Background Patients with chronic thromboembolic pulmonary hypertension (CTEPH) in countries with ... more Background Patients with chronic thromboembolic pulmonary hypertension (CTEPH) in countries with limited resources have, to date, been poorly represented in registries. Objective This work assesses the epidemiology, diagnosis, hemodynamic and functional parameters, and treatment of CTEPH in Russia, Kazakhstan, Turkey, Lebanon, and Saudi Arabia. Methods A prospective, cohort, phase IV, observational registry with 3-year follow-up (n = 212) in patients aged ≥ 18 years diagnosed with CTEPH was created. Clinical, hemodynamic, and functional parameters were obtained at an initial visit, follow-up visits, and a final visit at the end of 3 years' observation or end of follow-up. Data were recorded on electronic case report forms. Parameters evaluated included 6-minute walking distance (6MWD), use of pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA), pulmonary hypertension (PH)-targeted therapy, and survival. All statistical analyses were exploratory and descriptive, and were performed in the overall population. The most common symptoms were typical of those expected for CTEPH. Almost 90% of patients underwent right heart catheterization at diagnosis or initial study visit. In total, 66 patients (31%) underwent PEA before the initial visit; 95 patients (45%) were considered operable, 115 (54%) were inoperable, and two (1%) had no operability data. Only 26 patients (12%) had been assessed for BPA at their initial visit. PH-targeted therapy was documented at diagnosis for 77 patients (36%), most commonly a phosphodiesterase type 5 inhibitor (23%). Use of PH-targeted therapy increased to 142 patients (67%) at the initial visit, remaining similar after 3 years. Use of riociguat increased from 6% of patients at diagnosis to 38% at 3 years. Between baseline and end of observation, results for patients with paired data showed an increase in 6MWD. Survival at the end of observation was 88%. Conclusions These data highlight the current diagnosis and management of CTEPH in the participating countries. They show that early CTEPH diagnosis remains challenging, and use of off-label PH-targeted therapy is common. ClinicalTrials. gov: NCT02637050; registered December 2015.
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, 2003
Hormon Replasman Tedavisinin Kardiyovasküler Performans Üzerine Etkisi AMAÇ: Menopoz, kadın yaşam... more Hormon Replasman Tedavisinin Kardiyovasküler Performans Üzerine Etkisi AMAÇ: Menopoz, kadın yaşamının yaklaşık üçte birini ilgilendiren fizyolojik bir süreçtir. Menopozda over yetersizliğine bağlı hormon eksikliği nedeniyle bir çok organ ve sistemde değişiklikler meydana gelir. Bu değişikliklerden en çok etkilenen sistemlerden bir tanesi de kardiyovasküler sistemdir. Son yıllarda yapılan çalışmalarda HRTnin kardiyovasküler hastalıklardan korunmada yeri olmadığı anlaşılmıştır. Fakat kardiyak fonksiyonlar üzerinde HRT'nin etkisi yeterince araştırılmamıştır. Bu çalışma sağlıklı postmenopozal kadınlarda HRT'nin kardiyak fonksiyonlar üzerinde kısa dönem etkilerinin araştırılması amacıyla planlandı. MATERYAL - METOD: Çalışmaya HRT uygulanacak 37 ve kontrol grup için de aynı özelliklere sahip 32 sağlıklı postmenopozal kadın alındı. Tüm bireylere treadmill egzersiz testi ve standart ekokardiyografi yapıldı. Ardından doku Doppler pulsed wave yöntemi uygulanarak miyokardiyal hızlar ile sistolik ve diastolik zaman intervalleri ölçülerek miyokard performans indeksi hesaplandı.Üç ay sonra aynı işlemler tekrarlanarak bazal ve üç ay sonraki değerler karşılaştırıldı. BULGULAR: HRT alan grupta üç ay sonra egzersiz süresi (pO.001) ve METS değerinde (pO.001) anlamlı artış tesbit edildi. MPİ değerlerinde HRT alan grupta üç ay sonra azalma olmasına (p<0,07) rağmen bu sonuç istatistiki olarak anlamlılığa ulaşmadı. Doku Doppler parametrelerinden SV segmenter Sm, ortalama Sm ve triküspit Sm düzeylerinde her iki grupta da 3 ay sonra istatistiki olarak anlamlı değişiklik bulunmadı.HRT grubunda ortalama SV Em artarken Am azaldı. Em/Am oram ise arttı. Fakat bu değişiklikler istatistiki anlamlılığa ulaşmadı. 61SONUÇ: Üç aylık HRT tedavisi ile egzersize kardiyak cevapta düzelme tespit ettik. Kardiyak fonksiyonlarda düzelmeyi gösteren MPİ azalması ise istatistiki anlamlılığa ulaşmadı. Bu düzelme eğiliminin anlamlı olup olmadığının ortaya çıkarılması için uzun süreli, geniş katılımlı randomize çalışmalara ihtiyaç vardır.The Effect of Hormone Replacement Therapy on Cardiovascular Performance. OBJECTIVE: Menopause is a physiologic period concerning one third of a woman's life. Changes in many organs and systems occur in menopause because of hormone defficiency due to ovarian failure. Cardiovascular system is one of the most affected system from these changes. Recent studies demonstrated that HRT had no place at preventing from cardiovascular diseases. However, the effect of HRT on cardiovascular functions hasn't been investigated widely. In this study, it is aimed to investigate the short term effects of HRT on cardiovascular functions in healthy postmenopausal women. METHODS: Thirty-seven patients given HRT were taken as study group and 32 patients with qualifications similar to study group were taken as control group.Treadmill exercise test and standart echocardiography were performed to every patient.Sequencely, by using pulsed wave tissue Doppler, sistolic and diastolic time intervals were measured and myocardial performance index was calculated. After three months, the same processes were repeated, and then baseline and 3 month values were compared. RESULTS: Exercise duration (pO.OOl) and METS (p<0.001) value were detected to increase significantly after 3 months in HTR taking group. Although MPI values decreased after 3 months in HRT taking group, this result was not statistically significant. There was no statistically significant change at LV segmental Sm, mean Sm,and tricuspid Sm levels of the tissue Doppler parameters after 3 months in both groups. As mean LV Em increased in HRT group, Am level decreased and Em/Am ratio increased. Nevertheless these changes couldn't reach to a statistically significance. CONCLUSION: We detected improvement in cardiac response to exercise by using HRT. MPI reduction indicating improvement in cardiac functions didn't reach to statistically 63significance. Long term, wide spectrum randomized studies are needed to expose whether this improvement trend will be significant or not
Aim: The study is designed to compare the discharge prescriptions of ST-elevated (STEMI) and non ... more Aim: The study is designed to compare the discharge prescriptions of ST-elevated (STEMI) and non ST-elevated (NSTEMI) myocardial infarction patients and the medications used end of first year and also to investigate the relationship between MI type, gender, age groups and drug adherence.Material and Methods: In retrospect, data from 413 patients were collected via epicrisis and phone visits. Discharge and the outpatient medications end of one year were compared.Results: Of the 413 patients included in the study, 312 (%75) were male. MI type distribution was NSTEMI with a ratio of 38.5% (n = 159) and STEMI with a ratio of 61.5% (n = 254). Only 2 (0.5%) patients did not receive acetylsalicylic acid (ASA) at discharge. The rate of beta-blocker, statin, clopidogrel users were %94.4, %97.1 and %97.8, respectively. The rate of patients who used five drugs (ASA, beta blocker, ACEI/ARB, statin, clopidogrel) at discharge was 78.7% (n = 325). At the end of first year, the rate of ASA, statin,...
Interactive CardioVascular and Thoracic Surgery, 2017
Transfemoral aortic valve implantation has become an almost routine interventional procedure for ... more Transfemoral aortic valve implantation has become an almost routine interventional procedure for severe aortic stenosis in high-risk patients. Over time an increased number of experiences has led to unusual procedures. In this report, we present a successful valve-invalve transfemoral aortic valve implantation in a patient with aortic regurgitation, who previously had debranching and thoracic endovascular aortic repair operations.
The importance of the personality trait variables remains unclear in the patients with coronary a... more The importance of the personality trait variables remains unclear in the patients with coronary artery disease (CAD). The aim of this study was to assess the effect of temperament and character dimensions on male patients with CAD. Methods: In the case-control study, 279 male CAD patients and 101 healthy male controls were examined using temperament and character inventory (TCI), which is a 240 question, self-reporting true-false questionnaire designed to assess the four dimensions of temperament (i.e. novelty seeking [NS], harm avoidance [HA], reward dependence [RD] and persistence [P]) and the three dimensions of character (i.e. self-directedness [SD], cooperativeness [C] and self-transcendence [ST]). CAD was defined as a stenosis at least 50% in at least one major coronary artery. Results: The CAD patients scored higher on HA, P and ST and scored lower on NS, SD and C than that of the controls. Mean age of CAD patients was significantly higher than that of the controls (50.6±9.4 vs 33.4±11.5, p<0.0001). The multiple regression model generated by excluding age and the other risk factors of CAD revealed that NS (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.80-0.95, p=0.002), HA (OR 1.12, 95% CI 1.04-1.20, p=0.003), SD (OR 0.89, 95% CI 0.83-0.96, p=0.004) were independently associated with CAD. Conclusions: This study suggests that CAD male patients have distinctive temperament and character dimensions. Harm avoidance is associated with a higher risk of CAD, but both novelty seeking and self-directedness are associated with a lower risk of CAD.
The present work is based on the previously reported purification study of TaqI endonuclease 5 an... more The present work is based on the previously reported purification study of TaqI endonuclease 5 and aimed to simulate the experimentally obtained chromatograms in order to reduce the time and cost in the design, optimization and scaling up of purification processes. Three different models depending on equilibrium, rate and plate theories are used in the mathematical description of experimental elution profiles and the solutions of the model equations are compared. The equilibrium-dispersive theory provides excellent results in predicting the experimental chromatograms. It is thus recognized that band dispersion takes place in the column through axial dispersion and nonequilibrium effects. The userfriendly software written in Visual Basic can be used in the design of purification processes as well as in the determination of optimal separation conditions for many other enzymes.
Take-home message: We report a case of multivisceral Whipple's disease with severe precapillary p... more Take-home message: We report a case of multivisceral Whipple's disease with severe precapillary pulmonary hypertension cured by doxycycline and hydroxychloroquine therapy associated with initial oral combination of bosentan and tadalafil.
Background Although the Thrombolysis in Myocardial Infarction flow grade system is a widely used ... more Background Although the Thrombolysis in Myocardial Infarction flow grade system is a widely used index of coronary blood flow, it has important limitations. We recently described a new continuous measure of blood flow in native coronary arteries, the Thrombolysis in Myocardial Infarction frame count (TFC), and sought to extend this method to coronary artery bypass grafts. Methods We retrospectively analyzed
Introduction: Pulmonary pulse transit time (pPTT) is a novel noninvasive echocardiographic measur... more Introduction: Pulmonary pulse transit time (pPTT) is a novel noninvasive echocardiographic measure to assess pulmonary arterial hemodynamics. It has been shown to be shorter in precapillary pulmonary hypertension (PHT). Mitral stenosis (MS) is one of the causes of postcapillary PHT. We aimed to investigate pPTT in patients with MS and its relationship with symptoms. Methods: We included 51 patients with MS (25 were asymptomatic, NYHA I, and 26 were symptomatic, NHYA II or III), and 50 controls, and evaluated their demographic characteristics and echocardiographic variables, including pPTT. Results: Baseline characteristics, including age, sex, body mass index, and cardiovascular risk factors, were similar between the MS and the control group. The pPTT was longer in the MS group than in the control group (0.21 ± 0.08 vs 0.15 ± 0.05, P < .001). Patients with symptomatic MS had longer pPTT than asymptomatic patients (P = .005). The pPTT was positively correlated with left atrial volume index and systolic pulmonary artery pressure, and negatively with tricuspid annular plane systolic excursion (r = .432;
Objective: Dilated cardiomyopathy (DCM) is the most common type of cardiomyopathy which is charac... more Objective: Dilated cardiomyopathy (DCM) is the most common type of cardiomyopathy which is characterized by dilatation of the heart cavities and especially the systolic function failure. Genetic factors, endocrine disorders, collagen vascular diseases, drugs, congenital metabolic disorders, muscular dystrophies, structural heart disease, acute and chronic myocarditis, the toxins are involved in the etiology. Methods: 25-year-old female patient admitted to our clinic with the chief complaints of respiratory distress, fatigue and weariness for the last two months. Her length was 165 cm, her weight was 70 kg and she had a BMI of 25. The physical exam revealed that she had tachycardia (110 beats/min), tachypnea (34 /min), mild retractions and a palpable liver 2-3 cm below the rib cage. On auscultation, 3/6 systolic murmur was heard in the apex region. Telecardiogram showed an increased cardiothoracic index, however, pulmonary conus and vascular markings were seemed to be normal. In the ECG recording, sinus tachycardia and signs of left ventricular hypertrophy were detected. The transthoracic echocardiography revealed global hypokinesia with an EF of % 25-30. After establishment of the diagnosis of DCM and congestive heart failure (CHF), antithrombotic and diuretic treatment have been started to the patient and further investigation was planned for the etiology. In the laboratory examinations; serum electrolytes, renal and liver function tests, viral serology, and rheumatologic screening results, blood lactate, pyruvate levels, plasma and urine organic acid scans were normal. In her previous medical history was learned that the patient had primary amenorrhea. After consulting with the gynecologists, an USG was performed. The USG revealed that the patient had a hypoplastic uterus and no ovaries. E2, FSH and LH were measured and the values of FSH and LH were found to be compatible with hypergonadotropic hypogonadism. A pelvic MRI was taken and in the MRI hypoplastic uterus and no ovaries were seen, as well. A peripheral chromosomal analysis revealed a genotype of 46, XX From a more thorough family history was learned that her parents had a third degree relationship with eachother, her brother was lost at the age of 7 with the diagnosis of sudden cardiac death and 18 year old cousin of hers, who was also amenorrheic, was lost with sudden cardiac death with the diagnosis of DCM. We present this case because previously the association between primary amenorrhea and streak gonads and family history has not been emphasized in the literature and may be suggestive of familial syndrome.
Electronic journal of general medicine, Jan 15, 2006
A 43-year-old male patient was admitted to coronary intensive care unit with the diagnosis of acu... more A 43-year-old male patient was admitted to coronary intensive care unit with the diagnosis of acute inferolateral myocardial infarction and with a picture of cardiogenic shock. In physical examination, systolic blood pressure was 50 mmHg and diastolic blood pressure could not be taken. The patient was diagnosed with cardiogenic shock and was started on saline, dopamine and dobutamine infusion. His blood pressure did not increase although the dosage of positive inotropic agents was increased. A cardiac tamponade revealed with urgent echocardiographic evaluation and pericardiocentesis was carried out. Blood pressure returned to normal range within hours after pericardiosentesis. Echocardiographic examination performed on the second day of AMI on the asymptomatic patient revealed thrombosed myocardial rupture. The patient was referred to emergency surgery with the diagnosis of three-vessel disease and myocardial rupture according to urgent angiography. In the operation, the ruptured region in the ventricle free wall was primarily repaired. Bypass surgery was performed with saphenous vein graft to the LAD and CV-OM1 coronary arteries.
Fundamento: O paradoxo do fumante tem sido motivo de debate para pacientes com infarto agudo do m... more Fundamento: O paradoxo do fumante tem sido motivo de debate para pacientes com infarto agudo do miocárdio (IM) há mais de duas décadas. Embora haja muitas evidências demonstrando que não existe tal paradoxo, publicações defendendo desfechos melhores em fumantes pós-IM ainda são lançadas. Objetivo: Explorar o efeito do fumo na mortalidade de longo prazo após infarto do miocárdio por elevação de ST (STEMI). Métodos: Este estudo incluiu pacientes com STEMI que foram diagnosticados entre 2004 e 2006 em três centros terciários. Os pacientes foram categorizados de acordo com a exposição ao tabaco (Grupo 1: não-fumantes; Grupo 2: <20 pacotes*anos; Grupo 3: 2-040 pacotes*anos; Grupo 4: >40 pacotes*anos). Um modelo de regressão de Cox foi utilizado para estimar os riscos relativos para mortalidade de longo prazo. O valor de p <0,05 foi considerado como estatisticamente significativo. Resultados: Trezentos e treze pacientes (201 fumantes e 112 não-fumantes) foram acompanhados por um período médio de 174 meses. Os fumantes eram mais novos (54±9 vs. 62±11, p: <0,001), e a presença de fatores de risco cardiometabólicos foi mais prevalente entre os não-fumantes. Uma análise univariada do impacto do hábito de fumar na mortalidade revelou uma curva de sobrevivência melhor no Grupo 2 do que no Grupo 1. Porém, após ajustes para fatores de confusão, observou-se que os fumantes tinham um risco de morte significativamente maior. O risco relativo tornou-se maior de acordo com a maior exposição (
The prevalence of diabetes mellitus (DM) that is about 150 million today is estimated to exceed 3... more The prevalence of diabetes mellitus (DM) that is about 150 million today is estimated to exceed 300 million by the year 2025 (1). When considered that about half of the patients remain undiagnosed, it can be seen how serious the dimensions of the disease are (2). In the patients with DM more than 90% of whom are consisted by non-insulin dependent diabetes mellitus (NIDDM, Type 2 DM), the disease is a significant risk factor for the development of coronary artery disease (CAD) responsible for 75% of all deaths (3,4). In this group of the patients who generally require antidiabetic treatment inevitably, it is highly important to decide on an appropriate treatment due to the various cardiovascular (CV) effects of the anti-diabetics medications and drugs. In order to help establish this decision, in this review it was tried to investigate antidiabetic drugs after a general approach to CAD pathophysology in diabetic patients, especially in terms of their cardiovascular effects.
Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology, 2019
Depression and anxiety disorders are frequently found in combination with obstructive coronary ar... more Depression and anxiety disorders are frequently found in combination with obstructive coronary artery disease. Coronary artery ectasia (CAE) is an atypical form of coronary artery disease, the etiology of which has not yet been clearly defined. The aim of this study was to assess the existence of a relationship between anxiety/depression and CAE. Methods: A CAE group (n=41; mean age: 58.9±9.0 years) and a control group (n=42; mean age: 58.0±9.6 years) were compared. The anxiety and depression status of patients was evaluated using the Hospital Anxiety and Depression Scale (HADS) questionnaire. Results: Age, sex, ejection fraction, and cardiovascular risk factor data were similar in both groups. The serum Creactive protein (CRP) and uric acid levels as well as the leukocyte count were significantly higher in the CAE group (p<0.05). The HADS anxiety score was higher in the CAE group, but without statistical significance (p=0.23). The HADS depression score and total HADS score was significantly higher in the CAE group (p<0.001 and p<0.001). The total HADS score and the HADS depression score were correlated with the serum CRP level (r=0.489; p<0.001 and r=0.543; p<0.001, respectively), whereas the anxiety score was not correlated with CRP (r=0.85; p=0.23). The depression score, CRP, and uric acid levels were greater in patients with isolated CAE compared with those of patients with normal coronaries. The anxiety score did not demonstrate a relationship to CAE; however, there was an association between the depression score and CRP, which is an inflammatory marker. Amaç: Depresyon ve anksiyete bozuklukları sıklıkla obstrüktif koroner arter hastalığı ile birliktelik gösterir. Koroner arter ektazisi (KAE), koroner arter hastalığının etiyolojisinin açıkça tanımlanmadığı atipik bir şeklidir. Bu çalışmada anksiyete/depresyon durumu ile KAE arasındaki ilişkiyi değerlendirmeyi amaçladık. Yöntemler: Koroner arter ektazisi grubu (n=41, ortanca yaş: 58.9±9.0) ve kontrol grubu (n=42, ortanca yaş: 58.0±9.6) karşılaştırıldı. Hastaların anksiyete ve depresyon durumu, Hastane Anksiyete ve Depresyon Ölçeği (HADÖ) anketi kullanılarak değerlendirildi. Bulgular: Her iki grupta yaş, cinsiyet, ejeksiyon fraksiyonu ve kardiyovasküler risk faktörleri benzerdi. KAE grubunda serum C-reaktif protein (CRP), ürik asit ve lökosit sayısı anlamlı olarak yüksek bulundu (p<0.05). HADS-anksiyete skoru KAE grubunda istatistiksel olarak anlamlı olmamakla birlikte daha yüksekti (p=0.23). HADS-depresyon skoru ve total HADS skoru KAE grubunda anlamlı olarak yüksek bulundu (p<0.001 ve p<0.001). Toplam HADS skoru ve HADS-depresyon skoru serum CRP düzeyleri ile korele iken (sırasıyla, r=0.489, p<0.001 ve r=0.543, p<0.001), anksiyete skoru serum CRP düzeyleri ile korele değildi (r=0.85, p=0.23). Sonuç: Depresyon skoru, CRP ve ürik asit düzeyleri normal koronere sahip olan hastalara göre izole KAE'li hastalarda daha yüksekti. Ancak anksiyete skoru KAE ile ilişkili değildi. Depresyon skoru ile enflamatuvar bir belirteç olan CRP arasında bir ilişki vardı.
Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology, 2009
There is not enough available data in our country about the prevalence of risk factors for ST-ele... more There is not enough available data in our country about the prevalence of risk factors for ST-elevation myocardial infarction (STEMI), which has the highest in-hospital mortality rate within subtypes of acute coronary syndromes. Therefore, in this study, we aimed to evaluate the prevalence of risk factors for STEMI in Central Anatolia, one of the regions with high risk for coronary heart disease (CHD). This cross-sectional observational study included 1210 patients (962 men, 248 women) with the diagnosis of STEMI in 3 tertiary-medical centers in 3 cities in Central-Anatolia (Ankara, Konya, and Kayseri). Demographic characteristics (age, gender) and risk factors known to be traditional risk factors for CHD (history of hypertension (HT), diabetes mellitus (DM), smoking, and family history) were inquired and fasting blood samples within 24 hours from onset of STEMI were taken to analyze lipid levels. Patients were divided into 3 groups based on their ages: Group A--age = or <44 year...
Background Patients with chronic thromboembolic pulmonary hypertension (CTEPH) in countries with ... more Background Patients with chronic thromboembolic pulmonary hypertension (CTEPH) in countries with limited resources have, to date, been poorly represented in registries. Objective This work assesses the epidemiology, diagnosis, hemodynamic and functional parameters, and treatment of CTEPH in Russia, Kazakhstan, Turkey, Lebanon, and Saudi Arabia. Methods A prospective, cohort, phase IV, observational registry with 3-year follow-up (n = 212) in patients aged ≥ 18 years diagnosed with CTEPH was created. Clinical, hemodynamic, and functional parameters were obtained at an initial visit, follow-up visits, and a final visit at the end of 3 years' observation or end of follow-up. Data were recorded on electronic case report forms. Parameters evaluated included 6-minute walking distance (6MWD), use of pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA), pulmonary hypertension (PH)-targeted therapy, and survival. All statistical analyses were exploratory and descriptive, and were performed in the overall population. The most common symptoms were typical of those expected for CTEPH. Almost 90% of patients underwent right heart catheterization at diagnosis or initial study visit. In total, 66 patients (31%) underwent PEA before the initial visit; 95 patients (45%) were considered operable, 115 (54%) were inoperable, and two (1%) had no operability data. Only 26 patients (12%) had been assessed for BPA at their initial visit. PH-targeted therapy was documented at diagnosis for 77 patients (36%), most commonly a phosphodiesterase type 5 inhibitor (23%). Use of PH-targeted therapy increased to 142 patients (67%) at the initial visit, remaining similar after 3 years. Use of riociguat increased from 6% of patients at diagnosis to 38% at 3 years. Between baseline and end of observation, results for patients with paired data showed an increase in 6MWD. Survival at the end of observation was 88%. Conclusions These data highlight the current diagnosis and management of CTEPH in the participating countries. They show that early CTEPH diagnosis remains challenging, and use of off-label PH-targeted therapy is common. ClinicalTrials. gov: NCT02637050; registered December 2015.
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, 2003
Hormon Replasman Tedavisinin Kardiyovasküler Performans Üzerine Etkisi AMAÇ: Menopoz, kadın yaşam... more Hormon Replasman Tedavisinin Kardiyovasküler Performans Üzerine Etkisi AMAÇ: Menopoz, kadın yaşamının yaklaşık üçte birini ilgilendiren fizyolojik bir süreçtir. Menopozda over yetersizliğine bağlı hormon eksikliği nedeniyle bir çok organ ve sistemde değişiklikler meydana gelir. Bu değişikliklerden en çok etkilenen sistemlerden bir tanesi de kardiyovasküler sistemdir. Son yıllarda yapılan çalışmalarda HRTnin kardiyovasküler hastalıklardan korunmada yeri olmadığı anlaşılmıştır. Fakat kardiyak fonksiyonlar üzerinde HRT'nin etkisi yeterince araştırılmamıştır. Bu çalışma sağlıklı postmenopozal kadınlarda HRT'nin kardiyak fonksiyonlar üzerinde kısa dönem etkilerinin araştırılması amacıyla planlandı. MATERYAL - METOD: Çalışmaya HRT uygulanacak 37 ve kontrol grup için de aynı özelliklere sahip 32 sağlıklı postmenopozal kadın alındı. Tüm bireylere treadmill egzersiz testi ve standart ekokardiyografi yapıldı. Ardından doku Doppler pulsed wave yöntemi uygulanarak miyokardiyal hızlar ile sistolik ve diastolik zaman intervalleri ölçülerek miyokard performans indeksi hesaplandı.Üç ay sonra aynı işlemler tekrarlanarak bazal ve üç ay sonraki değerler karşılaştırıldı. BULGULAR: HRT alan grupta üç ay sonra egzersiz süresi (pO.001) ve METS değerinde (pO.001) anlamlı artış tesbit edildi. MPİ değerlerinde HRT alan grupta üç ay sonra azalma olmasına (p<0,07) rağmen bu sonuç istatistiki olarak anlamlılığa ulaşmadı. Doku Doppler parametrelerinden SV segmenter Sm, ortalama Sm ve triküspit Sm düzeylerinde her iki grupta da 3 ay sonra istatistiki olarak anlamlı değişiklik bulunmadı.HRT grubunda ortalama SV Em artarken Am azaldı. Em/Am oram ise arttı. Fakat bu değişiklikler istatistiki anlamlılığa ulaşmadı. 61SONUÇ: Üç aylık HRT tedavisi ile egzersize kardiyak cevapta düzelme tespit ettik. Kardiyak fonksiyonlarda düzelmeyi gösteren MPİ azalması ise istatistiki anlamlılığa ulaşmadı. Bu düzelme eğiliminin anlamlı olup olmadığının ortaya çıkarılması için uzun süreli, geniş katılımlı randomize çalışmalara ihtiyaç vardır.The Effect of Hormone Replacement Therapy on Cardiovascular Performance. OBJECTIVE: Menopause is a physiologic period concerning one third of a woman's life. Changes in many organs and systems occur in menopause because of hormone defficiency due to ovarian failure. Cardiovascular system is one of the most affected system from these changes. Recent studies demonstrated that HRT had no place at preventing from cardiovascular diseases. However, the effect of HRT on cardiovascular functions hasn't been investigated widely. In this study, it is aimed to investigate the short term effects of HRT on cardiovascular functions in healthy postmenopausal women. METHODS: Thirty-seven patients given HRT were taken as study group and 32 patients with qualifications similar to study group were taken as control group.Treadmill exercise test and standart echocardiography were performed to every patient.Sequencely, by using pulsed wave tissue Doppler, sistolic and diastolic time intervals were measured and myocardial performance index was calculated. After three months, the same processes were repeated, and then baseline and 3 month values were compared. RESULTS: Exercise duration (pO.OOl) and METS (p<0.001) value were detected to increase significantly after 3 months in HTR taking group. Although MPI values decreased after 3 months in HRT taking group, this result was not statistically significant. There was no statistically significant change at LV segmental Sm, mean Sm,and tricuspid Sm levels of the tissue Doppler parameters after 3 months in both groups. As mean LV Em increased in HRT group, Am level decreased and Em/Am ratio increased. Nevertheless these changes couldn't reach to a statistically significance. CONCLUSION: We detected improvement in cardiac response to exercise by using HRT. MPI reduction indicating improvement in cardiac functions didn't reach to statistically 63significance. Long term, wide spectrum randomized studies are needed to expose whether this improvement trend will be significant or not
Aim: The study is designed to compare the discharge prescriptions of ST-elevated (STEMI) and non ... more Aim: The study is designed to compare the discharge prescriptions of ST-elevated (STEMI) and non ST-elevated (NSTEMI) myocardial infarction patients and the medications used end of first year and also to investigate the relationship between MI type, gender, age groups and drug adherence.Material and Methods: In retrospect, data from 413 patients were collected via epicrisis and phone visits. Discharge and the outpatient medications end of one year were compared.Results: Of the 413 patients included in the study, 312 (%75) were male. MI type distribution was NSTEMI with a ratio of 38.5% (n = 159) and STEMI with a ratio of 61.5% (n = 254). Only 2 (0.5%) patients did not receive acetylsalicylic acid (ASA) at discharge. The rate of beta-blocker, statin, clopidogrel users were %94.4, %97.1 and %97.8, respectively. The rate of patients who used five drugs (ASA, beta blocker, ACEI/ARB, statin, clopidogrel) at discharge was 78.7% (n = 325). At the end of first year, the rate of ASA, statin,...
Interactive CardioVascular and Thoracic Surgery, 2017
Transfemoral aortic valve implantation has become an almost routine interventional procedure for ... more Transfemoral aortic valve implantation has become an almost routine interventional procedure for severe aortic stenosis in high-risk patients. Over time an increased number of experiences has led to unusual procedures. In this report, we present a successful valve-invalve transfemoral aortic valve implantation in a patient with aortic regurgitation, who previously had debranching and thoracic endovascular aortic repair operations.
The importance of the personality trait variables remains unclear in the patients with coronary a... more The importance of the personality trait variables remains unclear in the patients with coronary artery disease (CAD). The aim of this study was to assess the effect of temperament and character dimensions on male patients with CAD. Methods: In the case-control study, 279 male CAD patients and 101 healthy male controls were examined using temperament and character inventory (TCI), which is a 240 question, self-reporting true-false questionnaire designed to assess the four dimensions of temperament (i.e. novelty seeking [NS], harm avoidance [HA], reward dependence [RD] and persistence [P]) and the three dimensions of character (i.e. self-directedness [SD], cooperativeness [C] and self-transcendence [ST]). CAD was defined as a stenosis at least 50% in at least one major coronary artery. Results: The CAD patients scored higher on HA, P and ST and scored lower on NS, SD and C than that of the controls. Mean age of CAD patients was significantly higher than that of the controls (50.6±9.4 vs 33.4±11.5, p<0.0001). The multiple regression model generated by excluding age and the other risk factors of CAD revealed that NS (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.80-0.95, p=0.002), HA (OR 1.12, 95% CI 1.04-1.20, p=0.003), SD (OR 0.89, 95% CI 0.83-0.96, p=0.004) were independently associated with CAD. Conclusions: This study suggests that CAD male patients have distinctive temperament and character dimensions. Harm avoidance is associated with a higher risk of CAD, but both novelty seeking and self-directedness are associated with a lower risk of CAD.
The present work is based on the previously reported purification study of TaqI endonuclease 5 an... more The present work is based on the previously reported purification study of TaqI endonuclease 5 and aimed to simulate the experimentally obtained chromatograms in order to reduce the time and cost in the design, optimization and scaling up of purification processes. Three different models depending on equilibrium, rate and plate theories are used in the mathematical description of experimental elution profiles and the solutions of the model equations are compared. The equilibrium-dispersive theory provides excellent results in predicting the experimental chromatograms. It is thus recognized that band dispersion takes place in the column through axial dispersion and nonequilibrium effects. The userfriendly software written in Visual Basic can be used in the design of purification processes as well as in the determination of optimal separation conditions for many other enzymes.
Take-home message: We report a case of multivisceral Whipple's disease with severe precapillary p... more Take-home message: We report a case of multivisceral Whipple's disease with severe precapillary pulmonary hypertension cured by doxycycline and hydroxychloroquine therapy associated with initial oral combination of bosentan and tadalafil.
Background Although the Thrombolysis in Myocardial Infarction flow grade system is a widely used ... more Background Although the Thrombolysis in Myocardial Infarction flow grade system is a widely used index of coronary blood flow, it has important limitations. We recently described a new continuous measure of blood flow in native coronary arteries, the Thrombolysis in Myocardial Infarction frame count (TFC), and sought to extend this method to coronary artery bypass grafts. Methods We retrospectively analyzed
Introduction: Pulmonary pulse transit time (pPTT) is a novel noninvasive echocardiographic measur... more Introduction: Pulmonary pulse transit time (pPTT) is a novel noninvasive echocardiographic measure to assess pulmonary arterial hemodynamics. It has been shown to be shorter in precapillary pulmonary hypertension (PHT). Mitral stenosis (MS) is one of the causes of postcapillary PHT. We aimed to investigate pPTT in patients with MS and its relationship with symptoms. Methods: We included 51 patients with MS (25 were asymptomatic, NYHA I, and 26 were symptomatic, NHYA II or III), and 50 controls, and evaluated their demographic characteristics and echocardiographic variables, including pPTT. Results: Baseline characteristics, including age, sex, body mass index, and cardiovascular risk factors, were similar between the MS and the control group. The pPTT was longer in the MS group than in the control group (0.21 ± 0.08 vs 0.15 ± 0.05, P < .001). Patients with symptomatic MS had longer pPTT than asymptomatic patients (P = .005). The pPTT was positively correlated with left atrial volume index and systolic pulmonary artery pressure, and negatively with tricuspid annular plane systolic excursion (r = .432;
Objective: Dilated cardiomyopathy (DCM) is the most common type of cardiomyopathy which is charac... more Objective: Dilated cardiomyopathy (DCM) is the most common type of cardiomyopathy which is characterized by dilatation of the heart cavities and especially the systolic function failure. Genetic factors, endocrine disorders, collagen vascular diseases, drugs, congenital metabolic disorders, muscular dystrophies, structural heart disease, acute and chronic myocarditis, the toxins are involved in the etiology. Methods: 25-year-old female patient admitted to our clinic with the chief complaints of respiratory distress, fatigue and weariness for the last two months. Her length was 165 cm, her weight was 70 kg and she had a BMI of 25. The physical exam revealed that she had tachycardia (110 beats/min), tachypnea (34 /min), mild retractions and a palpable liver 2-3 cm below the rib cage. On auscultation, 3/6 systolic murmur was heard in the apex region. Telecardiogram showed an increased cardiothoracic index, however, pulmonary conus and vascular markings were seemed to be normal. In the ECG recording, sinus tachycardia and signs of left ventricular hypertrophy were detected. The transthoracic echocardiography revealed global hypokinesia with an EF of % 25-30. After establishment of the diagnosis of DCM and congestive heart failure (CHF), antithrombotic and diuretic treatment have been started to the patient and further investigation was planned for the etiology. In the laboratory examinations; serum electrolytes, renal and liver function tests, viral serology, and rheumatologic screening results, blood lactate, pyruvate levels, plasma and urine organic acid scans were normal. In her previous medical history was learned that the patient had primary amenorrhea. After consulting with the gynecologists, an USG was performed. The USG revealed that the patient had a hypoplastic uterus and no ovaries. E2, FSH and LH were measured and the values of FSH and LH were found to be compatible with hypergonadotropic hypogonadism. A pelvic MRI was taken and in the MRI hypoplastic uterus and no ovaries were seen, as well. A peripheral chromosomal analysis revealed a genotype of 46, XX From a more thorough family history was learned that her parents had a third degree relationship with eachother, her brother was lost at the age of 7 with the diagnosis of sudden cardiac death and 18 year old cousin of hers, who was also amenorrheic, was lost with sudden cardiac death with the diagnosis of DCM. We present this case because previously the association between primary amenorrhea and streak gonads and family history has not been emphasized in the literature and may be suggestive of familial syndrome.
Electronic journal of general medicine, Jan 15, 2006
A 43-year-old male patient was admitted to coronary intensive care unit with the diagnosis of acu... more A 43-year-old male patient was admitted to coronary intensive care unit with the diagnosis of acute inferolateral myocardial infarction and with a picture of cardiogenic shock. In physical examination, systolic blood pressure was 50 mmHg and diastolic blood pressure could not be taken. The patient was diagnosed with cardiogenic shock and was started on saline, dopamine and dobutamine infusion. His blood pressure did not increase although the dosage of positive inotropic agents was increased. A cardiac tamponade revealed with urgent echocardiographic evaluation and pericardiocentesis was carried out. Blood pressure returned to normal range within hours after pericardiosentesis. Echocardiographic examination performed on the second day of AMI on the asymptomatic patient revealed thrombosed myocardial rupture. The patient was referred to emergency surgery with the diagnosis of three-vessel disease and myocardial rupture according to urgent angiography. In the operation, the ruptured region in the ventricle free wall was primarily repaired. Bypass surgery was performed with saphenous vein graft to the LAD and CV-OM1 coronary arteries.
Fundamento: O paradoxo do fumante tem sido motivo de debate para pacientes com infarto agudo do m... more Fundamento: O paradoxo do fumante tem sido motivo de debate para pacientes com infarto agudo do miocárdio (IM) há mais de duas décadas. Embora haja muitas evidências demonstrando que não existe tal paradoxo, publicações defendendo desfechos melhores em fumantes pós-IM ainda são lançadas. Objetivo: Explorar o efeito do fumo na mortalidade de longo prazo após infarto do miocárdio por elevação de ST (STEMI). Métodos: Este estudo incluiu pacientes com STEMI que foram diagnosticados entre 2004 e 2006 em três centros terciários. Os pacientes foram categorizados de acordo com a exposição ao tabaco (Grupo 1: não-fumantes; Grupo 2: <20 pacotes*anos; Grupo 3: 2-040 pacotes*anos; Grupo 4: >40 pacotes*anos). Um modelo de regressão de Cox foi utilizado para estimar os riscos relativos para mortalidade de longo prazo. O valor de p <0,05 foi considerado como estatisticamente significativo. Resultados: Trezentos e treze pacientes (201 fumantes e 112 não-fumantes) foram acompanhados por um período médio de 174 meses. Os fumantes eram mais novos (54±9 vs. 62±11, p: <0,001), e a presença de fatores de risco cardiometabólicos foi mais prevalente entre os não-fumantes. Uma análise univariada do impacto do hábito de fumar na mortalidade revelou uma curva de sobrevivência melhor no Grupo 2 do que no Grupo 1. Porém, após ajustes para fatores de confusão, observou-se que os fumantes tinham um risco de morte significativamente maior. O risco relativo tornou-se maior de acordo com a maior exposição (
The prevalence of diabetes mellitus (DM) that is about 150 million today is estimated to exceed 3... more The prevalence of diabetes mellitus (DM) that is about 150 million today is estimated to exceed 300 million by the year 2025 (1). When considered that about half of the patients remain undiagnosed, it can be seen how serious the dimensions of the disease are (2). In the patients with DM more than 90% of whom are consisted by non-insulin dependent diabetes mellitus (NIDDM, Type 2 DM), the disease is a significant risk factor for the development of coronary artery disease (CAD) responsible for 75% of all deaths (3,4). In this group of the patients who generally require antidiabetic treatment inevitably, it is highly important to decide on an appropriate treatment due to the various cardiovascular (CV) effects of the anti-diabetics medications and drugs. In order to help establish this decision, in this review it was tried to investigate antidiabetic drugs after a general approach to CAD pathophysology in diabetic patients, especially in terms of their cardiovascular effects.
Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology, 2019
Depression and anxiety disorders are frequently found in combination with obstructive coronary ar... more Depression and anxiety disorders are frequently found in combination with obstructive coronary artery disease. Coronary artery ectasia (CAE) is an atypical form of coronary artery disease, the etiology of which has not yet been clearly defined. The aim of this study was to assess the existence of a relationship between anxiety/depression and CAE. Methods: A CAE group (n=41; mean age: 58.9±9.0 years) and a control group (n=42; mean age: 58.0±9.6 years) were compared. The anxiety and depression status of patients was evaluated using the Hospital Anxiety and Depression Scale (HADS) questionnaire. Results: Age, sex, ejection fraction, and cardiovascular risk factor data were similar in both groups. The serum Creactive protein (CRP) and uric acid levels as well as the leukocyte count were significantly higher in the CAE group (p<0.05). The HADS anxiety score was higher in the CAE group, but without statistical significance (p=0.23). The HADS depression score and total HADS score was significantly higher in the CAE group (p<0.001 and p<0.001). The total HADS score and the HADS depression score were correlated with the serum CRP level (r=0.489; p<0.001 and r=0.543; p<0.001, respectively), whereas the anxiety score was not correlated with CRP (r=0.85; p=0.23). The depression score, CRP, and uric acid levels were greater in patients with isolated CAE compared with those of patients with normal coronaries. The anxiety score did not demonstrate a relationship to CAE; however, there was an association between the depression score and CRP, which is an inflammatory marker. Amaç: Depresyon ve anksiyete bozuklukları sıklıkla obstrüktif koroner arter hastalığı ile birliktelik gösterir. Koroner arter ektazisi (KAE), koroner arter hastalığının etiyolojisinin açıkça tanımlanmadığı atipik bir şeklidir. Bu çalışmada anksiyete/depresyon durumu ile KAE arasındaki ilişkiyi değerlendirmeyi amaçladık. Yöntemler: Koroner arter ektazisi grubu (n=41, ortanca yaş: 58.9±9.0) ve kontrol grubu (n=42, ortanca yaş: 58.0±9.6) karşılaştırıldı. Hastaların anksiyete ve depresyon durumu, Hastane Anksiyete ve Depresyon Ölçeği (HADÖ) anketi kullanılarak değerlendirildi. Bulgular: Her iki grupta yaş, cinsiyet, ejeksiyon fraksiyonu ve kardiyovasküler risk faktörleri benzerdi. KAE grubunda serum C-reaktif protein (CRP), ürik asit ve lökosit sayısı anlamlı olarak yüksek bulundu (p<0.05). HADS-anksiyete skoru KAE grubunda istatistiksel olarak anlamlı olmamakla birlikte daha yüksekti (p=0.23). HADS-depresyon skoru ve total HADS skoru KAE grubunda anlamlı olarak yüksek bulundu (p<0.001 ve p<0.001). Toplam HADS skoru ve HADS-depresyon skoru serum CRP düzeyleri ile korele iken (sırasıyla, r=0.489, p<0.001 ve r=0.543, p<0.001), anksiyete skoru serum CRP düzeyleri ile korele değildi (r=0.85, p=0.23). Sonuç: Depresyon skoru, CRP ve ürik asit düzeyleri normal koronere sahip olan hastalara göre izole KAE'li hastalarda daha yüksekti. Ancak anksiyete skoru KAE ile ilişkili değildi. Depresyon skoru ile enflamatuvar bir belirteç olan CRP arasında bir ilişki vardı.
Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology, 2009
There is not enough available data in our country about the prevalence of risk factors for ST-ele... more There is not enough available data in our country about the prevalence of risk factors for ST-elevation myocardial infarction (STEMI), which has the highest in-hospital mortality rate within subtypes of acute coronary syndromes. Therefore, in this study, we aimed to evaluate the prevalence of risk factors for STEMI in Central Anatolia, one of the regions with high risk for coronary heart disease (CHD). This cross-sectional observational study included 1210 patients (962 men, 248 women) with the diagnosis of STEMI in 3 tertiary-medical centers in 3 cities in Central-Anatolia (Ankara, Konya, and Kayseri). Demographic characteristics (age, gender) and risk factors known to be traditional risk factors for CHD (history of hypertension (HT), diabetes mellitus (DM), smoking, and family history) were inquired and fasting blood samples within 24 hours from onset of STEMI were taken to analyze lipid levels. Patients were divided into 3 groups based on their ages: Group A--age = or <44 year...
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Papers by Mehmet Düzenli