Browsing by Author "Pac, Feyza Aysenur"

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Assessment of Cardiac Functions in Fetuses of Gestational Diabetic Mothers
(Springer, 2014) Balli, Sevket; Pac, Feyza Aysenur; Ece, Ibrahim; Oflaz, Mehmet Burhan; Kibar, Ayse Esin; Kandemir, Omer
We investigated cardiac function in 67 fetuses of gestational diabetic mothers (FGDMs) and 122 fetuses of healthy mothers between 24 and 36 weeks of gestation. Cardiac functions were evaluated by M-mode, pulsed-wave, and tissue Doppler echocardiography. Fetal echocardiograms were performed at 24, 28, 32, and 36 weeks of gestation. Glycated hemoglobin (HbA1c) levels were obtained from all pregnant women at 24 weeks of gestation. The mean age of diabetic pregnant women was significantly greater than that of controls. Serum HbA1c values of both groups were within normal limits, but they were significantly greater in the diabetic group (p = 0.003). The increase in peak aortic and pulmonary artery velocities were greater in FGDM (p < 0.001). No pathological interventricular septal (IVS) hypertrophy was observed. There was a significant increase in IVS thickness in FGDM compared with controls, which was more prominent at the end of the third trimester (p < 0.001). During the course of pregnancy, mitral E-wave (p < 0.001), A-wave (p = 0.007), tricuspid E-wave (p < 0.001) and A-wave (p = 0.002) velocities were greater in FGDM. The increases in mitral E/A and tricuspid E/A ratios were lower in FGDM with advancing gestation. The E (a)-wave (p = 0.02), A (a)-wave (p = 0.04), and S (a)-wave (p < 0.001) velocities of the right-ventricular (RV) free wall and the E (a) (p = 0.02) and A (a) (p = 0.01) velocities of the left-ventricle (LV) posterior wall were greater in FGDM during the course of pregnancy. The E (a)/A (a) ratio of the RV posterior wall was greater in FGDM with advancing gestation (p < 0.03). LV and RV E/E (a) ratios were similar in both groups. The LV myocardial performance index measured by pulsed-wave Doppler was greater in FGDM (p < 0.001). We detected diastolic dysfunction in FGDM. The data suggest that gestational diabetes mellitus may impair ventricular diastolic functions without causing pathological fetal myocardial hypertrophy. We detected subclinical diastolic dysfunction using both pulsed-wave and tissue Doppler imaging in FGDM.
Early Subclinical Left-Ventricular Dysfunction in Obese Nonhypertensive Children: a Tissue Doppler Imaging Study
(Springer, 2013) Kibar, Ayse Esin; Pac, Feyza Aysenur; Balli, Sevket; Oflaz, Mehmet Burhan; Ece, Ibrahim; Bas, Veysel Nejat; Aycan, Zehra
A direct effect of obesity on myocardial function has not been not well established. Our aim was to investigate the effect of body mass index (BMI) and homeostatic model assessment of insulin resistance (HOMA-IR) on left-ventricular (LV) myocardial function in normotensive overweight and obese children by tissue Doppler imaging (TDI). We calculated the mitral annular displacement index (DI) and myocardial performance index (MPI) using TDI indices of systolic and diastolic LV function. In this hospital-based, prospective cross-sectional study, we studied 60 obese (mean age 13.2 +/- A 2.0 years) and 50 normal children. Subjects were divided into three groups: group 1 (BMI < 25, n = 50, control), group 2 (BMI 25-29.9 kg/m(2), n = 30, overweight), and group 3 (BMI a parts per thousand yen 30 kg/m(2), n = 30, morbidly obese). Standard echocardiography showed increased LV diameters and LV mass/index and preserved ejection fraction in obese children. By TDI, LV systolic and diastolic function showed that peak late myocardial velocity (Em = 15.4 +/- A 2 cm/s), peak early myocardial velocity (Am = 8.7 +/- A 1.3 cm/s), Em/Am ratio (1.8 +/- A 0.3), isovolumetric relaxation time (IVRT = 59.2 +/- A 8.2 ms), MPI (0.39 +/- A 0.03), and DI (25.5 +/- A 3.2 %) of the lateral mitral annulus in the obese subgroups were significantly different from those of control subjects (18.2 +/- A 1.2 cm/sn, 6.9 +/- A 0.6 cm/sn, 2.6 +/- A 0.2, 51.2 +/- A 9.6 ms, 0.34 +/- A 0.03, and 33.13 +/- A 5.0 %, respectively; p < 0.001). These structural and functional abnormalities were significantly related to BMI. There were positive correlations between HOMA-IR, septal MPI, and LV mass. DI and MPI data indicated impaired subclinical LV function in all grades of isolated obesity at a preclinical stage. Insulin resistance and BMI correlated significantly with indices of LV function.
Effect of Obesity on Left Ventricular Longitudinal Myocardial Strain by Speckle Tracking Echocardiography in Children and Adolescents
(Galenos Publ House, 2015) Kibar, Ayse Esin; Pac, Feyza Aysenur; Ece, Ibrahim; Oflaz, Mehmet Burhan; Balli, Sevket; Bas, Veysel Nejat; Aycan, Zehra
Background: Impaired subclinical ventricular function may contribute to the risk of cardiovascular disease in obesity. Aims: The aim of this study was to determine the influence of obesity on left ventricular (LV) longitudinal myocardial function in normotensive obese children using two-dimensional (2D) speckle tracking echocardiography (STE). Study Design: Case-control study. Methods: Sixty normotensive obese children aged 1016 years (mean age, 13.9 +/- 2.3 years) were compared with 50 normal-weight controls. Obese participants had a body mass index (BMI)>= 95th percentile. Regional strain/strain rate (SR) values were compared with left ventricular (LV) parameters. The correlation was studied by linear regression analysis. Results: Obese subjects exhibited a significantly higher LV end-diastolic diameter, left atrium/aortic diameter ratio, and LV mass/index when compared to controls (p<0.001). Left ventricular ejection fraction and regional systolic myocardial velocities were similar in the obese and control groups. By 2D STE, regional strain of both the septal wall (average strain: -16.0 +/- 3.9% vs-21.9 +/- 2.4%, p<0.001) and lateral wall (average strain: -15.6 +/- 2.3% vs -22.9 +/- 3.5%, p<0.001); regional SR of both the septal wall (average SRsys: -0.7 +/- 0.22 s(-1) vs -1.3 +/- 0.32 s(-1), p<0.001) and lateral wall (average SRsys: -0.67 +/- 0.19 s(-1) vs-1.33 +/- 0.31 s(-1), p<0.001); regional SR E/A of both the septal wall (average SR E/A : 1.8 +/- 0.83 vs. 2.2 +/- 0.91, p: 0.004) and lateral wall (average SR E/A : 1.4 +/- 0.43 vs. 2.4 +/- 1.21, p<0.001); and global strain (-14.6 +/- 7.34% vs -20.9 +/- 3.24%, p<0.001) were lower in the obese group compared with the controls. These strain imaging parameters appear to be related to the severity of obesity and can contribute to increased BMI. Left ventricular mass was found to be correlated with a decrease in global LV strain. Conclusion: Our study showed that childhood obesity is associated with an alteration in the longitudinal LV function. Segmental analysis of the LV can provide subtle markers for the emergence of future obesity-related cardiac disease.
Evaluation of Morphological Characteristics of Septal Rims Affecting Successful Transcatheter Atrial Septal Defect Closure in Children and Adults
(Termedia Publishing House Ltd, 2013) Oflaz, Mehmet Burhan; Pac, Feyza Aysenur; Kibar, Ayse Esin; Balli, Sevket; Ece, Ibrahim
Introduction: Determining other echocardiographic predictors along with the measured atrial septal defect (ASD) size and evaluating the closure together with these predictors would increase the chance of success for transcatheter closure of ASD. Aim: To evaluate echocardiographic parameters affecting defect closure in children and adult patients with secundum ASD. Material and methods: In all patients, size of ASD, total length of atrial septum (TS), superior-posterior, inferior-posterior, superior-anterior and inferior-anterior rims surrounding the defect were measured by transesophageal echocardiography (TEE), and several measurement ratios were derived on the basis of TEE parameters. Results: A total 216 patients with secundum ASD were included in this study. The device was successfully implanted in 65 children and 65 adults. Both in pediatric and adult cases, the ratio of successful closure was found to be significantly higher when the ratio of defect size to TS was <= 0.35, the ratio of superior-anterior (SA) rim to the defect size was > 0.75 and the ratio of inferior-posterior (IP) rim to the defect size was > 1.0. It was found that having more than one of these predictors in a single case increased the chance of closure success significantly (p < 0.001). Conclusions: We concluded that a ratio of the defect size to TS <= 0.35, a ratio of SA rim to defect size > 0.75 and a ratio of IP rim to defect size > 1.0 were found to be echocardiographic predictors that could be used in successful transcatheter ASD closure both in children and adults.