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Öğe Assessment of atrial conduction time by tissue Doppler echocardiography and P-wave dispersion in patients with mitral annulus calcification(Churchill Livingstone Inc Medical Publishers, 2010) Pekdemir, Hasan; Cansel, Mehmet; Yagmur, Julide; Acikgoz, Nusret; Ermis, Necip; Kurtoglu, Ertugrul; Tasolar, HakanThe aim of our study was to investigate atrial conduction time in patients with mitral annulus calcification (MAC) using P-wave dispersion (PWD) and electromechanical coupling measured with the surface electrocardiogram and the tissue Doppler echocardiography. Fifty-nine patients with MAC and 43 control subjects underwent resting the surface electrocardiogram and tissue Doppler echocardiography. The difference between the maximum (Pmax) and minimum P-wave durations was calculated and defined as PWD. Interatrial and intraatrial electromechanical delays were measured with tissue Doppler echocardiography. Both Pmax and PWD were higher in patients with MAC compared with controls (111.4 +/- 15.8 vs 97.3 +/- 18.8 milliseconds; P < .0001 and 46.4 +/- 14.6 vs 31.4 +/- 13.1 milliseconds; P < .0001, respectively). Both interatial and intraatrial conduction time were also delayed in patients with MAC compared with controls (29.8 +/- 13.3 vs 17.6 +/- 12.5 milliseconds; P < .0001; 9.4 +/- 5.1 vs 6.8 +/- 4.0 milliseconds; P < .008, respectively). Left atrial (LA) diameter was significantly higher in patients with MAC compared with controls (35.4 +/- 5.0 mm vs 32.3 +/- 4.2 mm; P < .001). The LA diameter correlated significantly with both interatrial conduction times and PWD (r = 0.56; P < .0001 and r = 0.47; P < .0001, respectively). There is a delay in both intraatrial and interatrial electromechanical coupling intervals in patients with MAC. (C) 2010 Elsevier Inc. All rights reserved.Öğe Assessment of atrial conduction time by tissue Doppler echocardiography and P-wave dispersion in smokers(Springer, 2012) Akturk, Erdal; Yagmur, Julide; Acikgoz, Nusret; Ermis, Necip; Cansel, Mehmet; Karakus, Yasin; Tasolar, HakanThe aim of this study was to evaluate the relationship between cigarette smoking and atrial rhythm disorders with the use of noninvasive methods. The study population consisted of 50 healthy volunteer smokers and 40 healthy volunteer non-smokers who had normal echocardiographic parameters and similar sex and age profiles. P-wave dispersion (PWD) was calculated from the 12-lead surface ECG. Left ventricle (LV) end-systolic and end-diastolic diameters, LV ejection fraction, and interatrial and intraatrial electromechanical delay were measured by tissue Doppler imaging and conventional echocardiography. Isovolumetric relaxation time and deceleration time were significantly higher (91.5 +/- 11 vs. 82.35 +/- 8.6, p < 0.0001; 215.7 +/- 37.1 vs. 175.3 +/- 17.7, p < 0.0001, respectively), and HDL cholesterol was significantly lower in smokers (39.34 +/- 7.5 vs.44.3 +/- 8.07, p = 0.003). There were no significant differences between the groups with respect to Sm and Em values, Am value, and E/A and E/Em ratios. However, the Em/Am ratio was significantly lower in smokers (1.28 +/- 0.21 vs. 1.44 +/- 0.33, p < 0.006). Inter- and intraatrial electromechanical delay were significantly higher in smokers when compared with non-smokers (51.11 +/- 1.54 vs. 27.30 +/- 3.36, p < 0.0001, and 30.63 +/- 3.2 vs. 12.24 +/- 3.26, p < 0.0001, respectively). The amount of smoking was strongly correlated with interatrial electromechanical delay (r = 0.567, p < 0.0001), and a significant correlation was detected between PWD and interatrial electromechanical delay (r = 0.653, p = 0.001). We have demonstrated the relationship between inter- and intraatrial electromechanical delay and PWD. These parameters may be useful predictive markers for the development of AF in the asymptomatic period before cardiac rhythm disturbances occur. This finding may indicate that smokers have an increased risk of developing atrial rhythm disturbances.Öğe Assessment of atrial conduction time in patients with Behcet's disease(Publisaude-Edicoes Medicas Lda, 2014) Cansel, Melunet; Yagmur, Julide; Tasolar, Hakan; Karincaoglu, Yelda; Ermis, Necip; Acikgoz, Nusret; Bayramoglu, AdilObjective: Behcet's disease is characterized by increased inflammatory activity, and there there might be an increased risk of atrial arrhythmia in patients with this disease. Our study is aimed to evaluate a novel method of measuring atrial electromechanical features. expressed as interatrial and intraatrial electromechanical delay by tissue Doppler echocardiography in patients with Behcet's disease. Methods: We evaluated 57 patients (mean age: 36.3 +/- 12.1 years) with Behcet's disease and 34 sex and age matched healthy volunteers (mean age: 38.4 +/- 8.6 years) as control group. P-wave dispersion (PWD) was calculated from the 12-lead surface ECG, interatrial and intraatrial electromechanical delay were measured by tissue Doppler imaging and conventional echocardiography Results: Interatrial electromechanical delay and intraatrial electromechanical delay were prolonged in patients with active Behcet's disease compared with the patients with inactive disease and the controls (p<0.0001, p<0.0001, p=0.013 and p=0.001, respectively). Erythrocyte sedimentation rate and high-sensitivity C-reactive protein values of of patients with active Behcet's were significantly higher than those with inactive Behcet's disease and the controls (p<0.0001 and p<0.0001, respectively). High-sensitivity C-reactive protein and erythrocyte sedimentation rate were correlated with interatrial electromechanical delay in patients with Behcet's disease (r=0.44, p=0.001 and r=0.64, p<0.0001, respectively). Conclusions: The prolongation of atrial electrome-chanical conduction might be related with changes in structure and electrophysiological properties of the atrial myocardium or the conduction system in patients with active Behcet's disease.Öğe Assessment of atrial electromechanical delay and influential factors in patients with obstructive sleep apnea(Springer Heidelberg, 2012) Yagmur, Julide; Yetkin, Ozkan; Cansel, Mehmet; Acikgoz, Nusret; Ermis, Necip; Karakus, Yasin; Tasolar, HakanThe interaction between moderate-to-severe obstructive sleep apnea (OSA) and cardiac arrhythmias, especially atrial fibrillation (AF), is well known. We aimed to determine whether atrial electromechanical parameters assessed by tissue Doppler imaging (TDI) would be affected in moderate-to-severe OSA, and detect the influential factors of atrial electromechanical parameters in these patients. Interatrial and intra-atrial electromechanical delay was measured by TDI in patients with moderate-to-severe OSA (n = 64) and control subjects (n = 39). P-wave dispersion (PWD) was calculated on the 12-lead ECG. Interatrial and intra-atrial electromechanical delay was significantly higher in the OSA group when compared with the controls (52.26 +/- 12.9 vs 29.61 +/- 11.26, P < 0.0001 and 18.90 +/- 8.13 vs 8.71 +/- 5.46, P < 0.0001; respectively). PWD was higher in the OSA group (46.09 +/- 13.40 ms vs 34.10 +/- 10.75 ms, P < 0.0001). Interatrial electromechanical delay had a positive correlation with PWD (r = 0.490, P < 0.0001), left atrial (LA) diameter (r = 0.383, P = 0.002), LA volume index (r = 0.354, P = 0.004), and apnea-hypopnea index (r = 0.365, P = 0.003). In addition, interatrial electromechanical delay was negatively correlated with the magnitude of the lowest oxygen saturation percentage (r = -0.498, P < 0.0001). This study showed that interatrial and intra-atrial electromechanical delay and PWD were prolonged in patients with moderate-to-severe OSA. LA dilatation, hypoxemia, and the severity of the disease may contribute a prolongation in interatrial electromechanical delay via atrial structural and electrical alterations, which may predict the risk of future AF development in patients with moderate-to-severe OSA.Öğe Assessment of Atrial Electromechanical Delay by Tissue Doppler Echocardiography in Obese Subjects(Wiley, 2011) Yagmur, Julide; Cansel, Mehmet; Acikgoz, Nusret; Ermis, Necip; Yagmur, Murat; Atas, Halil; Tasolar, HakanOur aim was to evaluate whether atrial electromechanical delay measured by tissue Doppler imaging (TDI), which is an early predictor of atrial fibrillation (AF) development, is prolonged in obese subjects. A total of 40 obese and 40 normal-weight subjects with normal coronary angiograms were included in this study. P-wave dispersion (PWD) was calculated on the 12-lead electrocardiogram (ECG). Systolic and diastolic left ventricular (LV) functions, inter-and intra-atrial electromechanical delay were measured by TDI and conventional echocardiography. Inter-and intra-atrial electromechanical delay were significantly longer in the obese subjects compared with the controls (44.08 +/- 10.06 vs. 19.35 +/- 5.94 ms and 23.63 +/- 6.41 vs. 5.13 +/- 2.67 ms, P < 0.0001 for both, respectively). PWD was higher in obese subjects (53.40 +/- 5.49 vs. 35.95 +/- 5.93 ms, P < 0.0001). Left atrial (LA) diameter, LA volume index and LV diastolic parameters were significantly different between the groups. Interatrial electromechanical delay was correlated with PWD (r = 0.409, P = 0.009), high-sensitivity C-reactive protein (hsCRP) levels (r = 0.588, P < 0.0001). Interatrial electromechanical delay was positively correlated with LA diameter, LA volume index, and LV diastolic function parameters consisting of mitral early wave (E) deceleration time (DT) and isovolumetric relaxation time (IVRT; r = 0.323, P = 0.042; r = 0.387, P = 0.014; r = 0.339, P = 0.033; r = 0.325, P = 0.041; respectively) and, negatively correlated with mitral early (E) to late (A) wave ratio (E/A) (r = -0.380, P = 0.016) and myocardial early-to-late diastolic wave ratio (E-m/A(m)) (r = -0.326, P = 0.040). This study showed that atrial electromechanical delay is prolonged in obese subjects. Prolonged atrial electromechanical delay is due to provoked low-grade inflammation as well as LA enlargement and early LV diastolic dysfunction in obese subjects.Öğe Assessment of left atrial volume and function by real time three-dimensional echocardiography in obese patients(Wiley, 2017) Yagmur, Julide; Cansel, Mehmet; Kurtoglu, Ertugrul; Hidayet, Siho; Acikgoz, Nusret; Ermis, Necip; Ozyalin, FatmaObjective: To evaluate left atrial (LA) volume and functions in obese subjects using real time three-dimensional echocardiography (RT3DE) and also the relationship between LA mechanical functions and N-terminal pro-atrial natriuretic peptide (NT-proANP). Methods: This study included 40 obese (26 females and 14 males, mean age 51.9 years) and 40 normal weight subjects (23 females and 16 males, mean age 53.5 years) with normal coronary angiograms. All the study participants underwent RT3DE to assess LA volume and mechanical function. Plasma NT-proANP was determined by ELISA method. Results: There was no significant difference between groups in left ventricular (LV) diameters and ejection fraction, which reflect LV systolic function. However, transmitral deceleration time, isovolumetric relaxation time, and peak late diastolic tissue Doppler velocity values, which reflect LV diastolic function, were found to be significantly higher in obese subjects when compared with controls. LA maximum volume (LAVmax), LAVmax index (LAVI), LA minimal volume (LAVmin), before atrial contraction volume (LAVpreA), LA active emptying volume, LA total emptying volume, and LA active emptying fraction, which reflect LA reservoir and pump functions, were also higher in obese subjects when compared with controls. LA passive emptying fraction was significantly lower in obese subjects than in controls. NT-proANP levels were similar between groups. There were positive correlations between NT-proANP level and LAVI, LAVmax, LAVmin, LAVpreA, and LA total and active emptying volumes. Conclusions: Left atrial mechanical functions and volumes are impaired in obese subjects. These findings may be regarded as early markers of subclinical cardiac failure in obese subjects who have not yet exhibited any clinical evidence of cardiovascular disease.Öğe Assessment of left ventricular volume and functions by real-time three-dimensional echocardiography in patients with compensated and decompensated heart failure(Turkish Soc Cardiology, 2012) Akturk, Erdal; Kurtoglu, Ertugrul; Ermis, Necip; Yagmur, Julide; Acikgoz, Nusret; Karakus, Yasin; Pekdemir, HasanObjectives: The aim of the study was to evaluate congestive heart failure (HF) patients with real-time three-dimensional echocardiography (3DE) to investigate why some of them present with acute decompensation despite having two-dimensional echocardiographic (2DE) parameters with compensated HF patients. Study design:The study population consisted of 36 patients with decompensated HF (24 males, 12 females; mean age 65.8 10.4 years) and 30 patients with compensated HF (21 males, 9 females; mean age 63.2 +/- 11.5 years).The levels of pro-brain natriuretic peptide (pro-BNP), serum electrolytes, renal function tests and complete blood counts were determined. All patients underwent 2DE and 3DE evaluations. Results: Heart rate and blood urea nitrogen levels were higher in patients with decompensated HF than those with compensated HF (95.8 +/- 21.4 vs, 81.2 +/- 14.9, p=0.002; 28.3 +/- 15.7 mg/di vs. 18 +/- 6.8 mg/di, p=0.001, respectively). Pro-BNP levels and NYHA class were significantly higher in patients with decompensated heart failure [4925 pg/ml (2199-8711) vs. 330 pg/ml (197-756), p<0.0001 and 2.3 +/- 0.6 vs. 1.2 +/- 0.4, p<0.0001, respectively]. Although 2DE parameters were similar between groups, left ventricular ejection fraction was lower in patients with decompensated HF while end-diastolic and end -systolic volumes by 3DE were significantly higher in the same group (26.3 +/- 3.8% vs, 30.3 +/- 4.0%; 205.6 +/- 55.5 ml vs. 145.0 +/- 33.7 ml; 178.4 +/- 55.6 ml vs. 115.7 +/- 32.5 ml, all p<0.0001, respectively). However, systolic volume was higher in patients with compensated HF (52.0 +/- 15.5 ml vs. 62 +/- 12 ml, p=0.005). Conclusion: We think that 3DE provides more reliable information about left ventricular volume and functions in the evaluation of patients with HF.Öğe Assessment of the left ventricular systolic function in cardiac syndrome X using speckle tracking echocardiography(Turkish Soc Cardiology, 2016) Yagmur, Julide; Acikgoz, Nusret; Cansel, Mehmet; Ermis, Necip; Karakus, Yasin; Kurtoglu, ErtugrulObjective: The aim of this study was to evaluate left ventricular (LV) systolic strain by speckle tracking echocardiography (STE) and real-time three-dimensional echocardiography (3-DE) for the early detection of myocardial dysfunction in patients with cardiac syndrome X (CSX). Methods: We compared 34 patients with CSX (18 females, mean age 47.9 +/- 10.0 years) with 41 healthy persons as a control group (23 females, mean age 50.6 +/- 9.9 years). Inclusion criteria for CSX were typical angina, a positive exercise ECG stress test, and angiographically documented normal coronary arteries. Exclusion criteria for both groups were hypertension, valvular heart disease, cardiomyopathies, inflammatory diseases, myocarditis, vasculitis, arthropathies, Tietze's syndrome, gastrointestinal diseases, aortic diseases, hormone replacement therapy, arrhythmias, liver diseases, and alcohol use. All subjects underwent two-dimensional STE and 3-DE to assess resting LV function. STE measures were taken from the basal septum, mid-septum, apical septum, apex, apicolateral, mid-lateral, basal lateral, anteroseptal, anterior, anterolateral, inferolateral, inferior, and inferoseptal walls. Student's t-test, Mann-Whitney U test, and chi-square test were used to statistically analyze data. Results: LV echo ejection fraction (EF) and systolic wave peak velocity were similar for both groups. Regional mean longitudinal strain (-17.7 +/- 2.5% vs. -19.8 +/- 1.8%; p<0.0001) was significantly lower in patients with CSX than in healthy control patients. However, regional mean circumferential strain values (-22.0 +/- 1.6% vs. -22.2 +/- 2.3%; p=0.78) did not differ significantly between the two groups. Conclusion: Significant impairment of LV longitudinal myocardial systolic function was detected with STE in patients with CSX, although normal 3-D EF and tissue Doppler imaging systolic parameters were observed. Arteriosclerosis of small coronary arteries and microvascular dysfunction may affect myocardial longitudinal strain.Öğe Comparision of pain levels of transradial versus transfemoral coronary catheterization: a prospective and randomized study(Aves, 2014) Akturk, Erdal; Kurtoglu, Ertugrul; Ermis, Necip; Acikgoz, Nusret; Yagmur, Julide; Altuntas, Mehmet Sait; Pekdemir, HasanObjective: The aim of the present study was to assess access site pain levels of patients undergoing coronary catheterization via transradial route. Methods: We performed a prospective and randomized study in which 408 patients underwent coronary angiography (CAG) and/or percutaneous coronary intervention (PCI) via transradial approach (TRA) and 428 patients underwent CAG and/or PCI via transfemoral approach (TFA). Pain levels of patients were assessed with Visual Analog Scale (VAS) after catheterization and at 30 days. Student-t, Mann-Whitney U and chi-square tests were used for statistical analysis. Results: Patients in the TRA group showed higher VAS scores than those in TFA group after catheterization [CAG alone, 3 (2-5) vs. 1 (1-3), p<0.0001; PCI, 4 (2-6) vs. 2 (1-3), p<0.0001, respectively]. One month later, patients in TRA group also showed higher VAS scores than those in TFA group [CAG alone, 1 (0-1) vs. 0 (0-1), p<0.0001; PCI, 1 (0-2) vs. 0 (0-1), p<0.0001, respectively]. By the ROC analysis in TRA group, a level of BMI < 24.3 kg/m(2) predicted unacceptable pain with a 87.3% sensitivity and 91.6% specificity [area under curve (AUC): 0.875, 95% CI: 0.839-0.906, p<0.0001], while a wrist circumference <16.7 cm predicted unacceptable pain with 84.6% sensitivity and 89.8% specificity (AUC: 0.900, 95% CI: 0.867-0.928, p<0.0001). Conclusion: The current study suggests that a radial approach for CAG and PCI in patients with a low BMI and small wrist circumference may cause more access site pain as compared with a femoral approach.Öğe Comparison of atrial electromechanical coupling interval and P-wave dispersion in non-dipper versus dipper hypertensive subjects(Taylor & Francis Ltd, 2011) Ermis, Necip; Acikgoz, Nusret; Cuglan, Bilal; Cansel, Mehmet; Yagmur, Julide; Tasolar, Hakan; Barutcu, IrfanBackground. The lack of nocturnal BP fall less than 10% of the daytime, called non-dipper hypertension, is associated with increased cardiovascular morbidity and mortality. The aim of our study was to investigate atrial conduction time in patients with non-dipper hypertension using electromechanical coupling interval and P-wave dispersion (PWD), measured with the surface electrocardiogram and tissue Doppler echocardiographic imaging (TDI). Methods. Age-and sex-matched 43 dipper hypertensive patients (19 male, 24 female, mean age: 53.9 +/- 10.5 years), 40 non-dipper patients (18 male, 22 female, mean age 54.3 +/- 9.6 years) and 46 healthy subjects (22 male, 24 female, mean age: 52.8 +/- 9.6 years) were included in the study. The difference between the maximum and minimum P-wave durations was calculated and defined as PWD. Atrial electromechanical coupling (PA), inter-atrial and intra-atrial electromechanical delays were measured with TDI. Results. PWD was significantly higher in patients with non-dippers compared with dippers (p < 0.02) and controls (p < 0.001). The inter-atrial conduction time was delayed in non-dippers compared with dippers (p < 0.01) and controls (p < 0.001). There was a positive correlation between left atrial (LA) diameter and inter-atrial conduction times (r = 0.46, p < 0.001). LA diameter was also correlated with PWD (r = 0.44, p < 0.001). Conclusion. The patients with non-dipper hypertension have higher P-wave duration, PWD and delayed inter-atrial electromechanical coupling intervals compared with those of dippers and controls. This indicates that these subjects may be more prone to atrial rhythm disturbances.Öğe Comparison of left atrial volume and function in non-dipper versus dipper hypertensives: A real-time three-dimensional echocardiography study(Kare Publ, 2016) Ermis, Necip; Otlu, Yilmaz Omur; Afsin, Abdulmecit; Hidayet, Siho; Acikgoz, Nusret; Cansel, Mehmet; Yagmur, JulideObjective: Non-dipper hypertension is associated with an increased cardiovascular morbidity and mortality. Besides this, the left atrial (LA) size and functions are accepted to be prognostic factors in various cardiovascular diseases. In this study, we aimed to evaluate the effect of nondipper hypertension on LA volume and functions using real-time three-dimensional echocardiography (RT3-DE). Methods: Forty dipper and 52 non-dipper hypertensives enrolled in this prospective cross-sectional study. Patients with any comorbidities that have a potential for causing structural cardiac alterations were excluded. Two-dimensional echocardiography (2-DE) and RT3-DE were performed to assess LA volumes and functions. The statistical tests used in this study were Shapiro-Wilk's test, Student's t-test, Mann-Whitney U test, chi-square test, Spearman's test, and Pearson's correlation test. Results: LA minimal volume, LA volume before LA contraction, and LA total systolic volume were higher in non-dipper hypertensives than in dipper hypertensives (p<0.001, p=0.003, and p=0.03, respectively). Only, the 2-DE measurements of interventricular septal thickness and E/Em ratio were higher in non-dipper hypertensives (p=0.001 and p=0.03, respectively). There was a moderate correlation between LA minimal volume and LA volume before LA contraction with E/Em (r=0.31, p=0.007 and r=0.32, p=0.005, respectively). Conclusion: Although LA volume and passive LA systolic functions measured by RT3-DE are significantly increased in non-dipper hypertensives, the alterations in active LA systolic functions are not prominent. RT-3DE may be used to define LA volume and function alterations in conditions that have capabilities of adverse cardiac remodeling such as systemic hypertension.Öğe Degeneration of atrioventricular nodal reentrant tachycardia into polymorphic ventricular tachycardia: a case report(Turkish Soc Cardiology, 2011) Acikgoz, Nusret; Kilic, Ayhan; Jata, Bekim; Kose, SedatAtrioventricular nodal reentrant tachycardia (AVNRT) is the most common form of paroxysmal supraventricular tachycardia and is usually treated successfully by radiofrequency catheter ablation. We report on a 38-year-old woman whose AVNRT attacks occasionally degenerated into polymorphic ventricular tachycardia (VT). The patient presented with a complaint of palpitations. The electrocardiogram was in sinus rhythm with a normal corrected QT interval. During Holter monitoring, narrow QRS complex tachycardia with a heart rate of 220 beats/ min was noted at nighttime, that lasted for 90 minutes, during which two episodes of polymorphic VT were also seen. The diagnosis of AVNRT was confirmed on an electrophysiologic study and AVNRT was successfully treated by radiofrequency catheter ablation. The patient had no complaint during a follow-up of eight months, with no signs of arrhythmia on repeat Holter monitoring.Öğe Early Left Atrial Mechanics and Volume Abnormalities in Subjects with Prehypertension: A Real Time Three-Dimensional Echocardiography Study(Wiley, 2012) Akturk, Erdal; Ermis, Necip; Yagmur, Julide; Acikgoz, Nusret; Kurtoglu, Ertugrul; Cansel, Mehmet; Eyupkoca, FerhatThe aim of this study was to evaluate left atrial (LA) volume and mechanical functions by real time three-dimensional echocardiography (RT3DE) in prehypertensive subjects. The study included 54 (34 male and 20 female) prehypertensive subjects and 36 (14 male and 22 female) healthy control subjects. Transthoracic echocardiography and RT3DE were performed in all patients. Interventricular septum thickness and isovolumetric relaxation time were significantly higher in prehypertensives than in controls (10.7 +/- 0.7 vs. 10.1 +/- 0.8 P = 0.001 and 89.9 +/- 10 vs. 82.4 +/- 11 P = 0.002, respectively). LA maximum volume, volume before atrial contraction, total and active stroke volume, total and active emptying fractions, expansion index, and LA max volume index were significantly higher in prehypertensives when compared with controls (P < 0.0001 for all). However, the passive emptying fraction was significantly lower in prehypertensives than controls (45.7 +/- 5.6 vs. 48.6 +/- 4.1, P = 0.006), and the minimum LA volume between the two groups was similar. The main finding of this study was that although LA volume and LA active systolic functions were significantly increased in prehypertensive people, there was a reduction in passive LA systolic functions. These parameters may be important in showing hemodynamic and structural changes in cardiac tissue caused by prehypertension. (Echocardiography 2012;29:1211-1217)Öğe Early single clinical experience with the new Figulla ASD Occluder for transcatheter closure of atrial septal defect in adults(Elsevier Masson, 2011) Cansel, Mehmet; Pekdemir, Hasan; Yagmur, Julide; Tasolar, Hakan; Ermis, Necip; Kurtoglu, Ertugrul; Acikgoz, NusretBackground. Recently, the Occlutech Figulla ASD Occluder (FSO) has been introduced for transcatheter closure of atrial septal defects. This device can be used for transcatheter closure of small as well as large atrial septal defects. Aims. To evaluate the feasibility and short-term results of transcatheter closure of secundum type atrial septal defects using the FSO device in adult patients. Methods. Seventy-four consecutive adult patients were referred for transcatheter closure of secundum large atrial septal defects (stretched diameter > 20 mm and/or invasive pulmonary/systemic flow [Qp/Qs] ratio > 1.5) using the FSO device. Results. The FSO device was successfully implanted in 68 patients (mean +/- SD [range] age: 31.8 +/- 12.3 [17-64] years; weight: 71.5 +/- 18.4 [49-98] kg). All patients had right atrial and ventricular volume overload with a mean Qp/Qs ratio of 2.5 +/- 0.6 (range 1.5-3.8). Mean atrial septal defect diameter was 22.3 +/- 4.8 (range 12-33) mm and the size of the implanted FSO was 24.1 +/- 4.9 (range 12-36) mm. Two patients had trivial (jet width <1 mm in diameter) residual shunts and one patient had a small (1-2 mm) residual shunt. There were no moderate or severe residual shunts. No device embolization or other serious complication occurred during either the procedure or the follow-up. Conclusion. The present study found that transcatheter closure of isolated secundum atrial septal defects using the novel design of the FSO device was safe, effective, and had an excellent outcome during the 6 month follow-up period. (C) 2011 Elsevier Masson SAS. All rights reserved.Öğe Effect of Hemodynamic Changes During Percutaneous Mitral Balloon Valvuloplasty on Short and Long Term Clinical Outcome(Drunpp-Sarajevo, 2012) Akurk, Erdal; Kurtoglu, Ertugrul; Eyupkoca, Ferhat; Ermis, Necip; Acikgoz, Nusret; Yagmur, Julide; Cansel, MehmetAims: We aim of this study is to determine whether hemodynamic changes that occur before and after percutaneous mitral balloon valvuloplasty (PMV) procedure is a predictor in determining the short- and long-term clinical results in patients with mitral stenosis (MS). Methods: The study population consisted of 118 (26 males and 92 females) consecutive patients with symptomatic rheumatic MS, underwent successful PMV. Mean pulmonary artery pressure, pulmonary capillary wedge pressure (PCWP), mean transmitral gradient and mean left atrial was obtained before and immediately after valvuloplasty. Two separate groups were formed on the basis of these measured pressure differences. The first group pressure differences (PD) <= 15 mmHg and the second group PD > 15 mmHg. Results: There was no difference in immediate outcomes between two group. There was no significant difference in between groups in terms of primary endpoints. However, there was a difference in mean left atrial pressure difference (LAPD) between <= 15 mmHg group and > 15mmHg group. MVR and redo PMV rates were significantly lower in LAPD> 15mmHg group (p=0.027 and p=0.03, respectively), the difference between stroke and death rates was not statistically significant (p=0.6). Conclusion: The significant risk factors in determining long-term outcomes in patients undergoing PMV are; mitral valve morphology, atrial fibrillation, advanced age, NYHA class, post-PMV, MR grade, post-PMV MVA, prior surgical commissurotomy, post-PMV pulmonary artery pressure and echocardiographic score. In addition to these parameters we found that LAPD could also be a predictor of long term outcomes patients undergoing PMV.Öğe Effect of treadmill exercise testing on P wave duration and dispersion in patients with isolated myocardial bridging(Springer, 2009) Barutcu, Irfan; Esen, Ali Metin; Ozdemir, Ramazan; Acikgoz, Nusret; Turkmen, Muhsin; Kirma, CevatSeveral previous studies suggest that myocardial bridging (MB) is associated with ischemia and rhythm disturbances. We sought to examine exercise-induced changes in P wave duration and dispersion (PWD), the markers of atrial conduction abnormalities in patients with isolated MB of left anterior descending artery (LAD) and control subjects. Eighteen patients with MB of LAD (group-I) and 22 subjects with angiographically demonstrated normal coronary arteries (group-II) underwent treadmill exercise testing. Before and after exercise ECG was recorded at a paper speed of 50 mm/s. The change in maximum and minimum P wave duration was measured manually and difference between two values was defined as PWD. There was no difference between two groups in terms of demographic properties. Baseline maximum and minimum P wave duration and PWD durations were similar in both groups and they did not change after exercise. (Group-I: before and after test; 114 +/- A 10 vs. 114 +/- A 9, 66 +/- A 13 vs. 67 +/- A 10, and 47 +/- A 9 vs. 45 +/- A 13 ms, P > 0.05, group-II; 113 +/- A 9 vs. 115 +/- A 8, 68 +/- A 11 vs. 68 +/- A 11, 45 +/- A 11 vs. 48 +/- A 15 ms for each, respectively). In addition there was no significant correlation between PWD and P wave duration and echocardiographic variables. In patients with MB of LAD, PWD and P wave duration were not different than healthy subjects and treadmill exercise testing did not induce atrial conduction abnormalities in both groups.Öğe The effects of Ramadan fasting on heart rate variability in healthy individuals: A prospective study(Aves, 2014) Cansel, Mehmet; Tasolar, Hakan; Yagmur, Julide; Ermis, Necip; Acikgoz, Nusret; Eyupkoca, Ferhat; Pekdemir, HasanObjective: Ramadan fasting is one of the five fundamental rituals of Islam. Heart rate variability (HRV) is an independent predictor of increased mortality of patients with myocardial infarction and congestive heart failure. Although many patients in this region fast once a year, the effects of fasting on the HRV, which has a prognostic significance for patients with myocardial infarction and congestive heart failure, are not known. Therefore, the study on the effects of one month fast of HRV in healthy volunteers seems to be reasonable to address. Methods: Our study is a prospective cohort study that includes a total of 40 healthy volunteers with sinus rhythm between 19 and 40 years of age (16 female and 24 male). HRV was determined twice by ambulatory 24-hour Holter recordings at fasting in the middle of Ramadan and first week after Ramadan month. Mean values of continuous variables were compared by using the Student t-test or Mann-Whitney U test. Paired t-test or Wilcoxon test were used for comparison of variables between groups. Results: When two groups compared, statistically significant differences were found in terms of RR (p=0.049), SDNNI (p=0.010), rMSSD (p=0.009), pNN50 (p=0.015), T power (p=0.009), LF (p=0.008), Lfnu (p=0.002), HF (p=0.022) and Hfnu (p=0.013) values. Conclusion: In our study, HRV parameters were found to be increased in Ramadan month, so we think that Ramadan fasting enhances the activity of the parasympathetic system.Öğe Elevated Monocyte to High-Density Lipoprotein Cholesterol Ratio and Endothelial Dysfunction in Behcet Disease(Sage Publications Inc, 2018) Acikgoz, Nusret; Kurtoglu, Ertugrul; Yagmur, Julide; Kapicioglu, Yelda; Cansel, Mehmet; Ermis, NecipBehcet disease (BD) is a multisystemic disorder characterized by endothelial dysfunction and inflammation. Monocyte to high-density lipoprotein cholesterol ratio (MHR) is a recently emerged indicator of inflammation and oxidative stress. Sixty patients with BD and 50 control individuals were included to investigate the relationship between MHR and endothelial dysfunction. Endothelial function was assessed by flow- and nitroglycerin-mediated dilatation technique (FMD and NMD, respectively). Serum high-sensitivity C-reactive protein (hsCRP) levels were measured in all study participants. The MHR and hsCRP levels were significantly higher in patients with active BD than in controls. Brachial artery FMD was significantly lower in patients with active BD than in controls. Brachial artery NMD was similar between groups. There was a strong inverse correlation between MHR and FMD and a strong positive correlation between MHR and serum hsCRP levels. Thus, elevated MHR may be a useful marker reflecting impaired endothelial function and systemic inflammation in patients with BD.Öğe Elevated Oxidative Stress Markers and its Relationship With Endothelial Dysfunction in Behcet Disease(Sage Publications Inc, 2011) Acikgoz, Nusret; Ermis, Necip; Yagmur, Julide; Cansel, Mehmet; Karincaoglu, Yelda; Atas, Halil; Cuglan, BilalBehcet's disease (BD) is a multisystemic disorder characterized by endothelial dysfunction. However, the relationship between oxidative stress and endothelial function has not been clearly shown. We investigated the relationship between oxidative stress markers and endothelial function in patients with BD. Patients with BD (n = 40) having active disease and sex-and age-matched 40 controls were included. Endothelial function was assessed by flow-mediated dilatation (FMD) technique. Serum gammaglutamyltransferase (GGT) and high-sensitive C-reactive protein levels (hsCRP) were measured in all participants. Brachial artery FMD was significantly lower in patients with BD than in controls. Gamma-glutamyltransferase and hsCRP levels were higher in patients with BD than in controls. Also, GGT and hsCRP levels were inversely correlated with endothelial function. Oxidative stress markers are elevated in patients with BD having active disease. This may be one of the reasons behind the vasculitis in active BD.Öğe Elevated serum gamma-glutamyl transferase activity in patients with cardiac syndrome X and its relationship with carotid intima media thickness(Taylor & Francis Ltd, 2010) Yagmur, Julide; Ermis, Necip; Acikgoz, Nusret; Cansel, Mehmet; Atas, Halil; Karakus, Yasin; Pekdemir, HasanObjectives - We aimed to evaluate serum gamma-glutamyl transferase (GGT) activity and its relationship with carotid intima media thickness (CIMT) in patients with cardiac syndrome X (CSX). Methods - The study population consisted of 40 patients with CSX, 35 controls and 40 patients with coronary artery disease (CAD). All patients underwent a noninvasive stress test and conventional coronary angiography. Serum GGT and C-reactive protein (CRP) levels were measured and CIMT was assessed in all subjects. Results - Serum GGT activity was higher in the CSX and the CAD groups than in the control group (32.6 +/- 16.0 and 30.4 +/- 15.3 U/L, respectively, vs. 17.9 +/- 4.2 U/L; P < 0.001). There was no statistically significant difference in serum GGT activity between the CSX and the CAD groups. When compared to the control group, serum CRP levels were significantly increased in both the CSX and the CAD groups (4.1 +/- 2.0 and 4.7 +/- 2.6 mg/L, respectively, vs. 2.2 +/- 1.8 mg/L; P < 0.001). Patients with CSX and CAD had significantly higher CIMT values than the controls (0.74 +/- 0.17 and 0.94 +/- 0.12 mm, respectively, vs. 0.62 +/- 0.08 mm; P < 0.001). A significant correlation was found between GGT activity and CIMT measurements (r = 0.640, P < 0.001), but serum GGT activity did not correlate with serum CRP levels in patients with CSX (r = 0.277, P > 0.05). Conclusions - The present study showed that serum GGT activity in patients with CSX was as high as those in patients with CAD. Increased GGT levels may play a role in the pathogenesis of the microvascular atherosclerotic process of CSX.
