Browsing by Author "Akyol, Aytac"

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Association of Coronary Sinus Diameter With Pulmonary Hypertension
(Blackwell Publishing, 2008) Gunes, Yilmaz; Guntekin, Unal; Tuncer, Mustafa; Kaya, Yuksel; Akyol, Aytac
Background: Impaired venous drainage secondary to increased right atrial pressure (RAP) may result in coronary sinus (CS) dilatation. Methods: Two hundred fifteen patients referred for transthoracic echocardiography were included in the study. CS diameters were measured from apical four-chamber view with the transducer being slightly tilted posteriorly to the level of the dorsum of the heart. Pulmonary artery systolic pressure (PASP) is estimated by measurement of tricuspid regurgitation velocity (v) and estimate RAP based on size and collapsibility of inferior vena cava (VCI) with the formula PASP: 4v(2)+ RAP. Patients with PASP > 35 mmHg were considered to have pulmonary hypertension (PH). Results: CS diameter was measured in 80.3% of the patients with normal PASP (8.1 +/- 2.4 mm) and 93.1% of the patients having PH (12.3 +/- 2.5 mm). PASP was significantly correlated with CS diameter (r = 0.647, P < 0.001), RA volume index ( r = 0.631, P < 0.001), RV volume index (r = 0.475, P < 0.001), VCI diameter (r = 0.365, P < 0.001), and left ventricular ejection fraction (LVEF) (r = - 0.270, P < 0.001). CS diameter was also correlated significantly with estimated RAP (r = 0.557, P < 0.001), RA volume index (r = 0.520, P < 0.001), RV volume index (r = 0.386, P < 0.001), LVEF (r = - 0.327, P < 0.001), and VCI diameter (r = 0.313, P < 0.001). Multivariate analyses, testing for independent predictive information of CS size, VCI diameter, RA and RV volume indexes, and estimated RAP for the presence of PH revealed that estimated RAP (beta = 0.465, P < 0.001) and CS size (beta = 0.402, P = 0.003) were the significant predictors. Conclusions: Coronary sinus is dilated in patients with pulmonary hypertension. Coronary sinus diameter significantly correlates with PASP, RAP, right heart chamber volumes, LVEF, and VCI diameter.
Association of Epicardial Adipose Tissue Thickness and Inflammation Parameters With Cha2ds2-Vasasc Score in Patients With Nonvalvular Atrial Fibrillation
(Dove Medical Press Ltd, 2015) Akdag, Serkan; Simsek, Hakki; Sahin, Musa; Akyol, Aytac; Duz, Ramazan; Babat, Naci
Background: Epicardial adipose tissue (EAT), mean platelet volume (MPV), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR) have been shown to be helpful in predicting adverse cardiovascular events. However, to date, in the literature, there have been no studies demonstrating the relationship between EAT, MPV, PLR, NLR, and thromboembolism risk in atrial fibrillation (AF). Therefore, we examined the relationship between EAT, MPV, PLR, NLR, and CHA(2)DS(2)-VASc score used for the evaluation of thromboembolism risk in patients with AF. Methods: The study included 96 consecutive patients with AF and 52 age-and sex-matched control subjects. We calculated CHA2DS2-VASc risk score for each patient and measured baseline EAT thickness, MPV, PLR, NLR, left atrial volume index, and left ventricular ejection fraction. Results: The group with high CHA2DS2-VASc score had higher EAT (7.2 +/- 1.5 vs 5.9 +/- 1.2 mm, P<0.001), MPV (9.1 +/- 1.1 vs 8.4 +/- 1.0 fL, P=0.004), PLR (152.3 +/- 28.4 vs 126.7 +/- 25.4, P=0.001), and NLR (4.0 +/- 1.6 vs 3.2 +/- 1.3, P<0.001) compared to group with low-intermediate CHA2DS2-VASc score. Moreover, CHA2DS2-VASc score was found to be positively correlated with EAT (r=0.623, P<0.001), MPV (r=0.350, P=0.004), PLR (r=0.398, P=0.001), and NLR (r=0.518, P<0.001). Conclusion: Our study results demonstrated that EAT thickness, MPV, PLR, and NLR were associated with the thromboembolic risk exhibited by CHA2DS2-VASc score in patients with nonvalvular AF.
Bicuspit Aorta, Aneurysm of Ascendan Aorta, Significant Aort and Mitral Insufficiency in Patient With Marfan Syndrome
(Elsevier Ireland Ltd, 2010) Tuncer, Mustafa; Akdag, Serkan; Gumrukcuoglu, Hasan Ali; Akyol, Aytac; Gunes, Yilmaz
Clinical and Laboratory Aspects of Our Patients Have Pericardial Effusion
(Elsevier Ireland Ltd, 2010) Gumrukcuoglu, Hasan Ali; Akyol, Aytac; Tuncer, Mustafa; Gunes, Yilmaz; Akdag, Serkan; Begenik, Huseyin; Simsek, Hakki
Comparison of Inflammatory Markers in Non-Dipper Hypertension Vs. Dipper Hypertension and in Normotensive Individuals: Uric Acid, C-Reactive Protein and Red Blood Cell Distribution Width Readings
(Termedia Publishing House Ltd, 2014) Tosu, Aydin Rodi; Demir, Serafettin; Selcuk, Murat; Kaya, Yuksel; Akyol, Aytac; Ozdemir, Mahmut; Tenekecioglu, Erhan
Aim: In this study, we investigated the relationship of increased inflammatory parameters (C-reactive protein - CRP), oxidative stress markers (serum uric acid -SUA) and red blood cell distribution width (RDW) with non-dipper hypertension (NDHT). Material and methods: Among the individuals who presented to the cardiology clinic, 40 patients (32.5% male, 67.5% female; mean age: 54.4+/-7.1) who had hypertension and were diagnosed with NDHT through ambulatory blood pressure monitoring, 40 age- and sex-matched dipper hypertension (DHT) patients (25% male, 75% female, mean age: 54.2+/-7.0), and 40 normotensive individuals (42.5% male, 57.5% female, mean age: 51.9+/-9.0) were enrolled in the study. Peripheral venous blood samples were collected from all the patients in order to evaluate the hematological and biochemical parameters. All the assessed parameters were compared among the groups. Results: The CRP, RDW and uric acid levels were observed to be significantly higher in the non-dipper hypertension group in comparison to the dipper hypertension patients and the normotensive population (p < 0.05). These parameters were also significantly higher in the dipper HT group compared to the normotensive population (p < 0.05). Conclusions: We found in our study that increased CRP, uric acid and RDW levels, which are indicators of increased inflammation and oxidative stress, are significantly higher in the non-dipper HT patients in comparison to the dipper HT patients and control group.
Compliance With Dyslipidemia Guidelines in Daily Practice: How Effective Is Cardiovascular Risk Prevention
(Elsevier, 2018) Guntekin, Unal; Gumrukcuoglu, Hasan Ali; Yaman, Mehmet; Ozturk, Fatih; Akyol, Aytac; Gumrukcuoglu, Fatma Nur; Kandemir, Yasemin Behram
Purpose: Cardiovascular disease (CVD) due to atherosclerosis is the leading cause of early mortality and morbidity. The current European guidelines on CVD prevention in clinical practice recommend the use of the Systematic Coronary Risk Estimation (SCORE) system. The current American Heart Association guidelines recommend the use of the new pooled cohort risk assessment equations to estimate the 10-year atherosclerotic CVD risk. The purpose of this article was to investigate the compliance of dyslipidemia guidelines in daily practice in patients with dyslipidemia or who have risk factors for CVD. Methods: The study group consisted of 500 outpatients who had dyslipidemia or risk factors for CVD. The risk level was computed according to the European and American Heart Association guidelines. Therapeutic LDL-C targets were identified based on the calculated risk level. Therapeutic target levels were compared based on the dosage of statins used and achievement of the LDL-C goal in daily practice according to the risk levels. Findings: According to the European dyslipidemia guidelines, 231 patients were in the very-high/high-risk group, and 106 patients (45.9%) achieved the LDL-C target (<100 mg/dL); 210 patients were in the moderate-risk group, and 156 (74.3%) patients achieved the LDL-C target (<115 mg/dL); and 59 patients were in the low-risk group, and 55 (93.2%) patients achieved the LDL-C target (<155 mg/dL). Univariate and multivariate logistic regression analyses revealed that the LDL-C level and presence of coronary artery disease were significantly reverse associated with achievement of the LDL-C goal (both, P < 0.001). (C) 2018 Elsevier Inc. All rights reserved.
Decreased Risk of Ventricular Arrhythmias With Treatment of Nebivolol in Patients With Coronary Slow Flow
(Via Medica, 2016) Simsek, Hakki; Yaman, Mehmet; Babat, Naci; Akdag, Serkan; Akyol, Aytac; Demirel, Koray Celal; Gunes, Yilmaz
Background: Coronary slow-flow (CSF) is an angiographic phenomenon characterised by delayed opacification of vessels in the absence of any evidence of obstructive epicardial coronary disease. QT interval dispersion (QTD) reflects regional variations in ventricular repolarisation and cardiac electrical instability and has been reported to be longer in patients with CSF. Aim: To examine QT duration and dispersion in patients with CSF and the effects of nebivolol on these parameters. Methods: The study population included 67 patients with angiographically proven normal coronary arteries and CSF, and 38 patients with angiographically proven normal coronary arteries without associated CSF. The patients were evaluated with 12-lead electrocardiography, and echocardiography before and three months after treatment with nebivolol. Results: Compared to the control group QTcmax and QTcD were significantly longer in patients with CSF (p = 0.036, p = 0.019, respectively). QTcD significantly correlated with the presence of CSF (r = 0.496, p < 0.001). QTcmax (p = 0.027), QTcD (p = 0.002), blood pressure (p = 0.001), and heart rate (p < 0.001) values significantly decreased after treatment with nebivolol. Conclusions: Coronary slow flow is associated with increased QTD. Nebivolol reduced increased QTD in patients with CSF after three months.
The Effect of Low-Sodium Dialysate on Ambulatory Blood Pressure Measurement Parameters in Patients Undergoing Hemodialysis
(Dove Medical Press Ltd, 2015) Akdag, Serkan; Akyol, Aytac; Cakmak, Huseyin Altug; Tosu, Aydin Rodi; Asker, Muntecep; Yaman, Mehmet; Gumrukcuoglu, Hasan Ali
Background: End stage renal disease is related to increased cardiovascular mortality and morbidity. Hypertension is an important risk factor for cardiovascular disorder among hemodialysis (HD) patients. The aim of this study was to investigate the effect of low-sodium dialysate on the systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels detected by ambulatory BP monitoring (ABPM) and interdialytic weight gain (IDWG) in patients undergoing sustained HD treatment. Patients and methods: The study included 46 patients who had creatinine clearance levels less than 10 mL/min/1.73 m(2) and had been on chronic HD treatment for at least 1 year. After the enrollment stage, the patients were allocated low-sodium dialysate or standard sodium dialysate for 6 months via computer-generated randomization. Results: Twenty-four hour SBP, daytime SBP, nighttime SBP, and nighttime DBP were significantly decreased in the low-sodium dialysate group (P<0.05). No significant reduction was observed in both groups in terms of 24-hour DBP and daytime DBP (P=NS). No difference was found in the standard sodium dialysate group in terms of ABPM. Furthermore, IDWG was found to be significantly decreased in the low-sodium dialysate group after 6 months (P<0.001). Conclusion: The study revealed that low-sodium dialysate leads to a decrease in ABPM parameters including 24-hour SBP, daytime SBP, nighttime SBP, and nighttime DBP and it also reduces the number of antihypertensive drugs used and IDWG.
Effects of Illness Activity on Electrocardiographic Parameters in Patient With Multiple Sclerosis
(Drunpp-sarajevo, 2012) Gumrukcuoglu, Hasan Ali; Akyol, Aytac; Akdag, Serkan; Simsek, Hakki; Tombul, Temel
Background: Multiple sclerosis (MS) has been reported to be associated with autonomic dysfunction. QT and P wave duration are clearly related to autonomic nervous system. We compared P wave dispersion (PWD) and corrected QT dispersion (QTcD) in stable phase and active phase MS patients to healthy control subjects. Method: 76 MS patients and44 healthy control subjects were included. Twelve-lead surface ECG recording was performed all participants. The P and QT wave parameters were measured manually Results: Maximum P wave and QTc duration were higher in MS patients than control groups. The average PWD and QTcD value of MS patients was also found to be higher than control groups. According to illness activity, statistically differences weren't observed at ECG parameters in patients with MS. Conclusion: P wave and QTc duration were found to be statistically different in patients with MS and control subjects. But illness activity didn't affect these electrocardiographic parameters as significantly.
Effects of Lowering Dialysate Sodium on Carotid Artery Atherosclerosis and Endothelial Dysfunction in Maintenance Hemodialysis Patients
(Springer, 2012) Gumrukcuoglu, Hasan Ali; Ari, Elif; Akyol, Aytac; Akdag, Serkan; Simsek, Hakki; Sahin, Musa; Tuncer, Mustafa
Purpose Our aim in this study was to examine the effects of low-sodium dialysate on carotid artery atherosclerosis, endothelial dysfunction, and blood pressure (BP) in maintenance hemodialysis (HD) patients. Methods After baseline measurements were obtained, the dialysate sodium concentration was reduced from 140 to 137 mEq/L. Carotid artery intima-media thickness (CIMT) and flow-mediated dilatation (FMD %) were measured before and after 6 months of HD with low-sodium dialysate. Interdialytic weight gain (IDWG), pre- and post-dialysis BP, and dialysis-related symptoms were monitored during the study. Results Fifty-two patients were enrolled, and 41 patients completed the study. Twenty-one patients had hypertension and were receiving antihypertensive medications. The average number of antihypertensive drugs per patient was 1.9 +/- 0.8. There was no significant reduction in BP at the end of the study, but the average number of antihypertensive drugs was reduced to 1.2 +/- 0.4 (P < 0.001). There were significant improvements in CIMT (P = 0.003) and FMD (P < 0.001) with low-sodium HD. The IDWG decreased significantly during the low-sodium dialysate treatment (P < 0.001). However, hypotensive episodes and cramps were more frequent during the study period. Conclusions Our study demonstrated that the lowering of dialysate sodium concentration reduced CIMT, improved FMD, and provided better control of IDWG and BP, but increased the incidence of dialysis-related symptoms.
The Effects of Nebivolol on Qt Duration and Dispersion in Patients With Coronary Slow Flow
(Elsevier Science inc, 2013) Sahin, Musa; Simsek, Hakki; Akyol, Aytac; Akdag, Serkan; Akil, Mehmet Ata; Aksoy, Hakan; Gumrukcuoglu, Hasan Ali
Hemopericardium and Cardiac Tamponade in a Patient With an Elevated International Normalized Ratio: Two Case Report
(Elsevier Ireland Ltd, 2010) Gumrukcuoglu, Hasan Ali; Tuncer, Mustafa; Akdag, Serkan; Akyol, Aytac; Gunes, Yilmaz
Hepatosteatosis and Carotid Intima-Media Thickness in Patients With Myocardial Infarction
(Springer Japan Kk, 2016) Ozturk, Hasan; Gumrukcuoglu, Hasan Ali; Yaman, Mehmet; Akyol, Aytac; Ozturk, Senay; Akdag, Serkan; Gunaydin, Zeki Yuksel
The aim of the study was to determine the involvement of non-alcoholic fatty liver disease (NAFLD) in myocardial infarction patients and its relation with carotid intima-media thickness (CIMT). This study consisted of 224 patients divided into three groups: those with myocardial infarction (MI), stable coronary artery disease (CAD), and normal coronary artery. Measurement of CIMT and abdominal ultrasonography for hepatosteatosis was performed in all participants. NAFLD was significantly more frequent among MI patients compared to the other groups. There was a significant difference between CAD and the presence of NAFLD (p < 0.05). Also, we found significant correlations between the severity of CAD and hepatosteatosis grade (r = 0.648, p < 0.001), CAD and CIMT (r = 0.594, p < 0.001), and NAFLD and CIMT (r = 0.233, p = 0.005). NAFLD was also significantly correlated with the severity of CAD (r = 0.607, p < 0.001), and the grade of NAFLD significantly correlated with CIMT (r = 0.606, p < 0.001). Patients with more severe CAD were more likely to have NAFLD. In addition, hepatosteatosis may be associated with coronary plaque instability and high fatty volume. Patients with NAFLD should be screened regularly for other cardiovascular risk factors, and the presence of fatty liver may help better classify these patients.
Increased P-Wave Dispersion in Patients With New Diagnosed Lichen Planus
(Elsevier Science inc, 2013) Sahin, Musa; Bilgili, Serap Gunes; Simsek, Hakki; Akdag, Serkan; Akyol, Aytac; Gumrukcuoglu, Hasan Ali; Karadag, Ayse Serap
Increased P-Wave Dispersion in Patients With Newly Diagnosed Lichen Planus
(Hospital Clinicas, Univ Sao Paulo, 2013) Sahin, Musa; Bilgili, Serap Gunes; Simsek, Hakki; Akdag, Serkan; Akyol, Aytac; Gumrukcuoglu, Hasan Ali; Karadag, Ayse Serap
OBJECTIVE: Lichen planus is a chronic inflammatory autoimmune mucocutaneous disease. Recent research has emphasized the strong association between inflammation and both P-wave dispersion and dyslipidemia. The difference between the maximum and minimum P-wave durations on an electrocardiogram is defined as P-wave dispersion. The prolongation of P-wave dispersion has been demonstrated to be an independent risk factor for developing atrial fibrillation. The aim of this study was to investigate P-wave dispersion in patients with lichen planus. METHODS: Fifty-eight patients with lichen planus and 37 age-and gender-matched healthy controls were included in this study. We obtained electrocardiographic recordings from all participants and used them to calculate the P-wave variables. We also assessed the levels of highly sensitive C-reactive protein, which is an inflammatory marker, and the lipid levels for each group. The results were reported as the means +/- standard deviations and percentages. RESULTS: The P-wave dispersion was significantly higher in lichen planus patients than in the control group. Additionally, highly sensitive C-reactive protein, LDL cholesterol, and triglyceride levels were significantly higher in lichen planus patients compared to the controls. There was a significant positive correlation between highly sensitive C-reactive protein and P-wave dispersion (r = 0.549, p<0.001) in lichen planus patients. CONCLUSIONS: P-wave dispersion increased on the surface electrocardiographic measurements of lichen planus patients. This result may be important in the early detection of subclinical cardiac involvement. Increased P-wave dispersion, in terms of the tendency for atrial fibrillation, should be considered in these patients.
Increased Risk of Atrial and Ventricular Arrhythmia in Long-Lasting Psoriasis Patients
(Hindawi Ltd, 2013) Simsek, Hakki; Sahin, Musa; Akyol, Aytac; Akdag, Serkan; Ozkol, Hatice Uce; Gumrukcuoglu, Hasan Ali; Gunes, Yilmaz
Background. Several reports have demonstrated an association between psoriasis and cardiovascular diseases. P wave dispersion (PWD) is the most important electrocardiographic (ECG) markers used to evaluate the risk of atrial arrhythmias. QT dispersion (QTD) can be used to assess homogeneity of cardiac repolarization and may be a risk for ventricular arrhythmias. Aim. To search PWD and QTD in patients with psoriasis. Methods. Ninety-four outpatient psoriasis patients and 51 healthy people were evaluated by physical examination, 12-lead ECG, and transthoracic echocardiography. Severity of the psoriasis was evaluated by psoriasis area and severity index (PASI). Results. Mean disease duration was 129.4 +/- 83.9 (range, 3-360) months and PASI ranged from 0 to 34.0 (mean +/- SD; 7.6 +/- 6.7). Compared to control group, psoriatic patients had significantly shorter Pmax and Pmin durations, longer QTcmax, and greater PWD and QTcD. Transmitral deceleration time (DT) and isovolumetric relaxation time (IVRT) were significantly longer among psoriasis patients. QTcD and PWD were significantly correlated with disease duration (r = 0.693, P < 0.001, and, P = 0.368, P = 0.003, resp.). Conclusions. In this study, we found that both PWD and QTcD are increased in psoriasis patients compared to healthy subjects. In addition, they had longer DT and IVRT.
Left Ventricular Outflow Tract Obstruction After Bioprosthetic Mitral Valve Replacement With Posterior Mitral Leaflet Preservation
(Texas Heart inst, 2006) Guler, Niyazi; Ozkara, Cenap; Akyol, Aytac
We present a case of transient left ventricular outflow tract obstruction after mitral valve replacement with a high-profile bioprosthesis; only the posterior native mitral valve leaflet was preserved. A 76-year-old woman was admitted to our institution with pulmonary edema. Two weeks earlier, she had undergone mitral valve replacement at our hospital due to severe mitral stenosis and 2+ mitral regurgitation complicated by cardiac failure and atrial fibrillation. The patient was taking digoxin, furosemide, and warfarin at the time of readmission. Echocardiography showed a narrowed left ventricular outflow tract. Doppler echocardiography revealed a peak 64-mmHg gradient between the septum and the strut of the bioprosthesis. The patient was successfully treated medically This case indicates that the risk of left ventricular outflow tract obstruction after bioprosthetic mitral valve replacement is not always eliminated by removal of the anterior mitral valve leaflet when the posterior mitral leaflet is preserved.
Levosimendan Accelerates Recovery in Patients With Takotsubo Cardiomyopathy
(Via Medica, 2016) Yaman, Mehmet; Arslan, Ugur; Kaya, Ahmet; Akyol, Aytac; Ozturk, Fatih; Okudan, Yunus Emre; Bektas, Osman
Background: The aim of this study was to determine the efficacy and safety of levosimendan in takotsubo cardiomyopathy (TC). Methods: The study was conducted in a retrospective design and 42 consecutive patients were enrolled in 6 cardiovascular centers in Turkey. The records of TC patients having left ventricular ejection fraction (LVEF) <= 35% were examined at admission, discharge and recovery period including their clinical and echocardiographic data. Results: Of these 42 TC patients, 17 were treated with loading dose and i.v. infusion of levosimendan (group 1) and 25 were treated without levosimendan (group 2). Echocardiographic findings at admission and at discharge were similar and no serious complications were observed in either group. However recovery period including the interval of 50% increase in LVEF, time to achieve the baseline troponin values and hospitalization were significantly lower in patients taking levosimendan. Conclusions: This is the first study using loading dose and subsequent continuous intravenous administration of levosimendan demonstrating accelerated recovery in patients with TC.
Lowering Dialysate Sodium Improves Systemic Oxidative Stress in Maintenance Hemodialysis Patients
(Springer, 2016) Macunluoglu, Beyza; Gumrukcuoglu, Hasan Ali; Atakan, Aydin; Demir, Halit; Alp, Hamit Hakan; Akyol, Aytac; Ari, Elif
The purpose of the current prospective study was to evaluate the effects of low sodium dialysate on oxidative stress parameters, blood pressure (BP) and endothelial dysfunction in maintenance hemodialysis (HD) patients. After baseline measurements were taken, the dialysate sodium concentration was reduced from 140 to 137 mEq/L. Oxidative stress parameters and flow-mediated dilatation (FMD %) were measured before and after 6 months of HD with low sodium dialysate. Interdialytic weight gain (IDWG) and pre- and post-dialysis BP were monitored during the study. A total of 52 patients were enrolled and 41 patients completed the study. There was a significant reduction in systolic blood pressure at the end of the study [130.00 (90.00-190.00) vs. 120.00 (90.00-150.00), p < 0.001]. Similarly, there were significant improvements in IDWG [2670.00 (1670.00-4300.00) vs. 1986.00 (1099.00-3998.00), p < 0.001] and FMD % [7.26 (4.55-8.56) vs. 9.56 (6.55-12.05), p < 0.001]. Serum MDA levels (p < 0.001) were significantly decreased; serum SOD (p < 0.001) and GPx (p < 0.001) activities were significantly increased after low sodium HD compared to standard sodium HD. Our data seem to suggest a potential role of 137 mEq/L sodium dialysate for improving hemodynamic status, endothelial function and reducing oxidative stress than 140 mEq/L sodium dialysate in maintenance HD patients.
A New Echocardiographic Parameter of Arterial Stiffness in End-Stage Renal Disease
(Elsevier Science inc, 2013) Sahin, Musa; Simsek, Hakki; Akyol, Aytac; Akdag, Serkan; Yaman, Mehmet; Inan, Bekir; Gumrukcuoglu, Hasan Ali