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Öğe Assessment of the neutrophil to lymphocyte ratio in young patients with acute coronary syndromes(2013) Öztürk, Serkan; Erdem, Alim; Özlü, Mehmet Fatih; Ayhan, Selim; Erdem, Kemalettin; Özyaşar, Mehmet; Yazıcı, MehmetObjectives: It is well known that inflammation plays a key role in both initiation and propagation of acute coronary syndrome (ACS). White blood cell (WBC) and its subtypes are an indicator of inflammation in patients with ACS. We aimed to evaluate the WBC and its subtypes in patients aged <45 year with acute coronary syndromes. Study design: We retrospectively analyzed WBC and its subtypes (including neutrophil and lymphocyte) in 84 patients (<45 year) who were admitted to the emergency department for chest pain suggestive of ACS (44 unstable angina pectoris, 40 non-ST-segment elevation myocardial infarction [NSTEMI]), and 40 healthy controls. Results: Hypertension, diabetes mellitus, smoking, and family history were significantly higher in NSTE-ACS patients. Also, LDL levels was significantly higher and HDL levels was significantly lower in NSTE-ACS patients (p=0.041 and p=0.009). The difference in percent of lymphocytes between the groups was significant (p=0.048). N/L ratio was significantly different between all groups and between the NSTEMI and USAP (p<0.001 and p=0.041). Our results demonstrated that hypertension, percent of neutrophils, and N/L ratio was a significant independent predictor of NSTE-ACS (Beta=0.251, 95% CI=0.002-0.523, p=0.048; beta=0.561, 95% CI=0.008-0.137, p=0.028 and beta=0.260, 95% CI=0.042-0.438, p=0.018, respectively). Conclusion: N/L was found to be elevated in young patients with NSTE-ACS compared with control group. The inflammation assessed using WBC and its subtypes may be more important in young NSTE-ACS patients.Öğe Atrial electrical and mechanical dysfunction in non-diabetic, nonhypertensive hemodialysis patients(Carbone Editore, 2014) Tekçe, Hikmet; Öztürk, Serkan; Aktaş, Gülali; Tekçe, Buket Kın; Erdem, Alim; Üyetürk, Uğur; Özyaşar, Mehmet; Duman, Tuba Taslamacıoğlu; Yazıcı, MehmetBackground: Abnormalities in atrial conduction times and mechanical functions are considered as independent predictors of atrial fibrillation. However, there is no data in literature about functional parameters and electromechanical delay intervals in nondiabetic, non-hypertensive hemodialysis (HD) patients. We aimed to study atrial electromechanical conduction times and mechanical functions in this population. Methods: Forty-two non-diabetic, normotensive hemodialysis patients and age and sex matched control subjects have been enrolled in the study. Standard and Tissue Doppler Echocardiography have been performed before mid-week dialysis session for HD group and on admission for control group. Results: PA(lateral,), PA(septum) durations of the hemodialysis group were significantly longer than control group (70.6 +/- 9.1 vs 55.3 +/- 2.7, 50.8 +/- 5.2 vs 44.4 +/- 2.1; p<0.01). Interatrial and left-right intraatrial electromechanical delay intervals were significantly longer in hemodialysis group compared to controls (31.6 +/- 7.2 vs 18.0 +/- 2.6, 19.8 +/- 7.9 vs 10.9 +/- 2.7, 11.8 +/- 5.1 vs 7.1 +/- 1.2, respectively; all p<0.01). Measurements of left atrial diameter, maximum, minimum and before atrial systole, volumes and passive-active emptying volumes were both elevated in hemodialysis group compared to controls (all p<0.01). Conclusions: This is the first study enlightening deterioration in atrial mechanical and electromechanical functions in nondiabetic, non-hypertensive HD population. Results of the present study reflect not only negative effects of structural remodeling, which has been mentioned in previous studies in literature, but also negative effects of electrical remodeling. Prolonged inter- and intra-atrial electromechanical delay intervals should be the underlying pathophysiological factors increasing the rate of atrial fibrillation in hemodialysis population.Öğe Atrial electrical and mechanical dysfunction in non-diabetic, nonhypertensive hemodialysis patients(Oxford Univ Press, 2014) Tekçe, Hikmet; Öztürk, Serkan; Aktaş, Gülali; Tekçe, Buket Kın; Erdem, Alim; Üyetürk, Uğur; Özyaşar, MehmetÖğe Coronary artery ectasia is associated with atrial electrical and mechanical dysfunction: an observational study(2012) Öztürk, Serkan; Özyaşar, Mehmet; Ayhan, Selim Suzi; Özlü, Mehmet Fatih; Erdem, Alim; Alçelik, Aytekin; Öztürk, SelçukAmaç: Bizim çalışmamızın amacı, izole koroner arter ektazisi (İKAE) olan hastalarda total atriyal ileti süresi ve sol atriyal (SA) mekanik fonksiyonların araştırılmasıdır. Yöntemler: Enine-kesitli gözlemsel bu çalışmaya, herhangi bir darlığı olmayan 60 İKAE’li hasta alındı. Kontrol grubu yaş ve cinsiyet açısından eşleştirilen 40 bireyden oluşturuldu. Sol atriyal mekanik fonksiyonlar disk metoduyla apikal dört boşluktan ölçüldü. Sol atriyal mekanik fonksiyon parametreleri hesaplandı. P dalga dispersiyonu yüzey elektrokardiyografisinden (EKG) ölçüldü. Total atriyal ileti süresi, yüzey EKG’sinde P dalgasının başından, doku Doppler ile mitral lateral duvardan ölçülen A’ dalgasının tepesine kadar olan zaman aralığı olarak ölçüldü. İstatistiksel analizde; Student t, Mann-Whitney U, Pearson ve Spearman korelasyonu ve çoklu doğrusal regresyon analizi kullanıldı. Bulgular: Klinik ve laboratuvar bulgular açısından gruplar benzerdi. Her iki grupta Vmaks ve SA total boşalma oranı benzerdi (31.9±6.5 karşı 29.0±7.3 mL/$m^{2}$, p=0.082 ve 20.0±5.2 vs. 19.9±5.1 mL/$m^{2}$, p=0.821). Ancak, SA pasif boşalma hacmi ve SA pasif boşalma oranı İKAE hastalarında anlamlı olarak azalmıştı (11.1±3.2 karşı 13.5±3.8 mL/$m^{2}$, p=0.005 ve 35.2±7.2 karşı 47.8±9.4 mL/$m^{2}$, p<0.001). Fakat SA aktif boşalma hacmi ve SA aktif boşalma oranı İKAE hastalarında anlamlı olarak artmıştı (9.1±2.6 karşı 6.4±3.0 mL/$m^{2}$, p< 0.001 ve 45.3±8.1 karşı 40.7±6.7mL/$m^{2}$, p=0.002). Total atriyal ileti süresi İKAE grubunda normal gruba göre anlamlı olarak daha uzun ölçüldü (131.8±5.7 karşı 114.4±9.1 ms, p<0.001). Çoklu doğrusal regresyon analizinde ektazik segment sayısı total atriyal ileti süresinin bağımsız bir faktörü olarak tespit edildi (?=0.581, %95 GA=4.046-6.295, p<0.001). Sonuç: Bu çalışma İKAE’li hastalarda SA elektriksel ve mekanik fonksiyonlarının bozulduğunu gösteren ilk çalışmadır. Bozulmuş olan SA fonksiyonları kardiyak aritmiler, azalmış kardiyak atım hacmi ve kalp yetersizliği ile ilişkili olabilir. (Anadolu Kardiyol Derg 2012; 12: 637-43)Öğe The effects of a single dialysis session on atrial electromechanical conduction times and functions(Oxford Univ Press, 2014) Tekçe, Hikmet; Öztürk, Serkan; Aktaş, Gülali; Tekçe, Buket Kın; Erdem, Alim; Özyaşar, Mehmet; Duman, Tuba TaslamacıoğluÖğe Evaluation of left atrial mechanical functions and atrial conduction abnormalities in patients with clinical hypothyroid(Via Medica, 2012) Öztürk, Serkan; Dikbaş, Oğuz; Özyaşar, Mehmet; Ayhan, Selim; Özlü, Fatih; Erdem, Alim; Yazıcı, Mehmet; Alçelik, Aytekin; Tosun, MehmetBackground: The aim of this study was to investigate left atrial (LA) mechanical functions, atrial electromechanical delay and P wave dispersion in hypothyroid patients. Methods: Thirty-four patients with overt hypothyroid and thirty controls were included. A diagnosis of overt hypothyroid was reached with increased serum TSH and decreased free T4 (fT4) levels. LA volumes were measured using the biplane area length method and LA active and passive emptying volumes and fraction were calculated. Intra- and interatrial electromechanical delay (EMD) were measured by tissue Doppler imaging (TDI). P wave dispersion was calculated by 12 lead electrocardiograms. Results: LA diameter were significantly higher in patients with overt hypothyroid (p = 0.021). LA passive emptying volume and LA passive emptying fraction were significantly decreased with hypothyroid patients (p = 0.002 and p < 0.001). LA active emptying volume and LA active emptying fraction were significantly increased with hypothyroid patients (p < 0.001 and p < 0.001). Infra- and interatrial EMD, were measured significantly higher in hypothyroid patients (30.6 +/- 6.1 vs 18.0 +/- 2.7, p < 0.001; and 10.6 +/- 3.4 vs 6.9 +/- 1.4, p < 0.001, respectively). P wave dispersion were significantly higher in hypothyroid patients (48.8 +/- 6.2 vs 44.3 +/- 7.2, p = 0.022). In stepwise regression analysis demonstrated that, interatrial EMD and LA active emptying fraction related with TSH and fT4. Conclusions: This study showed that impaired LA mechanical and electromechanical function in hypothyroid patients. TSH and T4 were independent determinant of interatrial EMD and LA active emptying fraction. (Cardiol J 2012; 19, 3: 287-294)Öğe Evaluation of left ventricular systolic asynchrony in patients with subclinical hypothyroidism(Via Medica, 2012) Öztürk, Serkan; Alçelik, Aytekin; Özyaşar, Mehmet; Dikbaş, Oğuz; Ayhan, Selim; Özlü, Fatih; Erdem, Alim; Yazıcı, MehmetBackground: The heart was very sensitive to fluctuating thyroid hormone levels. To assess intra-left ventricular (LV) systolic asynchrony in patients with subclinical thyroid dysfunction. Methods: Fifty patients with subclinical hypothyroidism and 40 controls were included. A diagnosis of subclinical hypothyroidism was reached with increased TSH and normal free T4. All subjects were evaluated by echocardiography. Evaluation of intra-LV systolic asynchrony was performed by tissue synchronization imaging (TSI), and four TSI parameters of systolic asynchrony were calculated. LV asynchrony was defined by these parameters. Results: All of the groups were similar in terms of demographic findings and conventional and Doppler echocardiograpic parameters except peak systolic velocity and early diastolic velocity. LV systolic asynchrony parameters of TSI including; standard deviation of Ts of the 12 LV segments (Ts-SD-12), maximal difference in Ts between any 2 of the 12 LV segments (Ts-12), standard deviation of TS of the 6 basal LV segments (Ts-SD-6), maximal difference in Ts between any of the 6 basal LV segments (Ts-6) were significantly lengthened in patients with subclinical hypothyroidism than controls (p < 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively). The prevalence of LV asynchrony was significantly higher in patients with subclinical hypothyroidism than control. Conclusions: Patients with subclinical hypothyroidism present evidence of LV asynchrony by TSI. LV systolic asynchrony could be a warning sign of the early stage in cardiac systolic dysfunction in subclinical hypothyroid patients. (Cardiol J 2012; 19, 4: 374-380)Öğe Evaulation of atrial conduction abnormalities and left atrial mechanical functions in patients with subclinical thyroid disorders(Via Medica, 2012) Öztürk, Serkan; Dikbaş, Oğuz; Baltacı, Davut; Özyaşar, Mehmet; Erdem, Alim; Ayhan, Selim Suzi; Özlü, FatihIntroduction: Changes of thyroid hormones levels may lead to effects, not only in ventricular function, but also atrial function. The aim of this study was to investigate left atrial (LA) mechanical functions, atrial electromechanical coupling and P wave dispersion in patients with subclinical thyroid disorders. Material and methods: Eighty patients with subclinical thyroid disorders and forty controls were included. A diagnosis of subclinical thyroid disorders were reached with increased or decreased serum TSH and normal free T4 (fT4) levels. LA volumes were measured using the biplane area length method and LA active and passive emptying volumes and fraction were calculated. Intra- and interatrial electromechanical delay were measured by tissue Doppler imaging (TDI). Results: All groups had similar demographic findings. LA mechanical functions significantly impaired in subclinical thyroid disorders than control group. Intra- and Interatrial delay, were measured significantly higher in patients with subclinical thyroid disorders than control group. PA lateral and interatrial delay were positively correlated with TSH (r = 0.507, p = 0.006 and r = 0.455, p = 0.015, respectively) in subclinical hypothyroid patients. There was negative correlation between TSH and interatrial delay (r = -0.492,p = 0.006) in subclinical hyperthyroid patients. Linear multivariate regression analysis demonstrated that, TSH was the only an independent factor of interatrial delay in patients with subclinical thyroid disorders. Conclusions: This study showed that impaired LA mechanical and electromechanical function in subclinical thyroid disorders. TSH was an independent determinant of interatrial delay. Prolonged atrial electromechanical coupling time and impaired mechanical atrial functions may be related to the increased incidence of arrhythmias. (Endokrynol Pol 2012; 63 (4): 286-293)Öğe Hematological parameters and coronary collateral circulation in patients with stable coronary artery disease(Pulsus Group Inc, 2013) Ayhan, Selim; Öztürk, Serkan; Erdem, Alim; Fatih, Mehmet Fatih; Memioğlu, Tolga; Özyaşar, Mehmet; Yazıcı, MehmetBACKGROUND: Although hematological parameters have been associated with prognosis in patients with various cardiovascular diseases, their relationship with coronary collateral (CC) circulation in patients with stable coronary artery disease (CAD) is unknown. OBJECTIVE: To investigate the relationship between hematological parameters and CC vessel development in patients with stable CAD. METHODS: A total of 96 patients who underwent coronary angiography were retrospectively enrolled. All study participants had at least one occluded major coronary artery. Development of CCs was classified using the method of Rentrop. Rentrop grades of 0 and 1 indicate poor CCs, whereas grades 2 and 3 indicate good CCs. Hematological parameters, including mean platelet volume (MPV) and neutrophil/lymphocyte (N/L) ratio, were measured. Multivariate logistic regression analysis was performed to identify independent variables. RESULTS: The MPV and N/L ratio were significantly higher in the poor CC group compared with the good CC group. Negative correlations were found in the analyses comparing Rentrop score with MPV and N/L ratio (r=-0.274; P=0.012 and r=-0.339; P=0.001, respectively). In multivariate analysis, the N/L ratio was independently related to CC circulation (OR 0.762 [95% CI 0.587 to 0.988]; P=0.04). CONCLUSION: The results suggest that N/L ratio and MPV are associated with poor CCs, and a high N/L ratio is a significant predictor of poor CC development in patients with stable CAD.Öğe Nötrofil/lenfosit oranının koroner ektazisi varlığı ve yaygınlığı ile ilişkisi(2013) Ayhan, Selim Suzi; Öztürk, Serkan; Erdem, Alim; Özlü, Mehmet Fatih; Özyaşar, Mehmet; Erdem, Kemalettin; Yazıcı, MehmetAmaç: Nötrofil/lenfosit oranının (N/L oranı) kardiyovasküler olay ve mortalite ile ilişkili olduğu çalışmalarda gösterilmiştir. Bu çalışmada, koroner arter ektazisi (KAE) olan hastalarda N/L oranı araştırıldı. Çalışma planı: Koroner anjiyografi sonrası KAE tanısı konu- lan 50 hasta (29 erkek, 21 kadın; ortalama yaş 51.1±7.1 yıl) ve normal koroner arter saptanan 28 hasta (16 erkek, 12 ka- dın; ortalama yaş 49.5±9.4 yıl) çalışmaya dahil edildi. Temel demografik ve klinik özellikler kaydedildi. Ektazik segment sayısı hesaplandı. Hematolojik parametreler ölçüldü ve N/L oranı hesaplandı. Bulgular: Nötrofil/lenfosit oranı KAE grubunda anlamlı olarak yüksekti (sırasıyla, ortanca [%25-%75 persantil] 2.2 [1.6-3.0] ve 1.8 [1.4-2.0]; p=0.014). Spearman korelasyon analizinde N/L oranının ektazik segment sayısıyla pozitif korelasyon gösterdiği saptandı (r=0.35; p<0.002). Çok değişkenli lojistik regresyon analizi ile de KAE ve N/L oranı arasındaki bağımsız ilişki gösterildi (odds oranı 2.674, %95 güven aralığı 1.184- 6.039, p=0.018). Sonuç: Koroner ektazili hastalarda N/L oranı artmıştır. N/L oranı KAE varlığı ve ciddiyetiyle ilişkilidir.Öğe Prehipertansif ve hipertansif hastalarda serum omentin düzeyi ilişkisinin incelenmesi(Bolu Abant İzzet Baysal Üniversitesi, 2014) Özyaşar, Mehmet; Erdem, AlimHipertansiyon ABD ve Avrupa ülkelerinde kronik hastalıklar içerisinde en sık poliklinik ziyaretlerine sebep olan, inme ve kardiyovasküler hastalıkların en sık nedeni olarak ortaya çıkan hastalık olarak göze çarpmaktadır. Bununla birlikte hipertansiyon önlenebilir ve tedavi edilebilir bir hastalıktır. Omentin molekülü adipoz dokudan üretilen damar düz kaslarında gevşetici etkileri olduğu bildirilen bir adipokindir. Hipertansiyon tedavisindeki ilerlemeler moleküler ve genetik düzeyde devam etmektedir. Bu araştırma tezinin amacı visseral adipoz dokudan üretildiği ve damar düz kasları üzerinde gevşetici etkileri olduğu gösterilen 'omentin' molekülünün prehipertansif ve hipertansif hastalardaki serum düzeyi ilişkisini ortaya çıkarmak ve hipertansiyonun tanı ve tedavi yönetimine katkı sağlamak, bu konuda yapılabilecek yeni çalışmalara yol gösterici olmaktır. Abant İzzet Baysal Üniversitesi Tıp Fakültesi Kardiyoloji ve Dâhiliye Anabilim Dalları polikliniklerine prehipertansiyon ya da hipertansiyon ön tanısı ( tansiyon arteriyel 130/80 mmHg ve üzeri bulunan ) ile başvurup, muayene edilen hastaların demografik özellikleri kayıt edildi ve dışlama kriterlerinden herhangi biri bulunan hastalar çalışma dışında tutuldu. Bölge etik kurulundan alınan onay ile hastalar bilgilendirilerek gönüllülerden kan örneği alınıp, santrifüj uygulanarak saklandı. Bu serum örneğinden daha sonra omentin düzeyi AİBÜ Tıp Fak. Biyokimya laboratuarı tarafından çalışıldı. Çalışmaya dâhil edilen hastalardan elde edilen veriler ve demografik özellikleri kayıt edildi ve istatistiksel anlamlılıkları değerlendirildi. Her iki grup içinde temel özellikler bakımından MPV (fL) değeri dışında anlamlı istatistiksel fark bulunmadı. Hasta grubunda (n=52) serum omentin düzeyi ortalama 821,36 ±44,30 ng/ml, kontrol grubunda (n=36) 721,71 ±36,69 ng/ml olarak bulundu. Bu fark istatistiksel olarak anlamlı değildi (p=0,087). Prehipertansif ve hipertansif hastalarda serum omentin düzeyi ilişkisini incelediğimiz araştırmamızda gerek prehipertansif ve hipertansif hastaların tümünde gerekse bu hasta gruplarında ayrı ayrı serum omentin düzeyi ile hipertansiyon arasında anlamlı ilişki bulunmamıştır. Anahtar Kelimeler: Serum Omentin, Prehipertansiyon ve HipertansiyonÖğe The relationship between renal function and renal blood flow in patients with coronary slow flow(Carbone Editore, 2013) Üyetürk, Uğur; Dağıstan, Emine; Öztürk, Serkan; Üyetürk, Ümmügül; Özyaşar, Mehmet; Tekçe, Hikmet; Kemahlı, Eray; Gücük, AdnanObjective: Coronary slow flow (CSF) is a phenomenon characterized by slowly flowing contrast medium through the epicardial coronary arteries during angiographic examination without detectable stenosis or obstruction. To our knowledge, the relationship between CSF and renal blood flow has not been investigated. Therefore, this study investigated the relationship between CSF and renal blood flow. Material and methods: The study included 25 consecutive patients who were diagnosed with CSF at the Cardiology Outpatient Clinic between August 2012 and June 2013, and 25 consecutive subjects who presented to the Cardiology Outpatient Clinic without CSF. Doppler ultrasound was performed in all subjects. Result: The right and left renal artery flow rates were significantly lower in the CSF group (p=0.011, p=0.006). Serum creatinine was significantly higher in the CSF group compared to the controls (0.71 +/- 0.12 vs.0.83 +/- 0.11 mg/dl, p=0.001), while the glomerular filtration rate (GFR) was significantly lower in the CSF group (116.1 +/- 28.6 vs. 98.7+/-19, p=0.018). There was a significant negative correlation between mean Thrombolysis in Myocardial Infarction frame count and GFR (R-2 linear = 0.093, p = 0.035). Conclusion: We found that the renal artery flow rate and GFR are reduced and creatinine levels elevated in CSF patients. Therefore. renal function is impaired in patients with CSF: the underlying cause could be endothelial dysfunction.Öğe Sol ana koroner lezyonu ciddiyeti ile ventriküler repolarizasyon indeksleri arasındaki ilişki(2012) Özlü, Mehmet Fatih; Özyaşar, Mehmet; Memioğlu, Tolga; Öztürk, Serkan; Ayhan, Suzi Selim; Erdem, Alim; Yazıcı, MehmetBu çalışmanın amacı, ani kardiyak ölümün önemli bir nedeni olan sol ana koroner arter (SAKA) tutulumu ciddiyeti ile ventriküler repolarizasyon indeksleri arasındaki ilişkinin değerlendirilmesidir. Stabil koroner hastalığı olan elektif şartlarda koroner anjiografi yapılmış hastalar geriye dönük olarak tarandı ve SAKA lezyonu olan 84 hasta değerlendirmeye alındı. SAKA lezyonu olan hastalar %50 altı ve üstü olacak şekilde iki gruba ayrıldı. Hastaların koroner arter hastalığı ciddiyeti gensini skorlama sistemi ile hesaplandı. Bu hastaların 12 derivasyonlu elektrokardiyografi kayıtlarından QT, düzeltilmiş QT ve QT dispersiyonları hesaplandı. İki grubun verileri istatistiksel olarak karşılaştırıldı. Çalışmada 62 erkek ( % 73.8 ), 22 kadın ( % 26.2) olmak üzere toplam 84 hastanın medikal kayıtları değerlendirildi. Hastaların yaş ortalaması 66.0±9.48 yıl olup, erkek hastalarda 64.21±9.61 yıl, kadın hastalarda 71.05±7.12 yıl olarak tespit edildi. İki grup arasında QT, düzeltilmiş QT ve QT dispersiyonu değerleri açısından anlamlı istatistiksel farklılık saptanmadı (p>0.05). Tüm hastalar değerlendirildiğinde SAKA tutulumu ile Gensini skoru arasında pozitif korelasyon saptandı (r:0.308 ve p:0.04). Çalışmamızda stabil koroner arter hastalarında SAKA tutulumu ciddiyeti ile QT aralığı ve QT dispersiyonu gibi ventriküler repolarizasyon indexleri arasında istatistiksel anlamlı bir ilişki saptanmadı.
