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Öğe Altered cardiac autonomic function after recovery from COVID-19(Wiley, 2022) Kurtoglu, Ertugrul; Afsin, Abdulmecit; Aktas, Ibrahim; Akturk, Erdal; Kutlusoy, Ergun; Cagasar, OzlemBackground 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.Öğe Aspirin resistance(Turkish Soc Cardiology, 2005) Akturk, Erdal; Topal, Ergun; Aksoy, Yuksel[Abstract Not Available]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 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 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 Coronary aneurysm accompanied by a coronary artery fistula and atrial septal defect(Springer India, 2012) Akturk, Erdal; Battaloglu, Bektas; Yagmur, Julide; Eyupkoca, FerhatA 56-year-old female patient was admitted to our clinic with complaint of dyspnea on exertion with progressive worsening of the functional class in last months. Electrocardiography showed Atrial Fibrillation (AF) and Transthoracic Echocardiography (TTE) showed normal Left Ventricular (LV) systolic function with grade 3 tricuspide and grade 2 mitral insufficiency. Pulmonary arterial pressure was 45 mmHg and Right Atrium (RA) and right ventricle were dilated. Selective coronary angiography was performed. There was no obvious lesion on coronary arteries and their branches, except that the Right Coronary Artery (RCA) was dilated and tortuous and had an aneurysm. Multidetector computed tomography showed significantly dilated and tortuous RCA which significantly broadened distally and opened into the RA. Under cardiopulmonary bypass, right atriotomy was performed and an Atrial Septal Defect (ASD) revealed. This defect was closed and repaired primarily. Fistula ostium was seen from coronary sinus. Primary repair from coronary sinus window was performed. Severe regurgitation of tricuspid valve was observed and De Vega anuloplasty was performed.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 Endothelial nitric oxide synthase levels and their response to exercise in patients with slow coronary flow(Clinics Cardive Publ Pty Ltd, 2013) Tasolar, Hakan; Eyyupkoca, Ferhat; Akturk, Erdal; Karakus, Yasin; Cansel, Mehmet; Yagmur, Julide; Ozyalin, FatmaBackground: Endothelial dysfunction plays a key role in the aetiopathogenesis of slow coronary flow (SCF) even if there is no obstructive epicardial lesion. Reduced plasma levels of endothelial nitric oxide synthase (eNOS) are an important indicator of endothelial dysfunction. We aimed to determine plasma levels of eNOS and their relationship with exercise in patients with SCF. Methods: Twenty-two patients with SCF in at least one coronary artery and 17 healthy individuals were included in this study. The TIMI frame count method was used to determine SCF. Plasma levels of eNOS before and after effort were determined in the patient and control groups. Results: Basal eNOS levels in the patient group were lower than in the control group (p = 0.040), and plasma eNOS levels after exercise decreased more significantly in the patient group compared to the control group (p = 0.002). Median decreases of eNOS in response to exercise were higher in the SCF group than in the control group (p < 0.001), and the decrease observed in the control group was not statistically significant (p = 0.35). There were significantly negative correlations between TIMI frame count and plasma levels of eNOS at baseline and after exercise (r = -0.51, p = 0.015, r = -0.58, p = 0.005, respectively). Moreover, there was also a positive correlation between the rate-pressure product and plasma levels of eNOS after exercise in patients with SCF (r = 0.494, p = 0.019). Conclusion: Our findings indicate an important pathophysiological relationship between the severity of SCF in which endothelial dysfunction plays a role in its pathogenesis and the level of circulating plasma levels of eNOS.Öğe Evaluation of contrast nephropathy in percutaneous treatment of chronic total occlusions(Akademiai Kiado Zrt, 2019) Akturk, Erdal; Askin, Lutfu; Tasolar, Hakan; Kurtoglu, Ertugrul; Turkmen, Serdar; Tanriverdi, Okan; Uzel, Kader ElizBackground: Contrast-induced nephropathy (CIN) is a leading cause of morbidity and mortality in patients undergoing percutaneous coronary intervention (PCI). Chronic total occlusions (CTO) are frequently observed among patients undergoing coronary angiography. Methods: A total of 128 CTO patients were included. Mehran score, lesion characteristics, interventional procedure, serological specimens and devices were recorded. The first group was administered with 1 ml . kg(-1) . h(-1) saline (0.9% NaCl) infusion that started 12 h before the procedure and continued 12 h post procedure as recommended by the guidelines. The second group was administered with saline infusion of 12 ml . kg(-1) . h(-1) only during CTO-PCI procedure, which is called as intensive infusion. Results: CIN development was similar in two groups (four patients in standard hydration group and five patients in intensive hydration group). The amount of saline was significantly higher in the standard group (1,767 +/- 192.2 vs. 1,043.6 +/- 375; p < 0.001). Patients with higher creatinine levels prior to PCI had a higher rate of CIN development after procedure. Interestingly, age, left ventricular ejection fraction, and diabetes mellitus independently predicted CIN. Conclusion: Intensive hydration administration appears to be an effective and cost-effective method in CTO-PCI patients, especially in patients without left ventricular function failure.Öğe A free-floating left atrial thrombus visualized by real-time three-dimensional echocardiography(Oxford Univ Press, 2011) Yagmur, Julide; Atas, Halil; Cansel, Mehmet; Akturk, Erdal; Erdil, Nevzat[Abstract Not Available]Öğe Left atrial volume and function in patients with Behcet's disease assessed by real-time three-dimensional echocardiography(Oxford Univ Press, 2012) Akturk, Erdal; Yagmur, Julide; Kurtoglu, Ertugrul; Ermis, Necip; Acikgoz, Nusret; Sener, Serpil; Karakus, YasinAims Behcet's disease (BD), a multisystemic inflammatory disorder, has been associated with a number of cardiovascular dysfunctions, including endomyocardial fibrosis of the right heart, atrial fibrillation, ventricular arrhythmias and sudden cardiac death. The incidence and nature of cardiac involvement in BD are not yet clearly documented. Our aim was to evaluate left atrial (LA) volume and functions using real-time three-dimensional echocardiography (RT3DE) in Behcet's patients without any cardiac symptom. Methods end results The study included 40 BD (16 females, 24 males and mean age of 33 +/- 7 years) and 30 healthy (11 females, 19 males and mean age of 35 +/- 6 years) subjects. All the patients' demographic parameters such as age, gender, and duration of BD were recorded. All the individuals underwent comprehensive 2D echocardiography examination, and RT3DE was performed to assess LA volumes and mechanical functions. LA maximum volume (V-max) and before atrial contraction volume (V, re A) LA active stroke volume and total stroke volumes (TSV), total emptying and active emptying fractions and expansion index were significantly higher in Behcet's disease patients when compared with the controls (P < 0.0001 for all). LA passive emptying fraction was significantly lower in the patients with BD than in the controls (41 +/- 7 vs. 44 +/- 5, P = 0.039). There were positive correlations between TSV and high-sensitive C-reactive protein level (r = 0.413, P = 0.008), TSV, and disease duration (r = 0.417, P < 0.007). Conclusion Our study has shown that LA mechanical functions and volumes are impaired in BD. These results may be an early form of subclinical cardiac involvement in patients with BD who have no clinical evidence for cardiovascular disease.Öğe Multivessel Coronary Thrombosis in a Patient with Idiopathic Thrombocytopenic Purpura(Texas Heart Inst, 2012) Yagmur, Julide; Cansel, Mehmet; Acikgoz, Nusret; Yagmur, Murat; Eyupkoca, Ferhat; Ermis, Necip; Akturk, ErdalA 49-year-old woman who had idiopathic thrombocytopenic purpura was admitted to our hospital with severe chest pain. Electrocardiography revealed inferolateral myocardial infarction. The patient underwent immediate coronary angiography, which revealed thrombi in the left coronary system. Percutaneous intervention was not indicated, because the thrombi had occluded the distal segments of multiple coronary arteries. Administration of tirofiban satisfactorily dissolved the thrombi. (Tex Heart Inst J 2012;39(6):881-3)Öğe Saddle Pulmonary Embolism Visualized by Real Time Three-Dimensional Echocardiography(Wiley, 2012) Yagmur, Julide; Atas, Halil; Cansel, Mehmet; Akturk, Erdal; Yetkin, OzkanSaddle pulmonary embolism is defined as a visible thromboembolus straddling the bifurcation of the main pulmonary artery. It is very unusual to visualize a pulmonary artery thrombus on transthoracic echocardiography. We describe a case of a saddle embolus of the main pulmonary artery visualized by real time three-dimensional echocardiography and successfully treated with intravenous unfractionated heparin, followed by oral anticoagulation achieving a complete dissolution of the thrombus. (Echocardiography 2012;29:E8-E9)
