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Öğe Advanced age and apnea-hypopnea index predict subclinical atherosclerosis in patients with obstructive sleep apnea syndrome(BIOMED CENTRAL LTD, 2013) Arik, Bilal; Inci, Mehmet Fatih; Gumus, Cesur; Varol, Kenan; Ege, Meltem Refiker; Dogan, Omer Tamer; Zorlu, AliBackground: Both obstructive sleep apnea syndrome (OSAS) and coronary artery calcification (CAC) are considered to be related with the presence of coronary artery disease (CAD). In this study we evaluate the association between OSAS and presence of subclinical atherosclerosis assessed by tomographic coronary calcium score in patients who had OSAS but no history of known CAD. Methods: Seventy-three patients who were asymptomatic for CAD and had suspected OSAS were referred to overnight attended polysomnography. Patients were classified into 4 groups according to the Apnea-Hypopnea Index (AHI). All patients underwent computed tomographic examination for tomographic coronary calcification scoring. Physical examination, sleep study recordings, complete blood count and serum biochemistry were obtained from all patients. Results: In the whole group, AHI levels were weakly correlated with coronary calcium score (r = 0.342, p = 0.003) and body mass index (r = 0.337, p = 0.004), moderately correlated with basal oxygen saturation (r = -0.734, p < 0.001), and strongly correlated with oxygen desaturation index (r = 0.844, p < 0.001). In an univariate analysis, age, AHI, basal oxygen saturation, and oxygen desaturation index were associated with CAC in patients with OSAS. In a multiple logistic regression model, age (OR 1.108,% 95 CI 1.031-1.191, p = 0.005) and AHI (OR 1.036,% 95 CI 1.003-1.070, p = 0.033) were only independent predictors of CAC in patients with OSAS with a sensitivity of 88.9% and 77.8% and a specificity of 54.3% and 56.5% respectively. Conclusions: Our findings suggest that in patients with moderate or severe OSAS and advanced age, physicians should be alert for the presence of subclinical atherosclerosis.Öğe CA-125 and heart failure(ELSEVIER IRELAND LTD, 2011) Ege, Meltem Refiker; Zorlu, Ali; Yilmaz, Mehmet Birhan…Öğe Cardiac cachexia and gastrointestinal system(ELSEVIER IRELAND LTD, 2011) Ege, Meltem Refiker; Yilmaz, Mehmet Birhan; Guray, Yesim…Öğe Central Diastolic Blood Pressure Is Associated With the Degree of Coronary Collateral Development(SAGE PUBLICATIONS INC, 2013) Ege, Meltem Refiker; Zorlu, Ali; Yilmaz, Mehmet Birhan; Acikgoz, Savas; Tandogan, Izzet; Cinar, ZiynetCoronary collaterals (CCs) serve as alternative conduits for blood flow in obstructive coronary artery disease. We investigated the association of various components of blood pressure (BP) parameters with the the degree of coronary collateralization. Patients (n = 245) who underwent coronary angiography were included. Intraarterial BP in the ascending aorta was determined using a standard fluid-filled system. Readings of the conventional peripheral pressure were measured using a manual sphygmomanometer. All blood samples were drawn at admission, before coronary angiography. A total of 65 patients were found to have adequate CC development. Central diastolic BP and peripheral diastolic BP were found to be lower in the group with adequate CC. In multivariate logistic regression model, central diastolic BP and Gensini score were found to be independent predictors of adequate CC. In conclusion, low central diastolic BP in the case of severe coronary stenosis may be an important stimulus for adequate CC development.Öğe Depression and heart failure(ELSEVIER IRELAND LTD, 2012) Ege, Meltem Refiker; Yilmaz, Nuryil; Yilmaz, Mehmet Birhan…Öğe Depression and perceptions about heart failure predict quality of life(MOSBY-ELSEVIER, 2011) Ege, Meltem Refiker; Yilmaz, Nuryil; Yilmaz, Mehmet Birhan…Öğe Does electrocardiography at admission predict outcome in Crimean-Congo hemorrhagic fever?(MALARIA RESEARCH CENTRE, INDIAN COUNCIL MEDICAL RESEARCH-ICMR, 2011) Yilmaz, Mehmet Birhan; Engin, Aynur; Bektasoglu, Gokhan; Zorlu, Ali; Ege, Meltem Refiker; Bakir, Mehmet; Dokmetas, IlyasBackground & objectives: Crimean-Congo hemorrhagic fever is an acute viral hemorrhagic fever with considerable mortality. Despite increasing knowledge about hemorrhagic fever viruses, the pathogenesis of Crimean-Congo hemorrhagic fever and causes of death were not well described. We aimed to evaluate whether there were electrocardiographic parameters designating mortality among these patients. Study design: This retrospective study was performed among confirmed Crimean-Congo hemorrhagic fever cases in Turkey. Electrocardiography was available in 49 patients within 24 h of hospitalization. All electrocardiograms were evaluated by two expert cardiologists according to Minnesota coding system. Results: Among patients with available electrocardiograms, there were 31 patients who survived, and 18 patients who died of Crimean-Congo hemorrhagic fever. Both groups were similar in terms of age, sex, body temperature, heart rate, and blood parameters. T-wave changes and bundle branch block were more frequently encountered among those who died. Presence of T-wave negativity or bundle branch block in this cohort of patients with Crimean-Congo hemorrhagic fever predicted death with a sensitivity of 72.7%, specificity of 92.6%, positive predictive value of 88.9%, negative predictive value of 80.6%. Conclusions: We think within the light of our findings that simple electrocardiography at admission may help risk stratification among Crimean-Congo hemorrhagic fever cases.Öğe Echocardiographic Epicardial Adipose Tissue Predicts Subclinical Atherosclerosis: Epicardial adipose tissue and Atherosclerosis(SAGE PUBLICATIONS INC, 2012) Comert, Nuri; Yucel, Oguzhan; Ege, Meltem Refiker; Yaylak, Baris; Erdogan, Guney; Yilmaz, Mehmet BirhanWe examined the relationship between coronary flow rate and epicardial adipose tissue (EAT) in patients with slow coronary flow (SCF) and normal coronary arteries. The study included 40 consecutive patients with stable angina pectoris who had normal coronary arteries. All patients underwent echocardiography. To determine the SCF, thrombolysis in myocardial infarction (TIMI) frame count method was used. Half of the patients had SCF at least in 1 coronary artery. Thrombolysis in myocardial infarction frame counts, the mean TIMI frame count, and EAT thickness were significantly higher in patients with SCF. Slow coronary flow showed a significantly positive correlation with EAT thickness. Epicardial adipose tissue thickness was the only independent predictor of SCF. Our findings suggest that there is a significant correlation between the SCF and EAT. Therefore, echocardiographic EAT may become a predictor of subclinical atherosclerosis in patients with stable angina pectoris.Öğe High mortality among heart failure patients treated with antidepressants(Elsevier Ireland Ltd, 2011) Ege, Meltem Refiker; Yilmaz, Nuryil; Yilmaz, Mehmet Birhan[No abstract available]Öğe Increased d-dimer levels predict cardiovascular mortality in patients with systolic heart failure(SPRINGER, 2012) Zorlu, Ali; Yilmaz, Mehmet Birhan; Yucel, Hasan; Bektasoglu, Gokhan; Ege, Meltem Refiker; Tandogan, IzzetD-dimer is a fibrin degradation product, and is implicated in pathologies of cardiovascular system. Thrombosis within the vascular system in relation with inflammation and stasis might be associated with poor prognosis in patients with systolic heart failure (HF). In this study we aimed to investigate for relationship between d-dimer levels and cardiovascular mortality in patients with systolic HF. A total of 174 consecutive patients with hospitalized systolic HF were evaluated. All hospitalized patients were obtained d-dimer levels within the first 24 h following admission after obtaining informed consent. Patients were followed up for cardiovascular mortality and 40 (23%) patients died. d-dimer levels were higher among those who died compared to those who survived (2727 +/- A 2569 (710-4438) versus. 1029 +/- A 1319 (303-1061) ng/ml, P < 0.001). Optimal cut-off level of d-dimer to predict cardiovascular mortality was found to be > 1435 ng/ml. D-dimer levels were negatively correlated with ejection fraction, positively correlated with left atrium size and left ventricular diastolic diameter. D-dimer > 1435 ng/ml, age, diabetes mellitus, presence of atrial fibrillation, and creatinine level were found to have prognostic significance in univariate analyses. In multivariate Cox proportional-hazards model, d-dimer > 1435 ng/ml (HR = 3.250, 95% CI 1.647-6.414, P = 0.001), creatinine level (HR = 1.269, 95% CI 1.008-1.599, P = 0.043), and presence of atrial fibrillation (HR = 2.159, 95% CI 1.047-4.452, P = 0.037) remained associated with an increased risk of death after adjustment for variables found to be statistically significant in univariate analysis and correlated with d-dimer level. In conclusion, d-dimer measurement could help risk stratification in patients with systolic HF.Öğe Increased gamma-glutamyl transferase levels predict early mortality in patients with acute pulmonary embolism(W B SAUNDERS CO-ELSEVIER INC, 2012) Zorlu, Ali; Yucel, Hasan; Bektasoglu, Gokhan; Turkdogan, Kenan Ahmet; Eryigit, Umut; Sarikaya, Savas; Ege, Meltem Refiker; Tandogan, Izzet; Yilmaz, Mehmet BirhanBackground: Increased gamma-glutamyl transferase (GGT) level is associated with increased oxidative stress, all-cause mortality, the development of cardiovascular disease, and metabolic syndrome. However, its role in acute pulmonary embolism (PE) is unknown. In this study, we aimed to investigate the relationship between GGT and early mortality in patients with acute PE. Methods: A total of 127 consecutive patients with confirmed PE were evaluated. The optimal cutoff value of GGT to predict early mortality was measured as more than 55 IU/L with 94.4% sensitivity and 66.1% specificity. Patients with acute PE were categorized prospectively as having no increased (group I) or increased (group II) GGT based on a cutoff value. Results: Of these 127 patients, 18 patients (14.2%) died during follow-up. Among these 18 patients, 1 (1.4%) patient was in group I, and 17 (30.9%) patients were in group II (P < .001). gamma-Glutamyl transferase level on admission, presence of shock, heart rate, oxygen saturation, right ventricular dilatation/hypokinesia, main pulmonary artery involvement, troponin I, alanine aminotransferase, alkaline phosphatase, and creatinine levels were found to have prognostic significance in univariate analysis. In the multivariate Cox proportional hazards model, GGT level on admission (hazard ratio [HR], 1.015; P = .017), presence of shock (HR, 15.124; P = .005), age (HR, 1.107; P = .010), and heart rate (HR, 1.101; P = .032) remained associated with an increased risk of acute PE-related early mortality after the adjustment of other potential confounders. Conclusions: We have shown that a high GGT level is associated with worse hemodynamic parameters, and it seems that GGT helps risk stratification in patients with acute PE. (C) 2012 Elsevier Inc. All rights reserved.Öğe Letter to editor: Clinical profile and predictors of in-hospital outcome in patients with heart failure(ELSEVIER IRELAND LTD, 2011) Ege, Meltem Refiker; Yucel, Oguzhan; Zorlu, Ali; Yilmaz, Mehmet Birhan…Öğe Letter to the Editor: Weekend versus weekday hospital admissions for acute heart failure(ELSEVIER IRELAND LTD, 2011) Ege, Meltem Refiker; Yilmaz, Nuryil…Öğe Lymphocytopenia is associated with poor NYHA functional class in chronic heart failure patients with reduced ejection fraction(TURKISH SOC CARDIOLOGY, 2015) Yucel, Hasan; Ege, Meltem Refiker; Zorlu, Ali; Kaya, Hakki; Beton, Osman; Gungor, Hasan; Acar, Gurkan; Temizhan, Ahmet; Cavusoglu, Yuksel; Zoghi, Mehdi; Eren, Mehmet; Ural, Dilek; Yilmaz, Mehmet BirhanObjective: In heart failure (HF) patients, functional capacity has been demonstrated to be a marker of poor prognosis, independent of left ventricular ejection fraction (EF). Lymphocyte count is currently recognized in certain risk stratification scores for chronic HF, and severe HF is associated with lymphocytopenia. However, no data exists on the association between lymphocyte count and functional capacity in patients with stable HF. This study aimed to assess the relationship between lymphocyte count and New York Heart Association (NYHA) functional capacity in systolic HF outpatients. Methods: The Turkish Research Team-HF (TREAT-HF) is a network which undertakes multi-center observational studies in HF. Data on 392 HF reduced ejection fraction (HFREF) patients from 8 HF centers are presented here. The patients were divided into two groups and compared: Group 1 comprised stable HFREF patients with mild symptoms NYHA Class (I-II), while Group 2 consisted of patients with NYHA Class III-IV symptoms. Results: Patient mean age was 60 +/- 14 years. Lymphocyte count was lower in patients with NYHA functional classes III and IV than in patients with NYHA functional classes I and II, 0.9 [0.6-1.5] x1000 versus 1.5 [0.7-2.2] x1000, p<0.001). In multivariate logistic regression analysis, lymphocyte count OR: 0.602, 95% CI: 0.375-0.967, p=0.036), advanced age, male gender, presence of hypertension, EF, left atrium size, systolic pulmonary artery pressure, neutrophil and basophil counts, creatinine level, and diuretic usage were associated with poor NYHA functional class in systolic HF outpatients. Conclusion: The present study demonstrated that in stable HFREF outpatients, lymphocytopenia was strongly associated with poor NYHA function, independent of coronary heart disease risk factors.Öğe Microalbuminuria is Associated With the Severity of Coronary Artery Disease Independently of Other Cardiovascular Risk Factors(SAGE PUBLICATIONS INC, 2012) Ozyol, Ali; Yucel, Oguzhan; Ege, Meltem Refiker; Zorlu, Ali; Yilmaz, Mehmet BirhanThe potential early predictive value of microalbuminuria (MA) in the estimation of atherosclerosis and the relation between the degree of urinary albumin excretion and the extent of coronary artery disease (CAD) were investigated. Patients (n = 159) with stable angina pectoris and angiographically significant stenosis in at least 1 of the major coronary arteries were included. Microalbuminuria was measured by immunoturbidimetry. The extent of coronary artery stenosis was graded using the Gensini score. The Gensini score was significantly greater in patients who had MA. Also, the Gensini increased by 0.15 units with 1 unit increase in MA. In the groups who had diabetes mellitus and hypertension, there was no correlation between MA and Gensini score. The results of the present study suggest that MA is associated with the severity of CAD independent of other cardiovascular risk factors.Öğe Plasma osmolality predicts mortality in patients with heart failure with reduced ejection fraction(Via Medica, 2017) Kaya, Hakki; Yucel, Oguzhan; Ege, Meltem Refiker; Zorlu, Ali; Yucel, Hasan; Gunes, Hakan; Ekmekci, AhmetBackground: Heart failure (HF) is a fatal disease. Plasma osmolality with individual impacts of sodium, blood urea nitrogen (BUN), and glucose has not been studied prognostically in patients with HF. Aim: This study aims to investigate the impact of serum osmolality on clinical endpoints in HF patients. Methods: A total of 509 patients (383 males, 126 females) with HF with reduced ejection fraction in three HF centres were retrospectively analysed between January 2007 and December 2013. Follow-up data were completed for 496 patients. Plasma osmolality was calculated as (2 x Na) + (BUN/2.8) + (Glucose/18). Quartiles of plasma osmolality were produced, and the possible relationship between plasma osmolality and cardiovascular mortality was investigated. Results: The mean follow-up was 25 +/- 22 months. The mean age was 56.5 +/- 17.3 years with a mean EF of 26 +/- 8%. The mean levels of plasma osmolality were as follows in the quartiles: 1st % = 280 +/- 6, 2nd % = 288 +/- 1, 3rd % = 293 +/- 2 (95% confidence interval [ CI] 292.72-293.3), and 4th % = 301 +/- 5 mOsm/kg. The EF and B-type natriuretic peptide levels were similar in the four quartiles. Univariate and multivariate analyses in the Cox proportional hazard model revealed a significantly higher rate of mortality in the patients with hypo-osmolality. The Kaplan-Meier plot showed graded mortality curves with the 1st quartile having the worst prognosis, followed by the 4th quartile and the 2nd quartile, while the 3rd quartile was shown to have the best prognosis. Conclusions: Our study results suggest that normal plasma osmolality is between 275 and 295 mOsm/kg. However, being close to the upper limit of normal range (292-293 mOsm/kg) seems to be the optimal plasma osmolality level in terms of cardiovascular prognosis in patients with HF.Öğe Poor sleep quality, stress status, and sympathetic nervous system activation in nondipping hypertension(LIPPINCOTT WILLIAMS & WILKINS, 2011) Ege, Meltem Refiker; Acikgoz, Savas; Yucel, Oguzhan…Öğe The Relationship between Mean Pulmonary Artery Pressure and Quality of Life in Patients with Mitral Stenosis(KARGER, 2011) Zorlu, Ali; Amioglu, Gullu; Yilmaz, Nuryil; Semiz, Murat; Ege, Meltem Refiker; Aydin, Gulay; Tandogan, Izzet; Yilmaz, Mehmet BirhanObjectives: We aimed to evaluate echocardiography-guided hemodynamic determinants of quality of life (QoL) via the Medical Outcomes Study Short Form (SF-36) questionnaire in patients with mild to moderate mitral stenosis (MS). Methods: Eighty consecutive patients with rheumatic MS, who were admitted to the outpatient department, were enrolled into the study upon obtaining informed consent. Forty age-sex-matched healthy individuals were enrolled as a control group. Results: All subscale scores and total SF-36 scores were significantly lower in the patient group representing a worse QoL. In multivariable logistic regression analysis, only mean pulmonary artery pressure (OR 1.138, 95% CI 1.049-1.234, p = 0.002) was found to be an independent predictor of poor QoL in patients with mild to moderate MS. Conclusion: During follow-up of MS patients before intervention, physicians should consider that mean pulmonary artery pressure is the main factor which influences the patients' QoL. In patients with MS, it seems that referral to intervention should consider components and derivatives of QoL. Copyright (C) 2011 S. Karger AG, BaselÖğe Relationship between red cell distribution width and right ventricular dysfunction in patients with chronic obstructive pulmonary disease(MOSBY-ELSEVIER, 2012) Sincer, Isa; Zorlu, Ali; Yilmaz, Mehmet Birhan; Dogan, Omer Tamer; Ege, Meltem Refiker; Amioglu, Gullu; Aydin, Gulay; Ardic, Idris; Tandogan, IzzetBACKGROUND: Chronic obstructive pulmonary disease (COPD) is a progressively debilitating disease limiting patients' survival. The prognosis of COPD worsens with the addition of right ventricular (RV) failure. Red cell distribution width (RDW) is a measure of variability in the size of circulating erythrocytes, and is a powerful predictor of outcomes in patients with both chronic and acute left heart failure. Here we attempted to test whether RDW could provide an early marker of RV failure in patients with COPD. METHODS: Thirty-nine consecutive patients with COPD were enrolled in the study. All patients had at least 10 years' history of COPD, and all were treated appropriately. Thirty-nine age-matched and sex-matched individuals were enrolled for comparison. Red cell distribution width was obtained in all patients before transthoracic echocardiography. Right ventricular parameters were evaluated, and RV failure was identified via lateral tricuspid annulus longitudinal motion and systolic-tissue Doppler velocity, using transthoracic echocardiography. RESULTS: Patients with COPD had significantly higher RDW values compared with control subjects (patients with COPD, mean +/- SD, 16.1 +/- 2.5; range, 12.3 to 23.3; control subjects, mean +/- SD, 13.6 +/- 1.3; range, 11.7 to 18.3; P < .001). In multivariable logistic regression, the presence of high RDW was the only parameter independently predicting RV failure in patients with COPD (odds ratio, 2.098; P = .017). Levels of RDW, obtained before echocardiography, predicted the presence of RV failure with a sensitivity of 70% and specificity of 93.1%, with a cutoff value of >17.7. CONCLUSION: Red cell distribution width may be used to identify COPD patients with RV failure. Cite this article: Sincer, I., Zorlu, A., Yilmaz, M. B., Dogan, O. T., Ege, M. R., Amioglu, G., Aydin, G., Ardic, I., & Tandogan, I. (2012, MAY/JUNE). Relationship between red cell distribution width and right ventricular dysfunction in patients with chronic obstructive pulmonary disease. Heart & Lung, 41(3), 238-243. doi:10.1016/j.hrtlng.2011.07.011.Öğe Role of mean platelet volume in the diagnosis of acute coronary events(B M J PUBLISHING GROUP, 2012) Ege, Meltem Refiker; Acikgoz, Savas; Yucel, Oguzhan…
