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Öğe Assessment of cardiac functions in patients with adenotonsillar hypertrophy(Duzce University Medical School, 2011) Ordu, Serkan; Ozhan, Hakan; Uzun, Hakan; Alemdar, Recai; Erden, Ismail; Yazici, Mehmet; Gultekin, ErolBackground: The aim of this study is to compare cardiac function in children with and without adenotonsillar hypertrophy (ATH). Materials and methods: Ninety-one children (26 female 65 male) who were diagnosed as ATH in the pediatric outpatient clinic and twenty-three completely healthy, age-sex matched children (10 female 13 male) were included in the study. All patients underwent a complete twodimensional transthoracic echocardiographic and Doppler study. Results: Mean mitral E, A and deceleration time were significantly longer in ATH group. Also chamber areas and volumes were bigger. Pulmonary and mitral regurgitation were statistically more frequent in ATH group. Adenotonsillar grade was positively related with mean pulmonary arterial pressure (r: 0.44 p: <0.001). Mitral valve thickness was strongly correlated with tonsillar hypertrophy grade (r: 0.73; p.<0.001). Conclusions: ATH may lead to mild diastolic dysfunction and chamber dilatation. Mitral valve thickness was strongly correlated with adenotonsillar grade. © 2011 Düzce Medical Journal.Öğe Carbohydrate antigen-125 and N-terminal pro-brain natriuretic peptide levels: Compared in heart-failure prognostication(2012) Ordu, Serkan; Ozhan, Hakan; Alemdar, Recai; Aydin, Mesut; Caglar, Onur; Yuksel, Hatice; Kandis, HayatiCarbohydrate antigen-125 (CA-125) is emerging as a prognostic biomarker of risk in heart failure. In a prospective study, we compared the prognostic values of CA-125 and aminoterminal pro-brain natriuretic peptide (NT-proBNP) in patients with stable heart failure. We enrolled 102 consecutive chronic, stable, systolic-heart-failure patients (68 men and 34 women; median age, 71 yr) from November 2008 through February 2010. We measured baseline NT-proBNP and CA-125 levels and compared their prognostic values. The primary endpoint was all-cause death and other major adverse events, defined as hospitalization for decompensated heart failure or acute coronary syndrome. During a mean follow-up period of 14 ± 2 months, 12 patients died and 35 others sustained major adverse events. We found that CA-125 level significantly correlated with New York Heart Association functional class, pulmonary artery pressure, microalbuminuria, creatine kinase-MB fraction, and hemoglobin, albumin, and NT-proBNP levels. Upon receiver operating characteristic curve analysis, CA-125 and NT-proBNP had similar accuracy in predicting major adverse events and death: for major adverse events, area under the curve (AUC) was 0.699 for CA-125 (P=0.002) and 0.696 for NT-proBNP (P=0.002); for death, AUC was 0.784 for CA-125 (P=0.003) and 0.824 for NT-proBNP (P=0.001). Multivariate Cox regression analysis showed that CA-125 levels greater than 32 U/mL and NT-proBNP levels greater than 5,300 pg/mL had independent prognostic value for major adverse events and death. We conclude that baseline CA-125 and NT-proBNP levels are comparably reliable as heart-failure markers, and that CA-125 can be used for prognosis prediction in heart failure. © 2012 by the Texas Heart® Institute, Houston.Öğe Correlation between the body fat composition and high sensitive c-reactive protein in Turkish adults(2012) Aydın, Mesut; Dumlu, Talha; Alemdar, Recai; Kayapınar, Osman; Celbek, Gökhan; Karabacak, Ahmet; Türker, Yaseminobjectives. Te adipose tissue is an active immune organ. High sensitive C-reactive protein CRP (hs-CRP) is a strong independent predictor of a possible future myocardial infarction and stroke, and it has also been shown to be related to the sub clinical atherosclerosis. Te aim of this study was to investigate the relation between the body fat composition, metabolic syndrome, and the hs-CRP plasma levels. Methods. Total 246 consecutive Turkish subjects, admitted to the internal medicine clinic with the diagnosis of diabetes mellitus, insulin resistance or metabolic syndrome, were included into the study. Te total body fat composition was measured in every participant with a commercially available bio-impedance meter. Te hs-CRP levels, body composition parameters, and biochemical variables were compared. Results. Te hs-CRP levels increased in parallel with the body weight in Turkish subjects. Tis increase was significant especially in the women. Te waist circumference, body mass index (BMI), and body composition variables (visceral fat level, total body fat, and total body muscle mass) were significant correlates of the hs-CRP. Te waist circumference and BMI were independent predictors of the hs-CRP. Conclusion. Te waist circumference, BMI, and body composition variables (visceral fat level, total body fat and total body muscle mass) were significant correlates of the hs-CRP in Turkish adults. Body weight control may account for an important target especially in patients with the metabolic syndrome.Öğe Efficacy of olmesartan therapy on fibrinolytic capacity in patients with hypertension(2011) Bulur, Serkan; Ozhan, Hakan; Erden, Ismail; Alemdar, Recai; Aydin, Mesut; Caglar, Onur; Basar, CengizThe efficacy of olmesartan on fibrinolytic capacity has not been studied yet. Therefore, the aim of the present study was to investigate the efficacy of olmesartan on hemostatic/fibrinolytic status by measuring plasma level of plasminogen activator inhibitor-1 (PAI-1) and soluble thrombomodulin levels in patients with hypertension. Forty-two consecutive, newly diagnosed (25 women and 17 men with a mean age of 48 ± 8 years) patients with untreated essential hypertension were included in the study. Olmesartan medoxomil (20 mg/day) was started and the patients were followed up for 6 months. Baseline biochemical variables, thrombomodulin, and PAI-1 levels were compared with the levels of these variables measured at the end of the 6-month follow-up period. After 6 months of treatment with olmesartan medoxomil, there was a significant reduction in systolic and diastolic blood pressure (from 159.5 ± 10.9 to 134.6 ± 12.7 mmHg and from 98.0 ± 6.3 to 83.9 ± 7.0 mmHg, respectively). Mean plasma PAI-1 and thrombomodulin levels were also significantly decreased (59.73 ± 41.91 vs. 48.60 ± 33.65 ng/ml, P = 0.001 and 8.09 ± 2.29 vs. 6.92 ± 1.42 ?g/l, P < 0.001, respectively). Olmesartan medoxomil decreased plasma PAI-1 and thrombomodulin levels after 6 months of therapy, indicating a favorable effect on fibrinolytic capacity in patients with essential hypertension. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.Öğe OUTCOME OF PRIMARY PERCUTANEOUS INTERVENTION IN PATIENTS WITH INFARCT RELATED CORONARY ARTERY ECTASIA(Elsevier Ireland Ltd, 2010) Erden, Ismail; Ordu, Serkan; Alemdar, Recai; Aydin, Mesut; Ozhan, Hakan; Yazici, Mehmet; Basar, CengizÖğe Performance of Bioelectrical Impedance Analysis in the Diagnosis of Metabolic Syndrome(Bmj Publishing Group, 2012) Ozhan, Hakan; Alemdar, Recai; Caglar, Onur; Ordu, Serkan; Kaya, Ahmet; Albayrak, Sinan; Turker, YasinObjective: Central obesity is a prerequisite for the diagnosis of metabolic syndrome (MetS). Precise measurement of visceral fat by bioelectrical impedance analysis (BIA) has been validated. The aim of this study was to investigate the diagnostic performance of BIA in MetS and validate the best cutoff in a large adult cohort. Materials and Methods: The study was performed on the MELEN Study cohort-a prospectively designed survey on the prevalence of cardiometabolic risk factors in Turkish adults. The final cohort consisted of 2219 participants. Weight and visceral body composition were measured without shoes in light indoor clothes using a bioimpedance analyzer (Omron BF 510; Omron Corp, Kyoto, Japan). Plasma concentrations of cholesterol, insulin, fasting triglycerides, high-density lipoprotein cholesterol, glucose, and other biochemical variables were measured. The diagnostic performance of visceral fat measurement by BIA in patients with MetS was assessed. Results: Metabolic syndrome was detected in 751 participants (520 women and 231 men with a mean age of 55 [12] years; 34% of the whole study population). Total body fat and visceral fat levels were higher in subjects with MetS. Correlation analyses showed that there were significant correlations between anthropometric and BIA measurements. Receiver operating curve characteristics of visceral adiposity revealed the best cutoff values as greater than 12% for men and greater than 9% for women. The diagnostic performance was good in both sexes (the sensitivity/specificity and area-under-the-curve values were 76%/75% and 0.83 for men and 83%/67% and 0.81 for women, respectively). Conclusions: Visceral fat measured with BIA is an easily applicable and useful method for identifying people with MetS. The best cutoff values were higher than 12% for men and higher than 9% for women.Öğe Pioglitazone improves ventricular diastolic function in patients with diabetes mellitus: A tissue Doppler study(Acta Cardiologica, 2010) Ordu, Serkan; Ozhan, Hakan; Alemdar, Recai; Aydin, Mesut; Basar, Cengiz; Caglar, Onur; Yazici, MehmetObjective - Pioglitazone treatment in type 2 diabetes mellitus produced significant improvements in glycaemic control, plasma lipids, blood pressure and inflammation. The aim of this study was to investigate the effect of pioglitazone on systolic and diastolic function in diabetic patients. Methods and results - Forty-nine diabetic patients were included in the study.The patients had never received thiazolidinedione therapy before. Clinical and echocardiographic variables were measured. 30 mg pioglitazone were administered. The patients were followed up for six months and all the measurements were re-evaluated for comparison. Body mass index (BMI) significantly increased after treatment. Fasting glucose, HbA1c and systolic blood pressure decreased. Insulin resistance improved and the HOMA-IR index decreased after pioglitazone treatment. Mean aortic diameter, left atrial systolic and diastolic volumes significantly decreased after therapy. Among diastolic function variables mitral E wave, E/A, ejection time and pulmonary vein peak reverse flow velocity (PVA) significantly increased whereas isovolumetric relaxation time (IVRT), isovolumetric contraction time (IVCT), deceleration time, E/E' and pulmonary vein late systolic flow (PVS2) decreased after pioglitazone therapy. Among tissue Doppler variables early (E) ventricular inflow velocities measured from the tricuspid lateral annulus, the mitral septal and lateral annulus, the anterior, inferior and posterior free wall significantly increased. Late (A) ventricular inflow velocities measured from the anterior, inferior free wall and the mitral septal annulus also increased. Conclusion - Pioglitazone treatment in type 2 diabetes mellitus produced significant improvements in measures of glycaemic control and diastolic ventricular function.Öğe Poor-quality sleep score is an independent predictor of nondipping hypertension(Lippincott Williams and Wilkins, 2010) Erden, Ismail; Erden, Emine Cakcak; Özhan, Hakan; Basar, Cengiz; Aydin, Mesut; Dumlu, Talha; Alemdar, Recaiobjective: We aimed to investigate whether there was any association between the nondipping status and sleep quality in relatively young patients with an initial diagnosis of hypertension. METHODS: One hundred and thirty-three consecutive patients, diagnosed to have stage 1 hypertension by their primary physicians, were referred to our study. Patients with a history of use of any antihypertensive medication were excluded. Eligible patients underwent the Pittsburgh Sleep Quality Index (PSQI) survey, which has an established role in evaluating sleep disturbances. All patients underwent ambulatory blood pressure monitoring. RESULTS: There were 71 nondipper patients (mean age 44.3±5.3 years, 33 male/38 female) and 62 dipper hypertensive patients (mean age 43.3±6.3 years, 27 male/35 female). The PSQI scores, globally, were significantly higher in the nondippers compared with the dippers. It was noticed that all the components of the PSQI (sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleep medication, and daytime dysfunction) were significantly higher in the nondippers. Correlation analysis showed that systolic blood pressure fall at night was inversely and significantly related with the PSQI (r=-0.46, P<0.001). Logistic regression analysis showed that the PSQI score is an independent determinant for nondipping hypertension (HT) {odds ratio=0.842 [95% confidence interval (CI)=0.748-0.947; P=0.004]}. CONCLUSION: We showed that poor sleep quality was related with a nondipping pattern, and furthermore, it was an independent predictor of nondipping in newly diagnosed stage 1 hypertensive patients. © Lippincott Williams & Wilkins.Öğe Spontaneous coronary artery dissection in the post-partum period(Duzce Univ, 2011) Çaglar, Onur; Kayapınar, Osman; Aydın, Mesut; Alemdar, Recai; Albayrak, Sinan; Özhan, Hakanpregnancy. Spontaneous coronary artery dissection is the most common cause of myocardial infarction in this period. Although the exact etiology could not be resolved, hemodynamic stress and connective tissue trauma induced by pregnancy are the potential causes. Optimal treatment modalities have not been defined yet in spontaneous coronary artery dissections encountered in the postpartum period. The most suitable way of treatment among medical therapy, surgery and percutaneous intervention should be preferred. Herein, we report a case of non-ST wave elevation myocardial infarction in a 35-year old lady at the second week of her delivery, turned out to be a circumflex artery dissection. The treatment modalities were also discussed in the light of the literature.
