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Öğe 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, HakanDoxorubicin (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.Öğe Assessment of left atrial volume and function in patients with Sjogren's syndrome using three-dimensional echocardiography(Wiley, 2020) Hidayet, Siho; Yagmur, Julide; Karaca, Yucel; Bayramoglu, Adil; Yolbas, Servet; Hidayet, Emine; Ulutas, ZeynepObjective We used real time, three-dimensional transthoracic echocardiography (3DTTE) to evaluate left atrial (LA) volume and mechanical function in patients with primary Sjogren's syndrome (SS). Methods We prospectively included 42 consecutive patients with primary SS and 42 controls who were similar in terms of basal characteristics. 3DTTE was used to assess LA function. Results Maximum LA volume, minimum LA volume, pre-atrial contraction LA volume, LA Active Stroke Volume (ASV), LA Total Stroke Volume (TSV), maximal left atrial volume index (LAVImax), Left atrial pre-contraction volume index, and Left atrial minimum volume index, ASV index, and TSV index were significantly higher in the SS group, and the LA Total Emptying Fraction, LA Expansion Index, and LA Passive Emptying Fraction were significantly lower. Although the active emptying fraction was higher in the SS group, the difference was not statistically significant. LAVImax was positive correlated with disease duration (r = .753). Conclusion Left atrial function is impaired in SS patients and serves as an early marker of subclinical cardiac involvement.Öğe Atrial Fibrillation due to Blunt Cardiac Injury: Case Report(Aves, 2018) Turgut, Kasim; Yucel, Neslihan; Oguzturk, Hakan; Ulutas, Zeynep; Afsin, AbdulmecitIntroduction: 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.Öğe Bone Marrow Transplantation as a Rare Cause of Pulmonary Arterial Hypertension(Kare Publ, 2023) Ulutas, Zeynep; Ermis, Hilal; Ermis, Necip; Berber, Ilhami; Hidayet, SihoThe 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.Öğe 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]Öğe The effect of lactate levels on prognosis in patients with ST-segment elevation myocardial infarction(2020) Gur, Ali; Ulutas, Zeynep; Turgut, Kasim; Guven, Taner; Yucel, Neslihan; Ermis, NecipAim: The prognostic role of lactate for early mortality in patients with ST-segment elevation myocardial infarction (STEMI) submitted to primary percutaneous transluminal coronary angiography (PTCA) is not elucidated clearly. This study was conducted with patients that presented to the emergency department (ED) with STEMI and underwent PTCA to investigate whether the changes in lactate values from ED admission to 24 hours after PTCA affected mortality.Material and Methods: This prospective observational study on 143 patients with STEMI was conducted at emergency service and tertiary-level cardiology clinic in a public university hospital. The documentation for each patient included detailed information on demographics, type of myocardial infarction according to electrocardiography and PTCA results, duration of hospital stay, vital signs, laboratory findings on admission, lactate levels 24 hours after PTCA, and outcome (hospital discharge or death). Results: The lactate values are higher in non-surviving groups measured 24 hours after PTCA (P 0.001). The differences in the lactate levels from the time of admission to 24 hours after PTCA were significantly lower in the non-surviving group (P 0.001). Conclusion: Among patients presenting to the ED with STEMI, a high lactate level is associated with mortality. Also, the difference between lactate values of the patients after PTCA is associated with the risk of mortality. Therefore, we consider that first lactate levels in ED and last lactate levels after PTCA in patients with STEMI can provide physicians with an insight into the possibility of mortality.Öğe Evaluation of the Effect of Transcatheter Aortic Valve Implantation on Left Ventricular Function by 4-Dimensional Echocardiography(Kare Publ, 2023) Bayramoglu, Adil; Ulutas, Zeynep; Akaycan, Julide; Hidayet, Siho; Tasolar, Hakan; Cansel, Mehmet; Ermis, NecipObjective: Beneficial effects of transaortic valve implantation on left ventricular hemodyna-mics and prognosis of patients have been demonstrated. Although left ventricular systolic and diastolic function following transaortic valve implantation procedure have been examined in previous studies, 4-dimensional echocardiographic parameters have not been extensively studied, especially in patients with preserved ejection fraction aortic stenosis. In our study, we planned to evaluate the effect of transaortic valve implantation on myocardial deformation using 4-dimensional echocardiography. Methods: A total of 60 consecutive patients who underwent transaortic valve implantation for severe aortic stenosis with preserved ejection fraction were prospectively enrolled in the study. Standard 2-dimensional echocardiography and 4-dimensional echocardiography were per-formed in all patients before and 6 months after the transaortic valve implantation procedure. Results: Six months after valve implantation, significant improvement was observed in global longitudinal strain (P < 0.001), spherical circumferential strain (P = 0.022), global radial strain (P = 0.008), and global area strain (P < 0.001). In the regression analysis, global area strain and absence of diabetes mellitus were determined as independent predictors to show a 10% increase in the left ventricular ejection fraction. Conclusions: In patients with preserved ejection fraction who underwent transaortic valve implantation, left ventricle deformation parameters have improved after 6 months, especially by using 4-dimensional echocardiography. The use of 4-dimensional echocardiography should be more common in daily practice.Öğe The importance of pulmonary pulse transit time in indicating right ventricular dysfunction and pulmonary arterial stiffness in rheumatoid arthritis(Wiley, 2023) Ulutas, Zeynep; Tasolar, Hakan; Bayramoglu, Adil; Yigit, Yakup; Kuloglu, Huseyin Emre; Karaca, Yucel; Yolbas, ServetSubject Rheumatoid arthritis patients are at risk of developing cardiovascular disease such as right heart failure and pulmonary hypertension (PH). Arterial stiffness can be used to assess pulmonary hemodynamics. Noninvasive approaches can also be used to assess pulmonary hemodynamics. Recently, there have been reports that pulmonary pulse transit time (PPTT) may also be a useful measure. This study aims to examine the effects of pulmonary hemodynamic alterations on PPTT in RA patients.Methods Forty RA patients and 40 healthy controls were included in the study. Sociodemographic characteristics, laboratory data, and echocardiographic examinations were performed in both groups. Conventional echocardiographic examination included left and right ventricular systolic and diastolic diameters, right ventricular myocardial performance index (RVMPI), right ventricular diastolic function, estimated pulmonary artery systolic pressure (sPAP), tricuspid annular plane systolic excursion (TAPSE), pulmonary artery stiffness (PAS), and PPTT. Right ventricular diastolic and systolic volumes, right ventricular ejection fraction (RVEF), and right ventricular fractional area change (RVFAC) were determined by four-dimensional echocardiography (4DE).Results There was no difference between the sPAP values of the patients. RVMPI and PAS were increased in RA patients compared with controls. The PPTT was shortened in RA patients and correlated with RVEF, RVFAC, RVMPI, TAPSE/sPAP, disease duration, and C-reactive protein (CRP). In univariate linear regression analysis, PPTT (p < .001) was thought to be an independent predictor of PAS. RVFAC, disease duration, and PAS were also independent predictors of PPTT.Conclusion In RA patients, PPTT may be the first evidence of early abnormalities in pulmonary vascular hemodynamics. PPTT and PAS are the values that may predict each other in RA patients. Due to its more practical application, PPTT can be used instead of PAS to assess pulmonary hemodynamics.Öğe The Protective Effects of Compound 21 and Valsartan in Isoproterenol-Induced Myocardial Injury in Rats(Humana Press Inc, 2021) Ulutas, Zeynep; Ermis, Necip; Ozhan, Onural; Parlakpinar, Hakan; Vardi, Nigar; Ates, Burhan; Colak, CemilThis study investigated the protective effects of Compound 21 (C21), the first specific non-peptide AT2 receptor agonist, on cardiac injury in rats with isoproterenol-induced heart failure in vivo and compared it with valsartan, an AT1 receptor antagonist. In this study, 56 Wistar albino male rats (estimated body weights 250-400 g) were divided into eight groups (n = 7). Group 1 (Control) received no drug. Group 2 (ISO) was given 180 mg/kg of isoproterenol subcutaneously (s.c.); two doses were administered at 24-h intervals on days 29 and 30 of the experiment. Groups 3, 4, and 5 were given valsartan (30 mg/kg orally), C21 (0.03 mg/kg intraperitoneally), and a combination of Valsartan + C21, respectively, for 30 days. Groups 6, 7, and 8 were administered Valsartan, C21, and Valsartan + C21 in the same application, duration, and dose, respectively, and isoproterenol (180 mg/kg s.c.) was given on days 29 and 30 of the experiment. Transthoracic echocardiography was performed on the rats at the beginning and end of the experiment. Blood pressure, heart rate, and ECG alterations were monitored via a carotid artery cannula at the end of the experiment. Histopathological and biochemical measurements were performed on the cardiac tissue of the rats. For histopathological findings, C21 and Valsartan + C21 combination therapy significantly reduced the development of heart failure compared to valsartan alone. Also, the protective effect of C21 on myocardial injury was superior to that of valsartan. According to the results of echocardiographic and biochemical evaluations, C21, and Valsartan showed protective effects against heart failure. C21, valsartan, and combined therapy significantly prevented the decrease of ejection fraction. This report describes the cardioprotective effects of C21 and valsartan in ISO-induced myocardial damage.Öğe A rare cause of dyspnea: Isolated congenitally corrected transposition of the great arteries(2021) Ulutas, Zeynep; Yildirim, Erkan; Abdelrahman, Hasan; Hidayet, SihoCorrected transposition of the great arteries is a rare pathology with an incidence of 1% among the congenital heart diseases. It is thought to have multifactorial inheritance. It is mostly seen in men. If there is no concomitant pathology, the blood flow is physiological and does not show symptoms until advanced ages. Life expectancy is close to normal in those with isolated pathology. Risk factors determining mortality include progressive right ventricular dysfunction, AV block, and severe tricuspid insufficiency. In this case, we present a CCTGA patient with dyspnea symptoms without any additional pathology.Öğe Subclinical left ventricular dysfunction in Sjogren's syndrome assessed by four-dimensional speckle tracking echocardiography(Wiley, 2020) Akaycan, Julide; Hidayet, Siho; Bayramoglu, Adil; Yolbas, Servet; Karaca, Yucel; Yigit, Yakup; Ulutas, ZeynepObjective The aim of this study was to evaluate the left ventricular (LV) systolic strain by four-dimensional speckle tracking echocardiography (4D-STE) in order to provide the early detection of myocardial dysfunction in patients with Sjogren's syndrome (SS). Methods Forty consecutive patients with primary SS diagnosed at the rheumatology outpatient clinic and 35 age- and sex-matched healthy volunteers were included in the study. 4DSTE was performed, and global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and global area strain (GAS) were measured. 4DSTE results were compared with the healthy volunteers. Results No significant differences were observed between the GRS and GCS values of the two groups. A significant difference was observed in the GLS and GAS measurements between the two groups (P = .005 for GLS,P < .001 for GAS). Positive correlation was detected between disease duration and LV-GLS and LV-GAS. Conclusion We demonstrated subclinical systolic dysfunction in SS patients by 4DSTE, which is a sensitive marker of ventricular dysfunction. Deterioration of the LV became more evident as duration of the disease increased. Therefore, we believe that a cardiac evaluation will be of benefit to patients with long-term SS.Öğe Successful Bronchial Artery Embolization after Stabilization with Nitric Oxide for the Treatment of Haemoptysis in a Patient with Eisenmenger Syndrome(Aves, 2022) Ulutas, Zeynep; Kuloglu, Huseyin Emre; Kutlu, Ramazan; Ermis, NecipHemoptysis, accompanying various chronic lung diseases, some systemic diseases, infections, structural heart diseases, or syndromes is a clinical condition that is quite mortal when it is massive. Hemoptysis is a common complication of Eisenmenger syndrome. Its frequency increases with age. It is an important cause of mortality in patients with Eisenmenger syndrome. Embolization of systemic-pulmonary collateral arteries is an effective method in the treatment of hemoptysis in eligible patients with Eisenmenger syndrome. In this case report, a patient with Eisenmenger syndrome, developed due to large patent ductus arteriosus, received dual pulmonary arterial hypertension-specific treatment, after the development of hemoptysis, medical stabilization was provided with initial inhaled nitric oxide therapy and then treated with bronchial artery embolization without complications is presented.Öğe Unveiling cardiac insights: Exploring early left ventricular dysfunction in polycythemia vera through 4D-STE and fragmented QRS analysis(Wiley, 2023) Karasu, Mehdi; Berber, Ilhami; Karaca, Yuecel; Cansel, Mehmet; Ulutas, ZeynepBackgroundPolycythemia vera (PV), characterized by elevated red blood cell counts, poses challenges to cardiovascular health with potential impacts on cardiac function. Myocardial infarction (MI) and heart failure are major causes of mortality in PV patients. Early detection of left ventricular systolic dysfunction is crucial for optimizing outcomes.MethodsFifty-two PV patients and 45 healthy controls were recruited. Four-dimensional speckle tracking echocardiography (4D-STE) and fragmented QRS complexes (fQRS) on electrocardiograms were utilized to assess cardiac mechanics. Hematological and echocardiographic parameters were measured, and statistical analyses were performed.ResultsPV patients exhibited significantly higher hematocrit and red cell distribution width compared to controls. Global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and global area strain (GAS) were lower in PV patients. fQRS complexes were associated with longer disease duration and reduced GCS and GAS values. Hematocrit correlated positively with LV-GCS and LV-GAS. Multiple linear regression revealed that disease duration and fQRS presence independently predicted LV-GAS.ConclusionThis study underscores the intricate link between elevated red blood cell counts, disease duration, and cardiac function in PV patients. Combining 4D-STE and fQRS complexes enhances the identification of early left ventricular systolic dysfunction. These findings offer potential improvements in recognizing and managing cardiovascular complications in PV patients, with implications for future research and clinical practice. Further investigations are needed to elucidate underlying mechanisms and validate these markers in larger cohorts.
