Browsing by Author "Akcakoyun, Mustafa"

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Abnormal Left Ventricular Longitudinal Functional Reserve Assessed by Exercise Pulsed Wave Tissue Doppler Imaging in Patients With Subclinical Hypothyroidism
(Endocrine Soc, 2009) Akcakoyun, Mustafa; Kaya, Hasan; Kargin, Ramazan; Pala, Selcuk; Emiroglu, Yunus; Esen, Ozlem; Esen, Ali Metin
Background: Response of systolic and diastolic velocities of mitral annulus to exercise in patients with subclinical hypothyroidism (SCH) has not been explored previously. We sought to investigate whether SCH is associated with abnormal left ventricular (LV) longitudinal function reserve to exercise. Methods: Mitral annular systolic (S') and early diastolic (E') velocities were measured at rest and during supine bicycle exercise using tissue Doppler echocardiography (TDE) in 23 patients with newly diagnosed SCH and 25 controls. LV diastolic and systolic longitudinal function reserve indices were calculated. Results: There were no significant differences in mitral inflow velocities at rest between groups except for LV end-diastolic dimension and LV end-systolic dimension, which were higher in the control group. E' and S' at rest were also similar between the groups. However, S' (9.8 +/- 1.5 vs. 11.3 +/- 1.5 cm/sec at 25 W, P = 0.001; and 11.3 +/- 1.8 vs. 13.1 +/- 1.8 cm/sec at 50 W, P = 0.001) and E' (13.8 +/- 1.4 vs. 15.7 +/- 1.6 cm/sec at 25 W, P = 0.001; and 15.6 +/- 1.6 vs. 18.2 +/- 1.5 cm/sec at 50 W, P < 0.001) during exercise were significantly lower in patients with SCH. Longitudinal systolic and diastolic function reserve indices were significantly lower in patients with SCH (systolic index, 1.4 +/- 0.9 vs. 2.5 +/- 0.9 cm/sec at 25 W, P = 0.001; and 2.7 +/- 1.3 vs. 4.1 +/- 1.2 cm/sec at 50 W, P = 0.001; diastolic index, 2.3 +/- 1.3 vs. 3.6 +/- 1.5 cm/sec at 25 W, P = 0.003; and 3.9 +/- 1.6 vs. 5.9 +/- 1.3 cm/sec at 50 W, P < 0.001). Conclusion: Assessment of LV longitudinal functional reserve with exercise using TDE appears to be helpful in identifying early myocardial dysfunction in SCH. (J Clin Endocrinol Metab 94: 2979-2983, 2009)
Assessment of Atrial Conduction Time in Patients With Essential Hypertension
(Churchill Livingstone inc Medical Publishers, 2011) Emiroglu, Mehmet Yunus; Bulut, Mustafa; Sahin, Muslim; Acar, Gurkan; Akcakoyun, Mustafa; Kargin, Ramazan; Aung, Soe Moe
Background: We aimed to assess atrial conduction time in patients with essential hypertension. Methods: A total of 80 patients with hypertension (51 males/29 females, 53 +/- 12.5 years) and 80 controls (50 males/30 females, 50 +/- 12 years) were included. Atrial electromechanical coupling (time interval from the onset of P wave on surface electrocardiogram [ECG] to the beginning of A wave interval with tissue Doppler echocardiography [PA]), intraatrial and interatrial electromechanical delay (intra and inter atrial electromechanical delay [AEMD]), and P-wave dispersion (Pd) were measured (Appelton, C.P., Hatle, L., Popp, R.L., Relation of transmitral flow velocity patterns to left ventricular diastolic function: new insights from combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol. 1988; 12: 426-440). Results: Atrial electromechanical coupling at the left lateral mitral annulus (PA lateral) and septal mitral annulus were longer in patients with hypertension (63.0 +/- 8.0 vs 50.2 +/- 4.3, P < .001, and 53.3 +/- 6.2 vs 40.1 +/- 5.5, P < .001). Interatrial (PA lateral-PA tricuspid) and intraatrial electromechanical delay (PA septum-PA tricuspid) were longer in patients with hypertension (24.8 +/- 7.2 vs 12.4 +/- 4.3, P < .001, and 14.1 +/- 4.5 vs 2.3 +/- 1.6, P < .001, respectively). Maximum P-wave duration and Pd were higher in patients with hypertension compared with controls (95.6 +/- 8.0 vs 90.1 +/- 9.5, P = .01, and 41.3 +/- 7.1 vs 33.5 +/- 6.1 P < .001, respectively). In correlation analysis, a positive correlation was detected between interatrial electromechanical delay and Pd (r = 0.72, P < .001). There was a moderate correlation between left ventricular mass index and PA lateral (r = 0.48, P < .001). Conclusion: Our results revealed that interatrial electromechanical delay and Pd were prolonged in patients with hypertension. Our results also showed a correlation between interatrial electromechanical delay and Pd. Prolonged electromechanical delay and Pd found in hypertensive patients could be related with increased incidence of atrial fibrillation in these patients. Prospective studies are needed to document the association between intraatrial and interatrial electromechanical delays and the development of atrial fibrillation. (C) 2011 Elsevier Inc. All rights reserved.
Gamma Glutamyltransferase Levels and Its Association With High Sensitive C-Reactive Protein in Patients With Acute Coronary Syndromes
(Medknow Publications & Media Pvt Ltd, 2010) Emiroglu, Mehmet Yunus; Esen, Ozlem Batukan; Bulut, Mustafa; Karapinar, Hekim; Kaya, Zekeriya; Akcakoyun, Mustafa; Esen, Ali Metin
Background: Elevated Gamma-glutamyltransferase (GGT) level is independently correlated with conditions associatedwith increased atherosclerosis, such as obesity, elevated serum cholesterol, high blood pressure and myocardial infarction. It is also demonstrated that serum gamma-glutamyltransferase activity is an independent risk factor for myocardial infarction and cardiac death in patients with coronary artery disease. Although the relationship between gamma-glutamyltransferase and coronary artery disease has been reported, not many studies have shown the relationship between changes ofgamma-glutamyltransferase in acute coronary syndromes and a well established coronary risk factor high sensitive C-reactive protein. (hs-CRP). Aims: In this study, how gamma-glutamyltransferase levels changed in acute coronary syndromes and its relationship with high sensitive C-reactive protein if any were studied. Patients & Methods: This trial was carried out at Kosuyolu Cardiovascular Training and Research Hospital and Van Yuksek Ihtisas Hospital, Turkey. 219 patients (177 males and 42 females) presenting with acute coronary syndrome, and 51 control subjects between September 2007 and September 2008 were included in the study. Serum gamma-glutamyltransferase, high sensitive C-reactive protein, serum lipoprotein levels and troponin I were determined. Results: Serum gamma-glutamyltransferase and high sensitive C-reactive protein levels were higher in acute coronary syndrome patients compared to control. There was also correlation between gamma-glutamyltransferase and high sensitive C-reactive protein levels. Conclusion: Serum gamma-glutamyltransferase and high sensitive C-reactive protein levels were higher in acute coronary syndrome patients. In subgroup analyses, the higher difference with Non-ST elevation myocardial infarction and ST elevation myocardial infarction groups than unstable angina oectoris group proposes a relationship between gamma-glutamyltransferase and severity of acute coronary syndromes.
Ggt Levels in Type Ii Diabetic Patients With Acute Coronary Syndrome (Does Diabetes Have Any Effect on Ggt Levels in Acute Coronary Syndrome?)
(Springer-verlag Italia Srl, 2013) Emiroglu, Mehmet Yunus; Esen, Ozlem Batukan; Bulut, Mustafa; Karapinar, Hekim; Kaya, Zekeriya; Akcakoyun, Mustafa; Esen, Ali Metin
Elevated gamma-glutamyltransferase (GGT) level is independently correlated with conditions associated with increased atherosclerosis, such as obesity, elevated serum cholesterol, high blood pressure and myocardial infarction. It is demonstrated that serum GGT activity is an independent risk factor for myocardial infarction and cardiac death in patients with coronary artery disease. Diabetes is also a well-known cardiovascular risk factor and an equivalent of coronary artery disease. Although the relationship between GGT and coronary artery disease has been reported, there are limited data exploring the changes of GGT in acute coronary syndromes, especially in patients with diabetes. So, this study aimed to determine changes in GGT level in diabetic and non-diabetic acute coronary syndromes. This trial was carried out at Kosuyolu Cardiovascular Training and Research Hospital and Van Yuksek Ihtisas Hospital, Turkey. A total of 219 patients (177 men and 42 women) presenting with acute coronary syndrome) and 51 control subjects between September 2007 and September 2008 were included in the study. Serum gamma-glutamyltransferase and serum lipoprotein levels were determined. The resuls indicated that serum GGT levels were higher in acute coronary syndrome patients compared with control. In subgroup analyses, there was no difference between diabetic and non-diabetic subgroups. There was also weak correlation between GGT and blood glucose levels. There was no correlation between GGT and serum lipoprotein levels. In conclusion, serum GGT levels were higher in acute coronary syndrome patients. In subgroup analyses, There was no difference between diabetic and non diabetic subgroup.
Heart Rate Recovery and Chronotropic Incompetence in Patients With Subclinical Hypothyroidism
(Wiley-blackwell Publishing, inc, 2010) Akcakoyun, Mustafa; Emiroglu, Yunus; Pala, Selcuk; Kargin, Ramazan; Guler, Gamze Babur; Esen, Ozlem; Esen, Ali Metin
Methods: Twenty-five patients (11 men, 14 women with a mean age of 36 +/- 10 years) who were diagnosed SCH determined by an increased serum thyrothrophine (TSH) concentration (> 4.0 ng/mL) and the normal free triiodothyronine (fT3) and free thyroxin (fT4) levels, were included in the study. The control group of healthy individuals with normal TSH (12 males, 15 females) with a mean age of 36 +/- 3 years was also included. Two groups were well matched for age, sex, and body mass index. Medical history, physical examination, electrocardiogram, treadmill exercise testing, and chest radiogram were performed for all participants. Results: The characteristics of SCH patients and control cases were similar with regard to age, sex, and BMI except for TSH levels. Serum TSH levels were significantly higher in SCH patients than the controls (P < 0.001). No significant differences were observed in the changes of heart rate (HR), exercise tolerance (metabolic equivalents), or systolic and diastolic blood pressures at rest or during exercise between the groups, whereas HRR and CI were significantly lower during exercise testing in the SCH patients compared to controls (P < 0.003; P < 0.03, respectively). Conclusion: The results of the present study demonstrated that SCH can cause impaired cardiovascular autonomic function and attenuated HR response to exercise. (PACE 2010; 2-5).
The Prognostic Value of Combined Fractional Flow Reserve and Timi Frame Count Measurements in Patients With Stable Angina Pectoris and Acute Coronary Syndrome
(Wiley-blackwell, 2010) Esen, Ali M.; Acar, Goksel; Esen, Ozlem; Emiroglu, Yunus; Akcakoyun, Mustafa; Pala, Selcuk; Turkmen, Muhsin
Background: The aim of this study was to evaluate the prognostic value of different fractional flow reserve (FFR) cutoff values and corrected thrombolysis in myocardial infarction frame (TIMI) count ( CTFC) measurements in a series of consecutive patients with moderate coronary lesions, including patients with unstable angina, myocardial infarction, and/or positive noninvasive functional test findings. Methods: We included 162 consecutive coronary patients in whom revascularization of a moderate coronary lesion was deferred based on a FFR value >= 0.75. Patients were divided according to the results of the intracoronary pressure and flow measurements into four groups: group A: 0.75 < FFR < 0.85 and CTFC > 28 (n = 22), group B: 0.75 < FFR < 0.85 and CTFC < 28 (n = 55), group C: 0.85 < FFR and CTFC > 28 (n = 19), and group D: 0.85 < FFR and CTFC < 28 (n = 66). Adverse cardiac events and the presence of angina were evaluated at follow-up. Results: At a mean follow-up of 18 +/- 10 months, cardiac event rate in patients with 0.75 < FFR < 0.85 and FFR > 0.85 were 22% and 9%, respectively (P = 0.026) and also, a trend was observed toward a higher cardiac event rate in case of an abnormal CTFC (CTFC > 28) compared to a normal CTFC (24% vs 12%, P = 0.066). Furthermore, a significantly higher cardiac event rate was observed when group A was compared to group D (31.8% vs 7.6%, respectively, P = 0.004). Conclusion: Patients with potential microvascular dysfunction and borderline FFR values should be interpreted with caution, and management strategies should be guided not only by pressure measurement, but also by possibly supplementary clinical risk stratification and noninvasive tests. (J Interven Cardiol 2010;23:421-428).
Serum Levels of Angiopoietin-1 in Patients With Pulmonary Hypertension Due To Mitral Stenosis
(Springer, 2011) Karapinar, Hekim; Esen, Ozlem; Emiroglu, Yunus; Akcakoyun, Mustafa; Pala, Selcuk; Kargin, Ramazan; Esen, Ali Metin
The molecular basis and pathophysiology of pulmonary hypertension (PH) are rapidly evolving areas. Recently discovered angiopoietins (Ang) constitute a family of growth factors, and whether they play a causal or protective role in pulmonary hypertension has not been fully elucidated. Since left heart disease probably represents the most frequent cause of PH, we sought to determine whether there was a relationship between serum Ang-1 levels and pulmonary hypertension caused by mitral stenosis (MS). The study population was composed of 49 patients with isolated MS. These patients were then divided into group 1 [31 patients with severe MS: mitral valve area (MVA) <= 1.1 cm(2)] and group 2 (18 patients with mild-moderate MS: MVA 1.2-2.0 cm(2)). Twenty-one healthy volunteers comprised the control group (group 3). All of the subjects underwent complete transthoracic echocardiography with determination of systolic pulmonary artery pressure (PAPs). Ang-1 levels were determined in serum. Serum levels of Ang-1 were significantly higher in the control group compared to patients with severe (group 1) and mild-moderate (group 2) MS (p < 0.001). Ang-1 levels were found to have moderate inverse correlation with PAPs and left atrial (LA) diameter (r: -0.620, p < 0.001 and r: -0.489, p < 0.001, respectively). The AUC for the ROC curve for predicting PAPs < 50 mmHg by serum Ang-1 level was 0.824 (95% CI 0.722-0.926, p < 0.001). A serum level of Ang-1 above 34,656 pg/ml has 74% sensitivity and 80% specificity for predicting that PH is not severe (PAPs < 50 mmHg). In conclusion, the findings of this study are distinctive in the sense that they clearly demonstrate a negative correlation between serum Ang-1 levels and the degree of PH.
Uric Acid as a Marker of Oxidative Stress in Dilatation of the Ascending Aorta
(Oxford Univ Press, 2011) Esen, Ali M.; Akcakoyun, Mustafa; Esen, Ozlem; Acar, Goksel; Emiroglu, Yunus; Pala, Selcuk; Barutcu, Irfan
BACKGROUND Increased serum uric acid (UA) has been shown to directly promote oxidative stress. Recent studies point toward a role for oxidative stress in the pathogenesis of ascending aortic aneurysms (AscAAs). This study was designed to examine the relationship between serum UA concentrations, total antioxidant reductive capacity, and AscAAs. METHODS The serum UA concentrations, total antioxidant reductive capacity were compared in 60 patients with ascending aortic dilatation (ectasia group (3.8-4.3 cm), 34 patients; aneurysmal group (>= 4.4cm), 26 patients) vs. 30 control subjects. The patients were evaluated by a complete transthoracic echocardiographic examination including measurement of the aortic dimensions. RESULTS The serum UA concentration and total antioxidant reductive capacity were significantly higher in patients with AscAAs. In multiple linear regression analysis, hypertension and serum UA concentration were significantly associated with aortic dilatation (beta = 0.3, P=0.03; beta = 0.15, P < 0.001, respectively). CONCLUSIONS In conclusion, we found that serum UA concentration and total antioxidant capacity (TAC) were significantly associated with aortic dilatation. The higher serum UA concentration may be responsible for the elevated serum antioxidant capacity that was observed among individuals with AscAA. Large-scale epidemiological studies conducted over several years are required to correlate the cross-sectional findings from this study with clinical outcome.