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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, Ali
Background: 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.
Akut pulmoner emboli’de kırmızı hücre dağılım genişliği’nde artış ve bunun hastane içi mortalite ile ilişkisi
(Cumhuriyet Üniversitesi, 2010) Zorlu, Ali; Yılmaz, Mehmet Birhan
Giriş: Akut Pulmoner Emboli (APE) sık görülen bir kardiyopulmoner hastalık olup, yıllar içinde erken tanı, risk değerlendirilmesi ve gelişen tedavi yöntemleri ile mortalite ve morbiditesinde önemli oranda azalma sağlanmıştır. Kırmızı hücre dağılım genişliği (KDHG), alyuvarların hacimlerindeki değişkenliği gösteren bir indeks olup anizositozisin derecesini saptamak için kullanılabilmektedir. Kırmızı hücre dağılım genişliği düzeyinin birçok anemi türünde, hemoglobinopatilerde ve kan transfüzyonu gibi bazı durumlarda arttığı bilinmekle beraber, son yıllarda yapılan araştırmalarda; akut miyokard infarktüsü, kalp yetersizliği ve pulmoner hipertansiyon gibi kardiyopulmoner hastalıklarda da yükseldiği ve prognozla güçlü bir ilişki içinde olduğu gösterilmiştir.Yöntem ve Gereçler: Ocak 2008 ile Ocak 2010 tarihleri arasında acil servisten akut pulmoner emboli şüphesiyle Göğüs hastalıkları ve Kardiyoloji bölümlerine yatırılıp tanısı doğrulanan ardışık 96 hasta çalışmaya dahil edildi. Kontrol grubuna yaş ve cinsiyet olarak eşleştirilmiş sağlıklı 51 erişkin dahil edildi. APE hastaları serum KHDG düzeylerine göre üç tertile ayrıldı; KHDG değeri ?%13.9 olanlar birinci tertil, %14.0-16.2 arasında olanlar 2. tertil ve ?%16.3 olanlar 3. tertil olarak sınıflandırıldı. KHDG düzeyi ile hastaların hemodinamik durumu ve hastane içi mortalite arasındaki ilişki değerlendirildi.Sonuçlar: Yüksek KHDG düzeylerine sahip hastalarda kalp hızları daha yüksek (106±16 vs 109±21 vs 119±19 atım/dk, sırasıyla, p=0.010) sistolik ve diyastolik kan basınçları daha düşük (115±19 vs 104±20 vs 99±13 mmHg, sırasıyla, p=0.003, 71±16 vs 64±15 vs 60±12 mmHg, sırasıyla, p=0.012), parsiyel oksijen basınçları daha düşük (55±14 vs 52±11 vs 47±11 mmHg, sırasıyla, p=0.046) ve oksijen saturasyonları daha azdı (87±8 vs 86±8 vs 80±10 %, sırasıyla, p=0.006). Atriyal fibrilasyon yüksek KHDG düzeylerine sahip hastalarda daha sık izlendi (2(7) vs 8(27) vs 12(40) n,% , sırasıyla, p=0.010). Yüksek KHDG düzeylerine sahip hastalarda düşük düzeydekilere göre, ejeksiyon fraksiyonu daha düşük (r:-0.338, p=0.003), sağ kalp boşluklarında dilatasyon çıkma olasılığı daha yüksek (14(58) vs 18(78) vs 25(93) n,%, sırasıyla, p=0.015), triküspit yetersizliği daha ciddi (3/10/11/0 vs 1/7/9/5 vs 0/5/11/10, yok/hafif/orta/şiddetli, sırasıyla, p=0.023), sistolik pulmoner arter basıncı daha yüksekti (36±14 vs 46±17 vs 53±19 mmHg, sırasıyla, p=0.002). Anemi, yüksek KHDG düzeylerine sahip hastalarda daha sık tespit edildi (7(22) vs 13(41) vs 18(56) n,%, sırasıyla, p=0.019). Hastalar, hastaneye yatış sonrası ortalama 11 gün (aralık: 1-40) takip edildi ve takip sürecinde toplam 20 hasta (21%) öldü. Ölen hastaların ortalama KHDG değerleri yaşayanlara göre istatistiksel olarak anlamlı şekilde yüksek saptandı (%16.9±1.9 vs %15.1±2.6, p=0.005). Kırmızı hücre dağılım genişliği açısından birinci tertilde olan hastalar arasında ölenlerin oranı %3 (n=1), 2. tertilde ölenlerin oranı %25 (n=8) ve 3. tertilde ölenlerin oranı %34 (n=11) olup fark istatistiksel açıdan önemliydi (p=0.007). Kaplan-Meier eğrisi ile, KHDG sınıfı ile hastaların ölüm riskinin anlamlı şekilde ilişkili olduğu gösterildi. KHDG değerinin hastane içi mortaliteyi göstermek için kullanılabilecek optimal cut-off değeri 14.6, duyarlılığı %95 ve özgüllüğü %66 olarak saptandı (AUC 0.758, 95% CI 0.662 to 0.854). Yapılan çok değişkenli regresyon analizinde, KHDG ve D-dimer düzeylerinin APE'de hastane içi mortaliteyi gösteren bağımsız ön gördürücüler olduğu tespit edildi.Tartışma: Biz bu çalışmamızda, APE hastalarında, KHDG düzeyi artıkça hastaların hemodinamik parametrelerinin kötüleştiğini ve sonuçta hastane içi mortalite oranlarının yükseldiğini gösterdik. Gelecekte; APE hastalarının uzun dönem mortalitesini ön görmede KHDG'nin rolü üzerine prospektif ve büyük hasta populasyonuna sahip çalışmalara ihtiyaç duyulmaktadır.Anahtar Kelimeler: Akut pulmoner emboli, kırmızı hücre dağılım genişliği, kardiyopulmoner hastalık, anemi, hastane içi mortalite
Aortic Intracardiac Echocardiography Guided Septal Puncture During Mitral Valvuloplasty
(ELSEVIER SCIENCE INC, 2013) Akkaya, Emre; Vuruskan, Ertan; Zorlu, Ali; Sincer, Isa; Kucukosmanoglu, Mehmet; Ardic, Idris; Yilmaz, Mehmet Birhan
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Aortic intracardiac echocardiography-guided septal puncture during mitral valvuloplasty
(OXFORD UNIV PRESS, 2014) Akkaya, Emre; Vuruskan, Ertan; Zorlu, Ali; Sincer, Isa; Kucukosmanoglu, Mehmet; Ardic, Idris; Yilmaz, Mehmet Birhan
Transoesophageal echocardiography (TEE) and venous intracardiac echocardiography (ICE) are traditionally used to visualize the interatrial septum (IAS) and the tenting effect of the fossa ovalis in patients undergoing percutaneous balloon mitral valvuloplasty (PBMV). The aim of the present study was to assess the comparative efficacy and safety of arterial (intra-aortic) ICE and venous ICE, compared with TEE (traditional approach), in the patients undergoing PBMV. TEE, aortic ICE, and venous ICE were consecutively performed in 50 patients (40 9 years, 86 female). The images of intracardiac structures were obtained from both aortic and right atrial loci. The IAS was visualized using TEE, aortic ICE, and venous ICE. The mean mitral valve area was 1.14 0.2 cm(2), and the mean left atrial volume index was 57.5 12 mL/m(2). The mean size of the visualized septal length was 48 5 mm by TEE, 51 5 mm by aortic ICE, and 33 6 mm by venous ICE. The BlandAltman test indicated that the 95 limits of agreement for the measurement of septal diameter ranged from 11.0 to 5.9 mm (mean 2.5 mm) between TEE and aortic ICE, 2.8 to 33.5 mm (mean 15.3 mm) between TEE and venous ICE, and 36.6 to 0.8 mm (mean 17.9 mm) between venous and aortic ICE. Standard venous ICE generally tended to yield smaller values compared with TEE and aortic ICE for the measurement of septal length. Furthermore, the view of fossa ovalis and tenting effect was optimal in 11 patients on venous ICE; however, the fossa ovalis and tip of the needle were well visualized in all patients on aortic ICE (P 0.001). There were no major complications with the use of aortic ICE. Aortic ICE is a superior alternative to venous ICE and facilitates trans-septal puncture in patients with mitral stenosis.
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, Ali
BACKGROUND: 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.
Association between oxidative stress index and post-CPR early mortality in cardiac arrest patients: A prospective observational study
(2015) Yücel, Hasan; Türkdoğan, Kenan A.hmet; Zorlu, Ali; Aydın, Hüseyin; Kurt, Recep; Yılmaz, Mehmet B.irhan
OBJECTIVE: Cardiopulmonary resuscitation (CPR) is a series of lifesaving actions that improve the chance of survival following cardiac arrest (CA). Many clinical and laboratory parameters, such as the presence of asystole, out-of-hospital CPR, and duration of cardiac arrest, are associated with failed CPR in patients with CA. Asystole is a state of no cardiac electrical activity, along with the absence of contractions of the myocardium and absence of cardiac output. Oxidative stress index (OSI), which is the ratio of total oxidative status to total antioxidant status, increases by ischemia-reperfusion injury. We investigated whether OSI levels in patients with CA could predict early mortality after CPR.; METHODS: This study has a prospective observational cohort design. Five patients with a history of cancer, four patients who developed hemolysis in their blood, six patients who were transferred to our hospital from other hospitals, and six patients in whom blood samples for OSI could not be stored properly were excluded. Finally, a total of 90 in-hospital or out-of-hospital CA patients and 40 age- and sex-matched healthy volunteers as the control group were evaluated prospectively. The patients were classified according to the CPR response into a successful group (n=46) and a failed group (n=44). Comparisons between groups were performed using one-way ANOVA with post hoc analysis by Tukey's HSD or independent samples t-test and the Kruskal-Wallis tests or Mann- Whitney U test for normally and abnormally distributed data, respectively. Also, we used chi-square test, Spearman's correlation test, univariate and multible logistic regression analyses, and receiver operator characteristic curve analysis.; RESULTS: OSI was 3.0±4.0, 5.6±4.3, and 8.7±3.8 in the control group, the successful CPR group, and the failed CPR group, respectively (p<0.001 for the 2 comparisons). OSI on admission, ischemia-modified albumin, presence of asystole, mean duration of cardiac arrest, out-of-hospital CPR, pH, and potassium and sodium levels were found to have prognostic significance in the univariate analysis. In the multivariate logistic regression model, OSI on admission (OR=1.325, p=0.003), ischemia-modified albumin (OR=1.008, p=0.005), presence of asystole (OR=13.576, p<0.001), and sodium level (OR=1.132, p=0.029) remained associated with an increased risk of early mortality. In addition, the optimal cut-off value of OSI to predict post-CPR mortality was measured as >6.02, with 84.1% sensitivity and 76.1% specificity.; CONCLUSION: Elevated OSI levels can predict failed CPR in CA patients.
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
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Atrial fibrillation is associated with increased mean platelet volume in patients with type 2 diabetes mellitus
(TAYLOR & FRANCIS INC, 2013) Turgut, Okan; Zorlu, Ali; Kilicli, Fatih; Cinar, Ziynet; Yucel, Hasan; Tandogan, Izzet; Dokmetas, Hatice Sebila
Platelet abnormalities in diabetes mellitus (DM) and atrial fibrillation (AF) may underline the etiology of a prothrombotic state in these conditions. Increased mean platelet volume (MPV) is a marker of abnormal platelet function and activation. We aimed to investigate the possible association of chronic AF with MPV in patients who have type 2 DM. Patients who had type 2 DM with either chronic (>= 6 months) AF or normal sinus rhythm (NSR) were included in the study. A total of 162 patients (aged 38-89 years) were divided into 2 groups according to the presence of either AF or NSR. Group 1 consisted of 81 diabetic patients with AF, and group 2 consisted of 81 diabetic patients with NSR. The two groups were not significantly different in terms of age, and gender, as well as in hypertension, smoking, history of coronary artery disease, previous cerebrovascular accidents, microalbuminuria, retinopathy, duration of DM, body mass index, hemoglobin A(1c), total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride (p > 0.05 for all variables). Although no significant difference was present between groups concerning platelet count; for patients with AF, MPV was higher compared with patients with NSR (9.0 +/- 0.2 fl vs. 8.4 +/- 0.2 fl; p = 0.001). Furthermore, no significant difference was noted between groups regarding routine medications received by patients. In multivariate logistic regression analysis, MPV was the only variable independently related to AF (OR = 2.659; 95% CI, 1.286-5.498; p = 0.008). Consequently, it is concluded that AF is associated with increased MPV in patients with type 2 DM, suggesting the presence of tentatively related processes leading to reciprocal interaction.
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, Fatih
Background: 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.
C-type natriuretic peptide is associated with the severity of Crimean-Congo hemorrhagic fever
(ELSEVIER SCI LTD, 2012) Turkdogan, Kenan Ahmet; Zorlu, Ali; Engin, Aynur; Guven, Fatma Mutlu Kukul; Polat, Muhammed Mirhan; Turgut, Okan Onur; Yilmaz, Mehmet Birhan
Background: Crimean-Congo hemorrhagic fever (CCHF) is characterized by vascular dysfunction, indicating the involvement of endothelial cells. C-type natriuretic peptide (CNP) plays a critical role in the coordination of vascular tone and is associated with the prognosis in critically ill patients such as those with sepsis and septic shock. We investigated whether CNP is related to the severity of CCHF. Methods: Forty-eight consecutive patients with a laboratory confirmed diagnosis of CCHF and 40 age-sex-matched healthy volunteers as the control group were prospectively enrolled into the study. CCHF patients were classified according to the disease severity into a non-severe group (n = 28) and a severe group (n = 20). Results: The CNP levels were detected to be 0.43 (0.4-0.7) ng/ml in the control group, 0.87 (0.7-1.0) ng/ml in the non-severe CCFH group, and 1.27 (0.8-1.7) ng/ml in the severe CCHF group. According to the receiver operating characteristics curve analysis, the optimal cut-off value of CNP to predict disease severity was >1.22 ng/ml, with 89.3% specificity and 55% sensitivity. CNP >1.22 ng/ml, lactate dehydrogenase >480 IU/l, and aspartate aminotransferase >202 IU/l were found to have prognostic significance in the univariate analysis. In the multivariate logistic regression analysis by forward stepwise method, CNP >1.22 ng/ml (odds ratio 8.336, p = 0.016) and lactate dehydrogenase > 480 IU/l (odds ratio 16.206, p = 0.002) remained associated with disease severity after adjustment for confounding variables. Conclusions: CNP measurement could help in the risk stratification of patients with CCHF. (C) 2012 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
CA-125 and heart failure
(ELSEVIER IRELAND LTD, 2011) Ege, Meltem Refiker; Zorlu, Ali; Yilmaz, Mehmet Birhan
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CA-125, an omitted part of the heart
(ELSEVIER SCIENCE INC, 2011) Zorlu, Ali; Tandogan, Izzet; Yilmaz, Mehmet Birhan
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CA125 in heart failure: Implications for immunoinflammatory activity
(ELSEVIER IRELAND LTD, 2011) Turgut, Okan; Tandogan, Izzet; Yilmaz, Mehmet Birhan; Gul, Ibrahim; Zorlu, Ali
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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 Birhan
Length 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.
Cancer antigen-125 levels predict long-term mortality in chronic obstructive pulmonary disease
(INFORMA HEALTHCARE, 2015) Kaya, Hakki; Zorlu, Ali; Yucel, Hasan; Dogan, Omer Tamer; Sarikaya, Savas; Aydin, Gulay; Kivrak, Tarik; Yilmaz, Mehmet Birhan
Background: Cancer antigen-125 (CA-125) might be a useful biomarker to predict long-term mortality in patients with recent exacerbation of chronic obstructive pulmonary disease (COPD). Methods: A total of 87 consecutive patients with COPD were evaluated prospectively. Mean age of patients was 68 +/- 10 years (55% males, 45% females) with a median follow-up period of 49 months. Optimal cut-off value of CA-125 to predict mortality was found as >93.34 U/ml, with 91% specificity and 40% sensitivity. Results: After follow-up, 20 out of 87 (23%) experienced cardiovascular death. CA-125 levels were higher among those who died compared to those who survived [55 (12-264) versus 28 (5-245) U/ml, p = 0.013]. In multivariate Cox proportional-hazards model with forward stepwise method, only CA-125 > 93.34 U/ml on admission (HR 3.713, 95% Cl: 1.035-13.323, p = 0.044) remained associated with an increased risk of death. Conclusions: For the first time, we demonstrated that CA-125 helps the risk stratification of patients with COPD.
Cardiovascular Involvement in Behcet's Disease
(TURKISH LEAGUE AGAINST RHEUMATISM, 2015) Aksu, Tolga; Guler, Erdem; Arat, Nurcan; Zorlu, Ali; Yilmaz, Birhan; Guray, Umit; Tufekcioglu, Omac; Kisacik, Halil
Objectives: This study aims to evaluate left and right ventricular functions at rest by pulsed-wave Doppler and tissue Doppler echocardiography methods in patients with Behcet's disease (BD) without overt cardiovascular disease, and compare with age and sex matched subjects. Patients and methods: Fifty-four patients with BD (12 males, 42 females; mean age 35+/-8 years; range 18 to 51 years) without cardiovascular symptoms, and 36 age-matched controls (12 males, 24 females; mean age 33+/-5 years; range 18 to 47 years) were included. Cardiac functions were evaluated by conventional and tissue Doppler echocardiography. Results: Although conventional indices of left ventricular systolic function were similar in both groups, mitral annular systolic velocity was lower (p<0.001) and myocardial performance index was higher (p<0.001) in patients with BD compared to the controls. As an early diagnostic marker of contractile dysfunction, intra-and interventricular dyssynchrony were more common in patients with BD. In addition, mitral E/A ratio of <1 was more common (p<0.001), isovolumic relaxation time (p=0.032) and mitral deceleration time (p=0.037) were longer in patients with BD compared to the control group. All Doppler parameters of right ventricular function were impaired in patients with BD. Atrial septal aneurysm was more frequent in patients with BD than controls (p=0.007). Conclusion: Right ventricular and left ventricular function is impaired in patients with BD. Clinically silent cardiovascular involvement can be detected early by tissue Doppler echocardiography even in asymptomatic patients with BD.
Carotid intima-media thickness, nonalcoholic fatty liver disease, and hemoglobin A1c are independently associated with the severity of psoriasis
(ELSEVIER TAIWAN, 2016) Inci, Rahime; Ozturk, Perihan; Inci, Mehmet Fatih; Mulayim, Mehmet Kamil; Ozdemir, Mine Mujde; Zorlu, Ali
Background: Systemic inflammation plays an important role in the pathogenesis of atherosclerosis in psoriasis patients. Carotid artery intima-media thickness (CIMT) and nonalcoholic fatty liver disease (NAFLD) are accepted important markers for subclinical atherosclerosis and cardiovascular risk prediction. Objectives: The aim of this study was to evaluate the potential association between subclinical atherosclerosis and chronic plaque psoriasis without traditional cardiovascular risk factors. Methods: Sixty consecutive patients with chronic plaque psoriasis (patient group) attending our dermatology outpatient clinic and 60 age-and sex-matched healthy controls (control group) were included in this study. Demographic and biochemical data, and Psoriasis Area and Severity Index (PASI) score of the psoriasis group were recorded. CIMT and NAFLD values were compared. Results: Patients with psoriasis had significantly higher systolic and diastolic blood pressure, fasting levels of glucose, and hemoglobin A1c (HbA1c) compared with controls. Patients with psoriasis had greater CIMT and NAFLD values than matched controls. PASI score was significantly positively correlated with systolic and diastolic blood pressure, body mass index, waist circumference, psoriasis duration, HbA1c, the presence of NAFLD, moderate-severe NAFLD, and CIMT in psoriatic patients. In multivariate linear regression analysis, HbA1c, moderate-severe NAFLD, and CIMT were significantly and independently associated with PASI score, and CIMT showed the most significant association with PASI score. Conclusion: Our data suggest a need for aggressive treatment of the inflammatory process in psoriatic patients as well as better monitoring of nontraditional atherosclerotic risk factors to reduce cardiovascular mortality/morbidity and liver diseases. Abdominal and carotid ultrasonography appear to be useful, simple, and noninvasive examinations to investigate the presence of subclinical atherosclerosis even in psoriatic patients who seem to be otherwise healthy. Copyright (C) 2016, Taiwanese Dermatological Association. Published by Elsevier Taiwan LLC.
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, Ziynet
Coronary 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.
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. Birhan
Background: 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.
Coronary collateral development might be impaired by decreases in glomerular filtration rate Reply
(TURKISH SOC CARDIOLOGY, 2013) Zorkun, Cafer; Akkaya, Emre; Zorlu, Ali; Tandogan, Izzet
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