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Öğe Blood pressure response to exercise is exaggerated in normotensive diabetic patients(Taylor & Francis Ltd, 2013) Karavelioglu, Yusuf; Karapinar, Hekim; Gul, Ibrahim; Kucukdurmaz, Zekeriya; Yilmaz, Ahmet; Akpek, Mahmut; Kaya, Mehmet GungorIntroduction. The aim of this study was to investigate the blood pressure (BP) response to exercise in normotensive patients with type II diabetes mellitus (DM). Materials and methods. A cross-sectional study was carried out on 75 normotensive subjects with type 2 DM (group 1), and 70 age-gender matched normotensive healthy volunteers (group 2). Treadmill exercise test, 24-h ambulatory BP monitoring (ABPM) were performed for each patients and healthy volunteers. Results. There were 67 patients (mean age 52 +/- 9 years and 42% male) in group 1 and 68 healthy volunteers (mean age 51 +/- 7 years and 43% male) in group 2. Eight patients from group 1 and 2 subjects from group 2 were excluded because of high BP on ABPM. Groups were similar for systolic BP (SBP) and diastolic BP (DBP) on office measurements and on ABPM. Groups were similar for rest SBP, DBP, heart rate, exercise duration on exercise test. Peak SBP was significantly higher in group 1 than in group 2, but peak DBP was not (196.9 +/- 18 vs 165.9 +/- 18.6 mmHg, p < 0.001; 88.1 +/- 11.6 vs 86.2 +/- 8.7 mmHg, p = 0.283, respectively). Hypertensive response to exercise (HRE) was more frequent in group 1 than in group 2 [39 (58%) vs 6 (9%), p < 0.001]. Independent predictors of peak SBP were DM, office SBP and male gender, while independent predictors of HRE were DM, office SBP and age in multivariate analysis. Conclusions. SBP response to exercise is exaggerated in normotensive diabetic patients compared with non-diabetic subjects. DM, office SBP and male gender are independent predictors of peak SBP. DM, office SBP and age are independent predictors of HRE.Öğe Echocardiographic assessment of right ventricular functions in nondiabetic normotensive hemodialysis patients(AKADEMIAI KIADO RT, 2015) Karavelioglu, Yusuf; Ozkurt, Sultan; Kalcik, Macit; Karapinar, Hekim; Arisoy, ArifPurpose: Heart is affected structurally and functionally in end-stage renal disease (ESRD). However, the data available about adverse effects of ESRD on right ventricle (RV) is scarce. We aimed to evaluate echocardiographic parameters of RV in nondiabetic, normotensive patients with ESRD undergoing hemodialysis (HD). Methods: A total of 45 (24 women; mean age 52.4 +/- 12.4 years) consecutive nondiabetic, normotensive patients with ESRD undergoing HD and 39 healthy age and sex-matched control subjects (22 women; mean age 50.3 +/- 6.6 years) were enrolled in the study. M-mode and two dimensional images, color, pulsed and continuous wave Doppler, and tissue Doppler measurements were acquired from all subjects. Echocardiographic evaluation was performed in the days between HD dates of the patients. Results: RV fractional area change, tricuspid annular plane systolic excursion, tricuspid E velocity, E/A ratio, tricuspid annular E' velocity, and E'/A' ratio were lower in patients than controls (p < 0.001, p = 0.003, p = 0.007, p = 0.005, p < 0.001, and p = 0.034, respectively). However, RV diastolic area, RV myocardial performance index, E/E' ratio, and mean and systolic pulmonary artery pressure were higher in patients than controls (p < 0.001, p = 0.007, p = 0.005, p < 0.001, p = 0.006, respectively). Conclusions: RV systolic and diastolic functions of nondiabetic, normotensive HD patients are deteriorated as compared to healthy controls.Öğe Effect of Blood Donation Mediated Volume Reduction on Right Ventricular Function Parameters in Healthy Subjects(WILEY-BLACKWELL, 2012) Kucukdurmaz, Zekeriya; Karapinar, Hekim; Karavelioglu, Yusuf; Acar, Goksel; Gul, Ibrahim; Emiroglu, Mehmet Yunus; Bulut, Mustafa; Esen, Ali MetinPurpose: We aimed to investigate the effect of controlled and limited volume change by the blood donation model to the right ventricular (RV) function via different echocardiographic parameters in healthy adults. Methods: Study population was composed of 71 healthy subjects who were volunteers for blood donation and evaluated before and after 450 mL blood donation. Pulsed-wave Doppler of the RV inflow and tissue Doppler of tricuspid lateral annulus, and tricuspid annular plane systolic excursion (TAPSE) were assessed. Results: E velocity of inflow decreased significantly (67.6 +/- 15.9 vs 60.9 +/- 12.2, P = 0.006). S and A velocities did not change (15.3 +/- 3.2 vs 15.2 +/- 2.5 cm/s, P = NS; 14.1 +/- 3.3 vs 13.4 +/- 3.1 cm/s, P = NS, respectively) but E showed significant decrease (13.7 +/- 2.9 vs 12.2 +/- 3.2 cm/s, P = 0.011). E/A ratio and E/E ratio were found to be unchanged (1.0 +/- 0.3 vs 1.0 +/- 0.4, P = NS; 5.1 +/- 2 vs 5.3 +/- 2, P = NS, respectively). Myocardial performance index (MPI) was found to be increased but ejection time obtained from the tricuspid annulus did not change (0.50 +/- 0.13 vs 0.54 +/- 0.11, P = 0.040; 243 +/- 37 vs 240 +/- 27, P = NS, respectively). Isovolumetric relaxation and contraction times showed difference close to the significance limit (56 +/- 19 vs 64 +/- 23 ms, P = 0.055; 61 +/- 16 vs 67 +/- 16 ms, P = 0.062, respectively). TAPSE decreased significantly (2.62 +/- 0.29 vs 2.41 +/- 0.27 mm, P = 0.005). Conclusion: E velocity and TAPSE were sensitive to a volume reduction as little as 450 mL in healthy subjects. MPI index of the tricuspid annulus is less sensitive than E and TAPSE but need much care under changing volume state. However S and A velocity and E/A ratio were found to be resistant to the effects of volume depletion. (Echocardiography 2012;29:451-454)Öğe The effect of percutaneous mitral balloon valvuloplasty on left atrial systolic functions(TERMEDIA PUBLISHING HOUSE LTD, 2011) Karapinar, Hekim; Emiroglu, Mehmet Y.; Aung, Soe M.; Kaya, Zekeriya; Karavelioglu, Yusuf; Kucukdurmaz, Zekeriya; Gul, Ibrahim; Esen, Ali M.; Kirma, CevatBackground: Conventional echocardiographic methods have already shown that successful mitral balloon valvuloplasty (MBV) can effectively increase left atrial (LA) functions. Aim: To evaluate LA functions after MBV using colour tissue Doppler imaging. Material and methods: Sixty-eight patients (58 females, mean age: 38 +/- 12 years) were included in the study. Within 24 h before MBV, all the patients underwent colour tissue Doppler study in addition to routine conventional echocardiographic examinations. Late diastolic velocities (A') measured at the LA wall adjacent to the septal and lateral annuli were recorded. All the measurements were repeated 24 h after MBV. The MBV was done using the Inoue technique. Successful MBV patients were included in group A and those who developed severe mitral regurgitation (MR) were included in group B. Results: Sixty-one patients underwent successful MBV while 7 developed MR. Mitral valve areas (MVA) in both groups were significantly increased. Maximum and mean gradients, LA diameter, systolic pulmonary arterial pressure and mean LA pressures were decreased while septal and lateral A' were significantly increased in group A. In group B, no significant change in any variable was found except for the increase in MVA Conclusions: After successful MBV, increase in A' velocity was seen in parallel to the recovery of LA functions. Early improvements in left atrial systolic functions after successful MBV can easily be determined by colour tissue Doppler as a quick and reliable method.Öğe Evaluation of Atrial Electromechanical Coupling Times in Hemodialysis Patients(WILEY, 2014) Karavelioglu, Yusuf; Karapinar, Hekim; Ozkurt, Sultan; Sarikaya, Savas; Kucukdurmaz, Zekeriya; Arisoy, Arif; Kurt, Recep; Yilmaz, Ahmet; Kaya, Mehmet G.BackgroundThere are no definite data about the atrial electromechanical coupling times (AEMCT) in patients with end stage renal failure (ESRF). The aim of this study was to investigate the AEMCT in ESRF patients without hypertension (HT) and diabetes mellitus.MethodsThe study population consisted of 47 normotensive, nondiabetic ESRF patients and 41 healthy age/gender-matched control subjects. The time intervals from the onset of P-wave on the surface electrocardiogram to the beginning of late diastolic A-wave (PA) were obtained from the lateral mitral annulus (PA-lateral, maximum AEMCT), septal annulus (PA-septal), and tricuspid lateral annulus (PA-tricuspid). Time intervals were corrected according to the heart rate. The difference between PA-septal and PA-tricuspid (right AEMCT), PA-lateral and PA-septal (left AEMCT), and PA-lateral and PA-tricuspid (inter AEMCT) were calculated. Corrected time intervals were used for calculations.ResultsGroups were similar for age (5212.3 vs. 49.9 +/- 6years, P>0.05) and gender. Maximum (61 +/- 20 vs. 47 +/- 13ms; P<0.001) AEMCT was significantly higher in the patients compared with the control group, but septal and tricuspid EMCT were not different (P>0.05). Both inter-atrial (37 +/- 21 vs. 24 +/- 16ms, P=0.002) and left atrial (25 +/- 18 vs. 12 +/- 9ms; P<0.001) EMCT were significantly higher in patients when compared with the controls but intra-right atrial EMCT was not different.ConclusionsAtrial conduction parameters such as maximal EMCT, left atrial, and inter-atrial EMCTs were prolonged in ESRF patients. This prolongation is seen in ESRF patients even in the absence of factors that affect atrial coupling, such as HT.Öğe Evaluation of left ventricular diastolic function in nonhypertensive nondiabetic hemodialysis patients(LIPPINCOTT WILLIAMS & WILKINS, 2013) Karavelioglu, Yusuf; Ozkurt, Sultan; Karapinar, Hekim; Kucukdurmaz, Zekeriya; Arisoy, Arif; Kurt, Recep; Yilmaz, Ahmet; Yarlioglues, Mikail; Akpek, Mahmut; Kaya, Mehmet G.Aim Diastolic dysfunction (DD) is common in hemodialysis (HD) patients. Because diabetes mellitus (DM) and hypertension (HT) are also common in this patient group, the exact reason for DD in HD patients is not clear. The present study evaluated left ventricular (LV) diastolic function in HD patients without DM and HT. Methods Fifty patients on HD and 34 age-matched and sex-matched healthy control individuals were enrolled. Echocardiography was performed in all participants. LV systolic and diastolic functions were evaluated by B-mode echocardiography, pulsed wave, and tissue Doppler imaging. The HD patients were divided into two groups according to the presence or absence of left ventricular hypertrophy (LVH) in echocardiography. Results LV dimensions and systolic function were within normal limits and similar between groups. However, the HD patients had significantly worse diastolic function (E/A: 0.78 +/- 0.26 vs. 1.19 +/- 0.28, P < 0.001, e '/a ' septal: 0.77 +/- 0.36 vs. 1.04 +/- 0.21, P < 0.001) and increased filling pressure (E/e ': 8.55 +/- 3.2 vs. 5.79 +/- 1.93, P < 0.001). Thirty-one (62%) patients had LVH, whereas 19 (38%) patients did not have LVH. LV systolic and diastolic functions were similar in HD patients with and without LVH. Seventeen (55%) hypertrophies were concentric and 14 (45%) were eccentric. Diastolic functions were similar in patients with either concentric or eccentric hypertrophy. Conclusion Diastolic function is impaired in HD patients even in the absence of diseases that can cause DD such as HT and DM.Öğe Hypertensive response to exercise in dipper and non-dipper normotensive diabetics(TAYLOR & FRANCIS INC, 2014) Kucukdurmaz, Zekeriya; Karavelioglu, Yusuf; Karapinar, Hekim; Gul, Ibrahim; Yilmaz, Ahmet; Yarlioglues, Mikail; Akpek, Mahmut; Kaya, Mehmet GungorNon-dipper blood pressure (NDP) as an indicator of autonomic dysfunction could be associated with hypertensive response to exercise (HRE) in diabetic patients. HRE was determined as a predictor of development of unborn hypertension. We aimed to investigate if any correlation among NDP and HRE in normotensive type 2 diabetic patients. A total of 59 consecutive type 2 diabetic patients without history of hypertension and with normal blood pressure (BP) on ambulatory blood pressure monitoring (ABPM) were enrolled to the study. We divided the study population in to two groups depending on their BP on ABPM as dipper (group 1) or non-dipper (group 2). There were 22 patients (mean age 49.5 +/- 7 and 10 male) in group 1 and 37 patients (mean age 53.1 +/- 10 and 14 male) in group 2. Daytime diastolic and mean BP of dippers and night time systolic and mean BP of non-dippers were significantly higher. HRE was not significantly different between groups (59% vs. 62%, p = 0.820). Hemodynamic parameters during the exercise test were similar. At multivariate linear regression analysis, resting office systolic blood pressure (SBP) (r = 0.611, p < 0.001), male sex (r = 0.266, p = 0.002) and age (r = 0.321, p = 0.010) were independently correlated with peak exercises SBP. Logistic regression analyses identified the resting office SBP (OR 1.191, 95% CI 1.080-1.313; p<0.001) and age (OR 1.161, 95% CI 1.038-1.298; p = 0.012) were independent predictors of HRE. This study revealed that HRE is not related with non-dipper BP in diabetic patients. This study could inspire to further studies to explore the main reasons of HRE in diabetes mellitus.Öğe Neutrophil to Lymphocyte Ratio is Predictor of Atrial Fibrillation Recurrence After Cardioversion With Amiodarone(SAGE PUBLICATIONS INC, 2015) Karavelioglu, Yusuf; Karapinar, Hekim; Yuksel, Murat; Memic, Kadriye; Sarak, Taner; Kurt, Recep; Yilmaz, AhmetBackground: In this study, our aim is to examine the role of the neutrophil to lymphocyte ratio (NLR) in the predictions of recurrence under long-term follow-up in patients whose sinus rhythms (SRs) were restored with amiodarone in acute atrial fibrillation (AF). Methods: Retrospectively, patients with acute AF, which successfully converted to the SR with amiodarone treatment, were recruited into the study. Patients experiencing the first AF attack were enrolled to the study and followed up for 5 years (median 23 months, 25-75 percentiles 12-24 months). Neutrophil to lymphocyte ratio was computed as absolute neutrophil count divided by lymphocyte count. Results: A total of 218 patients were recruited into the study and followed up for 21.6 13.9 months; 87 (40%) patients had 1 recurrent AF attack within this period. The follow-up of 131 (60%) patients resulted in persisted SR without any other AF attack. Groups were similar in terms of age and gender. Left atrium (LA) diameter and NLR were increased, and platelet count and lymphocyte count were decreased in patients with AF recurrence in univariate analysis (P < .05 for all). Only LA diameter (for per mm, 1.077 [1.021-1.136], P = .006) and NLR (1.584 [1.197-2.095], P = .001) were independent predictors of AF recurrence in the multivariate analysis. Conclusion: Increased NLR is a marker of increased inflammation and may serve as simple, cheap, and readily available predictors of recurrence in the long-term follow-up of patients admitted with acute AF and successfully converted to SR with amiodarone.Öğe Red cell distribution width and hypertensive response to exercise in patients with type 2 diabetes mellitus(TAYLOR & FRANCIS INC, 2014) Kucukdurmaz, Zekeriya; Karavelioglu, Yusuf; Karapinar, Hekim; Sancakdar, Enver; Deveci, Koksal; Gul, Ibrahim; Yilmaz, AhmetObjective: There is no study about hypertensive response to exercise (HRE), which is a marker of unborn hypertension (HT), and red cell distribution width (RDW) association, in diabetic normotensive patients. So, we aimed to investigate any correlation among RDW and HRE in normotensive type 2 diabetic patients. Methods: Consecutive type 2 diabetic patients without history of HT and with normal blood pressure (BP) on ambulatory BP monitoring were included to the study. We divided the patients into two groups depending on their peak systolic BP on exercise; HRE (Group 1) or normal response to exercise (Group 2). Results: Data of 75 diabetic patients (51.9 +/- 9.7) were analyzed (31 male (48%)). Their mean RDW was 13.11 +/- 0.46. Patients with HRE were significantly older than patients without HRE. Smoking was more frequent in Group 2. Gender distribution and body mass index were similar between the groups. Else hemoglobin, hematocrit, red blood cell count and RDW values were not significantly different. Office systolic BP and diastolic BP, daytime and 24-h systolic BP were significantly higher in Group 1 but heart rate was similar between the groups. Conclusions: This study revealed that RDW do not differ between diabetic normotensive patients with HRE or not.Öğe Reversible Cardiomyopathy Associated with Autoimmune Polyendocrine Syndrome Type II(JAPAN SOC INTERNAL MEDICINE, 2013) Karavelioglu, Yusuf; Baran, Ahmet; Karapinar, Hekim; Kucukdurmaz, Zekeriya; Yilmaz, AhmetRecovery of the ventricular function in a patient with cardiomyopathy is very rare. Autoimmune polyendocrine syndrome is also very rare. We herein report a case of reversed cardiomyopathy associated with autoimmune polyendocrine syndrome type II (Schmidt's syndrome) composed of Addison's disease, vitiligo and Hashimoto's thyroiditis. The ventricular function and size were reversed following the administration of suitable hormone replacement therapy for polyendocrine syndrome.Öğe Thoracic outlet syndrome presenting as a pseudostenosis image of the right subclavian artery(Turkish Soc Cardiology, 2011) Karavelioglu, Yusuf; Karapinar, Hekim; Kucukdurmaz, Zekeriya; Bitigen, Atila[Abstract Not Available]
