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    Acute Effects of Passive Smoking on Endothelial Function
    (SAGE PUBLICATIONS INC, 2011) Guel, Ibrahim; Karapinar, Hekim; Yarlioglues, Mikail; Ozdogru, Ibrahim; Kaya, Mehmet Gungor; Yilmaz, Ahmet; Turgut, Okan Onur; Tandogan, Izzet; Eryol, Namik Kemal
    Impairment of endothelial functions has been shown to occur after acute and chronic exposure to passive smoking (PS), as assessed by flow-mediated dilatation (FMD) of the brachial artery. A total of 61 participants, 30 male and 31 female, mean ages 26 (18-36) were enrolled in the study. All were clinically well and nonsmokers. All participants stayed for 30 minutes in the smoking room. Carbon monoxide (CO) level was 7.42 +/- 0.98 ppm (4.71-10.50). Mean carboxyhemoglobin (COHb) levels of participants were significantly elevated after PS. Mean FMD was 18.6% +/- 9% and decreased to 12.4% +/- 7% after PS (P < .001). In the current study, with more number of participants at lower CO concentrations (7.42 ppm) and with smaller increase in COHb (51%) significant reduction (33%, P < .001) in FMD was observed.
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    Acute Effects of Passive Smoking on Left Ventricular Systolic and Diastolic Function in Healthy Volunteers
    (MOSBY-ELSEVIER, 2011) Dogan, Ali; Yarlioglues, Mikail; Gul, Ibrahim; Kaya, Mehmet Gungor; Ozdogru, Ibrahim; Kalay, Nihat; Inanc, Mehmet Tugrul; Ozdogru, Mehtap; Ardic, Idris; Dogdu, Orhan; Eryol, Namik Kemal; Ergin, Ali; Oguzhan, Abdurrahman
    Background: The aim of this study was to investigate the acute effects of passive smoking on left ventricular (LV) function in healthy volunteers. Methods: Sixty-one healthy nonsmoking volunteers were enrolled in this study. LV M-mode, two-dimensional, conventional Doppler, and color tissue Doppler echocardiography were performed, and carboxyhemoglobin (COHb) levels were obtained from subjects before and immediately after exposure to passive smoking for 30 min in a smoking room. The differences between baseline and post-smoke exposure measurements of transmitral E and mitral annular Em velocities, heart rate, systolic blood pressure, diastolic blood pressure, and COHb levels were assessed. Results: Mean COHb levels were statistically higher after exposure. There were no changes in LV systolic function and volumes. LV diastolic function changed significantly immediately after passive smoking. The transmitral E wave (0.89 +/- 0.12 vs 0.70 +/- 0.14 m/sec, P =.001), the pulmonary venous D wave (0.52 +/- 0.12 vs 0.49 +/- 0.13 m/sec, P = .01), and the transmitral E/A ratio 1.79 +/- 0.48 vs 1.47 +/- 0.32, P =.001) decreased, while the transmitral A wave did not change. The mitral annular Em velocity decreased (12.5 +/- 2.1 vs 11.7 +/- 1.9 cm/sec, P =.001), the Am velocity increased (6.3 +/- 2.1 vs 6.8 +/- 1.6 cm/sec, P =.001), and the Em/Am ratio decreased (2.28 +/- 0.82 vs 1.78 +/- 0.42, P =.001). Color Doppler echocardiography determined diastolic impairment in only women, whereas color tissue Doppler echocardiography demonstrated diastolic dysfunction in both genders. Acute deleterious effects of passive smoking on color Doppler echocardiographic parameters were more prominent in women. Change in E was related to changes in heart rate and systolic blood pressure and with COHb levels, while change in Em was related only to COHb levels. Conclusions: Acute exposure to passive smoking impairs LV diastolic function in healthy volunteers. The mechanism whereby passive smoking affects diastolic function is probably complex; however, carbon monoxide exposure and an increment in COHb level may be among the causes. (J Am Soc Echocardiogr 2011; 24: 185-91.)
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    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 Gungor
    Introduction. 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.
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    Effect of Infliximab Treatment on QT Intervals in Patients With Ankylosing Spondylitis
    (LIPPINCOTT WILLIAMS & WILKINS, 2011) Senel, Soner; Cobankara, Veli; Taskoylu, Ozgur; Guclu, Aydin; Evrengul, Harun; Kaya, Mehmet Gungor
    Background: Cardiovascular complications are one of the most common and the most serious extraskeletal manifestations of ankylosing spondylitis (AS). Infliximab, a monoclonal antibody against tumor necrosis factor, is widely used in the treatment of AS. QT dispersion (QTd), which relates to left ventricular function and is used as an index of cardiac dysrhythmia, may be useful as a prognostic guide. Early detection of possible cardiac involvement may not be clinically evident, whereas it may be detected by electrocardiography. Objectives: The aim of this prospective study was to assess the effect of infliximab treatment on QT intervals in patients with AS. Methods: Twenty-one patients (17 females and 4 males) with AS who were in the active phase of disease (Bath Ankylosing Spondylitis Disease Activity Index score >4) were enrolled in the study. Infliximab was administered intravenously at a dosage of 5 mg/kg at weeks 0, 2, and 6 and every 6 weeks thereafter. QT intervals were recorded before and after 6 months of treatment. Results: QT corrected (QTc) for heart rate was significantly reduced in the patients with AS after 6 months of infliximab therapy (406 +/- 5.5 vs 388 +/- 6.6 milliseconds; P = 0.029). There was no difference in the QTc dispersion (34.3 +/- 11.1 vs 34.1 +/- 8.6; P = 0.171). Body mass index and lipid profile were slightly increased after the treatment, but the difference was statistically insignificant. Conclusion: Inflammation can affect the ventricles with an unknown mechanism, and QTc may be slightly prolonged as a result in the active phase of AS. In our study, QTc was shortened under infliximab therapy by suppressing inflammation. Therefore, this effect may protect patients with AS from fatal arrhythmias and sudden cardiac death.
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    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 Gungor
    Non-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.
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    A multicentre, comparative study of Cera septal occluder versus AMPLATZER Septal Occluder in transcatheter closure of secundum atrial septal defects
    (EUROPA EDITION, 2014) Kaya, Mehmet Gungor; Akpek, Mahmut; Celebi, Ahmet; Saritas, Turkay; Meric, Murat; Soylu, Korhan; Karapinar, Hekim; Lam, Yat-Yin
    Aims: To evaluate the safety and efficacy of the new Cera septal occluder (CSO) for atrial septal defect (ASD) closure as compared to the AMPLATZER Septal Occluder (ASO). Methods and results: A total of 405 ASD patients receiving CSO or ASO were studied. The ASDs were classified into simple defects (isolated defects <26 mm) or complex defects (isolated defects >26 mm, large defects with a deficient rim, double or multi-fenestrated defects). Clinical and echocardiographic findings were collected before discharge, at one month, and every six months after implantation. Two hundred and five (133 females, aged 30 +/- 13 years) and 200 (135 females, aged 28 +/- 14 years) patients received CSO and ASO implants, respectively. The CSO group had similar ASD and device sizes, prevalence of complex lesions, procedural times and success rates as compared to the ASO group. Echocardiographic follow-up at one and six months showed similar residual shunts between devices. Both groups had similar rates for device embolisation and atrial arrhythmia. The average equipment cost per patient was lower in the CSO group than in the ASO group (US$3,500 vs. US$5,600, p<0.001). Conclusions: Transcatheter ASD closure with CSO is safe and effective. It appears to be an attractive alternative to ASO because of its relatively low cost.
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    Relation between Severity of the Disease and Arrhythmia Incidence in Patients with Psoriasis
    (ELSEVIER SCIENCE INC, 2013) Karadag, Zakir; Yildiz, Hatice; Gunebakmaz, Ozgur; Sarli, Bahadir; Yarlioglues, Mikail; Dogdu, Orhan; Ardic, Idris; Gul, Ibrahim; Dogan, Ali; Kaya, Mehmet Gungor; Ergin, Ali; Aktas, Ekrem
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    The Safety and Efficacy of Etanercept on Cardiac Functions and Lipid Profile in Patients With Active Rheumatoid Arthritis
    (LIPPINCOTT WILLIAMS & WILKINS, 2012) Senel, Soner; Cobankara, Veli; Taskoylu, Ozgur; Karasu, Ugur; Karapinar, Hekim; Erdis, Eda; Evrengul, Harun; Kaya, Mehmet Gungor
    Objectives: Patients with rheumatoid arthritis (RA) are known to be at increased cardiovascular risk. Etanercept is a tumor necrosis factor alpha (TNF-alpha) blocking agent that has been successfully used in the treatment of RA. We sought to assess the effects of etanercept on cardiac functions and lipid profile in RA patients without overt cardiac disease. Methods: Sixteen patients with active RA were recruited to the study prospectively. Etanercept was administered subcutaneously twice a week for 6 months. Clinical and laboratory predictors of RA activity and lipid profile were evaluated at baseline and at 6 months. The systolic and diastolic function parameters of the left ventricle were obtained by echocardiographic examination and included mitral inflow Doppler and tissue Doppler imaging. Results: Sixteen patients (13 women; median age, 48 years [range, 27-69 years]) completed the study. Patients' 28-item Disease Activity Score and Health Assessment Questionnaire scores were significantly reduced by treatment (6.35 to 4.45 [P < 0.001] and 2.0 to 0.75 [P = 0.005], respectively). Diastolic dysfunction was detected in 6 patients (37.5%) (3 in grade 1 and 3 in grade 2) by mitral inflow Doppler and the tissue Doppler parameters before the treatment. No significant change in diastolic dysfunction was observed during follow-up (6/16 to 5/16, P = 0.164). In addition, there were also no significant differences in the left ventricular ejection fraction (65.8-66.9, P = 0.168) and lipid profiles after 6 months of etanercept treatment. Conclusions: Etanercept treatment was safe for use as regards cardiac functions and lipid profiles and effective on RA parameters during 6-month follow-up in patients with active RA.