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Öğe Assessment of the left atrial volume index and plasma NT-proANP level in patients with acute ST-elevation myocardial infarction(Hospital Clinicas, Univ Sao Paulo, 2013) Bacaksız, Ahmet; Vatankulu, Mehmet Akif; Kayrak, Mehmet; Telli, Hasan Hüseyin; Ayhan, Selim SuziOBJECTIVES: Acute ST-elevation myocardial infarction is associated with ventricular dysfunction due to ischemia-induced progressive myocardial damage. The decrease in ventricular compliance causes left atrial dilatation and stretching of the atrial myocardium, which are the main stimuli for the secretion of atrial natriuretic peptide. The aim of this study was to evaluate left atrial dimensions and atrial natriuretic peptide levels in patients early after their first acute ST-elevation myocardial infarction and assess the probable interaction between coronary lesions and these measurements. METHODS: A total of 110 patients with acute myocardial infarction and 50 controls were studied. Plasma atrial natriuretic peptide was measured at admission. Left ventricular function, diameter, and volume index were evaluated using transthoracic echocardiography. Gensini and vessel scores of the patients who underwent coronary angiography were calculated. RESULTS: Plasma atrial natriuretic peptide in the patients with myocardial infarction was increased compared with that in controls (3.90 +/- 3.75 vs. 1.35 +/- 0.72 nmol/L, p<0.001). Although the left atrial diameter was comparable in patients and controls, the left atrial volume index was increased in patients with acute myocardial infarction (26.5 +/- 7.1 vs. 21.3 +/- 4.9 mL/m(2), p<0.01). Multivariate regression analysis showed a strong independent correlation between the left atrial volume index and the plasma atrial natriuretic peptide level (beta = 0.23, p = 0.03). CONCLUSIONS: The left atrial volume index and plasma atrial natriuretic peptide level were correlated in patients with acute myocardial infarction.Öğe The effect of smoking on myocardial performance index in middle-aged males after first acute myocardial infarction(Wiley, 2013) Bacaksız, Ahmet; Kayrak, Mehmet; Vatankulu, Mehmet Akif; Ayhan, Selim Suzi; Sönmez, OsmanBackground: Cigarette smoking is associated with increased rates of coronary artery disease and acute myocardial infarction (MI). Paradoxically, smokers had lower mortality after MI. The purpose of this study was to evaluate the effect of chronic smoking on myocardial performance index (MPI) in middle-aged men after an acute MI. Material and methods: A total of 429 patients (325 smokers vs. 104 nonsmokers) presenting with acute ST elevation MI were enrolled in this study. Thrombolysis in myocardial infarction (TIMI) flow of the infarct related artery was measured before and after the primary percutaneous coronary intervention (PCI), and Gensini score was also calculated. Conventional echocardiography and tissue Doppler echocardiography (TDI) were performed within 4872hours after onset of chest pain. Peak early (Em) and late (Am) diastolic velocities, peak systolic (Sm) mitral annular velocities and time intervals were recorded with TDI. The MPI, ratio of Em/Am, and E/Em were calculated. Results: Baseline demographic and angiographic characteristics such as Gensini score, pre and, post PCI TIMI flow were similar in 2 groups. In contrast, LV MPI was preserved among smokers (0.59 +/- 0.15 vs. 0.66 +/- 0.14, P=0.01), and Em/Am values were also higher in smokers (0.84 +/- 0.28 vs. 0.75 +/- 0.31, P=0.01). Independent predictors of impaired MPI (0.60) were determined as nonsmoking status (odds ratio 2.940, 95% CI 0.985.83, P=0.05), left anterior descending artery stenosis (odds ratio 3.196, 95% CI 1.735.91 P=0.001), and, age (odds ratio 1.12, 95% CI 1.031.22, P=0.01). Conclusions: Despite similar demographic and angiographic characteristics, smoker males had a paradoxically better MPI after acute MI.Öğe The evaluation of doxorubicin-induced cardiotoxicity: Comparison of doppler and tissue doppler-derived myocardial performance index(Via Medica, 2012) Ayhan, S. Selim; Özdemir, Kurtuluş; Kayrak, Mehmet; Bacaksız, Ahmet; Vatankulu, M. Akif; Eren, Önder; Koç, FatihBackground: Doxorubicin is a chemotherapeutic agent used in a wide spectrum of cancers. However, cardiotoxic effects have limited its clinical use. The early detection of doxorubicin-induced cardiotoxicity is crucial. The purpose of our study was to assess values of Doppler and tissue Doppler imaging (TDI) -derived myocardial performance index (MPI) in adult cancer patients receiving doxorubicin treatment. Methods: A total of 45 patients underwent echocardiographic examinations before any doxorubicin had been administered and then after doxorubicin. Doppler and TDI-derived MPI of left ventricular (LV) were determined in the evaluation of cardiotoxicity. Additionally, TDI-derived MPI of right ventricular (RV) was determined. Results: All patients underwent control echocardiographic examination after mean 5 +/- 1.7 months. The LV MPI obtained by both Doppler and TDI were increased after doxorubicin treatment (0.56 +/- 0.11, 0.61 +/- 0.10, p = 0,005 vs 0.51 +/- 0.09, 0.59 +/- 0.09, p = 0.001, respectively). There was no correlation between Doppler-derived MPI and cumulative doxorubicin dose (coefficient of correlation 0.11, p = 0.6). TDI-derived MPI was correlated with cumulative doxorubicin dose (coefficient of correlation 0.35, p = 0.015), but this correlation is weak (r = 0.38). The study population was divided into two groups according to doxorubicin dose (below and above 300 mg level). There was a moderate correlation between TDI-derived MPI and less than 300 mg of doxorubicin dose (coefficient of correlation 0.51, p = 0.028). However, Doppler-derived MPI was not correlated with less than 300 mg of doxorubicin dose (coefficient of correlation 0.38, p = 0.123). Also, there was no significant change in the TDI-derived RV-MPI (0.49 +/- 0.14, 0.50 +/- 0.12, p = 0.56). Conclusions: TDI-derived MPI is a useful parameter and an early indicator compared with Doppler-derived MPI in the detection of cardiotoxicity during the early stages. Also, doxorubicin administration does not affect RV function. (Cardiol J 2012; 19,4: 363-368)Öğe The relationship between exercise capacity and masked hypertension in sedentary patients with diabetes mellitus(Taylor & Francis Inc, 2014) Akıllı, Hakan; Kayrak, Mehmet; Arıbaş, Alpay; Tekinalp, Mehmet; Ayhan, Selim SuziAim: Although exaggerated blood pressure responses (EBPR) to exercise have been related to future hypertension and masked hypertension (MHT), the relationship between exercise capacity and MHT remains unclear. A sedentary life style has been related to increased cardiovascular mortality, diabetes mellitus (DM), and hypertension. In this study, we aimed to examine the relationship between exercise capacity and MHT in sedentary patients with DM. Methods: This study included 85 sedentary and normotensive patients with DM. Each patient's daily physical activity level was assessed according to the INTERHEART study. All patients underwent an exercise treadmill test, and exercise duration and capacity were recorded. Blood pressure (BP) was recorded during all exercise stages and BP values >= 200/110 mmHg were accepted as EBPR. MHT was diagnosed in patients having an office BP < 140/90 mmHg and a daytime ambulatory BP > 135/85 mmHg. Patients were divided into two groups according to their ambulatory BP monitoring (MHT and normotensive group). Results: The prevalence of MHT was 28.2%. Exercise duration and capacity were lower in the MHT group than in the normotensive group (p < 0.05) and were negatively correlated with age, HbA1c, mean daytime BP, and mean 24 hour BP. Peak exercise systolic BP and the frequency of EBPR were both increased in the MHT group (25.0% and 8.1%, respectively, p = 0.03). According to a multivariate regression, exercise capacity (OR: 0.61, CI95%: 0.39-0.95, p = 0.03), EBPR (OR: 9.45, CI95%: 1.72-16.90, p = 0.01), and the duration of DM (OR: 0.84, CI95%: 0.71-0.96, p = 0.03) were predictors of MHT. Conclusion: Exercise capacity, EBPR, and the duration of DM were predictors of MHT in sedentary subjects with DM.Öğe The value of serum asymmetric dimethylarginine levels for the determination of masked hypertension in patients with diabetes mellitus(Elsevier Ireland Ltd, 2013) Taner, Alpaslan; Ünlü, Ali; Kayrak, Mehmet; Tekinalp, Mehmet; Ayhan, Selim SuziBackground: An increased prevalence of masked hypertension (MHT) has been demonstrated among patients with diabetes mellitus (DM). MHT appears to cause cardiovascular (CV) complications similar to clinically overt hypertension. Asymmetric dimethylarginine (ADMA) is an endogenous nitric oxide inhibitor and higher plasma levels of ADMA are related to increased CV risk in both the general population and among patients with DM. The aim of this study was to evaluate the relationship between MHT and ADMA in diabetic patients. Methods: This study included DM patients (n = 131) with normal office blood pressure (<140/90 mmHg). None of the participants were using antihypertensive medications. All participants utilized an ambulatory blood pressure monitor (ABPM) for 24 h. Serum ADMA and arginine levels were measured using the fluorescence detector high performance liquid chromatography method. Results: The prevalence of MHT was 24.4% among the study subjects. ADMA levels were increased in the MHT group when compared with normotensive diabetics (6.2 +/- 2.2 vs 4.2 +/- 1.7 mu mol/L p = 0.001, respectively). Furthermore, arginine/ADMA ratio was lower in the MHT group than among the normotensive group (29.9 +/- 12.1 vs 46.0 +/- 19.0 p = 0.001). In the multivariate logistic regression model, ADMA, BMI and HDL levels were found to be independent predictors of MHT Odds ratio: 1.63 (1.28-2.06), 1.19 (1.05-1.35), and 0.95 (0.90-0.99), respectively. The cut-off value of the ADMA was 4.34 mu mol/L with a sensitivity, specificity, positive predictive value, and negative predictive value of 84.4%, 59.6%, of 40.3%, and 92.2%, respectively (AUC - 0.78). Conclusions: Serum ADMA may play a role in both the pathophysiology and screening of MHT in DM subjects. (C) 2013 Elsevier Ireland Ltd. All rights reserved.
