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Öğe The assessment of heart rate recovery index in patients with essential tremorEmine Altuntas(2021) Altuntas, Emine; Cuglan, Bilal; Karacay Ozkalayci, SebnemAim: In this study, it was aimed to investigate whether heart rate recovery index(HRRI), which is marker of cardiovascular mortality, was affected in patients with essential tremor(ET). Materials and Method: The study was conducted as retrospective and it consisted of 30 patients with ET and 30 healthy controls which were similar in terms of age and gender. During admission blood pressure and heart rate, fasting blood tests, hemogram, transthoracic echocardiography and exercise stress test results were recorded. Results: The groups were similar in point of age, gender, smoking(p>0.05). Diastolic and systolic blood pressure of the groups were similar, whereas patients with ET had higher heart rate during admission. When exercise stress test results were assessed, 1 st minute heart rate recovery, 2 nd minute HRRI, 5 th minute HRRI were lower in ET group and these differences were statistically significant(respectively p=0.017; 0.033; 0.019). However both groups were similiar with regards to 3 rd minute HRRI(p=0.063) Conclusion: According to this study results it might be thought that cardiovascular and total mortality may be higher in ET patients than healthy controls due to lower HRRI. Furthermore, it can be speculated that this disease may have an autonomous component since HRRI might be marker of an abnormal autonomic nervous system response.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 Clinical and Angiographic Parameters Right Coronary Artery Shapes in Patients With Acute Myocardial Infarction from Right Coronary Artery(Elsevier Science Inc, 2013) Altintas, Mehmet Sait; Ermis, Necip; Cuglan, Bilal; Alturk, Erdal; Ozdemir, Ramazan[Abstract Not Available]Öğe Comparison of long term clinical outcomes, event free survival rates of patients undergoing enhanced external counterpulsation for coronary artery disease in the United States and Turkey(Turkish Soc Cardiology, 2012) Soran, Ozlem; Ikizler, Coskun; Sengul, Atilla; Cuglan, Bilal; Kennard, Elizabeth; Kelsey, SherylObjectives: This study assessed the long-term efficacy of EECP (Enhanced External Counterpulsation) in Turkish (TR) patients initially and compared these results with the United States (US) in a real world setting. Study design: In this study, 2072 patients were treated and followed in the US and 82 patients were treated and followed in TR. The International EECP Patient Registry Phase I and II was initiated and coordinated at the University of Pittsburgh. The aim of the registry was to assess the outcomes of clinical trials in a real world setting. Another unique feature of this study was to enroll patients not only from university hospitals but also from private hospitals, educational hospitals, and treatment centers. Results:TR patients had less diabetes, hypertension, and hyperlipidemia than US patients (p<0.01) TR patients also had a higher proportion of diastolic augmentation (p<0.001). Both groups showed a significant reduction in the severity of angina after a 35h EECP course (p<0.001). Major Adverse Cardiac Events (MACE) rate (death, coronary artery bypass graft, percutaneous coronary intervention, myocardial infarction) was low in both groups during treatment (2.5% vs. 2.7%). At 1 year follow up, 84% of TR and 76% of US patients had maintained the improvement of angina. Conclusion: Patients presenting for EECP treatment from TR had different baseline profiles from US patients. However, despite the high risk baseline characteristics, both cohorts achieved similar reduction in angina. In the long term follow-up, the MACE rate was low and the improvement after EECP was sustained in most of the patients.Öğe The effect of asthma controlling on heart rate recovery in patients with asthma(2022) Cuglan, Bilal; Akbaba Bagci, Belma; Altintas, Mehmet Sait; Altuntas, EmineAim: The heart rate recovery index (HRRI) impairment was found in patients with pulmonary disease such as obstructive sleep apnea syndrome. Asthma is one of the most prevalent respiratory diseases in worldwide. In this study, we aimed to investigate the presence of HRRI impairment with asthma control test in patients with asthma. Material and Methods: A total of 45 people with asthma and 47 healthy participants were consequently enrolled to study from December 2019 through March 2020. The Asthma Control Test™(ACT) survey was used to evaluate the status of asthma. All participants were to undergo cardiopulmonary exercise testing. Heart rate recovery was calculated according to heart rate decreasing in recovery period. Results: Two groups had similar results in terms of laboratory parameters and demographic features. There was a statistically difference in exercise capacity, peak exercise heart rate, (METs) and duration of exercise. Also, all HRRI parameters were reached statistically significant when compared with control group. However, there was no statistically significance in HRRI when ACT groups were compared with each other. Conclusions: The differences of HRRI in ACT groups did not reach to statistically significance. This result could be a consequence of having only two ACT groups and not having any patients belonging to the well-controlled group.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 Frequency of sublingual nitroglycerin prescription in patients with coronary artery disease and angina and awareness of patients about the shelf life of the drug(Kare Publ, 2011) Yilmaz, Omer Caglar; Keskin, Gokhan; Cuglan, Bilal; Selcoki, Yusuf; Temizkan, Ayla; Eryonucu, Beyhan; Soran, OzlemObjectives: ACC/AHA/ESC guidelines recommend sublingual nitroglycerin (SNG) in patients with stable angina pectoris and coronary artery disease (CAD). However, the shelf life of SNG following first use is six months for SNG tablets and two years for SNG sprays. We investigated the frequency of prescription of SNG tablets/sprays in patients having anginal symptoms and documented CAD and the awareness levels of patients about appropriate use of SNG. Study design: Three hundred patients (201 men, 99 women; mean age 61.7 +/- 10.8 years) with documented CAD and angina were enrolled into this study. Angina pectoris was categorized according to the functional classification system of the Canadian Cardiovascular Society. Data on cardiovascular past histories, risk factors, medications, and the use of SNG were recorded. Results: At least one risk factor was present in 96% of the patients. Only 46% of the patients had a prescription for SNG. Of those with a prescription of SNG tablet and spray, 91.8% and 84.4% did not know the shelf life of the product, respectively. Of those who were routinely carrying SNG, 35.6% had an expired product. Of those with a prescription of SNG, only 65.9% were informed by the physician on the proper use of SNG. Conclusion: Our results show that, despite recommendations of the guidelines, SNG is not prescribed to a substantial percentage of patients with CAD and angina, a considerable fraction of patients carry an expired product, and that patients are not adequately informed by the physicians on the use of SNG. These problems will certainly affect the optimal medical management of CAD and its efficacy.Öğe Ignored Identity of Age-Dependent Increase in Pulmonary Embolism Atrial Fibrillation(Elsevier, 2019) Yetkin, Ertan; Cuglan, Bilal; Turhan, Hasan; Ozturk, Selcuk; Yetkin, Ozkan[Abstract Not Available]Öğe Influence of right coronary artery shape on TIMI frame count and lesion distribution Influencia de la forma de la arteria coronaria derecha en el recuento de cuadros TIMI y la distribucion de la lesion(Inst Nacional Cardiologia Ignacio Chavez, 2020) Altintas, Mehmet S.; Ermis, Necip; Cuglan, Bilal; Alturk, Erdal; Ozdemir, RamazanBackground: The shape of the right coronary artery (RCA) may vary between individuals. Objective: The aim of this study was to investigate whether the shape of RCA has any effect on TIMI frame count (TFC), TIMI flow score, and lesion distribution length in patients with ST-elevation myocardial infarction (STEMI) caused by RCA. Materials and methods: The angiograms of 163 patients who applied to our hospital with STEMI caused by the RCA were included in the study. TFC's were calculated. Results: The patients were divided into two groups according to the geometric shape of the RCA as C (124 pts, 101 males, mean age 66.1 +/- 12.3 years) or S (39 pts, 30 males, mean age 60.0 +/- 10.8 years) based on the angiographic view from the left oblique position. Lesion location was significantly higher in the proximal and mid regions compared to the distal region in patients with C-RCA (p < 0.001). TFC was significantly higher in the S-RCA group (p = 0.0014). There was a statistically significant difference between the groups in terms of mean age of p = 0.003. Conclusion: Lesion frequency was significantly higher in the proximal and mid regions in patients with C-RCA. TFC's were significantly higher in the S-RCA group. Longer S-RCA length compared to C-RCA and local shear stress characteristics may also explain these findings.Öğe 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, SihoBackgroundWhite-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.Öğe QT dispersion in patients with pulmonary embolism(Springer Wien, 2010) Ermis, Necip; Ermis, Hilal; Sen, Nazan; Kepez, Alper; Cuglan, BilalBackground: Various ECG patterns have been associated with acute pulmonary embolism. However, there is no data regarding the association between QT interval measurements and pulmonary embolism. We aimed to investigate the association between QT dispersion and the severity of pulmonary embolism (PE). Methods: One hundred twenty-nine pulmonary embolism patients (mean age 58 +/- 16.5 years) with ECGs obtained within the first 24 hours of hospital admission were included in the study. Patients were classified into low, intermediate and high-risk groups. We retrospectively measured ECG scores; maximum and minimum corrected QT intervals (QTc(max) and QTc(min)) and corrected QT interval dispersion (QTcd) in each risk group of patients. Results: There was an increasing ECG score through from low to high-risk PE [3 (Interquartile Range, IQR: 2), 5 (IQR: 6) and 10 (IQR: 7) p < 0.0001]. QT interval analysis showed that QTcd was higher in high-risk group than in low and intermediate-risk groups (59.5 +/- 23.4, 69.2 +/- 21, 95.9 +/- 33.2, p < 0.001 and p = 0.01, respectively). Patients who died after diagnosis had significantly higher QTcd values at baseline compared with the QTcd values of surviving patients (89.1 +/- 45.5 to 65 +/- 22.9, p = 0.001). The sensitivity of QTcd > 71.5 ms for prediction of mortality was 71% with a specificity of 73% (p = 0.001). We observed a strong correlation between QTcd and ECG score values (r = 0.69, p< 0.001). There was also a correlation between QTcd values and pulmonary artery pressure (PAP) (r = 0.027, p = 0.001) Conclusion: QTcd is significantly increased in high-risk PE patients compared to intermediate and low-risk patients. In addition, QTcd is significantly correlated with ECG score and PAP.r = 0.27, p = 0.05).Öğe Serum Gamma-Glutamyl Transferase (GGT) Levels and Inflammatory Activity in Patients With Non-dipper Hypertension(Informa Healthcare, 2012) Ermis, Necip; Yagmur, Julide; Acikgoz, Nusret; Cansel, Mehmet; Cuglan, Bilal; Pekdemir, Hasan; Ozdemir, RamazanNon-dipper hypertension is associated with increased cardiovascular morbidity and mortality. We aimed to evaluate serum gamma-glutamyl transferase (GGT) level, which is accepted as a marker for oxidative stress and its relationship with inflammatory activity in patients with non-dipper hypertension. Age and sex matched 43 dipper hypertensive patients, 40 non-dipper patients, and 46 healthy subjects were included into the study. Serum GGT and C-reactive protein (CRP) levels were measured and compared between each of the groups. Serum GGT activity was higher in the non-dipper and the dipper hypertensive groups than in the control group (33.5 +/- 11.8 and 28.1 +/- 10.1 U/l, respectively, vs. 21.2 +/- 6.5U/l; p < 0.001). There was a statistically significant difference in serum GGT activity between the non-dippers and the dippers (p = 0.021). When compared with the control group, serum CRP levels were significantly increased in both the non-dipper and the dipper hypertensive groups (6.1 +/- 2.6 and 5.4 +/- 2.1 mg/l, respectively, vs. 2.8 +/- 1.7mg/L; p < 0.001). Increased CRP levels were higher in non-dippers than dippers (p = 0.046). A significant correlation was found between GGT and CRP measurements (r = 0.37, p = 0.002). Serum GGT levels, which are markers of the oxidative stress and CRP levels, are both increased in non-dipper hypertension. Increased GGT activity, found to be correlated with CRP levels, may be one of the reasons behind the non-dipper hypertension related cardiovascular complications.
