Wos İndeksli Açık & Kapalı Erişimli Yayınlar
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Item T1 Mapping by Cardiac Magnetic Resonance and Multidimensional Speckle-Tracking Strain by Echocardiography for the Detection of Acute Cellular Rejection in Cardiac Allograft Recipients(2019) Sade, Leyla Elif; Hazirolan, Tuncay; Kozan, Hatice; Ozdemir, Handan; Hayran, Mutlu; Eroglu, Serpil; Pirat, Bahar; Sezgin, Atilla; Muderrisoglu, Haldun; 29680337; X-8540-2019OBJECTIVES The aim of this study was to test the hypothesis that echocardiographic strain imaging, by tracking subtle alterations in myocardial function, and cardiac magnetic resonance T1 mapping, by quantifying tissue properties, are useful and complement each other to detect acute cellular rejection in heart transplant recipients. BACKGROUND Noninvasive alternatives to endomyocardial biopsy are highly desirable to monitor acute cellular rejection. METHODS Surveillance endomyocardial biopsies, catheterizations, and echocardiograms performed serially according to institutional protocol since transplantation were retrospectively reviewed. Sixteen-segment global longitudinal strain (GLS) and circumferential strain were measured before, during, and after the first rejection and at 2 time points for patients without rejection using Velocity Vector Imaging for the first part of the study. The second part, with cardiac magnetic resonance added to the protocol, served to validate previously derived strain cutoffs, examine the progression of strain over time, and to determine the accuracy of strain and T1 measurements to define acute cellular rejection. All tests were performed within 48 h. RESULTS Median time to first rejection (16 grade 1 rejection, 15 grade >= 2 rejection) was 3 months (interquartile range: 3 to 36 months) in 49 patients. GLS and global circumferential strain worsened significantly during grade 1 rejection and >= 2 rejection and were independent predictors of any rejection. In the second part of the study, T1 time >= 1,090 ms, extracellutar volume GLS >= 32%, GLS >-14%, and global circumferential strain >=-24% had 100% sensitivity and 100% negative predictive value to define grade >= 2 rejection with 70%, 63%, 55%, and 35% positive predictive values, respectively. The combination of GLS > 16% and T1 time >= 1,060 ms defined grade 1 rejection with 91% sensitivity and 92% negative predictive value. After successful treatment, T1 times decreased significantly. CONCLUSIONS T1 mapping and echocardiographic GLS can serve to guide endomyocardial biopsy selectively. (C) 2019 by the American College of Cardiology Foundation.Item Assesment of Spatial QRS-T Angle in Patients with Cardiac Syndrome X(2019) Muderrisoglu, Mustafa; Muderrisoglu, Haldun; 0000-0002-9635-6313; AAG-8233-2020Objective: Cardiac syndrome x (CSX) is defined as typical exertional angina, one or more abnormal cardiac stress test(s), and normal coronary arteries after exclusion of spontaneous or inducible epicardial coronary spasm. The aim of this study was to investigate cardiovascular adverse events risks in patients with CSX. For this purpose, spatial QRS-T angle that is predictor of these risks was evaluated in patients with CSX and control subjects. Methods: In a retrospective study, a total of 179 subjects (95 patients with CSX, 84 control) were examined. Control subjects had a normal coronary computed tomography. Spatial QRS-T angle value was calculated and compared in patients with CSX and control group, p values <0.05 were considered as statistically significant. Results: There was a statistically significant difference between the groups in terms of spatial QRS-T angle values [control group spatial QRS-T angle value median 35 (12.5 - 60), CSX group spatial QRS-T angle value median 51 (27 - 115), p<0.001]. Conclusion: According to our results, spatial QRS-T angle value was elevated in patients with CSX than in normal population. Furthermore, these results may indirectly suggest that the risk of adverse cardiac events may be increased in patients with CSX.Item T1 Mapping for Cardiac Allograft Rejection(2019) Sade, Leyla Elif; Hayran, Mutlu; Muderrisoglu, Haldun; 0000-0002-9635-6313; 31072527; AAG-8233-2020Item Assessment of vascular inflammation and subclinical nephropathy in exaggerated blood pressure response to exercise test(2019) Coner, Ali; Genctoy, Gultekin; Akinci, Sinan; Altin, Cihan; Muderrisoglu, Haldun; 0000-0002-9635-6313; 30969228; AAG-8233-2020Objectives Exaggerated blood pressure response (EBPR) to exercise tests is an additional cardiovascular risk factor and predictor of future development of hypertension. However, there are conflicting data on the diagnostic threshold of EBPR and its clinical importance in kidney disease. The aim of this study was to investigate vascular inflammation and subclinical nephropathy in otherwise healthy volunteers with EBPR. Patients and methods The study included 170 middle-aged, healthy volunteers (mean age: 43.3 +/- 6.9; range: 35-65 years: 100 men and 70 women). Participants performed a treadmill exercise test until they reached their age-adjusted maximum heart rate and were divided into EBPR and normal/physiological blood pressure response groups. Before exercise tests, serum high sensitive C-reactive protein (hs-CRP) and urine albumin-to-creatinine ratio were measured to evaluate vascular inflammation and subclinical nephropathy, respectively. Anthropometrical measurements, fasting serum glucose, fasting lipid profile, and the full blood count of participants were also evaluated. Results EBPR was detected in 31 (18.2%) participants. Hs-CRP levels (1.03 vs. 0.46 mg/l) (P<0.001) and albumin-to-creatinine ratio levels (6.90 vs. 5.22 mg/g) (P=0.002) were higher in the EBPR group. BMI, abdominal obesity, and hs-CRP levels were found to be related to increased development of EBPR. Conclusion EBPR is an overlooked clinical finding during exercise tests and should be evaluated in apparently healthy, middle-aged populations for the early detection of possible subclinical nephropathy. Copyright (C) 2019 Wolters Kluwer Health, Inc. All rights reserved.Item Adequacy of Infective Endocarditis Prophylaxis Before Dental Procedures among Solid Organ Transplant Recipients(2019) Karacaglar, Emir; Akgun, Arzu; Ciftci, Orcun; Altiparmak, Nur; Muderrisoglu, Haldun; Haberal, Mehmet; 0000-0002-9635-6313; 31464231; AAG-8233-2020Infective endocarditis (IE) is a life-threatening condition with high morbidity and mortality. The current IE guidelines recommend antibiotic prophylaxis only in patients with certain cardiac conditions and before certain dental procedures. However, there is not enough data about solid organ transplant (SOT) recipients. In this study, we aimed to investigate the IE prophylaxis in general dental and periodontal surgical procedures among our SOT recipients. Medical records of 191 SOT recipients (32 liver transplant recipients, 54 heart transplant recipients, and 105 kidney transplant recipients) who were admitted to our hospital between January 2016 and January 2018 were evaluated. A total of 65 patients who underwent dental procedures were included in the study. We investigated the adequacy of IE prophylaxis according to the current guidelines. Two groups were created according to whether they received antibiotic prophylaxis or not. The mean age was 44.2 +/- 13.6 years, and 66.1% were male. The majority of patients (67.6%) received antibiotic prophylaxis. The most commonly used antibiotic was amoxicillin (48.8%). Among the procedures, 23.1% were classified as invasive and 76.9% were classified as noninvasive. No complication was observed after invasive and noninvasive dental procedures. There were no complications in both antibiotic prophylaxis and no-prophylaxis groups. According to our results, IE prophylaxis has been used appropriately in SOT recipients in our center. No serious infection has been reported. In addition, no complication due to antibiotic use was also observed.Item The opinion and recommendations of Turkish Board for Accreditation in Cardiology on Board Examination(2019) Yildirir, Aylin; Altun, Armagan; Ural, Dilek; Ozdemir, Murat; Aslan, Ozgur; Muderrisoglu, Haldun; 31582681; ABB-5844-2020Item Parathyroid Hormone and Ischemic Cerebrovascular Event(2019) Altay, Hakan; Altin, Cihan; Coner, Ali; Muderrisoglu, Haldun; Giray, Semih; 0000-0002-9635-6313; 0000-0002-0722-3181; 30806331; AAG-8233-2020; AAH-1091-2020Background: Increased parathyroid hormone (PTH) level is associated with coronary artery disease, hypertension and left ventricular hypertrophy which are all predisposing factors for the ischemic cerebrovascular event ( ICVE). Carotid intima-media thickness (CIMT) and aortic distensibility are the two early, subclinical predictors of atherosclerosis. The relation of PTH with CIMT and aortic distensibility in patients with ICVE has not been previously studied. Objective: Our aim was to study the relationship of PTH levels with aortic distensibility and CIMT in patients with ICVE. Methods: Sixty-four ICVE patients and 50 control group were enrolled in the study. PTH levels, aortic distensibility and CIMT were measured in all individuals. Results: PTH levels were significantly higher in ICVE patients than in the controls (60.1 +/- 21.6 vs. 52.3 +/- 6.2 pg/ml) (p=0. 008). PTH levels were found to be inversely correlated with aortic distensibility (r= -0. 420, p=0.001) and positively correlated with CIMT ( r:0, 285, p=0,002). Conclusion: The present study shows that PTH levels are increased in patients with acute ischemic cerebrovascular event compared to the control group. It also demonstrates that PTH levels are inversely related to aortic distensibility of ascending aorta and positively associated with CIMT.Item Subclinical myocardial dysfunction in liver transplant candidates determined using speckle-tracking imaging(2019) Inci, Saadet Demirtas; Sade, Leyla Elif; Altin, Cihan; Pirat, Bahar; Pamukcu, Hilal Erken; Yilmaz, Sabriye; Muderrisoglu, Haldun; 31802775Objective: There are various cardiovascular abnormalities in end-stage liver disease (ESLD). In these patients, left ventricular (LV) systolic function is normal at rest but deteriorates during stress. This deterioration may be due to subclinical myocardial dysfunction. This study evaluated global LV and right ventricular (RV) functions using 2-dimensional (2D) speckle tracking in patients with ESLD. Methods: Forty liver transplant candidates with ESLD and 26 healthy individuals were included in the study. All of the patients underwent conventional echocardiographic measurement. Longitudinal, circumferential, and radial strain measurements, as well as apical and parasternal short-axis image recordings were obtained. All 2D strain measurements were measured with offline analysis using velocity vector imaging (VVI) software. Results: In the apical 4- and 2-chamber measurements, the LV mean longitudinal strain was significantly lower in the patient group compared with that of the control group (-16.0 +/- 3.2% versus -17.6 +/- 2.2%, -16.7 +/- 3.3% versus -18.7 +/- 2.1 +/- 2.1 %; p=0.002, respectively). The LV mean circumferential strain did not differ between groups. The LV mean radial strain and RV longitudinal strain were significantly lower in the patient group (45.4 +/- 10.7 vs. 52.7 +/- 10.8%; p=0.01 and -19.2 +/- 3.5% versus -21.5 +/- 3.6%; p=0.03, respectively). Conclusions: Subclinical impairment of global LV and RV systolic functions was determined in liver transplantation candidates using VVI. This deterioration was detected in longitudinal and radial deformation rather than circumferential deformation mechanics, which is consistent with early-stage LV myocardial dysfunction.Item Preoperative Cardiac Risk Assessment in Renal Transplant Recipients: A Single-Center Experience(2019) Yilmaz, Kerem Can; Akgun, Arzu Neslihan; Ciftci, Orcun; Muderrisoglu, Haldun; Sezer, Siren; Moray, Gokhan; Haberal, Mehmet; 0000-0002-9635-6313; 29025386; AAG-8233-2020Objectives: Cardiovascular disease is the major cause of morbidity and mortality in patients on renal replacement therapy and in kidney transplant recipients. There are no specific recommendations for preoperative cardiac risk assessment before renal transplant. The aim of our study was to analyze preoperative cardiac test frequencies, test results, patient characteristics, and relations between cardiac stress test results and severe coronary artery disease. Materials and Methods: We retrospectively examined patients who underwent renal transplant between December 2011 and December 2016 in our hospital (Ankara, Turkey). Our study group included 216 patients. All patients had preoperative echocardiography. We recorded results of exercise stress tests, myocardial perfusion scintigraphy, and coronary angiography. For all patients, preoperative complete blood cell count, creatinine, high-density lipoprotein, triglycerides, low-density lipoprotein, and red cell distribution width values were obtained and recorded. Results: We classified patient groups according to presence or absence of severe coronary artery disease. Fourteen of 66 patients had severe coronary artery disease. In univariate analyses, age, having a history of familial coronary artery disease, diabetes mellitus, presence of coronary artery disease, and triglyceride levels were risk factors for severe coronary artery disease. In multivariate analysis, diabetes mellitus, presence of coronary artery disease, and having a history of familial coronary artery disease were statistically significant. Conclusions: Renal transplant recipients are a special patient population, and there must be specific suggestions for this population. If patients present with more than 1 risk factor, a stress test should be performed to evaluate cardiovascular risk. In some patients, especially those whose risk factors include prior cardiovascular disease or diabetes mellitus, stress tests should be skipped and patients should directly undergo coronary angiography to look for severe coronary artery disease.Item The effects of a low international normalized ratio on thromboembolic and bleeding complications in patients with mechanical mitral valve replacement(2014) Bal, Ugur; Aydinalp, Alp; Yilmaz, Kerem; Ozcalik, Emre; Hasirci, Senem; Atar, Ilyas; Gultekin, Bahadir; Sezgin, Atilla; Muderrisoglu, HaldunBackground: Mechanical heart valve replacement has an inherent risk of thromboembolic events (TEs). Current guidelines recommend an international normalized ratio (INR) of at least 2.5 after mechanical mitral valve replacement (MVR). This study aimed to evaluate the effects of a low INR (2.0-2.5) on thromboembolic and bleeding complications in patients with mechanical MVR on warfarin therapy. Methods: One hundred and thirty-five patients who underwent mechanical MVR were enrolled in this study. The end points of this study were defined as TEs (valve thrombosis, transient ischemic attack, stroke) and bleeding (all minor and major bleeding) complications. Patients were followed up for a mean of 39.6 months and the mean INR of the patients was calculated. After data collection, patients were divided into 3 groups according to their mean INR, as follows: group 1 (n = 34), INR < 2.0; group 2 (n = 49), INR 2.0-2.5; and group 3 (n = 52), INR > 2.5. Results: A total of 22 events (10 [7.4%] thromboembolic and 12 [8.8%] bleeding events) occurred in the follow-up period. The mean INR was an independent risk factor for the development of TEs. Mean INR and neurological dysfunction were independent risk factors for the development of bleeding events. A statistically significant positive correlation was found between the log mean INR and all bleeding events, and a negative correlation was found between the log mean INR and all TEs. The total number of events was significantly lower in group 2 than in groups 1 and 3 (P = 0.036). Conclusions: This study showed that a target INRs of 2.0-2.5 are acceptable for preventing TEs and safe in terms of bleeding complications in patients with mechanical MVR.