Browsing by Author "Gunes, Y."

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Asymptomatic Giant Pericardial Cyst Mimicking Dextrocardia on Chest X-Ray
(Urban & Vogel, 2014) Simsek, H.; Gunes, Y.; Akil, M. A.; Bilsel, T.
Author's Reply
(Arquivos Brasileiros de Cardiologia, 2010) Gunes, Y.
Comparison of Effects of Nebivolol and Atenolol on P-Wave Dispersion in Patients With Hypertension
(Russian Heart Failure Soc, 2008) Tuncer, M.; Fettser, D.; Gunes, Y.; Batyraliev, T. A.; Guntekin, U.; Gumrukcuoglu, H. A.; Sidorenko, B. A.
Background. P-wave dispersion has been shown to be a noninvasive electrocardiographic predictor for development of atrial fibrillation. Thus it may be possible to attenuate atrial fibrillation risk through normalization of P-wave variables and improvement in P-wave dispersion may be an important goal in treatment of hypertension. Objective. To compare the effects of nebivolol, a new P-blocker that have additional vasodilating activity via acting on endothelium and nitric oxide release, and atenolol on P-wave duration and dispersion in patients with mild-to-moderate hypertension. Methods. A total of 34 newly-diagnosed hypertensive patients were enrolled in the study. The patients were randomly assigned to receive treatment with either nebivolol (5 mg) or atenolol (50 mg). P-wave durations (Pmin and Pmax) and P-wave dispersion were measured before and one month after treatment. Results. While Pmin increased (50,6 +/- 11,2 ms to 54,7 +/- 9,1 ms, p=0,05), Pmax decreased (111,9 +/- 9,1 ms to 104,0 +/- 12,4 ms, p=0,003) and P-wave dispersion decreased (62,5 +/- 10,6 ms to 51,3 +/- 8,9 ms, p<0,001) with nebivolol, Pmin increased (44,4 +/- 9,8 ms to 58,0 +/- 15,5 ms, p=0,02), Pmax didn't change (106,1 +/- 13,8 ms to 107,0 +/- 11,6 ms, p=NS) and P-wave dispersion decreased (61,7 +/- 15,0 ms to 49,0 +/- 13,7 ms, p<0.001) with atenolol. However, there was no statistical difference between pre- and post-treatment values of two groups. Conclusions. Both nebivolol and atenolol are effective in improvement of P-wave dispersion in patients with hypertension and there's no significant difference between them.
Effects of Illness Activity on Electrocardiographic Parameters in Patients With Multiple Sclerosis
(Elsevier Ireland Ltd, 2011) Gumrukcuoglu, H. A.; Tuncer, M.; Simsek, H.; Sahin, M.; Akdag, S.; Gunes, Y.; Tombul, T.
A Novel Echocardiographic Method as an Indicator of Endothelial Dysfunction in Patients With Coronary Slow Flow
(verduci Publisher, 2013) Simsek, H.; Sahin, M.; Gunes, Y.; Akdag, S.; Akil, M. A.; Akyol, A.; Yaman, M.
BACKGROUND: To improve clinical outcomes, noninvasive imaging modalities have been proposed to measure and monitor atherosclerosis. Endothelial dysfunction is considered the first stage in the development of atherosclerosis. Brachial artery flow-mediated dilatation (FMD) has been impaired in patients with coronary slow flow (CSF). Recently, color M-mode derived propagation velocity of descending thoracic aorta (aortic propagation velocity-AVP) was shown to be an ultrasonographic marker for atherosclerosis. AIM: To assess endothelial function in patients with CSF and the correlation of AVP with FMD. MATERIALS AND METHODS: FMD and AVP were measured in 90 patients with CSF and 39 patients having normal coronary arteries (NCA) detected by coronary angiography. RESULTS: Compared to patients with normal coronary arteries patients having CSF had significantly lower AVP (39.1 +/- 8.4 vs. 53.7 +/- 12.7 cm/s, p < 0.001) and FMD (5.6 +/- 3.2 vs. 17.6 +/- 4.4 %, p < 0.001) measurements. There were significant correlations between AVP and FMD (r = 0.524, p < 0.001). CONCLUSIONS: Transthoracic echocardio-graphic determination of color M-mode propagation velocity of descending aorta is a simple practical method and correlates well with coronary slow flow and brachial endothelial function.
P Wave Dispersion in Hypertensive Urgency
(Russian Heart Failure Soc, 2008) Tuncer, M.; Fettser, D.; Gunes, Y.; Batyraliev, T.; Guntekin, U.; Gumrukcuoglu, H. A.; Guler, N.
Background and purpose: P wave dispersion (PWD) has been accepted as a predictor for atrial fibrillation (AF) in hypertension and some other cardiac diseases. The aim of this study was to compare the P wave parameters between patients with mild-moderate hypertension and those with hypertensive crises. Methods: A total of 48 patients, 24 of who presented to the emergency department with hypertensive urgency and 24 patients who were followed in the cardiology clinic with mild-moderate essential hypertension were included in this study. P wave durations were measured manually by two investigators blinded to data of patients. Results: The maximal duration of P wave (P-max) and the PWD were found to be significantly different between groups, being longer in patients with hypertensive urgency (p=0,05 and 0,02; respectively). Conclusions: PWD increases in hypertensive urgency states. Clinical implication of this finding should be addressed with further, prospective studies conducted on larger samples.
P Wave Duration and Dispersion in Patients With Hyperthyroidism and the Short-Term Effects of Antithyroid Treatment
(2009) Guntekin, U.; Gunes, Y.; Simsek, H.; Tuncer, M.; Arslan, S.
Background: Prolonged P wave duration and P wave dispersion (PWD) have been associated with an increased risk for atrial fibrillation (AF). Hyperthytodism is a frequent cause of atrial fibrillation (AF). Methods: Forty-two patients with newly diagnosed overt hyperthyroidism and 20 healthy people were enrolled in the study. Transthoracic echocardiography, 12 lead surface ECG and thyroid hormone levels were studied at the time of enrollment and after achievement of euthyroid state with propylthiouracil treatment. Results: Maximum P wave duration (Pmax) (97.4±14.6 vs. 84.2±9.5 msec, p<0.001), PWD (42.9±10.7 vs. 31.0±6.2 msec, p<0.001), deceleration (DT) (190.7±22.6 vs. 177.0±10.2 msec, p=0.013) and isovolumetric relaxation times (IVRT) (90.9±11.2 vs. 79.6±10.5 msec, p<0.001) were significantly higher in hyperthyroid patients compared to control group. Pmax and PWD were significantly correlated with the presence of hyperthyroidism. Pmax (97.4±14.6 to 84.3±8.6 msec, p<0,001) Pmin (54.1±8.6 to 48.1±8.5 msec, p=0.002), PWD (42.9±10.7 to 35.9±8.1 msec, p=0.002) and DT (190.7±22.6 to 185.5±18.3, p=0.036) were significantly decreased after achievement of euthyroid state in patients with hyperthyroidism. Diastolic dyfunction was seen in 5 patients at hyperthroid state but only in one patient at euthyroid state. Conclusions: Hyperthyroidism is associated with prolonged P wave duration and dispersion. Achievement of euthyroid state with propylthiouracil treatment results in shortening of P wave variables. Diastolic function may have a partial effect for the increased Pmax and PWD. Shortening of Pmax and PWD may be a marker for the prevention of AF with the anti-thyroid treatment.
Percutaneous Transluminal Angioplasty in Haemodialysis Patients With Central or Peripheral Venous Stenosis
(Ondokuz Mayis Universitesi, 2016) Yaman, M.; Sahin, M.; Simsek, H.; Gumrukcuoglu, H.A.; Tuncer, M.; Gunes, Y.; Akdag, S.
Dysfunction of arteriovenous fistulae (AVF), which result from peripheral or central venous occlusive illness, occurs very often in haemodialysis patients. In therapy, endovascular open procedures are prefered. Our study illustrated the clinical success of percutaneous transluminal angioplasty (PTA) for the treatment of these patient. A retrospective analysis was applied on patients presenting during a 2-years term with haemodialysis failure and ipsilateral arm swelling coherant with peripheral and/or central venous stenosis. PTA was performed as clinically and angiografically indicated. Technical success of PTA was defined less than 30% residual stenosis and clinical success was illustrated by resolution of pain and edema along with preservation of the AVF. Our study shows a subgroup of 26 patients that presented with symptomatic peripheral or central venous occlusive disease. Mean follow-up was 12.4 months (range, 3-24 months). PTA was successful in 26 patients 11 of whom were with central lesions and 15 of whom were with peripheral lesions. We were stated for central lesions PTA had a priority patency rates of 81.8%, 60%, 37.5% and supported primary patency rates of 90.9%, 70%, 62.5% at 3, 6, 12 months. For peripheral lesions, primary patency rates of 86.7%, 78.5%, 66.6% at 3, 6 and 12 months and assisted primary patency rates of 93.3%, 85.7% and 75%, separately. PTA for central and peripheral venous stenosis is be a successful and safe procedure in hemodialysis patients. In patients with lesions that are responsible for dilation, continuous functional access in the affected extremity is sustained, especially for patients with peripheral venous stenosis. © 2016 OMU.
Recurrence of Primary Cardiac Rhabdomyosarcoma Without Methastasis Two Years After Surgery
(TIP ARASTIRMALARI DERNEGI, 2012) Simsek, H.; Sahin, M.; Gumrukcuoglu, H.A.; Tuncer, M.; Gunes, Y.
Primary malignant cardiac tumors are rare. Rhabdomyosarcoma is the most common of these lesions. These tumors usually arise from the ventricular walls. They sometimes arise from the atrial walls and mimic atrioventricular valve stenosis. A case of recurrence of primary cardiac rhabdomyosarcoma without metastasis to other organs in a 34 year old woman is presented. The tumor arose from the posterior wall of the left atrium and extended to the posterior mitral valve leaflet. Histopathology confirmed recurrence of the cardiac rhabdomyosarcoma. Although cardiac rhabdomyosarcomas are highly lethal, operation indicated. Clarify diagnosis, relieve symptoms and improve survive intracardiac mass must be excision as as extensively as possible in these cases in order to prevent recurrence of tumor.
Regional Functions of the Left Ventricle in Patients With Coronary Slow Flow and the Effects of Nebivolol
(2009) Gunes, Y.; Tuncer, M.; Guntekin, U.; Ceylan, Y.; Sahin, M.; Simsek, H.
Background: Microvascular and endothelial dysfunction have been implicated for coronary slow flow (CSF). Nebivolol, besides its beta-receptor blocking activity, causes an endothelium-dependent vasodilatation through increased nitric oxide release. Methods: This study included 27 patients with CSF and 27 subjects with normal coronary arteries. Segmental functions of the left ventricle (LV) were assessed using myocardial tissue Doppler velocities before and 3 months after treatment with nebivolol 5 mg/day. Results: Compared with the control group, mitral deceleration time (DT) was significantly longer, and E/A ratio, systolic velocity of lateral mitral annulus (Sm) and regional myocardial peak systolic and early diastolic velocities (Vs, Vd) were significantly lower in patients with CSF. The reason for coronary angiography was typical angina in 21 (77.8%) and positive treadmill test in six (22.2%) CSF patients. There were significant correlations between presence of CSF in left anterior descending artery (LAD) with Sm (r =-0.404, p =0.002) and Vs in anterior (r =-0.531, p < 0.001 ) and lateral (r =-0.495, p < 0.001 ) segments and between presence of CSF in RCA and Vs in posterior segments (r =-0.501, p < 0.001). Treatment with nebivolol significantly decreased blood pressures (128.5±12.5/82.5±8.8 to 119.8± 12.6/76.4± 7.4 mmHg, p < 0.001), DT (252.3±53.6 to 222.0±41.0 ms, p < 0.001 ) and IVRT (115.7±19.9 to 103.3±17.0 ms, p <0.001), and increased exercise capacity (8.7±1.3 to 10.4±0.9 METs, p < 0.001), E/A ratio (0.87±0.26 to 1.08±0.23, p <0.001) and myocardial velocities (p < 0.001). All the patients were free of angina after treatment. Patients with CSF had impaired diastolic and regional LV functions. Conclusions: Nebivolol may therefore be useful in improving angina, exercise capacity and LV functions in patients with CSF. © 2009, SAGE Publications. All rights reserved.
Role of Echocardiography in the Evaluation of Atrial Function and Diseases
(Edizioni Minerva Medica, 2010) Gunes, Y.; Gumrukcuoglu, H. A.; Tuncer, M.
This article describes four essential components (hemodynamic, bioelectrical, hormonal and metabolic) of atrial function. And then discusses the traditional and more recent echocardiographic measures that have been employed to evaluate atrial function. Conventional parameters include the study of the various phases of atrial activity using atrial volume measurements, the peak A wave velocity, its velocity time integral (VTI), fraction of atrial contribution and atrial ejection force. Newer parameters for atrial function assessment include Doppler tissue imaging (DTI) including segmental atrial contractility using color Doppler tissue imaging (CDTI) and estimates of atrial strain and strain rate. Furthermore, the authors relate various particular types of atrial function in physiological and in selected pathological conditions.
Vascular Endothelial Function in Patients With Coronary Slow Flow and the Effects of Nebivolol
(Elsevier Ireland Ltd, 2011) Gunes, Y.; Gumrukcuoglu, H. A.; Akdag, S.; Simsek, H.; Sahin, M.; Tuncer, M.