Browsing by Author "Bilge, AR"
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Item Coarctation of the aorta evaluated with 64-row multislice computed tomographyUtuk, O; Karaca, M; Bayturan, O; Oncel, G; Tezcan, UK; Bilge, ARItem Increased serum leptin concentrations in patients with chronic stable angina pectoris and ST-elevated myocardial infarctionTaneli, F; Yegane, S; Ulman, C; Tikiz, H; Bilge, AR; Ari, Z; Uyanik, BSLeptin is an adipocytokine that is produced mainly by adipose tissue; it is also identified in atherosclerotic lesions in human coronary atherosclerosis. However, the relation of serum leptin concentrations to ischemic heart disease (IHD) is still obscure. The aims of the present study were to investigate serum leptin concentrations in patients with ST-elevated myocardial infarction (STEMI) and with chronic stable angina pectoris (CSAP) and to evaluate the possible correlations of leptin to other atherosclerotic risk factors; including serum high sensitive C-reactive protein (Hs-CRP), serum homocysteine, and fibrinogen concentrations. For this purpose, 35 patients with CSAP, 40 with acute STEMI, and 30 control subjects with normal findings from coronary angiography were taken into the study prospectively. Serum leptin concentrations were significantly higher in patients with CSAP and STEMI compared to the control group (7.74 +/- 1.34 vs 6.37 +/- 1.85 ng/mL, p=0.021 and 8.22 +/- 3.13 vs 6.37 1.85 ng/mL, p=0.023, respectively). In addition, serum homocysteine concentrations were significantly increased in patients with CSAP (15.23 +/- 5.96 vs 11.40 +/- 2.11 mu mol/L, p=0.025) and patients with STEMI (15.90 +/- 5.02 vs 11.40 +/- 2.11 mu mol/L, p=0.012) compared to the control group. Serum fibrinogen concentrations were significantly increased only in the CSAP group as compared to controls (4.15 +/- 1.39 vs 3.45 +/- 1.19 g/L, p = 0.025). No significant correlation was found between leptin levels and selected risk factors. In conclusion, serum leptin concentrations were significantly higher in both the CSAP and STEMI groups. However, owing to the lack of correlation between the leptin levels and selected classical coronary risk factors, it may be considered that leptin can be evaluated as one of the independent risk factors for IHD. Further randomized and controlled studies will be required to determine the pathophysiological meaning of the increased leptin levels and the central role between adipocyte function and atherosclerosis.Item Evaluation of coronary sinus strain in patients with dipper and nondipper hypertensionAkcay, S; Turker, Y; Kobat, MA; Cetin, N; Bilge, AR; Tezcan, UKObjective Hypertension has been reported to affect both the left and the right ventricular functions, but its effect on the coronary sinus has not been investigated. The aim of this study was to investigate the effect of systemic hypertension on the cardiac venous system by evaluating the coronary sinus strain (CSS). Methods One-hundred and twelve hypertensive patients without diabetes and 44 healthy individuals (the control group) were evaluated consecutively at the outpatient clinic and enrolled in the study. CSS was evaluated by echocardiography in all the participants before blood pressure evaluations. Twenty-four-hour ambulatory blood pressure monitoring enabled the study population to be divided into two groups: 52 patients with dipper pattern hypertension and 60 with nondipper pattern hypertension. Results Nondipper pattern patients had significantly lower values of CSS compared with the participants in the control group (140.8 +/- 54.2 and 193.9 +/- 48.1, P < 0.001). Similarly, dipper pattern patients had significantly lower values of CSS values compared with the controls (164 +/- 68.4 and 193.9 +/- 48.1, P = 0.036). On comparing the three groups, the CSS values showed a progressive decrease from normal individuals to dipper and nondipper hypertension patients. Correlation analysis indicated a positive correlation between the aortic strain and the CSS (r = 0.247, P = 0.002). There was a weak correlation between left ventricular mass and CSS (r = -164, P = 0.041). Conclusion Our study suggests that systemic hypertension may affect the cardiac venous system as well as the arterial system, which has been reported in many papers. The effect on the venous system may be more pronounced in nondipper pattern hypertension. Blood Press Monit 19: 320-326 (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.Item Prognostic value of C-reactive protein/albumin ratio in hypertensive COVID-19 patientsÖzdemir, IH; Özlek, B; Özen, MB; Gündüz, R; Çetin, N; Özlek, E; Yildiz, BS; Bilge, ARObjectives The aim of this study was to investigate the relationship between the C-reactive protein/albumin ratio and the prognosis of hypertensive COVID-19 patients. Methods It was designed as a single center retrospective study. PCR positive COVID-19 patients who were followed up in the intensive care unit (ICU) and received antihypertensive treatment were included in the study. The patients were divided into two groups as survivor and non-survivor. C-reactive protein/albumin (CAR) ratios of the patients were compared. The cut-off value was determined as a mortality predictor. The effect of CAR on mortality was evaluated using Logistic Regression analysis. Results 281 patients were included in the study. Groups consisted of 135 (non-survivor) and 146 (survivor) patients. CAR was significantly higher in the non-survivor group (p<0.001). The area under the ROC curve for CAR for mortality was 0.807, with sensitivity of 0.71 and specificity of 0.71. The cut-off value for CAR was calculated as 56.62. In logistic regression analysis, CAR increases mortality 4.9 times compared to the cut-off value. Conclusion CAR is a powerful and independent prognostic marker for predicting mortality and disease progression in hypertensive COVID-19 patients.Item Evaluation of Coronary Sinus Strain in Patients with Dipper and Non-Dipper HypertensionAkçay, S; Turker, Y; Kobat, MA; Çetin, N; Bilge, AR; Tezcan, UKItem The Echocardiographic Evaluation of Right Ventricular Function in Patients with Non-Dipper HypertensionAkçay, S; Bilge, AR; Turker, Y; Yavuz, V; Çetin, N; Dalgic, OItem Hydroxychloroquine/azithromycin treatment, QT interval and ventricular arrhythmias in hospitalised patients with COVID-19Özdemir, IH; Özlek, B; Özen, MB; Gündüz, R; Çetin, N; Bilge, ARBackground Hydroxychloroquine (HCQ) and azithromycin (AZM) are widely used in off-label treatment of novel coronavirus disease (COVID-19). However, cardiac safety of these drugs is still controversial in COVID-19. Therefore, we aimed to evaluate association of HCQ or HCQ + AZM treatment regimens, corrected QT (QTc) interval and malignant ventricular arrhythmias in hospitalized patients. Methods This is a single-center, retrospective and observational study. All data were extracted from the electronic medical records. The initial and post-treatment mean QTc intervals were calculated and compared in patients with HCQ alone or HCQ + AZM therapy. Associated factors with QTc prolongation, the incidence of ventricular arrhythmia during treatment and in-hospital mortality because of ventricular arrhythmias were evaluated. Results Our cohort comprised 101 hospitalized COVID-19 patients (mean age of 49.60 +/- 18 years, 54.4% men). HCQ + AZM combination therapy group (n = 56) was more likely to have comorbidities. After 5-days treatment, 19 (18.8%) patients had QTc prolongation, and significant increase in the QTc interval was observed in both two groups (P < .001). However, HCQ + AZM combination group had significantly higher Delta QTc compared to HCQ group (22.5 +/- 18.4 vs 7.5 +/- 15.3 ms, P < .001). All of 101 patients completed the 5-days treatment without interruption. Also, no malignant ventricular arrhythmia or death secondary to ventricular arrhythmia occurred during the treatment in both groups. Conclusions The present study revealed that although HCQ + AZM treatment was independently associated with QTc prolongation, none of patients experienced malignant ventricular arrhythmia or death during treatment. Further prospective studies are needed to determine the exact implications of these drugs on arrhythmias in patients with COVID-19.Item THE EFFECT OF SMOKING AND DISEASE SEVERITY ON QT DISPERSION IN CHRONIC OBSTRUCTIVE PULMONARY DISEASEHepcivici, U; Acar, M; Tikiz, H; Tezcan, UK; Tavli, T; Bilge, AR; Bayturan, O; Utuk, OItem The effect of long-term continuous positive airway pressure treatment on systolic and diastolic function in patients with obstructive sleep apnoea syndrome: A five year observational studyBilge, AR; Yavuz, V; Çetin, N; Dalgiç, O; Kum, G; Yilmaz, H; Tikiz, HObjective: Evaluation of the long-term effects of continuous positive airway presure (CPAP) on mean heart rate and left ventricular systolic and diastolic parameters in obstructive sleep apnea syndrome (OSAS) using conventional and tissue Doppler techniques. Methods: This prospective cohort study is designed to evaluate the long-term effects of CPAP treatments in normotensive OSAS patients. Initially 40 patients aged from eighteen to fifty five with documented OSAS syndrome were evaluated within one month of CPAP treatment. All had high self-reported compliance with treatment. From the latter, 21 patients with uninterrupted CPAP therapy (for at least 5 years, 5 hours per day) were included in the study and further evaluated with treatment. The left ventricular systolic function was assessed on apical four-chamber view using modified Simpson method and diastolic function was evaluated with classic transmitral pulsed and tissue Doppler techniques. Paired t test and Wilcoxon signed rank test had been used to compare the clinical and echocardiography data before and after treatment period. Results: A comparison of values assessed after one month and after 5 years of CPAP therapy, revealed a significant increase in the acceleration time(AT) Em/Am ratio and ejection time (ET) (AT: p=0.04; Em/Am ratio p=0.03 ET: p=0.04) while a significant decrease was observed on deceleration time (DT), isovolumetric relaxation time (IRT), myocardial performance index (MPI), mitral regurgitation (MR) and 24 hour mean heart rate (HR) in all subjects (DT: p=0.02; IVRT: p=0,04; MPI: p=0,01; MR: p=0.001; HR: p=0.004). Conclusion: We observed a significant improvement in the left ventricular systolic and diastolic function and a significant decrease of 24-hour heart rate and mitral regurgitation with unchanged ejection fraction of the left ventricle with long-term CPAP treatment similar to short-term treatment studies. The long-term maintenance of the beneficial effect of CPAP throughout the 5 year long-term treatment can be one of the pathophysiologic mechanisms that may explain the decrease of cardiovascular mortality observed with long-term CPAP therapy in OSAS patients.Item Giant unruptured noncoronary sinus of valsalva aneurysmUtuk, O; Bayturan, O; Bilge, AR; Tikiz, H; Tezcan, UKItem Antithrombotic Drug Resistance In Patients With Coronary Artery Disease.Türkel, G; Bilge, AR; Taneli, F; Tikiz, HItem The effect of tirofiban on ST segment resolution in patients with non-ST elevated myocardial infarctionBayturan, Ö; Bilge, AR; Seküri, C; Ütük, O; Tikiz, H; Eser, E; Tezcan, UKST segment resolution in ST elevated myocardial infarction has independent predictive value for congestive heart failure and death at 30 days.(1-2)) ST segment depression in unstable angina pectoris (UAP) and non-ST elevated myocardial infarction (NSTEMI) predicts high risk of MI and death and may discriminate patients likely to have greater benefit from aggressive antithrombotic and interventional therapy.(5-6)) This study assessed the effect of tirofiban added to conventional treatment on ST segment resolution in NSTEMI patients. Sixty-four patients were randomized to one of the two groups: 32 patients received conventional treatment while tirofiban was added in the second group of 32 patients. In the first group, 6 patients refused to participate further after giving initial informed consent while 1 patient in the tirofiban group dropped out. We had 26 patients (mean age, 59 years) in the conventional treatment group and 31 patients (mean age, 59 years) received also tirofiban. Tirofiban was administered by intravenous infusion over a 72 hour period. More than 50% regression of depression was considered to be ST segment resolution. The characteristics of the two groups were comparable (Table I). The ST segment resolution evolution did not differ at the 4(th) and 24(th) hours between the two groups. Significant differences occurred in the 72(nd) hour ECG (Table III). ST resolution was present in 67.9% of the tirofiban patients and in 32.1% of the conventional treatment group (P < 0.05). Tirofiban treatment was not associated with an increase in major bleeding even though there was a trend toward an increase in minor bleeding cases and did not influence the occurrence of refractory angina pectoris.Item Huge pulsating cystic cardiac massUtuk, O; Bilge, AR; Bayturan, O; Sirin, H; Iskesen, I; Teznan, UKItem Comparison of Resistance Rate in Coronary Artery Patients With Antithrombotic TreatmentTürkel, G; Taneli, F; Bilge, AR; Tikiz, HItem HbA1c Levels Increase in Patients with Non-Dipper Hypertension without Diabetes MellitusAkçay, S; Kobat, MA; Inci, F; Birkan, Z; Yildiz, M; Dagli, N; Cetin, N; Bilge, ARItem The Evaluation of Galectin-3 Levels in Non-dipper Hypertensive PatientsAkçay, S; Cakin, O; Ilhan, N; Kalayci, H; Kobat, MA; Gulger, M; Yavuz, V; Dalgic, O; Bilge, ARItem Strenuous Exercise Induced Syncope Due to Coronary Artery AnomalyYavuz, V; Cetin, N; Tuncer, E; Dalgic, O; Taskin, U; Bilge, AR; Tikiz, HCoronary artery anomalies are among the neglected topics in cardiology. Anomalous origin of the left main coronary artery from the right sinus of valsalva is a rare coronary anomaly observed in 0.15% of patients. During exercise, the distended aorta and pulmonary artery with increased blood flow may squeeze the Left Main Coronary Artery (LMCA) between them. Even though arrhythmias are common causes of syncope, one should also think about aberrant coronary artery in the patients with syncope of unexplained origin. Patients experiencing exercise induced syncope accompanied by symptoms of coronary ischemia (typically: chest pain, ischemic findings on ECG, and raised cardiac markers) should be referred to diagnostic coronary angiography.0Item Implications of continuous positive airway pressure on heart rate variability in patients with obstructive sleep apnea: Does gender matter?Özlek, B; Özlek, E; Dogan, V; Basaran, Ö; Çil, C; Çelik, O; Biteker, M; Bilge, ARObjective: This study was designed to determine the effectiveness of continuous positive airway pressure (CPAP) treatment on the improvement of heart rate variability (HRV) and whether gender plays a role in HRV in patients with moderate to severe obstructive sleep apnea syndrome (OSAS). Methods: Consecutive patients with recently diagnosed moderate to severe OSAS underwent continuous synchronized electrocardiographic monitoring and were prospectively considered for inclusion in the study. HRV was analyzed before starting CPAP therapy and 1 year thereafter. The effects of CPAP on HRV were evaluated in men and women separately to ascertain whether there are gender differences in the clinical manifestations of OSAS and whether female HRV responses to CPAP are similar to those of men. Results: A total of 18 patients (10 men, median age: 56 years) were included in the study. There were no significant differences in the baseline clinical characteristics of the male and female patients. After 1 year of CPAP treatment, heart rate decreased (p<0.05) and time domain parameters increased (p<0.05) in both men and women. None of the frequency domain parameters changed in women (p>0.05), whereas the high frequency power measured increased (p<0.05) and the ratio of low frequency to high frequency decreased (p<0.05) in men after 1 year of CPAP treatment. The increase in HRV after 1 year of CPAP therapy was significantly higher in men than in women (p<0.05). Conclusion: CPAP therapy reduced enhanced cardiac sympathetic nerve activity in patients with OSAS assessed according to HRV. The beneficial effect of long-term CPAP therapy on HRV was more pronounced in men.