Fakülteler / Faculties
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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 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 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 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 Assessment of Myocardial Mechanics in Patients with End-Stage Renal Disease and Renal Transplant Recipients Using Speckle Tracking Echocardiography(2015) Pirat, Bahar; Bozbas, Huseyin; Simsek, Vahide; Sade, L. Elif; Sayin, Burak; Muderrisoglu, Haldun; Haberal, Mehmet; 0000-0002-9635-6313; 0000-0003-4576-8630; 0000-0003-3737-8595; 0000-0002-3462-7632; 0000-0001-8287-6572; 25894162; AAG-8233-2020; AAI-8897-2021; AAQ-7583-2021; AAJ-8097-2021; J-3707-2015Objectives: Velocity vector imaging allows quantitation of myocardial strain and strain rate from 2-dimensional images based on speckle tracking echocardiography. The aim of this study was to analyze the changes in myocardial strain and strain rate patterns in patients with end-stage renal disease and renal transplant recipients. Materials and Methods: We studied 33 patients with end-stage renal disease on hemodialysis (19 men; mean age, 36 +/- 8 y), 24 renal transplant recipients with functional grafts (21 men; mean age, 36 +/- 7 y) and 26 age- and sex-matched control subjects. Longitudinal peak systolic strain and strain rate for basal, mid, and apical segments of the left ventricular wall were determined by velocity vector imaging from apical 4- and 2-chamber views. The average longitudinal strain and strain rate for the left ventricle were noted. From short-axis views at the level of papillary muscles, average circumferential, and radial strain, and strain rate were assessed. Results: Mean heart rate and systolic and diastolic blood pressure during imaging were similar between the groups. Longitudinal peak systolic strain and strain rate at basal and mid-segments of the lateral wall were significantly higher in renal transplant recipients and control groups than end-stage renal disease patients. Average longitudinal systolic strain from the 4-chamber view was highest in control subjects (-14.5% +/- 2.9%) and was higher in renal transplant recipients (-12.5% +/- 3.0%) than end-stage renal disease patients (-10.2% +/- 1.6%; P <= .001). Radial and circumferential strain and strain rate at the level of the papillary muscle were lower in patients with end-stage renal disease than other groups. Conclusions: Differences in myocardial function in patients with end-stage renal disease, renal transplant recipients, and normal controls can be quantified by strain imaging. Myocardial function is improved in renal transplant recipients compared with end-stage renal disease patients.Item Adherence to Mediterranean Diet and Its Relation with Cardiovascular Diseases in Turkish Population(2015) Hoscan, Yesim; Yigit, Fatma; Muderrisoglu, Haldun; 0000-0003-1541-6167; 0000-0002-9635-6313; 25932246; ABC-8170-2021; AAG-8233-2020Mediterranean diet (MD) is considered a model for healthy eating. However, prospective evidence in Turkey evaluating the relationship between MD and cardiovascular events is scarce. We surveyed the adherence of Alanya population to MD and its association with coronary heart diseases (CHD). The study population consisted of participants in Alanya, a region placed southern Turkey. Followed-up 900 participants (52 percent women) initially free of CHD during 5.1 years. The general dietary habits of study population were detected with a food frequency questionnaire. Data obtained from that questionnaire were tested with Mediterranean diet score in order to find out the relevance to Mediterranean diet. A MD score (scale 0-8) was computed reflecting high ratio of monounsaturated to saturated fat; high intake of legumes, cereals, vegetables, and fruits; low intakes of meat and it's products, milk and dairy products. Scoring <5 was defined as Low-MD consuming, while 5+ as High-MD consuming. We observed 25 incident cases of CHD. Consumption of High-MD was 21% in men and 19% in women. The risk for myocardial infarction, coronary bypass, coronary angioplasty, and any cardiovascular disease in men increased by 1.3 (P = 0.02), 1.4 (P = 0.03), 1.5 (P = 0.01), and 1.3 (P = 0.02), respectively, for each MD score decrease. In women, the risk for myocardial infarction and angioplasty increased by 1.3 (P = 0.02) and 1.5 (P = 0.01), respectively, for each MD score decrease. The risk for coronary bypass, and any cardiovascular disease in women, crude odds ratios ranged from 1.1 to 1.3 but were not statistically significant. The current rate of MD in Alanya is fairly low. There is an inverse association between adherence to MD and the incidence of fatal and non-fatal CHD in initially healthy adults.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.