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Öğe Abnormal Heart Rate Recovery in Stable Heart Failure Patients(WILEY, 2013) Yilmaz, Ahmet; Erdem, Alim; Kucukdurmaz, Zekeriya; Karapinar, Hekim; Gul, Ibrahim; Sarikaya, Savas; Dizman, RafetBackground Heart rate decrease after exercise, that is associated with reactivation of parasympathetic system, is important, as it is also associated with mortality. Previous studies have shown that this is an independent mortality predictor in patients having no coronary artery disease and having normal left ventricular function. In our study, we aimed to study heart rate recovery (HRR) after exercise in patients having impaired left ventricular function. Methods One hundred and two consecutive patients (68 males, 34 females) requested to perform an exercise stress test were included in our study. Patients were divided into two groups as those having a normal heart rate reserve (Group1, n = 72) and those having an abnormal heart rate reserve (Group2, n = 30). Results In Group1 and Group2, resting heart rate averages were found to be 83.61 +/- 18.01/min and 85.10 +/- 13.40/min, respectively (P > 0.05), and maximum heart rates during exercise were 141.42 +/- 19.70/min and 121.17 +/- 19.01/min while those in Group1 had statistically significantly higher heart rates (P < 0.001). A statistically significant positive association was found in the correlation test carried out between the maximum heart rate during the treadmill exercise test and ejection fraction (EF) value (r = 0.201; P < 0.05). Metabolic equivalents of task values obtained during the treadmill exercise test in Group1 and Group2 were 9.48 +/- 2.28 and 8.36 +/- 2.50, respectively, and the difference between the said values was statistically significant (P < 0.05). Conclusions We believe that the association between low EF and abnormal HRR is worth studying and randomized large-scale studies are needed to determine mortality risk.Öğe The assessment of subsegmental branches of the pulmonary artery by intravascular ultrasound in patients with mitral stenosis(TERMEDIA PUBLISHING HOUSE LTD, 2012) Karapinar, Hekim; Kaya, Zekeriya; Acar, Goksel; Esen, Ozlem Batukan; Bulut, Mustafa; Kucukdurmaz, Zekeriya; Gul, Ibrahim; Yazicioglu, Mehmet; Esen, Ali; Kirma, CevatBackground: There are limited data that examine the assessment of subsegmental branches of the pulmonary artery by intravascular ultrasound (IVUS). Aim: To assess the structural characteristics of pulmonary arteries by IVUS in the setting of severe mitral stenosis. Material and methods: Twenty-one consecutive patients (3 men and 18 women; mean age: 38 11 years) who were selected for percutaneous mitral balloon valvuloplasty entered the study. Subsegmental branches of the right lower lobe pulmonary artery were imaged by 40 MHz IVUS when the patients underwent right heart catheterization. Minimal lumen diameter (MLD), external elastic membrane diameter (EEMD), lumen area (LA), and area circumscribed by the external elastic membrane (the total vessel area - TVA) were measured. From these measurements, wall area (WA = TVA - LA), intima-media wall thickness [IMT = (EEMD - MLD)/2], relative wall thickness (RWT = IMT/EEMD), and relative wall area (RWA = WA/TVA) were derived. Results: We were able to perform the IVUS examination in all patients without complications. Several IVUS anatomic indexes correlated with hemodynamic data. Pulmonary artery IMT, RWT, and RWA correlated significantly with pulmonary artery systolic pressure (r = 0.763, p = 0.002; r = 0.698, p = 0.001; r = 0.717, p = 0.006, respectively). However, there was no significant correlation between ultrasound measurements and echocardiographic parameters of the mitral valve. Conclusions: The subsegmental branches of the pulmonary artery can be assessed by IVUS. Patients with pulmonary hypertension in the setting of mitral stenosis have greater pulmonary arterial WT. The severity of WT is correlated with pulmonary artery pressure, but it is not associated with mitral valve area. Intravascular ultrasound may provide useful additional information in the management of patients with mitral stenosis.Öğe Atypical antipsychotic use is an independent predictor for the increased mean platelet volume in patients with schizophrenia: A preliminary study(ISFAHAN UNIV MED SCIENCES, 2013) Semiz, Murat; Yucel, Hasan; Kavakci, Onder; Yildirim, Osman; Zorlu, Ali; Yilmaz, Mehmet Birhan; Kucukdurmaz, Zekeriya; Canan, FatihBackground: Cardiovascular diseases, cardiovascular risk factors, and mortality due to these situations are more frequently encountered in schizophrenic patients when compared with the general population. The mean platelet volume (MPV) is a surrogate biomarker of the platelet activity and an useful prognostic test in cardiometabolic diseases. The aim of this study was to investigate what influenced MPV levels in patients with schizophrenia. Materials and Methods: We evaluated hospital records of 60 hospitalized schizophrenia patients. Thirty age-and sex-matched healthy control subjects were also included as a control group. Results: MPV levels were significantly higher in patients who were on atypical antipsychotic drugs than in patients who were not using any drug (9.2 +/- 0.8 vs. 8.6 +/- 0.8 fL, P = 0.016) and also higher than control group (9.2 +/- 0.8 vs. 8.1 +/- 0.9 fL, P < 0.001). Furthermore, patients who were not using antipsychotics had higher MPV than control group (8.6 +/- 0.8 vs. 8.1 +/- 0.9 fL, P = 0.036). Atypical antipsychotic use [Odds ratio (OR) = 6.152, 95% confidence interval (CI,) P = 0.003)] and platelet distribution width (OR = 0.989, 95% CI, P = 0.032) were associated with high MPV levels in univariate analysis. In multivariate logistic regression model, only atypical antipsychotics use (OR = 6.152, 95% CI, P = 0.003) was found to be independent predictor of high MPV levels after adjustment of other potential confounders (age, gender, presence of hypertension, diabetes mellitus, hyperlipidemia, and smoking). Conclusion: MPV seems to be influenced not only by schizophrenia itself but also by atypical antipsychotic drugs. It might be concluded that schizophrenic patients are under increased risk for cardiometabolic diseases and risk factors and this risk is higher in patients on atypical antipsychotic treatment.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 Bradycardia Seen In Children With Crimean-Congo Hemorrhagic Fever(MARY ANN LIEBERT, INC, 2013) Oflaz, Mehmet Burhan; Kucukdurmaz, Zekeriya; Guven, A. Sami; Karapinar, Hekim; Kaya, Ali; Sancakdar, Enver; Deveci, Koksal; Gul, Ibrahim; Erdem, Alim; Cevit, Omer; Icagasioglu, F. DilaraIntroduction: Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic viral disease with a high mortality rate. In clinical practice, we observed bradycardia in some pediatric patients with CCHF during the clinical course. So we aimed to report CCHF cases that presented bradycardia during the clinical course and the relation of bradycardia with the clinical findings and ribavirin therapy. Methods: Charts of all hospitalized pediatric CCHF patients were reviewed with respect to age, sex, history of tick bite or history of removing a tick, other risk factors for CCHF transmission, and interval between the tick bite and the onset of symptoms. Outcomes and clinical and laboratory findings and medications were recorded for each patient. We searched the patient records for information regarding the existence of bradycardia. Bradycardia was accepted as the heart rate 2 standard deviations (SD) lower than the suspected heart rate based on age. Results: Fifty-two patients (mean age 11.24.4 years, 31 female) were enrolled into the study. Bradycardia was seen in seven patients. Six patients with bradycardia were male and only one was female, and the mean age was 13.1 +/- 1.6 years. It was observed that male gender is frequent among patients with bradycardia, as compared with those without bradycardia (p=0.01). Bleeding was found to be more frequent in patients with bradycardia (p=0.02). There were significant differences between the bradycardia and nonbradycardia groups with regard to the requirements for fresh frozen plasma transfusion, the number of platelet suspension given, requirement for intravenous immune globulin (IVIG) and in the days of stay in hospital (p=0.01, p=0.03, p=0.03, p=0.04, respectively). Conclusion: Reversible bradycardia might be seen in the clinical course of pediatric CCHF patients, and the clinicians must be aware of this finding. The possibility that ribavirin may potentiate bradycardia cannot be assessed without a placebo-control study. So further studies may help to reveal the cause of the bradycardia, the disease itself, or the ribavirin therapy. Hence this study supports the need for a randomized, placebo-controlled study to assess intravenous ribavirin in treating CCHF and to support approval of the drug.Öğe A BULLET NUCLEUS MOBILE WITH CARDIAC CYCLE(NOBEL ILAC, 2012) Kucukdurmaz, Zekeriya; Sezen, Yusuf; Yildiz, Ali; Gur, Mustafa; Demirbag, RecepWe hereby report a case of atypical chest pain after a firearm injury occurring 20 years ago, which remained asymptomatic throughout the years. The patient had a positive treadmill exercise test and his coronary angiographic examination revealed plaque lesions and a bullet embedded in the myocardium. The bullet could not be localized clearly by echocardiography or computerised tomography due to the shiny nature of the metal. Penetrating gun traumas are quite frequent in developed countries and in countries in war, with most of the cases ending with death. A situation similar to our case was reported only once in the medical literature. Firearm injuries lead to free mural perforations, fistulisations between cardiac spaces and pericardial tamponade. Usually the patients die before reaching the hospital. But in asymptomatic patients, the bullet may be found as embedded in the myocardium.Öğe Cardiac findings in children with Crimean-Congo hemorrhagic fever(INT SCIENTIFIC LITERATURE, INC, 2011) Gul, Ibrahim; Kaya, Ali; Guven, Ahmet Sami; Karapinar, Hekim; Kucukdurmaz, Zekeriya; Yilmaz, Ahmet; Icagasioglu, Fusun Dilara; Tandogan, IzzetBackground: Crimean-Congo hemorrhagic fever (CCHF) involves the multi-organ systems. The involvement of the heart in adult patients has been described previously. We investigated the electrocardiographic and echocardiographic findings of pediatric patients with CCHF. Material/Methods: Patients younger than 16 years of age diagnosed with CCHF were enrolled in the study. The diagnosis of CCHF infection was based upon typical clinical and epidemiological Findings and serological tests. All patients underwent a thorough cardiologic evaluation. A standard 12-lead electrocardiography and echocardiography were performed. Results: Twenty-three consecutive patients who were hospitalized with diagnosis of CCHF were enrolled in the study (mean age: 12 2 years, 6 female). All electrocardiographic parameters were within normal ranges according to age. Seven patients (30%) had minimal (<1 cm) pericardial effusion. Fifteen (65%) patients had segmental wall motion abnormalities (hypokinesia). A second echocardiography revealed that all wall motion abnormalities had disappeared; the pericardial effusion persisted in only 2 of 7 patients (28%). Conclusions: Cardiac involvement appears to be more frequent in children with CCHF disease than in adults, but it is slighter and almost totally reversible; however, the course of the disease in children is milder than it is in adults.Öğe Catheter ablation for atrial fibrillation results in greater improvement in cardiac function in patients with low versus normal left ventricular ejection fraction(SPRINGER, 2013) Kucukdurmaz, Zekeriya; Kato, Ritsushi; Erdem, Alim; Golcuk, Ebru; Tobiume, Takeshi; Nagase, Takahiko; Ikeda, Yoshifumi; Nakajima, Yoshie; Matsumura, Makoto; Komiyama, Nobuyuki; Nishimura, Shigeyuki; Matsumoto, KazuoIt is still unknown whether left ventricular ejection fraction (LVEF) might affect the magnitude of improvement after atrial fibrillation (AF) ablation on cardiac function in persistent or longstanding persistent AF (CAF) patients. We performed echocardiography in 35 patients with CAF before and after catheter ablation (CA). Patients were stratified by LVEF into two groups prior to CA-normal LVEF (a parts per thousand yen50 % LVEF, N group, n = 24) and a low LVEF group (< 50 % LVEF, L group, n = 11). Patients were followed at 1 month, 3 months, 6 months, 1 year, and 2 years after ablation. After 15.8 +/- 7.4 months follow-up, the L group showed greater improvement in LVEF and left atrial ejection fraction (LAEF; N group vs L group: LVEF difference (%), 5 +/- 8 vs 20 +/- 13, p < 0.01; LAEF difference (%), 11 +/- 12 vs 21 +/- 10, p < 0.05). LA maximal volume and E/e' showed the same tendency after ablation, although the extent of improvement was not statistically significant. Both groups showed almost the same time course of improvement up to 2 years, although the L group showed earlier recovery in LVEF. The greater improvement in several cardiac functions was seen in patients with greater LV dysfunction, after the CA for CAF.Öğe Closure of patent ductus arteriosus with oversized Amplatzer occluder in a patient with pulmonary hypertension(TERMEDIA PUBLISHING HOUSE LTD, 2013) Karapinar, Hekim; Kucukdurmaz, Zekeriya; Oflaz, Mehmet Burhan; Gul, Ibrahim; Yilmaz, AhmetDiagnosis of patent ductus arteriosus is rare in adulthood. Closure of ductus is difficult when diagnosed at an adult age due to the development of pulmonary hypertension and pulmonary arterial disease that generally occurs. Closure of the ductus might be contraindicated, as it may lead to deterioration of the pulmonary arterial perfusion or to a pulmonary hypertensive crisis. In addition, another risk associated with percutaneous closure for these patients is the risk of embolism of the asymmetrically shaped device to the systemic circulation. We present in this manuscript a case with patent ductus arteriosus diagnosed at an adult age that underwent successful closure by the percutaneous method. During closure, an oversized Amplatzer duct occluder device was used to reduce the risk of device embolism.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 Endothelium Functions by Flow-mediated Dilatation in Pediatric Patients With Crimean-Congo Hemorrhagic Fever(LIPPINCOTT WILLIAMS & WILKINS, 2015) Karapinar, Hekim; Kaya, Ali; Uysal, Elif Bilge; Kucukdurmaz, Zekeriya; Deveci, Koksal; Guven, Ahmet Sami; Sancakdar, Enver; Yilmaz, AhmetBackground: Crimean-Congo hemorrhagic fever (CCHF) is a systemic viral disease that also affects the endothelium. Thrombocytopenia and hemorrhage are seen in this disease. But, the cause of thrombocytopenia is not clear. We hypothesized that endothelium dysfunction may be the cause of thrombocytopenia. We evaluated the endothelium functions by flow-mediated dilatation (FMD) in CCHF. Methods: Consecutive children with suspected CCHF who applied to our hospital were evaluated for recruitment into the study. FMD analysis was done in the active and healing period of the disease. Diagnosis was confirmed or ruled out by polymerase chain reaction and/or ELISA test. Basal brachial artery diameter (BBAD) and dilated brachial artery diameter (DBAD) after ischemic period were measured and percent dilatations [(DBAD-BBAD)/BBAD, FMD%] were computed from all subjects. Results: Fifty-four children (40 male, mean age 12.4 +/- 4.4 years) were recruited into the study. CCHF diagnosis was confirmed in 28 children and ruled out in 26 children. Groups were similar for age and gender. FMD% was significantly decreased in CCHF patients when comparing this with the control patients in the active period (2.65 +/- 2.76 vs. 13.76 +/- 7.95, P < 0.001). FMD% was correlated with platelet count in the active period of the disease (r = 0.599, P = 0.004). FMD% was recovered in the healing period (2.65 +/- 2.76 vs. 14.72 +/- 2.66, P < 0.001) and was not significantly different from basal values of control patients (P > 0.05). Conclusions: FMD is significantly decreased in CCHF and recovers in the healing period. So, endothelium functions are disturbed, and disturbance is correlated with thrombocytopenia in CCHF.Öğe The Evaluation of Hypoxia-Inducible Factor 1 in N-Nitro-L-Arginine Methyl Ester Preeclampsia Model of Pregnant Rats(BMJ PUBLISHING GROUP, 2011) Kaya, Ali; Boztosun, Abdullah; Seckin, Hulya; Guven, Ahmet Sami; Kucukdurmaz, Zekeriya; Gulturk, Sefa; Cevit, OmerObjective: The objective of the study was to evaluate hypoxia-inducible factor 1 (HIF-1), which plays a major role in the stimulation of angiogenesis in placental tissues, by using immunohistochemical staining in preeclampsia model of rats, developed by N-nitro-L-arginine methyl ester (L-NAME) Methods: Thirty pregnant rats were randomized into 2 groups (n = 15 in each group) on day 10 of gestation. L-NAME was given to rats in the study group by gavage. On days 0, 10, and 20 of gestation, rats were weighted, and urine protein values and blood pressures were measured. Hypoxia-inducible factor 1 expressions were assessed with immunohistochemical staining by using avidin-biotin peroxidase via selecting preparation. Results: Systolic and diastolic blood pressures and urine protein value of L-NAME group on day 20 of gestation were found to be significantly higher than those obtained on days 0 and 10 of gestation in the same group and those obtained on day 20 of gestation in the sham group (P < 0.05). Maternal weight, number of fetuses, and mean fetal weight of rats in L-NAME group on day 20 of gestation were found to be significantly lower than those obtained from rats in the sham group (P < 0.05). Regarding HIF-1 expression of placental tissues, mild immunohistochemical staining was found in 2 rats (13.4%) and moderate in 13 rats (86.6%) in the L-NAME group. A significant difference was found in terms of HIF-1 positivity in the maternal placentas of both groups (P < 0.05). Conclusions: L-NAME preeclampsia model of pregnant rats is consistent with human preeclampsia in terms of hypertension, proteinuria, and intrauterine growth retardation; in addition, it also shows evidence of placental hypoxia findings.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 External iliac artery pseudo-stenosis associated with catheterization: report of two cases(TERMEDIA PUBLISHING HOUSE LTD, 2012) Karapinar, Hekim; Gul, Ibrahim; Kucukdurmaz, Zekeriya; Gumrukcuoglu, Hasan Ali; Yilmaz, AhmetIn invasive cardiology practices, the most commonly used vascular access site is the femoral artery. Atherosclerotic stenoses on the femoral and iliac arteries create difficulties in these practices. Vasospasm rarely occurs on large arteries like these. This paper reports stenosis encountered during coronary angiography on iliac arteries in 2 patients. The stenoses caused difficulties for guidewire and catheter insertion in catheterization. In the revisualization of these arteries at the next session, the stenoses had disappeared, but the arteries were tortuous. The patients did not have peripheral ischemia signs previously, nor did they appear after the procedure. These transient stenoses might have occurred due to vasospasm and the accordion effects caused by the guidewire and/or catheter.Öğe Giant Left Atrium(WILEY-BLACKWELL, 2013) Kucukdurmaz, Zekeriya; Gunes, Hakan; Kurt, Recep; Karapinar, Hekim…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 Is Atrial Electromechanical Coupling Delayed in Patients with Secundum Atrial Septal Defect?(WILEY-BLACKWELL, 2013) Oflaz, Mehmet Burhan; Karapinar, Hekim; Kucukdurmaz, Zekeriya; Guven, Ahmet Sami; Gumrukcuoglu, Hasan Ali; Sarikaya, Savas; Yilmaz, AhmetBackground: There is no available published information about the atrial electromechanical coupling time (AEMCT) in patients with atrial septal defect (ASD). The aim of this study was to investigate the relationship between ASD and AEMCT obtained by tissue Doppler imaging (TDI). Methods: A total of 35 patients with ASD and 22 healthy controls were included in the study. The time intervals from the onset of the P-wave on the surface electrocardiogram to the beginning of the late diastolic A-wave (PA) representing AEMCT were obtained from the lateral mitral annulus, septal mitral annulus, and right ventricular (RV) tricuspid annulus, and named PA-lateral, PA-septal, and PA-tricuspid, respectively. The difference between PA-septal and PA-tricuspid, PA-lateral and PA-septal, and PA-lateral and PA-tricuspid were defined as intra-right AEMCT, intra-left AEMCT, and inter-AEMCT, respectively. Results: PA-tricuspid, PA-septal, and PA-lateral values were longer in patients with ASD when compared with the controls, but did not reach statistical significance (39.9 +/- 19.1 vs. 37.2 +/- 15.5, P = 0.952; 49.6 +/- 14.0 vs. 45.4 +/- 11.1, P = 0.826 and 60.3 +/- 16.3 vs. 59.7 +/- 12.5, P = 0.437, respectively). There were no significant differences between the ASD and control groups in terms of inter-atrial, intra-right atrial, and intra-left AEMCT (21.3 +/- 2.3 vs. 20.8 +/- 4.6, P = 0.957; 9.7 +/- 3.3 vs. 6.9 +/- 1.3, P = 0.723 and 13.6 +/- 4.7 vs. 10.9 +/- 4.5, P = 0.518, respectively). Furthermore, ASD diameter and total septum length did not correlate with AEMCT. Conclusion: Both intra-and inter-AEMCT were not increased in patients with ASD than control subjects. In addition, we found no association between the ASD diameter and indices of AEMCT in patients with ASD.Öğe Kissing balloons and kissing devices: transcatheter closure of multiple atrial septal defects on hypermobile atrial septum with two devices(TERMEDIA PUBLISHING HOUSE LTD, 2012) Kucukdurmaz, Zekeriya; Karapinar, Hekim; Oflaz, Mehmet Burhan; Gul, Ibrahim; Yilmaz, AhmetEndovascular treatment has become an accepted treatment modality for atrial septal defects (ASD) in adults. In multiple defects on a hypermobile atrial septum with atrial septal aneurysm (ASA), surgery used to be the treatment of choice, but transcatheter occlusion has emerged as a successful alternative in appropriate cases. We present a case with multiple ASDs treated with two ASD occluder devices.
