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Öğe Adropin and circadian variation of blood pressure(VIA MEDICA, 2018) Bolayir, Hasan Ata; Kivrak, Tarik; Gunes, Hakan; Bolayir, Asli; Karaca, IlginBackground: Nocturnal hypertension and non-dipping pattern are often associated with endothelial dysfunction. Previous studies suggested that adropin, a novel secreted energy homeostasis protein, has the unique ability to regulate endothelial cell function. Aim: This study aims to investigate the association between absolute night-time blood pressure (BP) and circadian BP pattern with serum adropin and high-sensitivity C-reactive protein (hsCRP) levels in patients with newly diagnosed untreated arterial hypertension. Methods: Twenty-four-hour ambulatory BP monitoring was recorded in 100 hypertensives (50 dippers, 50 non-dippers) and 50 healthy controls. Serum levels of adropin and hsCRP were measured and recorded. Results: A strong correlation was found between night-time BP levels with adropin and hsCRP levels (p < 0.001). On the other hand, the non-dipper group demonstrated lower adropin levels compared to the dipper and normotensive groups: non dipper group, 2580 +/- 457 pg/mL; dipper group, 3298 +/- 530 pg/mL; normotensive group, 3681 +/- 411 pg/mL; p < 0.001). HsCRP levels were significantly higher in the non-dipper group than in the two other groups (p = 0.017). In a multivariate logistic regression analysis, adropin (p = 0.012) and hsCRP (p = 0.039) were independently associated with a non-dipping pattern. Conclusions: Decreased adropin levels were found in the nocturnal hypertensive and non-dipper groups. Adropin and hsCRP were found to be independently associated with a non-dipping pattern. We suggest that decreased levels of adropin in non-dipper hypertensive patients might be associated with a longer duration of exposure to high BP. These results point to a possible future role of adropin in identifying hypertensive patients at higher risk of target organ damage.Öğe Association between multidrug resistance-1 C3435T gene polymorphism and right ventricular dysfunction in patients with chronic obstructive pulmonary disease: cross-sectional study(ASSOCIACAO PAULISTA MEDICINA, 2018) Yucel, Oguzhan; Gunes, Hakan; Yucel, Hasan; Zorlu, AliBACKGROUND: Right ventricular (RV) dysfunction may develop over the course of chronic obstructive pulmonary disease (COPD) and is an important predictor of morbidity and mortality Polymorphism of the multidrug resistance-1 (MDR-1) gene has been correlated with worse clinical findings among patients with COPD Our aim here was to investigate the relationship between MDR-1 C3435T gene polymorphism and RV dysfunction in COPD patients. DESIGN AND SETTING: This was a cross-sectional study investigating the relationship between RV dysfunction and genetic defects in COPD patients. METHODS: Forty-one consecutive patients diagnosed with COPD and hospitalized due to acute exacerbation were enrolled Polymorphism was analyzed using the strip assay technique. RV parameters were evaluated, and RV dysfunction was identified via transthoracic echocardiography Patients were categorized into three groups according to gene polymorphism MDR-1 CC (wild type, n = 9), MDR-1 CT (heterozygote mutant, n = 21) or MDR-1 TT (homozygote mutant, n = 11) RESULTS: The study included 14 males and 27 females (mean age 65 +/- 11 years). The mean systolic pulmonary artery pressure was 31.4 +/- 8 mmHg in the wild-type group, 42.2 +/- 12 mmHg in the heterozygote mutant group and 46.5 +/- 14 mmHg in the homozygote mutant group (P = 0.027). Presence of RV dilatation was significantly different among the three groups (33%, 71%, and 100%, respectively; P = 0.005). In multiple logistic regression analysis, MDR-1 C3435T gene polymorphism (OR = 9.000, P = 0.019) was an independent predictor of RV dysfunction after adjustment for potential confounders. CONCLUSION: MDR-1 C3435T gene polymorphism was associated with RV dysfunction in patients with COPD.Öğe The association between serum serglycin level and coronary artery disease severity in patients with stable angina pectoris(VIA MEDICA, 2018) Bolayir, Hasan Ata; Kivrak, Tarik; Gunes, Hakan; Bolayir, Asli; Karaca, IlginBackground: Serglycin plays a key role in the inflammatory status however the relationship between coronary artery disease (CAD) and serglycin is still unknown. Aim: In this study, we aimed to investigate association of serglycin levels with CAD severity in patients with stable angina pectoris (SAP). Methods: In total, 100 SAP patients diagnosed by coronary angiography and clinical manifestations, and 100 control subjects matched for age and sex were enrolled in this case-control study. Plasma levels of serglycin, high-sensitivity C-reactive protein (hsCRP), lipid profiles, and clinical parameters were assayed for all participants. The severity of coronary lesions was evaluated based on the SYNTAX score (SS) assessed by coronary angiography. Results: Positively correlated with the SS (r = 0.564, p < 0.001), the plasma serglycin level in the SAP group was higher than that in the control group (11.17 +/- 1.82 vs. 19.28 +/- 1.88 ng/mL, p < 0.001). The plasma serglycin level was an independent predictor for both SAP (odds ratio [OR] 1.037, 95% confidence interval [CI] 1.020-1.054, p < 0.001) and a high SS (OR = 1.087, 95% CI 1.051-1.124, p < 0.001) in a multivariate logistic regression model. In the receiver operating characteristic curve analysis, the plasma serglycin level was found to have a better predictive value for a high SS (area under the curve [AUC] 0.858, 95% CI 0.788-0.929, p < 0.001) compared with hsCRP (AUC 0.665, 95% CI 0.557-0.773, p = 0.006; Z = 2.94, p < 0.001), with an optimal cut-off value of 17.25 ng/mL (sensitivity 94.3%, specificity 68.2%). Conclusions: Plasma serglycin levels correlate with both the presence and severity of coronary stenosis in patients with SAP, suggesting that it could be a potential predictive marker of severe stenosis in SAP patients.Öğe Association of CA-125 Levels with Presence of Permanent Atrial Fibrillation in Patients with Systolic Heart Failure(ELSEVIER SCIENCE INC, 2013) Kaya, Hakki; Yucel, Hasan; Zorlu, Ali; Gunes, Hakan; Yimaz, Mehmet Birhan…Öğe Association of soluble ST2 Level with 6-month Mortality and/or Recurrent Cardiovascular-Related Hospitalization in Pulmonary Embolism(Arquivos Brasileiros Cardiologia, 2024) Gunes, Hakan; Gunes, Handan; Dagli, Musa; Kirisci, Mehmet; Ozbek, Meryem; Atilla, Nurhan; Yilmaz, Mehmet BirhanBackground: The association of soluble suppression of tumorigenesis-2 (sST2) levels with prognosis in pulmonary embolism (PE) is unknown. Objective: This study aimed to investigate the relationship between sST2 levels in patients with acute PE and 6 -month mortality and recurrent hospitalizations. Methods: This prospective study included 100 patients with acute PE. Patients were classified into two groups according to 6 -month mortality and the presence of recurrent Cardiovascular -Related hospitalizations. Two groups were compared. A p -value of 0.05 was considered statistically significant. Results: Soluble ST2 levels were significantly higher in the group with mortality and recurrent hospitalizations. (138.6 ng/mL (56.7-236.8) vs. 38 ng/mL (26.3-75.4); p<0.001) The best cut-off threshold for sST2 levels in the prediction of a composite outcome of 6 -month mortality and/or recurrent Cardiovascular -Related hospitalization was found to be >89.9 with a specificity of 90.6% and a sensitivity of 65.2%, according to the receiver operating characteristic curve (area under the curve = 0.798; 95% CI, 0.705-0.891; p <0.0001). After adjusting for confounding factors that were either statistically significant in the univariate analysis or for the variables correlated with the sST2 levels, sST2 level (OR = 1.019, 95% CI: 1.009-1.028, p 0.001) and C -reactive protein (CRP ) (OR = 1.010, 95% CI: 1.001-1.021, p = 0.046) continued to be significant predictors of 6 -month mortality and/or recurrent Cardiovascular -Related hospitalization in the multiple logistic regression model via backward stepwise method. Conclusion: Soluble ST2 level seems to be a biomarker to predict 6 -month mortality and/or recurrent CardiovascularRelated hospitalization in patients with acute PE.Öğe Cancer Antigen 125 is Associated with Length of Stay in Patients with Acute Heart Failure(TEXAS HEART INST, 2017) Kaya, Hakki; Kurt, Recep; Beton, Osman; Zorlu, Ali; Yucel, Hasan; Gunes, Hakan; Oguz, Didem; Yilmaz, Mehmet BirhanLength of stay is the primary driver of heart-failure hospitalization costs. Because cancer antigen 125 has been associated with poor morbidity and mortality rates in heart failure, we investigated the relationship between admission cancer antigen 125 levels and lengths of stay in heart-failure patients. A total of 267 consecutive patients (184 men, 83 women) with acute decompensated heart failure were evaluated prospectively. The median length of stay was 4 days, and the patients were classified into 2 groups: those with lengths of stay <= 4 days and those with lengths of stay > 4 days. Patients with longer lengths of stay had a significantly higher cancer antigen 125 level of 114 U/mL (range, 9-298 U/mL) than did those with a shorter length of stay (19 U/mL; range; 3-68) (P < 0.001). The optimal cutoff level of cancer antigen 125 in the prediction of length of stay was > 48 U/mL, with a specificity of 95.8% and a sensitivity of 96% (area under the curve, 0.979; 95% confidence interval [CI], 0.953-0.992). In the multivariate logistic regression model, cancer antigen 125 > 48 U/mL on admission (odds ratio=4.562; 95% CI, 1.826-11.398; P=0.001), sodium level (P< 0.001), creatinine level (P=0.009), and atrial fibrillation (P=0.015) were also associated with a longer length of stay after adjustment for variables found to be statistically significant in univariate analysis and correlated with cancer antigen 125 level. In addition, it appears that in a cohort of patients with acute decompensated heart failure, cancer antigen 125 is independently associated with prolonged length of stay.Öğe COHgb levels predict the long-term development of acute myocardial infarction in CO poisoning(W B SAUNDERS CO-ELSEVIER INC, 2016) Kaya, Hakki; Coskun, Abuzer; Beton, Osman; Zorlu, Ali; Kurt, Recep; Yucel, Hasan; Gunes, Hakan; Yilmaz, M. BirhanBackground: There are several studies evaluating the cardiac effects of carbon monoxide (CO) poisoning during the acute period; however, the number of studies evaluating the long-term cardiac effects is limited. Objective: The present study aimed to evaluate the effects of blood carboxyhemoglobin (COHb) levels, elevated due to CO poisoning on the long-term development of acute myocardial infarction (AMI). Methods: This cross-sectional cohort study included a total of 1013 consecutive patients who presented to the emergency department (ED) due to CO poisoning, between January 2005 and December 2007. The diagnosis of CO poisoning was made according to the medical history and a COHb level of greater than 5%. In terms of AMI development, the patients were followed up for an average of 56 months. Results: At the end of follow-up, 100 (10%) of 1013 patients experienced AMI. Carboxyhemoglobin levels at the time of poisoning were higher among those who were diagnosed with AMI compared to those who were not (55% +/- 6% vs 30% +/- 7%; P < .001). Using a multivariate Cox proportional hazards model with forward stepwise method, age, COHb level, CO exposure time, and smoking remained associated with an increased risk of AMI after adjustment for the variables found to be statistically significant in a univariate analysis. According to a receiver operating characteristic curve analysis, the optimal cutoff value of COHb used to predict the development of AMI was found to be greater than 45%, with 98% sensitivity and 94.1% specificity. Conclusion: In patients presenting to the ED with CO poisoning, COHb levels can be helpful for risk stratification in the long-term development of AMI. (C) 2016 Elsevier Inc. All rights reserved.Öğe Determination of Vascular Endothelial Growth Factor (VEGF) and Tie-2 Levels in Patients with Primary Hypertension(ELSEVIER SCIENCE INC, 2013) Filiz, Ahmet Kemal; Gunes, Hakan; Ozdemir, Ercan; Gunes, Handan; Yilmaz, Mehmet Birhan…Öğe Evaluation of Atrial Electromechanical Delay to Predict Atrial Fibrillation in Hemodialysis Patients(MDPI, 2018) Gunes, Hakan; Sokmen, Abdullah; Kaya, Hakki; Gungor, Ozkan; Kerkutluoglu, Murat; Guzel, Fatma Betul; Sokmen, GulizarBackground and objective: Prevalence of atrial fibrillation is higher in hemodialysis patients as compared to the general population. Atrial electromechanical delay is known as a significant predictor of atrial fibrillation. In this study, we aimed to reveal the relationship between atrial electromechanical delay and attacks of atrial fibrillation. Materials and methods: The study included 77 hemodialysis patients over 18 years of age giving written consent to participate in the study. The patients were divided into two groups based on the results of 24-h Holter Electrocardiogram (Holter ECG) as the ones having attacks of atrial fibrillation and the others without any attack of atrial fibrillation. Standard echocardiographic measurements were taken from all patients. Additionally, atrial conduction times were measured by tissue Doppler technique and atrial electromechanical delays were calculated. Results: Intra- and interatrial electromechanical delay were found as significantly lengthened in the group of patients with attacks of atrial fibrillation (p = 0.03 and p < 0.001 respectively). The optimal cut-off time for interatrial electromechanical delay to predict atrial fibrillation was >21 ms with a specificity of 79.3% and a sensitivity of 73.7% (area under the curve 0.820; 95% confidence interval (CI), 0.716-0.898). In the multivariate logistic regression model, interatrial electromechanical delay (odds ratio = 1.230; 95% CI, 1.104-1.370; p < 0.001) and hypertension (odds ratio = 4.525; 95% CI, 1.042-19.651; p = 0.044) were also associated with atrial fibrillation after adjustment for variables found to be statistically significant in univariate analysis and correlated with interatrial electromechanical delay. Conclusions: Interatrial electromechanical delay is independently related with the attacks of atrial fibrillation detected on Holter ECG records in hemodialysis patients.Öğe The evaluation of renal hemodynamics changes in Familial Mediterranean fever with color Doppler sonography(TAYLOR & FRANCIS LTD, 2016) Sezer, Ferhat; Uslu, Ali Ugur; Egilmez, Hulusi; Balta, Sevket; Varol, Kenan; Arik, Bilal; Seker, Emrah; Gunes, Hakan; Yonem, OzlemBackground: Renal resistive index (RRI) scanned through renal Doppler is a practical marker employed in measuring blood flow in renal and intrarenal arteries and in noninvasive evaluation of renal vascular resistance. We aimed to investigate the renal hemodynamic variations in patients with Familial Mediterranean Fever (FMF).Material and methods: Seventy-nine FMF patients and 51 healthy subjects suitable for age and sex were included. Patients were divided into two groups according to their urinary albumin excretion. Fifty-two patients with 0-29mg/day albuminuria were included in the normoalbuminuric group while 27 patients with 30-299mg/day albuminuria were included in the microalbuminuric group.Results: RRI values were higher in patients with FMF compared to the healthy subjects (p<0.0001). Additionally, RRI values were found to be higher in the microalbuminuric patients group compared to the normoalbuminuric patients group, and RRI values were also higher in normoalbuminuric patients group compared to the control group (p=0.002, p<0.0001). The ROC curve analysis suggested that the optimum RRI cutoff value for microalbuminuria in patients was 0.63, sensitivity of 66%, specificity of 60%, and p=0.013.Conclusion: RRI may be a marker that may be used in assessing resistance to renal blood flow, early renal damage, and progression of renal damage in FMF patients.Öğe Giant Left Atrium(WILEY-BLACKWELL, 2013) Kucukdurmaz, Zekeriya; Gunes, Hakan; Kurt, Recep; Karapinar, Hekim…Öğe Letter to Editor: Takotsubo cardiomyopathy(Kare Publ, 2013) Kucukdurmaz, Zekeriya; Karapinar, Hekim; Oflaz, Mehmet Burhan; Gul, Ibrahim; Aydin, Gulay; Gunes, Hakan; Yilmaz, Ahmet[Abstract Not Available]Öğe Methylphenidate Induced Myocarditis(ELSEVIER SCIENCE INC, 2013) Kurt, Recep; Gunes, Hakan; Yilmaz, Mehmet Birhan; Karapinar, Hekim…Öğe NEUTROPHIL TO LYMPHOCYTE RATIO PREDICTS CARDIOVASCULAR MORTALITY IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION(ELSEVIER SCIENCE INC, 2014) Yilmaz, Mehmet Birhan; Ekmekci, Ahmet; Gunes, Hakan; Oguz, Didem; Uslu, Ali Ugur; Eren, Mehmet…Öğe Plasma Osmolality Predicts Mortality in Patients with Heart Failure(ELSEVIER SCIENCE INC, 2013) Gunes, Hakan; Ekmekci, Ahmet; Uslu, Ali Ugur; Eren, Mehmet; Yilmaz, Mehmet Birhan…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 Relation of Levels of Soluble ST2 with Clinic and Prognosis in Heart Failure Patients.(EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC, 2017) Gunes, Hakan; Zararsiz, Abdullah; Gul, Ibrahim; Gunes, Handan…Öğe Relationship between endothelial dysfunction and microalbuminuria in familial Mediterranean fever(AVES, 2016) Gunes, Hakan; Kivrak, Tarik; Tatlisu, Mustafa; Kaya, Hakki; Yilmaz, Mehmet BirhanObjective: The aim of our study is to investigate the relationship between microalbuminuria and flow-mediated dilatation in familial Mediterranean fever (FMF) patients. Material and Methods: In our study, there were two groups consisting of 54 patients who were out of the attack period (43 of whom had no microalbuminuria and 11 of whom had microalbuminuria) and 40 healthy controls (M/F: 12/28). Results: There was no statistically difference between patient and control groups'age (25.06 +/- 8.07, 22.89 +/- 6.00 years, respectively). Flow-mediated dilatation (FMD) percentages were significantly different between the three groups (p=0.01). It was observed that there was a correlation between microalbuminuria and FMD percentage. Conclusion: Endothelial dysfunction and renal damage occurred as a result of low-grade chronic inflammation. Microalbuminuria, which is the indicator of renal damage and endothelial dysfunction, and FMD show that endothelial functions can be used in the following of early detection of renal damage and endothelial functions in FMF patients.Öğe The role of SCUBE1 in the development of late stent thrombosis presenting with ST-elevation myocardial infarction(ELSEVIER DOYMA SL, 2018) Bolayir, Hasan Ata; Kivrak, Tarik; Gunes, Hakan; Akaslan, Dursun; Sahin, Omer; Bolayir, AsliIntroduction and Aim: There is an important link between platelets and inflammation, thrombosis, and vascular and tissue repair mechanisms. SCUBE1 (signal peptide-CUB-EGF domain-containing protein 1) may function as a novel platelet-endothelial adhesion molecule and play pathological roles in cardiovascular biology. Stent thrombosis (ST) following percutaneous coronary intervention is an uncommon and potentially catastrophic event that can manifest as myocardial infarction and sudden death. High platelet reactivity is a risk factor for thrombotic events, including late ST. For this reason, in the current study, we researched the rote of SCUBE1 in the development of late coronary ST. Methods: We included 40 patients admitted to our hospital with a diagnosis of ST-elevation myocardial infarction (STEMI) and signs of late ST on a coronary angiogram. For the control group, we recruited 50 healthy gender-and age-matched individuals who were seen for health check-ups. We also randomly included 100 patients with a diagnosis of STEMI without ST. Results: There were no significant differences between the groups in terms of baseline and demographic characteristics. The mean SCUBE1 level in patients with STEMI with late ST at admission and the STEMI without ST group was significantly higher than in the control group (p<0.01). The mean SCUBE1 level in the STEM! with late ST group was significantly higher than in the STEM1 without ST group (p=0.03). In multivariate regression analysis, serum SCUBE1 (odds ratio [OR]: 1.022; 95% confidence interval [CI]: 1.011-1.033, p<0.001) remained an independent predictor for the presence of Late ST. In addition, receiver operating characteristic curve analysis was used to determine the optimal SCUBE1 cut-off value for predicting late ST. The area under the curve was 0.972 (95% CI 0.95-0.98). The SCUBE1 cut-off value was 59.2 ng/ml, with a sensitivity of 95.4% and specificity of 82.9%. Conclusion: The present work is the first clinical study to demonstrate that serum SCUBE1 levels are significantly higher in patients with late ST and serum SCUBE1 was an independent predictor for the presence of late ST in our study population. (C) 2018 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.Öğe Spontaneous coronary artery dissection diagnosed by multislice computed tomography(TERMEDIA PUBLISHING HOUSE LTD, 2013) Gunes, Hakan; Kucukdurmaz, Zekeriya; Seker, Emrah; Kurt, Recep; Salk, Ismail; Karapinar, HekimSpontaneous coronary artery dissection is a rare cause of acute coronary syndrome. Spontaneous coronary artery dissection can cause stable angina pectoris, unstable angina pectoris, acute myocardial infarction, cardiogenic shock and sudden cardiac death. It usually occurs in young to middle aged women. Atherosclerosis, peripartum period, and structural and inflammatory diseases affecting the artery wall are predisposing factors. It shows similar clinical presentation to coronary artery disease. Diagnosis and early treatment decrease mortality. Treatment options are medical treatment, percutaneous coronary intervention and surgery. The treatment decision is made according to the clinical presentation of the patient, the affected coronary artery and the length of the dissected segment. Diagnosis of the disease is usually made by coronary angiography. We present a patient who consulted our clinic with atypical chest pain and was diagnosed with spontaneous left anterior descending dissection by coronary computed tomography angiography.
