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    Analysis of all-cause mortality and coronary events in the Turkish Adult Risk Factor Survey 2005
    (Turkish Soc Cardiology, 2006) Onat, Altan; Karabulut, Ahmet; Esen, Ali Metin; Uyarel, Huseyin; Ozhan, Hakan; Albayrak, Sinan; Keles, Ibrahim
    Objectives: To analyze all-cause and coronary mortality as well as newly diagnosed coronary heart disease (CHD) in the cohort of the Turkish Adult Risk Factor Study which was surveyed in the summer of 2005 and included individuals residing essentially in the regions of Marmara and Central Anatolia. Study design: Information on the mode of death was obtained from first-degree relatives and/or health personnel of local health offices. Diagnosis of coronary heart disease was based on history, physical examination, and 12-lead electrocardiograms. New coronary events were defined as those that developed after the last survey, including fatal or nonfatal myocardial infarction, stable angina and/or myocardial ischemia. Results: Of 1646 participants, 1078 subjects (mean age 54.8 +/- 11.8 years) were examined; information alone was gathered for 507 subjects; 43 subjects (28 men, 15 women) had died, and 18 subjects were lost to follow-up. Incorporation of 3104 person-years of follow-up raised the total follow-up of the survey to 42,600 personyears. Twenty-three deaths were classified as CHD-related. New coronary events were identified in 37 participants. Annual mortality and coronary mortality rates were 13.9 and 7.4 per 1000 adults, respectively. Overall mortality per 1000 person-years was 16.3 in rural areas and 12.0 in urban areas. The high share of coronary deaths among all deaths persisted. In the age bracket of 45 to 74 years, overall mortality declined to 10.6 (p= 0.09) and coronary mortality to 5.5 per 1000 person-years, thus supporting the presence of a consistently decreasing trend of all-cause mortality and coronary mortality. Estimated fatal and nonfatal new coronary events appeared to be high with 18 per 1000 person-years. Conclusion: A rising trend persists in the incidence of coronary mortality and its share in overall mortality as well as in new coronary events. The occurrence of coronary deaths among women seems to be gradually shifting to older ages.
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    Angiotensin-converting enzyme, angiotensin II receptor, apolipoprotein E and endothelial constitutive nitric oxide synthase gene polymorphisms in dilated cardiomyopathy
    (2004) Özhan, Hakan; Zungur, Mustafa; Yazıcı, Mehmet; Akdemir, Ramazan; Gündüz, Hüseyin; Erbilen, Enver; Albayrak, Sinan; Uyan, Cihangir
    Amaç: Dilate kardiyomiyopati (DCM) sol yada her iki ventrikülün sistolik fonksiyonlarının bozulması ve genişlemesi ile karakterize bir hastalıktır. Ailesel kökenli DCM'nin tanımlanmasından sonra ailesel olmayan DCM olguları için de genetik faktörlerin rol oynayabileceği düşünülmüş ve konuyla ilgili araştırmalar yapılmıştır. Makalemizde ülkemizde yaşayan DCM'li olgularda, hastalığın patofizyolojisinde rol oynaması muhtemel dört aday genin polimorfizmleri araştırılmıştır (Angiotensin dönüştürücü enzim (ACE) I/D polimorfizmi, angiotensin II reseptör (AGTR1) 1166 A/C polimorfizmi, apolipoprotein E (APOE) ve endotelyal konstitütif nitrik oksit sentaz (ecNOS) geni polimorfizmi). Ortalama yaşı 58±12 olan ardışık 76 hasta ve yaş ortalaması 59±12 olan 88 kontrol grubu çalışmaya alındı. Bütün hastalara ve kontrol grubuna ekokardiyografik çalışma yapıldı. DCM tanısı için ekokardiyografik olarak end-diastolik çapın >55mm ve ejeksiyon fraksiyonunun <%40 altında olması kriter alındı. Yine hasta grubuna koroner anjiografi yapılarak hastalar iskemik ve idyopatik DCM gruplarına ayrıldı. Spesifik kalp kası hastalığı, izole sağ ventrikül genişlemesi, kapak ve perikard hastalığı olanlar çalışma dışında tutuldu. Hasta ve kontrol grubunun kan hücrelerinden deoxiribonükleik asit (DNA) spesifik polimeraz zincir reaksiyonu (PCR) yöntemi ile genetik analiz yapıldı. Gen distribüsyonu ki kare testi ile değerlendirildi. Bağımsız risk için multivariate regresyon analizi uygulandı. 0,05 altındaki p değerleri istatistiksel olarak anlamlı kabul edildi. Sonuçlar: Hasta ve kontrol grubunun allel sıklıkları, ekokardiyografi, biyokimya analizi sonuçları ve demografik verileri karşılaştırıldı. APO E gen allel sıklığına ait dağılım her iki grupta farklılık gösterse de regresyon analizi sonuçlarına göre bu farklılığın bağımsız bir risk oluşturmadığı gözlendi.
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    Association between mild renal dysfunction and insulin resistance or metabolic syndrome in a random nondiabetic population sample
    (Karger, 2007) Onat, Altan; Hergenc, Gulay; Uyarel, Huseyin; Ozhan, Hakan; Esen, A. Metin; Karabulut, Ahmet; Albayrak, Sinan
    Aims: The association of mild renal dysfunction (estimated glomerular filtration rate [eGFR] 60-89.9 ml/min/1.73 m(2)) with insulin resistance (IR) or metabolic syndrome (MS) needs be investigated in a population in which MS prevails. Methods: After excluding subjects with diabetes mellitus, 1,678 subjects from a representative cohort (median age 52 years) were studied cross sectionally. eGFR was based on serum creatinine concentrations using the quadratic GFR equation and categorized by 90 and 60 ml/min/1.73 m(2) as limits. MS was identified using the modified criteria of the Adult Treatment Panel-III. Results: In men, whereas MS was not significantly associated with a reduced eGFR category when controlled for homeostatic model assessment (HOMA), HOMA adjusted for MS or for its components was significantly associated with the likelihood of a reduced eGFR. This likelihood was increased by 14% with a doubling of HOMA in men. Age was the dominant correlate of reduced eGFR in women, whereby an association with HOMA was not significant. Conclusion: Mildly impaired kidney function is common in nondiabetic adults among whom MS prevails, and in men it is mainly associated with IR but not with central obesity and MS-related dyslipidemia. The quadratic GFR equation enables an acceptable estimation of GFR in a general population. Copyright (c) 2007 S. Karger AG, Basel.
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    Asymptomatic giant left atrial myxoma supplied from right coronary artery in a 65-year-old woman
    (Elsevier Ireland Ltd, 2005) Yazıcı, Mehmet; Norgaz, Tuğrul; Akdemir, Ramazan; Albayrak, Sinan
    Primary cardiac tumors are rare and approximately 50% of them are atrial myxomas [1,2]. Myxomas rarely remain asymptomatic, especially if they are large. On the other hand, visualization of a myxoma by contrast dye during coronary angiography is an infrequent sign, which clarifies the vascular supply of the tumor. The present study reports a case of an asymptomatic giant left atrial myxoma, which was opacified by contrast dye on right coronary angiography.
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    Atrial fibrillation after electrical shock: a case report and review
    (B M J Publishing Group, 2004) Akdemir, Ramazan; Gündüz, Hüseyin; Erbilen, Enver; Özer, İlker; Albayrak, Sinan; Ünlü, Hakan; Uyan, Cihangir
    A 52 year old man was admitted to an emergency department with a fast ventricular rate atrial fibrillation after an electrical shock. Electrical cardioversion was attempted after echocardiographic examination. This failed, but the heart rate slowed. Successful pharmacological cardioversion was achieved after 16 hours of amiodarone infusion. Preexcitation syndrome was detected on baseline echocardiograph. Serum cardiac specific markers were all within normal limits. No abnormal findings were detected by chest radiography, echocardiographic, or coronary angiographic investigations. Acute onset atrial fibrillation after electrical injury is discussed.
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    Clustering of risk factors for abdominal obesity in Turkish adults and its demographic distribution
    (Turkish Soc Cardiology, 2005) Onat, Allan; Uyarel, Huseyin; Karabulut, Ahmet; Albayrak, Sinan; Dogan, Yuksel; Can, Gunay; Hergenc, Gunay
    Objectives: We investigated the distribution of abdominal obesity among Turkish adults, according to age groups and geographic regions, and the prevalence and type of its clustering with traditional risk factors including high total and low HDL cholesterol levels, smoking, hypertension, and diabetes. Study design: The study included a cohort of 3267 individuals (1607 men, 1660 women; mean age 52 +/- 12 years) whose waist circumferences were measured at least one time in the past three surveys of the Turkish Adult Risk Factor Study from 2000 to 2004. Cardiovascular disease was diagnosed on the basis of the presence of angina history, the Minnesota coding of resting electrocardiograms, and a history of stroke. Criteria of the NCEP ATP III guidelines proposed for metabolic syndrome were adopted for defining abdominal obesity and hypertension. Results: Out of every four adults aged 50 years or above, one man and three women had abdominal obesity. The prevalence of abdominal obesity did not exhibit marked changes among geographic regions. Coexistence of 3-5 risk factors in subjects with abdominal obesity showed a significantly higher proportion than other clusters of risk factors (p<0.001). All of the six risk factors studied exhibited significant and independent associations with abdominal obesity in women, whereas in men, only smoking, low HDL-C levels, and hypertension were independent factors. In contradistinction to men, there was an over three-fold adjusted likelihood of diabetes to accompany abdominal obesity in women, with hypercholesterolemia significantly clustering with both. While abdominal obesity conferred an increased likelihood of coronary heart disease through mediation of five risk factors in women, it was found as a residual independent component in men. Conclusion: According to the NCEP ATP III criteria, abdominal obesity is three times more prevalent among Turkish women than in men. The female-specific combination of abdominal obesity, diabetes, and hypercholesterolemia may partly contribute to the comparatively high risk for cardiovascular disease in Turkish women. This study needs a re-evaluation of the role of abdominal obesity in Turkish men with a threshold of >= 96 cm, which was previously proposed by the authors.
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    Color M-mode regurgitant flow propagation velocity: A new echocardiographic method for grading of mitral regurgitation
    (2004) Akdemir, Ramazan; Özhan, Hakan; Gündüz, Hüseyin; Yazıcı, Mehmet; Erbilen, Enver; Albayrak, Sinan; Ünlü, Hakan; Bulur, Serkan; Uyan, Cihangir; Arınç, Hüseyin
    The aim of this study was to evaluate the reliability of mitral regurgitation color M-mode regurgitant flow propagation velocity (RFPV) in grading mitral regurgitation (MR). This new transthoracic Doppler echocardiographic technique is easier and equally or more practical than qualitative and quantitative methods used to grade MR in patients both with normal and low left ventricular ejection fraction (LVEF). Color M-mode echocardiography allows resolution of regurgitant flow propagation along the echocardiography beam inside the left atrium. The characteristics of the velocity of this jet have not been studied in detail before. The present study compares the different qualitative and quantitative methods of MR grading with the RFPV. We prospectively examined 52 consecutive patients with grades of MR mild in 10 patients, moderate in 19 patients and severe in 23 patients with quantitative pulse Doppler echocardiography. MR was evaluated by vena contracta diameter (VCD), regurgitant jet area (RJA) and RFPV. These qualitative and quantitative methods were compared with the pulsed Doppler quantitative flow measurements and concordance of these 3 methods was determined. The mean RFPV for mild, moderate and severe MR were 26.4±7 cm/s, 43.3±7 cm/s and 60.3±7.3, respectively (p<0.001). RFPV is highly sensitive and moderately specific in differentiating mild and severe MR from other subgroups. Sensitivity and specificity were 92.1-64.3% for mild and 100-68.5% for severe MR, respectively. Significant correlation was observed between pulse Doppler quantitative grades, RFPV, VC and RJA (p<0.0001, r=.87; p<0.0001, r=-.84; p<0.0001, r=.76, respectively). This results show that RFPV is a reliable and simple semi-quantitative new method that can be used for determining severity of MR.
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    Color M-mode regurgitant flow propagation velocity: A new echocardiographic method for grading of mitral regurgitation
    (2004) Akdemir, Ramazan; Özhan, Hakan; Gündüz, Hüseyin; Yazici, Mehmet; Erbilen, Enver; Albayrak, Sinan; Ünlü, Hakan
    The aim of this study was to evaluate the reliability of mitral regurgitation color M-mode regurgitant flow propagation velocity (RFPV) in grading mitral regurgitation (MR). This new transthoracic Doppler echocardiographic technique is easier and equally or more practical than qualitative and quantitative methods used to grade MR in patients both with normal and low left ventricular ejection fraction (LVEF). Color M-mode echocardiography allows resolution of regurgitant flow propagation along the echocardiography beam inside the left atrium. The characteristics of the velocity of this jet have not been studied in detail before. The present study compares the different qualitative and quantitative methods of MR grading with the RFPV. We prospectively examined 52 consecutive patients with grades of MR mild in 10 patients, moderate in 19 patients and severe in 23 patients with quantitative pulse Doppler echocardiography. MR was evaluated by vena contracta diameter (VCD), regurgitant jet area (RJA) and RFPV. These qualitative and quantitative methods were compared with the pulsed Doppler quantitative flow measurements and concordance of these 3 methods was determined. The mean RFPV for mild, moderate and severe MR were 26.4±7 cm/s, 43.3±7 cm/s and 60.3±7.3, respectively (p<0.001). RFPV is highly sensitive and moderately specific in differentiating mild and severe MR from other subgroups. Sensitivity and specificity were 92.1-64.3% for mild and 100-68.5% for severe MR, respectively. Significant correlation was observed between pulse Doppler quantitative grades, RFPV, VC and RJA (p<0.0001, r=.87; p<0.0001, r=-.84; p<0.0001, r=.76, respectively). This results show that RFPV is a reliable and simple semi-quantitative new method that can be used for determining severity of MR.
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    Correlation of plasma B-type natriuretic peptide with shunt severity in patients with atrial or ventricular septal defect
    (Springer, 2007) Özhan, Hakan; Albayrak, Sinan; Uzun, Hakan; Ordu, Serkan; Kaya, Ahmet; Yazıcı, Mehmet
    The goal of this study was to test the utility of bedside plasma concentration of B-type natriuretic peptide (BNP) assay as a screen for large shunts in pediatric patients with atrial septal defects (ASDs) and ventricular septal defects (VSDs). Thirty-five children at a mean age of 70 +/- 129 weeks with ASD or VSD were included in the study. Nine patients had VSD and 26 had ASD. Plasma BNP values were compared with the Q(p)/Q(s) ratios derived from quantitative Doppler flow measurements. Mean BNP was 29 +/- 42 pg/ml, with a range between < 5 pg/ml and 208 pg/ml. Sixteen patients had Q(p)/Q(s) values > 1.5 and 19 had values < 1.5. The difference of mean BNP in these patient groups was statistically significant (45 +/- 56 vs 14 +/- 17, p = 0.03). BNP was positively correlated with shunt significance. Receiver operating characteristic curve analysis revealed a sensitivity of 69% and a specificity of 79% at a plasma BNP cut-off level of >= 20 pg/ml. Bedside measurement of BNP correlates with magnitude of ASD and VSD in children. BNP can provide information for the management of children with ASD or VSD. It can be used as part of the evaluation of a child with a preliminary diagnosis of a congenital defect.
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    Determinants and definition of abdominal obesity as related to risk of diabetes, metabolic syndrome and coronary disease in Turkish men
    (Elsevier Ireland Ltd, 2007) Onat, Altan; Uyarel, Huseyin; Hergenc, Gulay; Karabulut, Ahmet; Albayrak, Sinan; Can, Gunay
    We aimed to investigate determinants of abdominal obesity and its clinical impact on metabolic syndrome (MS), diabetes (DM) and coronary heart disease (CHD) in men. Methods: Prospective evaluation of 1638 male participants (aged 48.5 +/- 12.3), representative of Turkey's men who have a high prevalence of MS. For components of MS, criteria of NCEP guidelines were adopted, modified for abdominal obesity. Follow-up constituted 9650 person-years. Results: Insulin level (relative risk [RR] 1.40 for doubling), C-reactive protein (CRP) and heavy smoking (protective) were independent predictors of newly developing abdominal obesity. High triglyceride and low HDL-cholesterol were significantly associated already with waist girth quartile II, apolipoprotein B with quartile III. Waist girth significantly predicted future MS from quartile II on, independent of insulin resistance (IR) by homeostatic model assessment, whereby its hazard ratio (HR, 2.6) exceeded double that of HOMA. CRP independently predicted MS. Age-adjusted HR of waist girth (1.59) was significant in predicting DM. Age- and smoking-adjusted top waist quartile conferred significant risk for incident CHD (RR 1.71) but not for overall mortality. As judged by sensitivity and specificity rates for future CHD, DM and MS, abdominal obesity was most appropriately defined with a waist girth of >= 95 cm, and an action level 1 of >= 87 cm was proposed for MS in this population. Conclusions: Serum insulin, CRP levels and (inversely) heavy smoking are predictors for abdominal obesity in Turkish men. Atherogenic dyslipidemia and elevated blood pressure are associated significantly already with modest rises in waist girth adjusted for age and smoking. Abdominal obesity shows substantial independence of IR in the development of MS. Increasing waist girth was predictive of MS, more strongly than of DM. Risk for CHD imparted by abdominal obesity is essentially mediated by risk factors it induces. (c) 2006 Elsevier Ireland Ltd. All rights reserved.
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    Diyabetik hastalarda egzersiz stres testinde hesaplanan Qt parametrelerine trimetazidinin etkisi
    (2005) Özhan, Hakan; Yazici, Mehmet; Albayrak, Sinan; Erbilen, Enver; Gülcan, Erim; Bulur, Serkan
    Amaç: Çalışmamızda normal epikardiyal koroner arterlere sahip tip II diyabetik hastalarda, egzersizle QT parametrelerindeki değişim ve buna trimetazidin tedavisinin etkisi araştırıldı.Gereç ve Yöntem: Çalışmaya koroner anjiografisi normal olan tip II diabetes mellitus (DM) tanısı almış 19 hasta (ortalama yaş; 52±15, erkek/kadın; 9/10) ve 20 sağlıklı birey (ortalama yaş; 51±11, erkek/kadın; 10/10) alındı. Tüm bireylere trimetazidinle 3 aylık tedavi öncesi ve sonrası Bruce protokolü ile semptom-sınırlı treadmill egzersiz testi (EST) uygulandı. Çalışmaya alınan bireylerin klinik, biyokimyasal, ekokardiyografik ve elektrokardiyografik değerleri kaydedildi. EST sırasında belli aralıklarla QT intervalleri, Bazzet formülüyle hıza göre düzeltililen QT dispersiyonu (QTcD) kaydedildi.Bulgular: EST öncesinde, hastaların QTcD değerleri kontrollerden yüksekti. Pik egzersizde ölçülen QTcD'de (pik QTcD) kontrol grubunda anlamlı değişiklik olmazken hasta grubunda belirgin bir artış (sırasıyla; 31.7±6.9 ms; p>0.05, 53.7±9.6 ms; p<0.001) saptandı. EST sonrası QTcD değerleri de azalmasına rağmen kontrollere göre yüksekti (43.4±8.1 ms; p<0.01) . Tedavi sonrasında yapılan EST öncesi, sonrası ve pik egzersizde hesaplanan QTcD değerleri azalmış ve kontrollerinkine benzer bulundu (sırasıyla; 34.7±6.9 ms, 35.9±8.9 ms, 33.9±7.3 ms, p>0.05). Bunlardan pik QTcD değerleri tedavi öncesine göre belirgin olarak azaldı (35.9±8.9 ms; p<0.005).Sonuç: Bu bulgular, tip II DM'li hastalarda QTcD'de özellikle egzersizle belirginleşen artışın ventriküler aritmiyi tetikleyebileceği ve dolayısıyla ani ölüm sıklığındaki artışla ilişkili olabileceğini düşündürmektedir. Trimetazidinle tedavi sonrası pik QTcD'deki belirgin azalma ilacın hücresel düzeydeki anti-iskemik etkisinden kaynaklanan dolaylı bir elektrofizyolojik sonuç olarak görülebilir.
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    Effect of reperfusion on p-wave duration and p-wave dispersion in acute myocardial infarction: primary angioplasty versus thrombolytic therapy
    (Blackwell Futura Publishing, Inc, 2005) Akdemir, Ramazan; Özhan, Hakan; Gündüz, Hüseyin; Tamer, Ali; Yazıcı, Mehmet; Erbilen, Enver; Albayrak, Sinan
    Background: Atrial fibrillation (AF) is a common arrhythmia occurring in about 10-20% of patients with acute myocardial infarction (AMI). P-wave dispersion (PWd) and P-wave duration (PWD) have been used to evaluate the discontinuous propagation of sinus impulse and the prolongation of atrial conduction time, respectively. This study was conducted to compare the effects of reperfusion either by thrombolytic therapy or primary angioplasty on P-wave duration and dispersion in patients with acute anterior wall myocardial infarction. Methods: We have evaluated 72 consecutive patients retrospectively (24 women, 48 men; aged 58 +/- 12 years) experiencing acute anterior wall myocardial infarction (AMI) for the first time. Patients were grouped according to the reperfusion therapy received (primary angioplasty (PTCA) versus thrombolytic therapy). Left atrial diameter and left ventricular ejection fraction (LVEF) were determined by echocardiography in all patients. Electrocardiography was recorded from all patients on admission and every day during hospitalization. Maximum (P max) and minimum (P min) P-wave durations and P-wave dispersions were calculated before and after the treatment. Results: There were not any significant differences between the groups regarding age, gender, left ventricular ejection fraction, left atrial diameter and volume, cardiovascular risk factors, and duration from symptom onset to treatment. P-wave dispersions and P-wave durations were significantly decreased after PTCA [Mean P max was 113 +/- 111 ms before and 95 +/- 17 ms after the treatment (P = 0.007)]. Mean PWd was 46 +/- 12 ms before and 29 +/- 10 ms after the treatment (P = 0.001). Also, P max and PWd were significantly lower in PTCA group (for P max 97 +/- 22 ms vs 114 +/- 16 ms and for PWd 31 +/- 13 ms vs 55 +/- 5 ms, respectively). Conclusions: Primary angioplasty reduces the incidence of AF by decreasing P max and P-wave dispersion.
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    Effect of reperfusion on P-wave duration and P-wave dispersion in acute myocardial infarction: Primary angioplasty versus thrombolytic therapy
    (2004) Akdemir, Ramazan; Özhan, Hakan; Gündüz, Hüseyin; Tamer, Ali; Yazici, Mehmet; Erbilen, Enver; Albayrak, Sinan
    Atrial fibrillation is a common arrhythmia occurring in about 10-20% of patients with acute myocardial infarction. P-wave dispersion and P-wave duration have been used to evaluate the discontinuous propagation of sinus impulse and the prolongation of atrial conduction time respectively. This study was conducted to compare the effects of reperfusion either by thrombolytic therapy or primary angioplasty on P wave duration and dispersion in patients with acute anterior wall myocardial infarction. We have retrospectively evaluated 72 consecutive patients (24 women, 48 men; aged 58 ±12 years) experiencing a first acute anterior wall myocardial infarction (AMI). Patients were grouped according to the reperfusion therapy received (primary angioplasty (PTCA) versus thrombolytic therapy). Left atrial diameter and left ventricular ejection fraction (LVEF) were determined by echocardiography in all patients. Electrocardiography was recorded from all patients on admission and on pach day of hospitalization. Maximum (P max) and minimum (P min) P wave durations and P wave dispersions (PWd) were calculated before and after treatment. There were no significant differences between the groups regarding age, gender, left ventricular ejection fraction (LVEF), left atrial diameter and volume, cardiovascular risk factors and duration from symptom onset to treatment. PWd and P wave durations were significantly reduced after PTCA (mean P max was 113±11 ms before and 95±17ms after the treatment [p=0.007]. Mean PWd was 46±12 ms before and 29±10 ms after the treatment (p=0.001). Also, P max and PWd were significantly lower in PTCA group (for P max 97±22 ms versus 114±16 ms and for PWd 31±13 ms versus 55±5 ms, respectively). Primary angioplasty reduces P max and P wave dispersion.
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    Effect of reperfusion P-wave duration and P-wave dispersion in acute myocardial infarction: Primary angioplasty versus thrombolytic therapy
    (2004) Akdemir, Ramazan; Özhan, Hakan; Gündüz, Hüseyin; Tamer, Ali; Yazıcı, Mehmet; Erbilen, Enver; Albayrak, Sinan; Bulur, Serkan; Uyan, Cihangir
    Atriyal fibrilasyon akut miyokard enfarktüslü hastalarda %10-20 sıklıkla görülen bir aritmidir. P dalga süreleri ve dispersiyonu sinus noddan çıkan uyarının atriyal yayılımının bozulmasını incelemede kullanılmaktadır. Bu çalışma akut ön duvar miyokard enfarktüsü geçirmiş hastalarda primer anjioplasti ve trombolitik tedavinin P dalga süre ve dispersiyonuna etkisini araştırmaktadır. Akut ön duvar miyokard enfarktüsü geçiren 24 kadın, 48 erkek toplam 72 hasta çalışmaya alındı. Hastalar primer anjioplasti ve trombolitik tedavi almak üzere randomize edildi. Klinik, ekokardiyografik ve EKG değerleri incelendi. Tedavi öncesi ve sonrası P dalga süreleri ve dispersiyonu karşılaştırıldı. Yaş, cinsiyet, sol ventrikül ejeksiyon fraksiyonu, sol atriyum çapları ve kardiyovasküler risk faktörleri açısından karşılaştırıldıklarında her iki grupta anlamlı istatistiksel farklılık bulunmadı. Primer anjioplasti grubunda tedaviden sonar P dalga süreleri ve dispersiyonu anlamlı olarak azalmış ve her iki grup karşılaştırıldığında p max ve dispersiyon azalması anjioplasti grubunda istatistiksel olarak daha fazla saptandı. Primer anjioplasti, P dalga süreleri ve dispersiyonunu trombolitik tedaviye göre anlamlı olarak azaltır.
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    Effect of treatment on echocardiographic variables in the follow-up of dilated cardiomyopathy
    (2005) Özhan, Hakan; Zungur, Mustafa; Akdemir, Ramazan; Yazıcı, Mehmet; Albayrak, Sinan; Erbilen, Enver
    Amaç: Dilate kardiyomiyopati sol ya da her iki ventrikülün sistolik fonksiyonlarında bozulma ve dilatasyonla seyreden bir hastalıktır. Medikal tedavideki ilerlemelere rağmen ölüm oranı yüksektir. Bu çalışmanın amacı, tedavi altındaki hastaların takiplerindeki iyileşmenin ekokardiyografik değişkenlere ne şekilde yansıdığını saptamaktır. Gereç ve Yöntemler: İlk kez tanı alan DKM’li 66 hasta çalışmaya alınmıştır (ekokardiyografik olarak ejeksiyon fraksiyonları (EF) %40’ın altında ve sol ventrikül diyastol sonu çapları >55 mm). Hastaların klinik, ekokardiyografik ve demografik kayıtları alındıktan sonra, ACE inhibitörü, diüretik ve tolere edildiğinde dijital, spiranolakton ve beta bloker başlanmıştır. Hastalar, 6 aylık aralıklarla toplam 12 ay boyunca takip edilmiştir ve izlem bulguları, ilk bulgularla karşılaştırılmıştır Bulgular: Ölen 4 hasta çalışma dışı bırakılmış, iyileşen ya da durumu stabil seyreden hastaların sonuçları karşılaştırılmıştır. Ortalama sol ventrikül kütlesi, EF, deselerasyon zamanı, ejeksiyon zamanı ve miyokard performans indeksinde anlamlı farklılık saptanmıştır. Sonuç: Ortalama sol ventrikül kütlesi, EF, deselerasyon zamanı, ejeksiyon zamanı ve miyokard performans indeksi dilate kardiyomiyopatili hastaların takiplerinde kullanılabilecek, iyileşmeye işaret eden anlamlı parametrelerdir.
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    Effects of iohexol on pulmonary functions in patients undergoing diagnostic coronary angiography
    (2004) Akdemir, Ramazan; Özhan, Hakan; Balbay, Öner; Erbaş, Mete; Gündüz, Hüseyin; Arbak, Peri; Yazıcı, Mehmet; Erbilen, Enver; Albayrak, Sinan; Annakkaya, Ali Nihat; Uyan, Cihangir
    Background: Adverse respiratory reactions have been reported with intravascular radiographic contrast media. The aim of the present study was to assess the effects of iohexol on pulmonary functions in patients undergoing diagnostic coronary angiography. Methods: Thirty patients diagnosed as coronary artery disease undergoing diagnostic coronary angiography were enrolled in the study. Subjects with chronic obstructive pulmonary disease, asthma, allergic bronchitis, myocardial infarction and documented systolic dysfunction by transthoracic echocardiography were excluded. The respiratory functions of the patients before and immediately after the coronary angiography were measured and arterial blood gas analyses were performed. The subjects were divided into two groups according to results of angiography as having coronary artery disease (Group 1) and without significant coronary artery disease (Group 2). The angiography procedures were performed by a single, experienced angiographer. Left Ventriculography was not performed on any patient Results: The results gathered before and after angiography procedure were compared. Forced expiratory volume in the first second (FEV1), maximum mid-expiratory flow rate, (MMFR) 25-75, arterial oxygen pressure (PaO2) and bicarbonate (HCO3) were significantly reduced ( p<0.01), where as forced vital capacity (FVC), pH, oxygen saturation and arterial carbondioxide pressure were not changed. The comparison between two groups resulted that FEV1 and PaO2 were significantly decreased after angiography in Group 1. Conclusions: Diagnostic coronary angiography using iohexol decreases ventilatory functions in a small but significant extent in patients without any overt pulmonary disease. Therefore they should be used cautiously in patients with chronic lung disease.
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    Effects of thyroxin therapy on cardiac function in patients with subclinical hypothyroidism: Index of myocardial performance in the evaluation of left ventricular function
    (2004) Yazıcı, Mehmet; Görgülü, Şevket; Sertbaş, Yaşar; Erbilen, Enver; Albayrak, Sinan; Yıldız, Özcan; Uyan, Cihangir
    Objective: We investigated the effects of thyroxine (T4) therapy on the cardiac function in subclinical hypothyroidism (SHT) by using the index of myocardial performance (IMP) and the conventional echocardiographic parameters. Methods: Forty-five SHT patients (F/M:38/7, age 39.9±7.9) and 29 healthy subjects (F/M:25/4, age 38.3±8.6) were studied. Patients were randomly assigned, in a double-blind manner to receive T4 therapy (group I) or a placebo (group II) and for a period of up to 12 months, were followed up using thyroid function tests and both conventional and Doppler echocardiographic measurements. Results: At the baseline, the SHT patients has a significantly higher isovolumic relaxation time (IRT) (98.3±23.7 vs. 81.7±14.7<0.01) , IMP (0.52±0.06 vs. 0.42±0.05; P<0.001), A max (late mitral peak velocity) (83.4±12.6 vs. 74.3±13.5; P<0.01) and significantly lower (early mitral peak velocity) Emax/Amax ratio (1.19±0.18 vs. 1.34±0.17; P<0.01) than the individuals in the control group. In group I, the thyroid hormone profile became normalized after 1 year of L-T4 therapy, but there was no significant change in the left ventricular (LV) morphology or systolic function. After 1 year of follow-up, group I showed a significant reduction of MPI (0.53±0.05 vs. 0.42±0.07; P<0.001), Amax (84.2±13.7 vs. 74.5±11; P<0.001) and IRT (98.6±23.7 vs. 82.9± 23.3; P<0.001) along with a normalization of the E/A ratio (1.17±0.16 vs. 1.33±0.19; P<0.001). Conversely, no change was observed in group II. Conclusions: An impairment of left ventricular diastolic function, which may be reversible with T4 therapy, was observed in the SHT patients, and IMP may be useful in the evaluation of LV myocardial dysfunction in these patients. © 2003 Elsevier Ireland Ltd. All rights reserved.
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    Efficacy of nebivolol on flow-mediated dilation in patients with slow coronary flow
    (2009) Albayrak, Sinan; Ordu, Serkan; Yuksel, Hatice; Ozhan, Hakan; Yazgan, Ömer; Yazici, Mehmet
    Slow coronary flow (SCF) is the phenomenon of slow progression of angiographic contrast in the coronary arteries in the absence of stenosis in the epicardial vessels in some patients presenting with chest pain. There are no definite treatment modalities for patients with SCF. Our aim was to investigate the efficacy of nebivolol in patients with slow coronary flow by monitoring its effects on endothelial function and different markers of inflammation. Forty-two patients (16 females, 26 males; mean age, 55±10) with slow coronary flow (SCF) were included in the study. After baseline assessment, the patients were administered nebivolol 5 mg once daily. After 12 weeks of nebivolol therapy, the biochemical and ultrasonographic examinations were repeated. Chest pain relief was detected in 38 patients after treatment (90%). Systolic and diastolic blood pressure and high sensitive CRP were significantly decreased after nebivolol therapy. Among brachial artery dilation variables that reflect endothelial function, basal resistive index (RI), post-flow mediated dilation RI, and post-nitrate mediated dilation RI were significantly decreased after therapy. Nebivolol is effective at improving endothelial function in patients with SCF. It controls chest pain, decreases CRP, and has favorable effects on brachial artery dilation variables in patients with coronary slow flow.
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    Elastic properties of the ascending aorta and left ventricular function in patients with hypothyroidism
    (Blackwell Publishing, 2005) Özhan, Hakan; Yazıcı, Mehmet; Albayrak, Sinan; Erbilen, Enver; Bulur, Serkan; Akdemir, Ramazan; Uyan, Cihangir
    Background: We sought to clarify the possible role of elastic properties of the ascending aorta in the development of cardiac disease associated with hypothyroidism (HT). Methods: A total of 37 patients with HT (age: 39.3 +/- 8.9years) and 29 control subjects were studied. AscendingAortic (Ao) diameter, Ao elastic indexes, strain (AoST), distensibility (AoD), stiffness index (AoSI), and pressure strain modulus were calculated from the echocardiographically derived Ao diameters. Myocardial performance index (MPI), E/A ratio, isovolumetric relaxation time (IVRT), deceleration time (DT) were measured by Doppler echocardiography to assess diastolic LV function. Patients were treated with levothyroxine and followed-up for 6 months. Thyroid function tests and echocardiographic measurement's were repeated at the end of the study. Results: AoD (cm(2) dyn(-1) 10(-3)) and AoST (%) were significantly lower (3.8 vs. 6.1; P < 0.001, 7.4 vs. 12.6, P < 0.001; respectively), whereas AoSI was higher in HT patients (6.2 vs. 3.3; P < 0.001). After treatment, AoD and AoST were increased (5.7; P < 0.001 and 11.8; P < 0. 001; respectively), whereas AoSI was decreased significantly (3.7; P < 0. 001). Also, early / late mitral peak velocity ratio (Emax/Amax) was significantly lower in HT patients (1.19 vs 1.34; P < 0.001), whereas MPI was higher (0.52 vs. 0.42; P < 0.001). MPI showed a strong correlation with aortic root indexes [AoST (r = -0.61/P < 0.001); AoD, (r = -0.57/P < 0.002); AoSI, (r = 0.531P < 0.005)] in the HT group. After 6 months of therapy, MPI significantly decreased P < 0.001) and EIA ratios were normalized (P < 0.001). Conclusions: Ao root functions have an important role on diastolic LV function. Levothyroxine replacement therapy can reverse all of these adverse effects of HT.
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    Family income in shaping cardiometabolic risk profile: a prospective analysis including gender-related differences
    (Turkish Soc Cardiology, 2006) Onat, Altan; Ozhan, Hakan; Can, Guay; Hergenc, Gulay; Karabulut, Ahmet; Albayrak, Sinan
    Objectives: We investigated the extent to which family income predicts smoking, metabolic syndrome (MS) and its components, elevated levels of apolipoprotein (hyperapo) B and C-reactive protein (CRP), and incident coronary heart disease (CHD), with reference to gender-related differences. Study design: A total of 3,273 participants (1610 males, 1630 females; mean age 48.3 +/- 12 years, minimum age 28 years) of the TEKHARF surveys 1997/98 and 2002/03 were prospectively evaluated during a mean of 5.9 years. Monthly family incomes were grouped into four categories. Elevated apoB and CRP levels were based on the cutoff values of 120 mg/dl and 3 mg/l, respectively. Identification of MS was made according to the Adult Treatment Panel III criteria modified by the TEKHARF study. Diagnosis of CHD was based on history, physical examination, and the Minnesota coding of resting electrocardiograms. Results: In age-adjusted logistic regression analyses, men with higher income brackets had an increased incidence of diabetes, hypertension, and elevated hyperapo B. In women, income was positively associated with smoking and elevated hyperapo B, and inversely related with obesity, abdominal obesity, and - at borderline significance - triglyceride/HDL dyslipidemia; diabetes and hypertension were not predicted by income. Lower income brackets (<910 NTL) predicted elevated CRP levels in both genders (relative risk 1.47, p<0.002). Income exhibited an insignificant relative risk (1.27) for incident CHD. Conclusion: The level of family income contributes to the development of an adverse risk profile in Turks. Given increased smoking in women and its inhibitory effect on (abdominal) obesity, rising income seems to predict improvement in some elements of the cardiometabolic risk profile.