed 1 year. PWD and CQTD values before and 3rd, 6th, and 12th months after the surgery were calculated and compared. There was a statistically significant decline in body mass index (BMI), PWD, and CQTD values among baseline, 3rd, 6th, and 12th months (p < 0.001 for all comparisons). Correlation analysis showed a statistically significant correlation between Delta PWD and Delta BMI (r = 0.719, p < 0.001), Delta PWD and Delta left ventricular end-diastolic diameter (LVEDD) (r = 0.291, p = 0.002), Delta PWD and Delta left atrial diameter (LAD) (r = 0.65, p < 0.001), Delta CQTD and Delta BMI (r = 0.266, p = 0.004), Delta CQTD and Delta LVEDD (r = 0.35, p < 0.001), Delta CQTD and Delta LAD (r = 0.289, p = 0.002). In multiple linear regression analysis, there was a statistically significant relationship between Delta PWD and Delta BMI (beta = 0.713, p < 0.001), Delta PWD and Delta LVEDD (beta = 0.174, p = 0.016), Delta PWD and Delta LAD (beta = 0.619, p < 0.001), Delta CQTD and Delta BMI (beta = 0.247, p = 0.011), Delta CQTD and Delta LVEDD (beta = 0.304, p < 0.001), Delta CQTD and Delta LAD (beta = 0.235, p = 0.009). PWD and CQTD values of patients were shown to be attenuated after bariatric surgery. These results indirectly offer that there may be a reduction in risk of AF, ventricular arrhythmia, and sudden cardiac death after obesity surgery.Item Epicardial Adipose Tissue Thickness and Carotid Intima-Media Thickness in Hemodialysis Patients(2017) Aydin, Elcin; Altin, Cihan; Sakalhoglu, Onur; Yilmaz, Mustafa; Gezmis, Esin; Sade, Leyla Elif; Muderrisoglu, Haldun; 0000-0002-9635-6313; 0000-0003-0907-3647; 0000-0002-1001-6028; 0000-0003-3737-8595; 28559657; AAG-8233-2020; AAI-8276-2021; AAE-8301-2021; AAQ-7583-2021; HGC-1839-2022Background: It is well-known that cardiovascular risk and all-cause mortality is increased in hemodialysis patients. Epicardial fat thickness (EFT), which reflects visceral adiposity, has been suggested as a new cardiometabolic risk factor. The purpose of this study was to investigate EFT in hemodialysis patients. Methods: A total of 144 consecutive patients (60 hemodialysis patients and 84 controls) were enrolled into the study, and patients with diabetes mellitus and cardiovascular diseases (CVD) were excluded. EFT was measured on the free wall of the right ventricle at end-diastole from the parasternal long-axis view by standard transthorasic 2D echocardiography. Results: The groups were similar in terms of sex distribution, age, blood pressure, heart rate and frequencies of CAD risk factors including smoking status, family history of CAD and hypertension. There were no significant differences between the hemodialysis patients and controls in 2D echocardiographic parameters, including ejection fraction and biochemical parameters except low-density lipoprotein, high-density lipoprotein and c-reactive protein. Despite having lower body mass index, EFT levels were significantly higher in hemodialysis patients compared to the controls (8.0 +/- 2.2 mm vs. 5.8 +/- 1.9 mm; p < 0.01). In multivariate linear regression analysis we determined that hemodialysis patient status was found to be an independent predictor for both EFT ((3 = 0. 700, p = 0.014) and carotid intima-media thickness (CIMT, beta = 0. 614, p = 0.047). Conclusions: Hemodialysis patients are independently associated with high EFT and CIMT.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 Assessment of Epicardial Fat and Carotid Intima Media Thickness in Gestational Hypertension(2018) Altin, Cihan; Yilmaz, Mustafa; Ozsoy, Hasmet M.; Gezmis, Esin; Balci, Serdar; Tekindal, Mustafa A.; Sade, Leyla E.; Muderrisoglu, Haldun; 0000-0002-3996-5681; 0000-0002-2557-9579; 0000-0002-1001-6028; 0000-0002-1782-7325; 0000-0002-4060-7048; 0000-0003-3737-8595; 0000-0002-9635-6313; 29603491; S-6973-2016; AAE-8301-2021; AAJ-1097-2021; U-9270-2018; AAQ-7583-2021; AAG-8233-2020AimGestational hypertension (GHT) is a common disorder of pregnancy characterized by new onset hypertension without the presence of detectable proteinuria after 20 weeks of gestation. Epicardial fat thickness (EFT) and carotid intima media thickness (CIMT) are suggested as new predictors of subclinical atherosclerosis. Although the relationship between these parameters and essential hypertension has been demonstrated, this association in patients with GHT is still unknown. We aimed to investigate CIMT and EFT in patients with GHT. MethodsA total of 90 patients (44 GHT and 46 controls) were enrolled. Patients with diabetes mellitus, chronic hypertension and cardiovascular disease (CVD) were excluded. In the third trimester, the mean CIMT at the far wall of both left and right common carotid arteries was measured on B-mode duplex ultrasound. EFT was measured on the free wall of the right ventricle at the end systole in the parasternal long-axis view by standard transthorasic 2D echocardiography. ResultsUnlike the mean CIMT (0.52 0.13 mm vs 0.47 +/- 0.11 mm; P = 0.078), the mean EFT was significantly higher in the GHT group compared to the controls (5.31 +/- 1.68 mm vs 4.17 +/- 1.16 mm; P = 0.002). In multivariate logistic regression analysis, among the most pertinent clinical variables, only EFT is an independent determinant of GHT (OR: 2.903; 95% confidence interval [CI]: 1.454-5.796; P = 0.003). In receiver operating characteristic (ROC) analysis, EFT >5.5 mm had 82.6% specificity and 52.3% sensitivity in predicting a diagnosis of GHT (ROC area under curve: 0.689, 95% CI: 0.577-0.802, P = 0.002). ConclusionMaternal EFT may be higher in pregnant women with GHT in comparison with those of controls.Item Angiotensin receptor neprilysin inhibitor for patients with heart failure and reduced ejection fraction: Real-world experience from Turkey (ARNi-TR)(2021) Ekici, Berkay; Yaman, Mehmet; Kucuk, Murathan; Dereli, Seckin; Yenercag, Mustafa; Yigit, Zerrin; Bas, Mehmet Memduh; Karavelioglu, Yusuf; Cakmak, Huseyin Altug; Kivrak, Tarik; Ozkan, Hakan; Altin, Cihan; Sabanoglu, Cengiz; Demirkan, Burcu; Atas, Ali Ekber; Kilicaslan, Fethi; Altay, Hakan; Tengiz, Istemihan; Erkan, Aycan Fahri; Kilicaslan, Baris; Olgun, Fatih Erkam; Durakoglugil, Murtaza Emre; Alhan, Aslihan; Zoghi, Mehdi; 34308869Objective: Heart failure (HF) is a growing public health problem with high morbidity and mortality. Recently, angiotensin receptor neprilysin inhibitor (ARNi) has emerged as a promising treatment for HF with reduced ejection fraction (HFrEF). Here, we shared our experience with the use of ARNi in HFrEF from multiple centers in Turkey. Methods: The ARNi-TR is a multicenter, nonintervention al, retrospective, observational study. Overall, 779 patients with HF from 22 centers in Turkey who were prescribed sacubitril/valsartan were examined. Initial clinical status, biochemical and echocardiographic parameters, and New York Heart Association functional class (NYHA-FC) values were compared with follow-up values after 1 year of ARNi use. In addition, the effect of ARNi on number of annual hospitalizations was investigated, and the patients were divided into 2 groups, depending on whether ARNi was initiated at hospitalization or under outpatient clinic control. Results: N-terminal pro-brain natriuretic peptide (NT-proBNP), left-ventricle ejection fraction (LV-EF), and NYHA-FC values improved significantly in both groups (all parameters, p<0.001) within 1-year follow-up. In both groups, a decrease in hemoglobin A1c (HbA1c) values was observed in ARNi use (p<0.001), and a decrease in daily diuretic doses and hospitalizations owing to HF were observed after ARNi use (all comparisons, p<0.001). Hypotension (16.9%) was the most common side effect in patients using ARNi. Conclusion: The ARNi-TR study offers comprehensive real-life data for patients using ARNi in Turkey. The use of ARNi has shown significant improvements in FC, NT-proBNP, HbA1c levels, and LV-EF. Likewise, reductions in the number of annual hospitalizations and daily furosemide doses for HF were seen in this study.Item Management of Sacubitril/Valsartan Combination in an End-stage Heart Failure Patient Hospitalized for COVID-19 Pneumonia: Should we Withdraw Temporarily or Continue?(2021) Coner, Ali; Altin, CihanBackground: Many factors were blamed for the worse prognosis in COVID-19. Heart failure patients are thought to be under increased risk because of either immune-compromised basal status or possible interaction of viral infection with on-going medications, such as the Renin-Angiotensin-Aldosterone system (RAAS) blockers. Sacubitril is a neprilysin inhibitor and its' combination with valsartan is recommended as a novel medication for heart failure. Case Report: A 71 years of age female with end-stage heart failure was hospitalized for COVID-19 pneumonia. She was under sacubitril/valsartan combination for the heart failure, and at the end of the first week of hospitalization, clinical and laboratory parameters recovered uneventfully. Sacubitril/valsartan therapy was continued without complications during the in-hospital course. Conclusion: Specific therapies for heart failure should not be withdrawn in COVID-19. To our knowledge, this is the first case report documenting the clinical progress of a COVID-19 pneumonia patient who was already under sacubitril/valsartan treatment.
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