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    Altered cardiac autonomic function after recovery from COVID-19
    (Wiley, 2022) Kurtoglu, Ertugrul; Afsin, Abdulmecit; Aktas, Ibrahim; Akturk, Erdal; Kutlusoy, Ergun; Cagasar, Ozlem
    Background Autonomic dysfunction may occur during the acute phase of COVID-19. Heart rate variability (HRV) is a useful tool for the assessment of cardiac sympathetic and parasympathetic balance. We aimed to evaluate cardiac autonomic function by using HRV in subjects after recovery from COVID-19 who had previously symptomatic and were followed outpatiently. Methods The study group composed of 50 subjects with a confirmed history of COVID-19 and the control group composed of 50 healthy subjects without a history of COVID-19 and vaccination. All the study participants underwent 2-dimensional, pulsed- and tissue-Doppler echocardiographic examinations and 24-hour Holter monitoring for HRV analysis. Results Time domain parameters of SDNN, SDANN, SDNNi, RMSSD, pNN50, and HRV triangular index were all decreased in the study group when compared with the control group. Frequency domain parameters of TP, VLF, LF, HF, and HFnu were also decreased in the study group in comparison with the control group. LFnu was similar between groups. Nonlinear parameters of HRV including alpha(1) and alpha(2) decreased in the study group. By contrast, Lmax, Lmean, DET, REC, and Shannon entropy increased in the study population. Approximate and sample entropies also enhanced in the study group. Conclusions The present study showed that all three domain HRV significantly altered in patients after recovery from COVID-19 indicating some degree of dysfunction in cardiac autonomic nervous system. HRV may be a useful tool for the detection of preclinical autonomic dysfunction in this group of patients.
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    Atrial Fibrillation due to Blunt Cardiac Injury: Case Report
    (Aves, 2018) Turgut, Kasim; Yucel, Neslihan; Oguzturk, Hakan; Ulutas, Zeynep; Afsin, Abdulmecit
    Introduction: Blunt cardiac injury secondary to chest trauma is an important cause of emergency department admissions. It can range from asymptomatic myocardial contusion to significant dysrhythmia, acute heart failure, valvular injury, or cardiac rupture. Case Report A 38-years-old patient was admitted to the emergency department with atrial fibrillation (AF) that occurred after a car accident. The patient had chest trauma caused by striking the steering wheel during the accident. The AF rhythm of the patient reverted to the normal sinus rhythm at the 3rd hour after trauma. Conclusion: Emergency medicine professionals should keep in mind arrhythmias due to blunt chest trauma and take electrocardiograms of patients to be able to provide treatment in time.
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    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, Julide
    Objective: 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.
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    Left atrial volume and function in patients with white-coat hypertension assessed by real-time three-dimensional echocardiography
    (Lippincott Williams & Wilkins, 2016) Ermis, Necip; Afsin, Abdulmecit; Cuglan, Bilal; Acikgoz, Nusret; Cansel, Mehmet; Yagmur, Julide; Hidayet, Siho
    BackgroundWhite-coat hypertension (WCH) is a disease based on the disparity of a patient's blood pressure measurements between the physician's office and the patient's home environment. The aim of the present study is to evaluate the left atrial (LA) volume and functions in WCH.MethodsIn total, this study included 37 WCH (17 women, 20 men, mean age 48.45.7 years) and 30 healthy individuals (18 women, 20 men, mean age 47.97.5 years). All patients underwent real-time three-dimensional and comprehensive two-dimensional echocardiography (2DE) with tissue Doppler evaluation to estimate left atrial volumes and mechanical functions.ResultsLA diameters were significantly higher in the patients compared with the controls (37 +/- 2.8 vs. 35 +/- 3.1mm, P=0.017). LA total systolic volume and LA maximal volume were significantly higher in the patients. (41.1 +/- 6.9 vs. 35.5 +/- 3.7ml, P<0.001; 25.8 +/- 5.4 vs. 21.3 +/- 3.3ml, P<0.001, respectively). LA volume before LA contraction and LA active stroke volume were significantly higher in the patients with WCH than in the normotensives (24.4 +/- 6.3 vs. 20.9 +/- 2ml, P=0.002; 9.1 +/- 4.8 vs. 6.7 +/- 2.5ml, P=0.007, respectively). Moreover, the LA expansion index was significantly higher in the patients with WCH than in the normotensives (178.7 +/- 53.6 vs. 155.3 +/- 36.3, P=0.037). However, the total emptying volume fraction of the LA was similar between the two groups.ConclusionWe showed that LA structural functions and volumes were increased in the WCH group. Although increased LA volume has been observed in many diseases, structural changes in LA may be accepted as an early sign for clinical cardiac remodeling in patients with WCH, suggesting the necessity of early intervention for preventing clinical cardiovascular disease.
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    Relationship between platelet-to-lymphocyte ratio and fractional flow reserve in left anterior descending artery with intermediate stenosis
    (2020) Asoglu, Ramazan; Afsin, Abdulmecit; Atici, Adem; Asoglu, Emin
    Aim: Platelet-to-lymphocyte ratio has been used as a determinant factor for coronary artery disease. Since platelet activation is central to the initiation of atherosclerosis, our goal was to evaluate the relationship between platelet-to-lymphocyte ratio and fractional flow reserve (FFR) values in the left anterior descending artery (LAD) with intermediate coronary stenosis.Material and Methods: The present report encompassed 173 subjects having stable angina pectoris. These subjects were categorized into 2 groups: 91 subjects with a FFR less than or equal to 0.80 and 82 patients with a FFR greater than 0.80. The platelet-to-lymphocyte ratio of each subject was determined from the complete blood count. The two groups were evaluated for differences using a Student's unpaired t-test. A p-value of 0.05 was considered statistically significant.Results: The average platelet-to-lymphocyte ratio value of subjects with a FFR less than or equal to 0.80 were significantly higher than those with a FFR greater than 0.80 ((115.5±38.0) vs. (103.8±38.9), p=0.04). The correlation between platelet-to-lymphocyte ratio with stenosis degree was significant (r= 0.22, p= 0.003).Conclusion: Platelet-to-lymphocyte ratio was associated with a FFR measurement of equal or less than to 0.80 in subjects with stable angina pectoris.
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    The Time in Therapeutic Range and Bleeding Complications of Warfarin in Different Geographic Regions of Turkey: A Subgroup Analysis of WARFARIN-TR Study
    (Galenos Publ House, 2017) Kilic, Salih; Celik, Ahmet; Cakmak, Huseyin Altug; Afsin, Abdulmecit; Tekkesin, Ahmet Ilker; Aciksari, Gonul; Memetoglu, Mehmet Erdem
    Background: The time in therapeutic range values may vary between different geographical regions of Turkey in patients vitamin K antagonist therapy. Aims: To evaluate the time in therapeutic range percentages, efficacy, safety and awareness of warfarin according to the different geographical regions in patients who participated in the WARFARIN-TR study (The Awareness, Efficacy, Safety and Time in Therapeutic Range of Warfarin in the Turkish population) in Turkey. Study Design: Cross-sectional study. Methods: The WARFARIN-TR study includes 4987 patients using warfarin and involved regular international normalized ratio monitoring between January 1, 2014 and December 31, 2014. Patients attended follow-ups for 12 months. The sample size calculations were analysed according to the density of the regional population and according to Turkish Statistical Institute data. The time in therapeutic range was calculated according to F.R. Roosendaal's algorithm. Awareness was evaluated based on the patients' knowledge of the effect of warfarin and fooddrug interactions with simple questions developed based on a literature review. Results: The Turkey-wide time in therapeutic range was reported as 49.5% +/- 22.9 in the WARFARIN-TR study. There were statistically significant differences between regions in terms of time in therapeutic range (p<0.001). The highest rate was reported in the Marmara region (54.99%+/- 20.91) and the lowest was in the South-eastern Anatolia region (41.95 +/- 24.15) (p< 0.001). Bleeding events were most frequently seen in Eastern Anatolia (41.6%), with major bleeding in the Aegean region (5.11%) and South-eastern Anatolia (5.36%). There were statistically significant differences between the regions in terms of awareness (p< 0.001). Conclusion: Statistically significant differences were observed in terms of the efficacy, safety and awareness of warfarin therapy according to different geographical regions in Turkey.