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Öğe Left ventricular myocardial performance index in prehypertensive patients with normal coronary arteries(Lıppıncott wıllıams & wılkıns, two commerce sq, 2001 market st, phıladelphıa, pa 19103 usa, 2017) Açıkgöz, NusretObjectives Prehypertension, which may be the precursor of hypertension, is an important public health problem in the community. Myocardial performance index (MPI) is a noninvasive Doppler measurement of global ventricular function. Thus, our aim was to evaluate left ventricule (LV) functions with the MPI in prehypertensive patients with normal coronary artery angiography. Patients and materials Forty prehypertensive patients (21 women and 19 men), with blood pressures between 120/80 and 139/89 mmHg, and 40 normotensive controls (18 women and 22 men), with blood pressures under 120/80 mmHg, were included in the study. Patient population comprised those who underwent coronary angiography because of typical angina and had normal coronary arteries. The MPI was calculated and compared between the two groups. Results No statistically significant differences were found between the two groups in terms of age, sex, or other demographic characteristics (P > 0.05). Moreover, LV ejection fraction, late diastolic flow, deceleration time, isovolumetric contraction time, and ejection time values were not significantly different between the two groups (P > 0.05). However, early diastolic mitral inflow velocity, E/A ratio, isovolumetric relaxation, and MPI were all significantly higher in the patient group than in the control group. Conclusion The MPI was increased in prehypertensive patients. This result demonstrates that LV diastolic and systolic functions may be negatively affected in patients with prehypertension. The advantages of our method are as follows: it is simple, it does not demand special equipment, and it is not time consuming. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.Öğe 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, FatmaObjective: 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.Öğe 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, NecipDeep 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.Öğe What have we learned from Turkish familial hypercholesterolemia registries (A-HIT1 and A-HIT2)?(Elsevıer ıreland ltd, elsevıer house, brookvale plaza, east park shannon, co, clare, 00000, ıreland, 2018) Kuku, İrfanBackground and aims: Familial hypercholesterolemia (FH) is a common genetic disease of high-level cholesterol leading to premature atherosclerosis. One of the key aspects to overcome FH burden is the generation of largescale reliable data in terms of registries. This manuscript underlines the important results of nation-wide Turkish FH registries (A-HIT1 and A-HIT2). Methods: A-HIT1 is a survey of homozygous FH patients undergoing low density lipoprotein (LDL) apheresis (LA). A-HIT2 is a registry of adult FH patients (homozygous and heterozygous) admitted to outpatient clinics. Both registries used clinical diagnosis of FH. Results: A-HIT1 evaluated 88 patients (27 +/- 11 years, 41 women) in 19 centers. All patients were receiving regular LA. There was a 7.37 +/- 7.1-year delay between diagnosis and initiation of LA. LDL-cholesterol levels reached the target only in 5 cases. Mean frequency of apheresis sessions was 19 +/- 13 days. None of the centers had a standardized approach for LA. Mean frequency of apheresis sessions was every 19 +/- 13 (7-90) days. Only 2 centers were aware of the target LDL levels. A-HIT2 enrolled 1071 FH patients (53 +/- 8 years, 606 women) from 31 outpatients clinics specialized in cardiology (27), internal medicine (1), and endocrinology (3); 96.4% were heterozygous. 459 patients were on statin treatment. LDL targets were attained in 23 patients (2.1% of the whole population, 5% receiving statin) on treatment. However, 66% of statin-receiving patients were on intense doses of statins. Awareness of FH was 9.5% in the whole patient population. Conclusions: The first nationwide FH registries revealed that FH is still undertreated even in specialized centers in Turkey. Additional effective treatment regiments are urgently needed.Öğe An intelligent system for the classification of postoperative pleural effusion between 4 and 30 daysusing medical knowledge discovery.(Scıentıfıc publıshers ındıa, 87-greater azad enclave, p o quarsı, alıgarh, 00000, ındıa, 2017) Guldogan, Emek; Arslan, Ahmet Kadir; Colak, M. Cengiz; Colak, Cemil; Erdil, NevzatObjective: Pleural Effusion (PE) is a considerable and a common health problem. The classification of this condition is of great importance in terms of clinical decision making. The purpose of the study is to design an intelligent system for the classification of postoperative pleural effusion between 4 and 30 days after surgery by medical knowledge discovery (MKD) methods. Materials and methods: This study included 2309 individuals diagnosed with coronary artery disease for elective coronary artery bypass grafting (CABG) operation. The results of chest x-ray were used to diagnose PE. The subjects were allocated to two groups: PE group (n=81) and non-PE group (n=2228), consecutively. In the preprocessing step, outlier analysis, data transformation and feature selection processes were performed. In the data mining step, Naive Bayes, Bayesian network and Random Forest algorithms were utilized. Accuracy and area under receiver operating characteristics (ROC) curve (AUC) were calculated as evaluation metrics. Results: In the preprocessing step, 85 outlier observations were removed from the study. The rest of the data consisted of 2224 subjects: 2149 of these individuals were in non-PE group, and the 75 were in PE group. Random Forest yielded the best classification performance with 97.45% of accuracy and 0.990 of AUC for 0.7 of the optimal split ratio by Grid search algorithm. Conclusion: The achieved results pointed out that the best classification performance was obtained from the RF ensemble model. Therefore, the suggested intelligent system can be used as a clinical decision making tool.Öğe A case of fetal atrial flutter treated successfully by cardioversion in the postnatal period.(Scıentıfıc publıshers ındıa, 87-greater azad enclave, p o quarsı, alıgarh, 00000, ındıa, 2007) Rauf, Melekoglu; Sevil, Eraslan; Ayse, Bastemur; Ebru, Celik; Cemsid, KarakurtFetal atrial flutter (AF) is the second common fetal tachyarrhythmias that exist in less than 1% of all pregnancies. It may be related to congestive heart failure, hydrops, neurologic morbidity, or intrauterine death. Early detection and treatment are crucial for getting better neonatal outcomes. We presented a case of fetal atrial flutter diagnosed in the 36th week of gestation and managed successfully by cardioversion in the postpartum period. Cardioversion could be carried out successfully for the treatment of atrial flutter especially in arrhythmias resistant to antiarrhythmic medication during the immediate postpartum period. The recurrence rate of AF after this procedure is very low.Öğe Rapid ımprovement of pulmonary functions in children after transcatheter closure of an atrialseptal defect(Sprınger, 233 sprıng st, new york, ny 10013 usa, 2018) Çelik, Serkan; Karakurt, Cemsit; Acar Yıldırım, NurdanThere are very few studies in the literature on respiratory system functions and complications of children with an atrial septal defect (ASD). The aim of this study is to investigate the pulmonary functions and pulmonary complications before and after transcatheter closure in children with an ASD. In this study, pulmonary function test parameters of 30 ASD patients between 5 and 18 years of age who were eligible to be treated by transcatheter ASD closure were compared with 30 healthy children. The patients undergoing transcatheter ASD closure received pulmonary function tests (PFT) at baseline (1 day before ASD closure), and 3 months after the procedure. Forced vital capacity (FVC), forced expired volume in 1 s (FEV1), peak expiratory flow, and mean forced expiratory flow during the middle half of FVC were measured. The mean age of the 30 ASD patients was 9.59 +/- 3.1 years; and 20 (66.6%) were female and 10 (33.3%) were male. The mean age of the control group was 10.15 +/- 2.21 years, and 19 (63.3%) were girls and 11 (36.6%) were males. ASD patients had significantly reduced FVC (73.11 +/- 24.6%; 86.05 +/- 26.1; p = 0.001, respectively), and FEV1 (81.34 +/- 26.2% and 99.2 +/- 19.6%; p = 0.001; respectively) at baseline. But significant improvement was observed in FVC values in the 3(rd)-month post-closure comparison of the patient group with the control group (73.11 +/- 24.6%; and 88.36 +/- 14.5%; p = 0.01, respectively); FEV1 values (81.34 +/- 26% and 99.54 +/- 18.2%; p = 0.005, respectively) and mean forced expiratory flow between 25 and 75% of vital capacity (MEF25-75) values (94.6 +/- 33.4% and 124.2 +/- -24.1%; p = 0.01, respectively) were also improved. There was no statistically significant relationship between the PFT measurements at baseline and after closure of the defect and age at transcatheter closure, gender, body height, body weight, ASD diameter, Q (p)/Q (s), right ventricle systolic pressure, or mean pulmonary artery pressure values. At the 3(rd) month of ASD closure, there was no significant difference in the comparison of the PFT values of the patient and control group. Disturbance in the significant flow limitation of the peripheral airway of ASD patients was observed with PFT. Better pulmonary outcomes were observed in ASD patients after transcatheter closure.Öğe Relationship between serum homocysteine levels and structural-functional carotid arterialabnormalities in inactive Behcet's disease(VIA MEDICA, UL SWIETOKRZYSKA 73, 80-180 GDANSK, POLAND, 2018) Yağmur, Jülide; Açıkgöz, Nusret; Cansel, Mehmet; Karıncaoğlu, Yelda; Ermiş, Necip; Pekdemir, Hasan; Arslan, A. KadirBackground: Behcet's disease (BD) is a chronic autoimmune disorder with symptoms manifesting from an underlying vasculitis. Since the disease activity is correlated with characteristic vascular endothelial dysfunction, BD places individuals at increased risk of cardiovascular diseases, such as atherosclerosis. Hyperhomocysteinaemia is an independent risk factor for arteriosclerotic vascular diseases. Aim: This study was designed to investigate how plasma homocysteine (Hcy) affects the structural and functional properties of the carotid artery in humans. Methods: Sixty-eight BD patients with subclinical atherosclerosis and 40 healthy controls underwent carotid sonography and Doppler ultrasound to measure carotid artery intima-media thickness (C-IMT) and carotid stiffness and distensibility (indicating elasticity). Total Hcy level was determined by enzyme-linked immunosorbent assay. For analysis, the BD patients were sub-grouped according to hyperhomocysteinaemia (>15 mu mol/L). Results: The patients with BD were found to have increased C-IMT and beta stiffness and decreased distensibility. In addition, hyperhomocysteinaemia was significantly correlated with these detrimental changes in the carotid artery, possibly raising the risk of these patients developing atherosclerosis. Conclusions: These findings suggest a potential mechanism of atherosclerosis in BD and highlight the processes that future research should focus on to address identification and prophylactic treatment of BD patients at risk of cardiovascular disease.Öğe Prediction of postoperative atrial fibrillation with left atrial mechanical functions and nt-pro anplevels after coronary artery bypass surgery: A three-dimensional echocardiography study(WILEY, 111 RIVER ST, HOBOKEN 07030-5774, NJ USA, 2018) Yağmur, Jülide; Tasolar, M. Hakan; Özyalin, FatmaObjectivePostoperative AF (POAF) is the most common cause of morbidity after coronary artery bypass surgery. In this study, we aimed to show the relationship between POAF and N-terminal pro-atrial natriuretic peptide (NT-pro ANP) levels and the relationship between mechanical functions and left atrial volume measured using preoperative three-dimensional echocardiography (3D ECHO) among patients that will undergo isolated coronary artery bypass grafting (CABG) in elective conditions. MethodSixty-six consecutive patients (51 male, 15 female) who were decided to undergo CABG and had normal sinus rhythm were involved in the study. Patients were followed by continuous electrocardiography monitoring and daily electrocardiogram. LA volume and mechanical functions were calculated with 3D ECHO. In addition, for the analysis of plasma levels of NT-pro ANP, blood samples were collected before the surgery. ResultsDuring follow-up after the operation, 15 patients (22.7%) had postoperative atrial fibrillation. LA Vmax, Vmin, VpreA values were higher (P<.001, P=.004, P<.001 respectively) Also in POAF-developed group and SR group, LAVI values were 27.564.2 and 20.7 +/- 4.64mL/m(2), respectively (P<.001). In POAF-developing group, NT-pro ANP levels were significantly higher (P<.001). In multiple logistic regression analysis, age (=0.355, P=.007) and LAVI (=0.668, P=.012) are independent predictors of POAF. ConclusionIt was found that 3D echocardiography can be used as a helping noninvasive method to show subclinical atrial volume and mechanical dysfunction in patients undergoing CABG. Also, blood levels of NT-pro ANP in POAF group were increased.Öğe Elevated monocyte to high-density lipoprotein cholesterol ratio and endothelial dysfunction inbehcet disease(SAGE PUBLICATIONS INC, 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA, 2018) Açıkgöz, Nusret; Kurtoğlu, Ertuğrul; Yağmur, Jülide; Kapıcıoğlu, Yelda; Cansel, Mehmet; Ermiş, NecipBehcet disease (BD) is a multisystemic disorder characterized by endothelial dysfunction and inflammation. Monocyte to high-density lipoprotein cholesterol ratio (MHR) is a recently emerged indicator of inflammation and oxidative stress. Sixty patients with BD and 50 control individuals were included to investigate the relationship between MHR and endothelial dysfunction. Endothelial function was assessed by flow- and nitroglycerin-mediated dilatation technique (FMD and NMD, respectively). Serum high-sensitivity C-reactive protein (hsCRP) levels were measured in all study participants. The MHR and hsCRP levels were significantly higher in patients with active BD than in controls. Brachial artery FMD was significantly lower in patients with active BD than in controls. Brachial artery NMD was similar between groups. There was a strong inverse correlation between MHR and FMD and a strong positive correlation between MHR and serum hsCRP levels. Thus, elevated MHR may be a useful marker reflecting impaired endothelial function and systemic inflammation in patients with BD.Öğe Effectiveness and safety of lmwh treatment in patients with cancer diagnosed with non-high-riskvenous thromboembolism: Turkish observational study (trebeca)(SAGE PUBLICATIONS INC, 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA, 2018) Elkıran, Emin T.We compared the efficacy and safety of low-molecular-weight heparins (LMWHs) in patients with cancer who are at low risk of venous thromboembolism (VTE). Patients were treated by medical oncologists in Turkey at 15 sites, where they were enrolled and followed up for a period of 12 months. Due to the study design, there was no specific treatment protocol for LMWH. Primary end points were efficacy and the time to change in VTE status. Of the included 250 patients, 239 (95.6%), 176 (70.4%), 130 (52.0%), and 91 (36.4%) completed their day 15, month 3, month 6, and month 12 visits, respectively. Number of patients treated with enoxaparin, bemiparin, and tinzaparin were 133, 112, and 5, respectively. Anticoagulant therapy provoked thrombus resolution in 1.2% and 12.7% of patients using enoxaparin and bemiparin, respectively (P = .004). Thrombus resolution was observed in 81 more patients at month 3 visit. This ratio was 35 (40.2%) of 87 and 46 (54.1%) of 85 patients administered enoxaparin and bemiparin at the third visit, respectively (P = .038). Thrombus resolution was observed in 21 more patients during month 6 visit. This ratio was 5 (7.7%) of 65 and 15 (23.4%) of 64 patients administered enoxaparin and bemiparin at the fourth visit, respectively (P = .022). The LMWH was discontinued in only 2 patients due to gastrointestinal bleeding. This pioneering study shows bemiparin is more effective than enoxaparin in thrombosis resolution and has a similar tolerability profile.
