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Acute and Subacute Effects of Low Versus High Doses of Standardized Panax ginseng Extract on the Heart: An Experimental Study
(Humana Press Inc, 2019) Parlakpinar, Hakan; Ozhan, Onural; Ermis, Necip; Vardi, Nigar; Cigremis, Yilmaz; Tanriverdi, Lokman H.; Colak, Cemil
Panax ginseng is commonly used in Chinese medicine and Western herbal preparations. However, it has also been recently noted to be associated with some cardiac pathologies-including cardiogenic shock due to acute anterior myocardial infarction, trans-ischemic attack, and stent thrombosis. This study was aimed to elucidate acute and subacute effects of the low and high doses of standardized Panax ginseng extract (sPGe) on cardiac functions. Rats were randomly assigned to control group, acute low-dose group (ALD), subacute low-dose group (SALD), acute high-dose group (AHD), and subacute high-dose group (SAHD). The cardiac effects of sPGe were evaluated using hemodynamic, biochemical, echocardiographic, genetic, and immunohistopathologic parameters. Mean blood pressures were significantly lower in all sPGe-treated groups compared with the control group. Troponin I and myoglobin levels were increased in the SALD, AHD, and SAHD groups. Mitral E-wave velocity was reduced after sPGe administration in all the groups. Acidophilic cytoplasm and pyknotic nucleus in myocardial fibers were observed in AHD and SAHD groups. Cu/Zn-SOD1 gene expressions were significantly higher in the sPGe-treated groups whereas caveolin 1 and VEGF-A gene expressions were not changed. According to our results, sPGe may have a potential effect to cause cardiac damage including diastolic dysfunction, heart failure with preserved ejection fraction, and reduction of blood pressure depending on the dose and duration of usage. Healthcare professionals must be aware of adverse reactions stemming from the supplementation use, particularly with cardiac symptoms.
Angiotensin II type 2 receptor agonist treatment of doxorubicin induced heart failure
(Taylor & Francis Ltd, 2023) Ermis, Necip; Ulutas, Zeynep; Ozhan, Onural; Yildiz, Azibe; Vardi, Nigar; Colak, Cemil; Parlakpinar, Hakan
Doxorubicin (DOX) is an anthracycline derivative used for treatment of malignancies; however, its clinical use is limited by its cardiotoxicity. We investigated the effects of angiotensin II type 2 receptor agonist compound 21 (C21) on DOX induced heart failure in rat heart. We compared C21 with losartan (LOS), an AT 1 receptor antagonist used for treating heart failure. We allocated 40 rats into five groups of eight: saline treated control group, DOX group administered a single 20 mg/kg dose of DOX, DOX + C21 group administered 0.3 mg/kg C21 for 21 days following the 20 mg/kg dose of DOX, DOX + losartan (LOS) group administered a 21 day regimen of 20 mg/kg LOS following the single dose of DOX, and a DOX + LOS + C21 group administered 0.3 mg/kg C21 and 20 mg/kg LOS for 21 days following the single dose of DOX. We assessed histopathology and conducted echocardiograpic and hemodynamic measurements. Left ventricular ejection fraction (EF) was reduced only in the DOX treated group. C21, LOS and C21 + LOS therapy prevented decreased EF due to DOX. Less histopathology was observed in the DOX + LOS + C21 group than for the other treatment groups. Application of C21 decreased DOX induced cardiac injury similar to LOS. Combined use of C21 and LOS was most beneficial for DOX induced heart failure.
Anticoagulant therapy for acute venous thromboembolism
(Turkısh soc cardıology, cobancesme sanayı cad no 11, nısh ıstanbul a blok kat 8 no 47-48, yenıbosna, bahcelıevler, ıstanbul 34196, turkey, 2017) Ermis, Hilal; Ermis, Necip
Deep vein thrombosis (DVT) and pulmonary embolism (PE) are currently defined as venous thromboembolism (VTE) since they share pathophysiological features and the treatment is similar in many respects. It has been determined that more than 90% of PE cases originate from DVT in the legs. PE, which is difficult to diagnose, has a mortality rate of 12% when untreated. The worldwide increase in obesity, cancer diseases, and average survival time also contribute to the increase in the incidence of VTE. Traditional treatment of VTE includes heparin, low-molecular-weight heparin, and warfarin. Despite availability for oral use, warfarin has a narrow therapeutic range and a wide range of food interactions. After many years of research, new oral anticoagulant agents (NOACs) are expected to overcome these handicaps in treatment. In this review, the use of NOACs in the treatment of VTE is investigated in the light of current guidelines.
Anticoagulant therapy for acute venous thromboembolism
(Turkish Soc Cardiology, 2017) Ermis, Hilal; Ermis, Necip
Deep vein thrombosis (DVT) and pulmonary embolism (PE) are currently defined as venous thromboembolism (VTE) since they share pathophysiological features and the treatment is similar in many respects. It has been determined that more than 90% of PE cases originate from DVT in the legs. PE, which is difficult to diagnose, has a mortality rate of 12% when untreated. The worldwide increase in obesity, cancer diseases, and average survival time also contribute to the increase in the incidence of VTE. Traditional treatment of VTE includes heparin, low-molecular-weight heparin, and warfarin. Despite availability for oral use, warfarin has a narrow therapeutic range and a wide range of food interactions. After many years of research, new oral anticoagulant agents (NOACs) are expected to overcome these handicaps in treatment. In this review, the use of NOACs in the treatment of VTE is investigated in the light of current guidelines.
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, Hakan
The 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.
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, Hakan
The 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.
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, Adil
Objective: 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.
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, Hakan
The 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.
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, Hakan
Our 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.
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, Fatma
Objective: 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.
Assessment of left atrial volume and function by real time three-dimensional echocardiography inobese patients
(Wıley, 111 rıver st, hoboken 07030-5774, nj usa, 2017) Yağmur, Julide; Cansel, Mehmet; Kurtoğlu, Ertuğrul; Hidayet, Siho; Açıkgöz, Nusret; Ermis, Necip; Ozyalin, Fatma
Objective: 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.
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, Hasan
Objectives: 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.
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, Ertugrul
Objective: 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.
Beneficial role of aminoguanidine on acute cardiomyopathy related to doxorubicin-treatment
(Springer, 2006) Cigremis, Yilmaz; Parlakpinar, Hakan; Polat, Alaadin; Colak, Cemil; Ozturk, Feral; Sahna, Engin; Ermis, Necip
Doxorubicin (DOX) is a broad-spectrum anthracycline antibiotic that has cardiotoxicity as a major side effect. One mechanism of this toxicity is believed to involve the reactive oxygen radical species (ROS); these agents likely account for the pathophysiology of DOX-induced cardiomyopathy. Aminoguanidine (AG) is an effective antioxidant and free radical scavenger which has long been known to protect against ROS formation. We investigated the effects of AG on DOX-induced changes in thiobarbituric acid reactive substances (TBARS) and reduced glutathione (GSH) content. The rats were divided into four groups:1) Control; 2) DOX group; injected intraperitoneally (i.p.) with DOX 20 mg/kg in a single dose 3) AG-treated group; injected i.p. in single dose of 20 mg/kg DOX plus 100 mg/kg AG 1 h before the DOX for 3 days, 4) AG group; injected i.p. with AG 100 mg/kg for 3 days. DOX administration to control rats increased TBARS and decreased GSH levels. AG administration before DOX injection caused significant decrease in TBARS and increase in GSH levels in the heart tissue when compared with DOX only. Morphological changes, including severe myocardial fibrosis and inflammatory cell infiltration were clearly observed in the DOX-treated heart. AG reversed the DOX-induced heart damage. Therefore AG could protect the heart tissue against free radical injury. The application of AG during cancer chemotherapy may attenuate tissue damage and improve the therapeutic index of DOX.
Bone Marrow Transplantation as a Rare Cause of Pulmonary Arterial Hypertension
(Kare Publ, 2023) Ulutas, Zeynep; Ermis, Hilal; Ermis, Necip; Berber, Ilhami; Hidayet, Siho
The development of pulmonary arterial hypertension after bone marrow transplantation (BMT) is a rare but serious complication. In this case report, we presented the development of pulmonary arterial hypertension in a 22-year-old woman who underwent BMT due to aplastic anemia. Her symptoms on admission included shortness of breath, palpitations and fatigue. Pulmonary hypertension was classified with right heart catheterization as pul monary arterial hypertension. The patient's laboratory, echocardiographic and hemodynamic findings improved with pulmonary arterial hypertension-specific treatment. Pul monary arterial hypertension should be considered in the differ ential diagnosis of BMT patients with 'unexplained' hypoxemia or respiratory distress.
Coexistence of Sinus Valsalva Aneurysm Rupture and Atrial Septal Defect
(Excerpta Medica Inc-Elsevier Science Inc, 2014) Hidayet, Siho; Otlu, Yilmaz Omur; Bayramoglu, Adil; Ulutas, Zeynep; Ermis, Necip; Ozdemir, Ramazan
[Abstract Not Available]
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, Hasan
Objective: 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.
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, Irfan
Background. 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.
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]
Comparison of Fibrinolytic versus Surgical Therapy in the Treatment of Obstructive Prosthetic Valve Thrombosis: A Single-Center Experience
(Forum Multimedia Publishing, Llc, 2011) Ermis, Necip; Atalay, Hakan; Altay, Hakan; Bilgi, Muhammet; Binici, Suleyman; Sezgin, Alpay T.
Objective: Prosthetic heart valve thrombosis (PVT) is a rare but severe cardiac condition. There are only a few data regarding comparison of the fibrinolytic and surgical approaches for the treatment of PVT. In this study, we compared the results of fibrinolytic therapy versus surgery in patients who presented to our institution with a diagnosis of obstructive-type PVT. Methods: From January 2001 to August 2008 in our institution, 33 patients who met clinical and echocardiographic criteria for obstructive-type PVT were included in the study. Fifteen of these patients underwent fibrinolytic treatment with streptokinase, which consisted of an initial bolus of 250,000 U followed by 100,000 U/h. Eighteen patients were treated with surgery. Results: The 2 groups had similar baseline characteristics, including New York Heart Association functional status, types and positions of prosthetic valves, international normalized ratio values, and presentation symptoms. Full hemodynamic success was achieved in 12 patients who underwent fibrinolytic therapy and in 15 patients in the surgery group. The mean (+/- SD) streptokinase infusion time was 17.8 +/- 11.1 hours. Two major hemorrhages and 2 cases of systemic embolism were observed in the fibrinolytic group. The 2 groups did not differ with respect to mortality rate (P = .79). The duration of hospitalization was longer in the fibrinolytic group than in the surgery group (10.7 +/- 6.6 days versus 6.9 +/- 6.7 days, P = .045). Conclusions: Although fibrinolytic therapy is generally recommended for the treatment of PVT for specific patient groups, our results suggest that it may be as efficacious and safe as surgery, depending on patient selection.

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