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Erdem Y, Erdem S, Barburoglu M, Karaayvaz EB, Shugaiv E, Kurtuncu M, Salmaslioglu A, Oflaz H, Kose AA, Kadioglu A. The risk of endothelial and erectile dysfunctions in Behçet's disease: a comparative analysis of mucocutaneous and systemic patient groups. Postepy Dermatol Alergol 2021; 38:622-628. [PMID: 34658705 PMCID: PMC8501428 DOI: 10.5114/ada.2021.108931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/16/2020] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Behçet's disease (BD) is a chronic inflammatory disease which can be limited to only mucocutaneous tissues or can affect different systems of the body. AIM To investigate the association of endothelial and erectile dysfunctions with BD, on the basis of comparative analysis between mucocutaneous and systemic BD. MATERIAL AND METHODS Thirty-eight men diagnosed with BD were included in the present study. The patients were stratified into two groups as mucocutaneous BD (n = 20, MBD group), and systemic BD (n = 18, SBD group). Erectile dysfunction (ED) was assessed using the Erectile Function domain of the International Index of Erectile Function (IIEF-EF) questionnaire. The coronary flow reserve (CFR) assessment was done for analysing endothelial dysfunction (EnD), and CFR < 2 was defined as EnD. Penile Doppler ultrasonography (PDU) was performed for ED. The demographic and clinical parameters, IIEF-EF score ED classification, CFR and PDU test findings were compared between two groups. RESULTS The median age was 34 (22-52) years in the overall population, and there was no difference between two groups (p = 0.558). Time from diagnosis was significantly longer (24 vs. 102 months, p = 0.021) and the use of immunosuppressive therapies was higher (0 vs. 70.6%, p < 0.001) in the SBD group. In overall, median CFR was 1.92 (1.1-5.96), and there was no difference between two groups (1.88 vs. 1.97, p = 0.812). The percentage of patients with CFR < 2 was similar in two groups (52.6% vs. 52.9%, p = 0.985). The ED status according to IIEF-EF was similar in two groups (45% vs. 27.8%, p = 0.538) as well as according to PDU analyses (10% vs. 16.7%, p = 0.544). CONCLUSIONS The increased risk of endothelial, and erectile dysfunctions should be considered in men who were diagnosed with mucocutaneous and systemic BD.
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Affiliation(s)
- Yasemin Erdem
- Department of Dermatology, Health Science University, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Selcuk Erdem
- Department of Urology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Barburoglu
- Department of Radiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ekrem Bilal Karaayvaz
- Department of Cardiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Erkingul Shugaiv
- Department of Neurology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Kurtuncu
- Department of Neurology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Artur Salmaslioglu
- Department of Radiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Huseyin Oflaz
- Department of Cardiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Afet Akdag Kose
- Department of Dermatology and Venereology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ates Kadioglu
- Department of Urology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Demir S, Atici A, Coskun R, Olgac M, Unal D, Sarikaya R, Gelincik A, Colakoglu B, Oflaz H, Sonsoz MR, Buyukozturk S. Evaluation of the left venticular systolic function with the measurement of global longitudinal strain by Speckle tracking echocardiography in anaphylaxis. Asia Pac Allergy 2018; 8:e40. [PMID: 30402407 PMCID: PMC6209598 DOI: 10.5415/apallergy.2018.8.e40] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 10/13/2018] [Indexed: 12/20/2022] Open
Abstract
Background It is not known how cardiac functions are affected during anaphylaxis. Objective Our aim was to measure the cardiac functions shortly after an anaphylaxis attack using a new technique that detects subclinical left ventricular dysfunction. Methods Patients in our hospital who experienced anaphylaxis and urticaria (control group) due to any cause were included in the study. Tryptase levels were measured on the third hour of the reaction and 6 weeks later. Left ventricular systolic functions were evaluated with global strain measurement using echocardiography, approximately 4 hours and 6-week post reaction. Results Twelve patients were included in the anaphylaxis group (83.3% female; mean age, 43.25 ± 9.9 years). The causes of anaphylaxis were drug ingestion (n = 11) and venom immunotherapy. Eight of the anaphylactic reactions (66.7%) were severe and in 9 reactions (75%) tryptase levels increased. In the anaphylaxis group, strain values measured shortly after anaphylaxis were significantly lower than those calculated 6 weeks later (p < 0.001) and tryptase levels significantly increased (p = 0.002). The strain values measured both shortly after anaphylaxis and 6 weeks later did not differ according to severity of anaphylaxis. In severe anaphylaxis, tryptase levels during anaphylaxis and 6 weeks later were significantly higher (p = 0.019, p = 0.035). The control group evidenced no differences regarding strain and tryptase levels measured at reaction and 6 weeks later. At reaction, in the anaphylaxis group, the tryptase levels were higher and the strain values were lower than those in the urticaria group (p = 0.007, p = 0.003). Conclusion Cardiac dysfunction may develop during an anaphylaxis independent of severity of reaction.
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Affiliation(s)
- Semra Demir
- Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Adem Atici
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Raif Coskun
- Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Muge Olgac
- Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Derya Unal
- Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Remzi Sarikaya
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aslı Gelincik
- Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Bahattin Colakoglu
- Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Huseyin Oflaz
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Rasih Sonsoz
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Suna Buyukozturk
- Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Oflaz H, Gunal I. Maximum loading of carpal bones during movements: a finite element study. Eur J Orthop Surg Traumatol 2018; 29:47-50. [DOI: 10.1007/s00590-018-2287-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/01/2018] [Indexed: 10/28/2022]
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Ozben B, Kurt R, Oflaz H, Sezer M, Basaran M, Goren T, Umman S. Acute Anterior Myocardial Infarction After Chemotherapy for Testicular Seminoma in a Young Patient. Clin Appl Thromb Hemost 2016; 13:439-42. [PMID: 17911198 DOI: 10.1177/1076029607303334] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Testicular cancer is the most common solid tumor among young men aged 15 to 35 years. Combination chemotherapy with cisplatin, etoposide, and bleomycin remains the mainstay of treatment. We present a 27-year-old man who presented with an acute anterior myocardial infarction during the second course of chemotherapy for seminoma. Because the patient had no significant risk factors for coronary heart disease, the infarction was likely caused by the chemotherapy regimen.
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Affiliation(s)
- Beste Ozben
- Department of Cardiology, Istanbul University, Istanbul, Turkey.
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Onur ST, Emet S, Surmen S, Kara K, Kose M, Oflaz H, Onur I. A novel parameter for the diagnosis of acute pulmonary embolism: the T-wave peak-to-end interval. Eur Rev Med Pharmacol Sci 2016; 20:1566-1570. [PMID: 27160129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Acute pulmonary embolism (APE) is a very common disease that must be diagnosed and treated quickly and accurately to reduce significant morbidity and mortality rates. Acute pulmonary embolism is associated with numerous electrocardiographic (ECG) changes including prolonged QT interval with global T-wave inversion. The aim of the study was to investigate the relationship between the T-wave peak-to-end interval and diagnosis of APE, which has never been investigated in the literature. PATIENTS AND METHODS Seventy-three patients who were suspected of having APE took part in the present study. The Local Ethics Committee of Istanbul University, Turkey, approved the study protocol. Forty-one of the patients were diagnosed as having APE using computed tomography. Surface ECGs were taken in the initial assessment at admission. The Tp-Te interval was identified as the interval from the peak of the T-wave to the end of the T-wave. The measurements of the Tp-Te interval were taken using precordial leads. All measurements were compared using appropriate statistical tests. Statistical analysis was performed using SPSS version 22.0. RESULTS We enrolled 73 patients to the study, 41 of which were diagnosed as having APE. Men comprised 54% of the APE group. The mean ages in the APE (+) and APE (-) groups were 59.5 ± 14.5 years and 61±9.2 years, respectively. There was a significant increase in Tp-Te results in V1 (p<0.01). The Tp-Te interval was 74.21 ± 20.81 in the APE (+) group, whereas it was 59.73 ± 12.82 in APE (-) group (p<0.01). CONCLUSIONS Acute pulmonary embolism (APE) is a mortal condition and as such, rapid and accurate diagnosis is very important. Surface ECG can be used to measure Tp-Te in patients admitted to the emergency room with suspected APE in the differential diagnosis as a fast and easily accessible tool.
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Affiliation(s)
- S T Onur
- Chest Disease, Yedikule Education and Research Hospital, Istanbul, Turkey.
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Oz F, Cizgici AY, Kaya MG, Kurt M, Basibuyuk M, Tufan F, Oflaz H. Low bilirubin levels are associated with coronary slow flow phenomenon. Kardiol Pol 2015; 73:40-5. [DOI: 10.5603/kp.a2014.0117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 03/01/2014] [Accepted: 04/22/2014] [Indexed: 11/25/2022]
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Elitok A, Ikitimur B, Onur I, Oz F, Emet S, Karaayvaz EB, Serbest NG, Sarikaya R, Kasali K, Bilge AK, Kaya MG, Mercanoglu F, Oflaz H. The relationship between T-wave peak-to end interval and ST segment recovery on intracoronary ECG during primary PCI. Eur Rev Med Pharmacol Sci 2015; 19:1086-1091. [PMID: 25855936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE T-wave peak to end interval (TPE) is a measure of repolarization dispersion, which has been reported as a major arrhythmogenic factor post acute myocardial infarction. The aim of our study was to investigate the changes in TPE in this patient population with regard to peri-procedural intracoronary ECG findings. PATIENTS AND METHODS Forty-four patients (34 male and mean age of 54.9 ± 10.9 years) with acute STEMI were included. Intracoronary ECG was performed during primary PCI. TPE indices were calculated before and after the procedure. Measurement of the intracoronary ST-segment was carried out before and just after coronary blood flow was established in the infarct related artery. Intracoronary ST-segment resolution (IC-STR) was defined as ≥ 1 mm compared to baseline. RESULTS There was no difference with respect to baseline characteristics when patients with IC-STR were compared with patients without IC-STR. TPE values decreased significantly after primary PCI in patients with IC-STR (80.9 ± 22.8 ms vs. 65.8 ± 14.4 ms; p < 0.001) whereas they did not change significantly after PCI in patients without IC-STR (79.2 ± 20.9 ms vs. 68.5 ± 16.3 ms; p = 0.18). CONCLUSIONS TPE measured from surface ECG recordings is significantly reduced in STEMI patients with successful reperfusion after primary PCI, as determined by IC-ECG recordings.
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Affiliation(s)
- A Elitok
- Department of Cardiology, Istanbul University, School of Medicine, Istanbul, Turkey.
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Köse M, Akpinar T, Özkök A, Açar G, Bakkaloglu O, Sumnu A, Erk O, Kayacan M, Oflaz H, Akkaya V, Demirel A. OP-095 Association of Genetic Polymorphisms with Endothelial Dysfunction in Chronic Heart Failure. Am J Cardiol 2014. [DOI: 10.1016/j.amjcard.2014.01.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Turkmen K, Tufan F, Engin S, Akpinar T, Oflaz H, Ecder T. Author's reply. Indian J Nephrol 2014; 24:66. [PMID: 24574640 PMCID: PMC3927200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- K. Turkmen
- Department of Internal Medicine, Division of Nephrology, Selcuk University, Meram School of Medicine, Konya, Turkey,Address for correspondence: Dr. Kultigin Turkmen, Department of Nephrology, Selcuk University Meram School of Medicine, Turkey. E-mail:
| | - F. Tufan
- Department of Internal Medicine, Istanbul, Turkey
| | - S. Engin
- Istanbul University, Istanbul School of Medicine, Department of Medico-social, Istanbul University, Istanbul School of Medicine, Istanbul, Turkey
| | - T. Akpinar
- Department of Internal Medicine, Istanbul, Turkey
| | - H. Oflaz
- Department of Cardiology, Istanbul, Turkey
| | - T. Ecder
- Department of Nephrology, Istanbul, Turkey
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Akpinar TS, Ozkok A, Kose M, Atas R, Sumnu A, Bakkaloglu OK, Erk O, Kayacan MS, Oflaz H, Akkaya VA, Demirel AS. Endothelial constitutive nitric oxide synthase, angiotensin converting enzyme, angiotensin II type 1 receptor gene polymorphisms and endothelial functions in healthy individuals. Eur Rev Med Pharmacol Sci 2014; 18:39-45. [PMID: 24452940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Endothelial dysfunction is recognized as an early and initiating event in the pathogenesis of coronary artery disease. Gene polymorphisms of endothelial constitutive nitric oxide synthase (ecNOS), angiotensin converting enzyme (ACE) and angiotensin II type 1 receptor (AT1R) have been found to be associated with atherosclerosis. We aimed to investigate the possible effects of ecNOS, ACE and AT1R gene polymorphisms on endothelial functions in healthy population. MATERIALS AND METHODS In 255 healthy subjects (male/female: 119/136 mean age 35.1±2.3 years) ecNOS, ACE and AT1R gene polymorphisms were assessed by polymerase chain reaction (PCR). Endothelium dependent (EDD, flow-mediated) and endothelium independent vasodilation (EID) were measured by high resolution brachial artery ultrasound and 0.5 mg sublingual nitroglycerine respectively. RESULTS ecNOS and ACE genes had no significant effect on EDD and EID. However, subjects with AT1RAC+CC genotypes had lower EDD compared to subjects with AT1RAA genotype in females (19.4 ± 6.6% vs 21.5 ± 7.8%, p = 0.041). EDD and EID were significantly negatively associated with age, body mass index, serum creatinine, glucose, uric acid and hemoglobin levels. When the data on age, uric acid, BMI, glucose, creatinine, and hemoglobin were split into 3 as low-1/3, mid-1/3 and high 1/3, there was significant graded decrease in EDD and EID with these parameters. In multiple regression analysis, age and presence of AT1RAC+CC genotype retained as significant independent factors predicting endothelial functions. CONCLUSIONS Gene polymorphisms of endothelial constitutive nitric oxide synthase and angiotensin converting enzyme had no effect on endothelial functions. However, the presence of angiotensin II type 1 receptor polymorhism (AT1RAC+CC genotype) seemed to adversely affect the endothelial functions as reflected by impaired endothelium dependent and independent vasodilatation in healthy individuals.
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Affiliation(s)
- T S Akpinar
- Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
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Oz F, Cizgici AY, Ucar A, Karaayvaz EB, Kocaaga M, Bugra Z, Mercanoglu F, Oncul A, Nisli K, Oflaz H. Doppler-derived strain imaging detects left ventricular systolic dysfunction in children with Turner syndrome. Echocardiography 2013; 31:1017-22. [PMID: 24410871 DOI: 10.1111/echo.12500] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES Children with Turner syndrome (TS) are at increased risk of cardiovascular disease (CVD), but associations with subclinical CVD are not well-characterized. The purpose of this study was to assess myocardial function using strain imaging (SI) by echocardiography in children with TS and without known CVD. METHODS The study included 48 children with TS aged 4-16 years and 20 healthy control children. Children with TS were excluded if they had a cardiac malformation, a decreased left ventricular (LV) systolic function, or any chronic disease. Each child had an echocardiographic examination with conventional echocardiography and one-dimensional longitudinal strain (1DST) echocardiography. RESULTS Septal and lateral systolic strain (S) and strain rate (SR) values, which are indicative of longitudinal myocardial function, were significantly decreased in TS patients. However, LV ejection fraction (LVEF) and LV fractional shortening (LVFS) was not significantly different between groups. LV mass index (LVMi), interventricular septum (IVS) thickness, LV posterior wall (LVPW) thickness, and left atrial (LA) diameter index were significantly higher in TS children compared to controls. Peak transmitral flow velocity in late diastole (peak A) was significantly higher, whereas peak transmitral flow velocity in early diastole (peak E), deceleration time (DT), and the ratio of early to late diastolic filling were significantly lower, in TS patients. CONCLUSION Reduced LV systolic S and SR in children with TS may indicate early myocardial dysfunction before any detectable change in LVEF.
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Affiliation(s)
- Fahrettin Oz
- Department of Cardiology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
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Oflaz S, Yucel B, Oz F, Sahin D, Ozturk N, Yaci O, Polat N, Gurdal A, Cizgici AY, Dursun M, Oflaz H. Assessment of myocardial damage by cardiac MRI in patients with anorexia nervosa. Int J Eat Disord 2013; 46:862-6. [PMID: 23922168 DOI: 10.1002/eat.22170] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 07/05/2013] [Accepted: 07/07/2013] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Cardiac damage is a major complication of anorexia nervosa (AN). The present study evaluated the prevalence of myocardial damage in patients with AN by cardiac magnetic resonance imaging (CMR). METHOD This study was cross-sectional and observational. Forty consecutive female patients with a diagnosis of AN and 28 healthy female subjects were evaluated from January 2007 to 2011 at the Department of Psychiatry (University of Istanbul, Istanbul, Turkey). Following enrollment in the study, participants underwent a cardiac evaluation, a physical examination, a standard electrocardiogram (ECG), an echocardiography and a CMR. RESULTS Body weight, body mass index and heart rate values were lower in patients with AN than in the control group. When compared with control groups, patients with AN showed reduced left ventricular mass with normal systolic function. Compared to control subjects, patients with AN had higher prevalence of pericardial effusion (30% in the AN group, 4% in the control group, p = .005) and mitral valve prolapses (23% in the AN group, 4% in the control group, p = .03). Myocardial fibrosis (detected as late gadolinium enhancement on CMR) was found in 23% of patients with AN. Myocardial fibrosis was not detected in any control subject (p = .007). CONCLUSION A strong association was found between myocardial fibrosis and AN. Cardiac damage of myocardial fibrosis in asymptomatic patients with AN can be found by CMR examination.
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Affiliation(s)
- Serap Oflaz
- Department of Psychiatry, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
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Onur I, Oz F, Yildiz S, Oflaz H, Sigirci S, Elitok A, Pilten S, Karaayvaz EB, Cizgici AY, Kaya MG, Onur ST, Sahin I, Dinckal HM. Serum Omentin 1 Level Is Associated With Coronary Artery Disease and Its Severity in Postmenopausal Women. Angiology 2013; 65:896-900. [DOI: 10.1177/0003319713511322] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We evaluated whether serum omentin levels are associated with coronary artery disease (CAD) and its severity among postmenopausal women. We enrolled 193 consecutive postmenopausal women who had undergone coronary angiography for suspected stable CAD. The study population was divided into 2 groups based on the results of coronary angiography (CAD group, n = 110 and control group, n = 83). Omentin 1 levels were measured and disease severity was assessed using the SYNTAX score (SS) in the CAD group. Those patients with angiographic CAD had significantly decreased omentin 1 levels, compared to those without CAD (247.5 + 127.4 vs 506 + 246 ng/mL, P < .001). After adjusting for cardiovascular risk factors, a decreased omentin 1 level was found to be an independent predictor of both angiographic CAD and a high SS. Our data indicate that a decreased omentin 1 level is associated with CAD and its severity among postmenopausal women.
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Affiliation(s)
- Imran Onur
- Department of Cardiology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Fahrettin Oz
- Department of Cardiology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Sezai Yildiz
- Cardiology Clinic, Bagcılar Education and Research Hospital, Istanbul, Turkey
| | - Huseyin Oflaz
- Department of Cardiology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Serhat Sigirci
- Cardiology Clinic, Bagcılar Education and Research Hospital, Istanbul, Turkey
| | - Ali Elitok
- Department of Cardiology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Saadet Pilten
- Department of Biochemistry, Bagcılar Education and Research Hospital, Istanbul, Turkey
| | - Ekrem Bilal Karaayvaz
- Department of Cardiology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Ahmet Y. Cizgici
- Department of Cardiology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet G. Kaya
- Department of Cardiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Seda Tural Onur
- Department of Chest Diseases, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey
| | - Irfan Sahin
- Cardiology Clinic, Bagcılar Education and Research Hospital, Istanbul, Turkey
| | - Hakan M. Dinckal
- Cardiology Clinic, Bagcılar Education and Research Hospital, Istanbul, Turkey
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Elitok A, Oz F, Cizgici AY, Kilic L, Ciftci R, Sen F, Bugra Z, Mercanoglu F, Oncul A, Oflaz H. Effect of carvedilol on silent anthracycline-induced cardiotoxicity assessed by strain imaging: A prospective randomized controlled study with six-month follow-up. Cardiol J 2013; 21:509-15. [PMID: 24142687 DOI: 10.5603/cj.a2013.0150] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 10/17/2013] [Accepted: 09/16/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The use of antracycline (ANT) in breast cancer has been associated with adverse cardiac events. Two-dimensional (2D) strain imaging (SI) can provide a more sensitive measure of altered left ventricular (LV) systolic function. We aimed to evaluate the preventive effect of carvedilol administration assessed by SI in a patient with breast cancer treated with ANT. METHODS Patients receiving ANT were randomly assigned to the carvedilol- or placebo-receiving group. Each received an echocardiographic examination with conventional 2D echocardiography, pulsed tissue Doppler, and 2D SI prior to and 6 months post ANT treatment. RESULTS During the 6-month follow-up period there were no patient deaths or interrupted chemotherapy treatments due to doxorubicin-induced cardiotoxicity. Both left ventricular ejection fraction (LVEF) and fractional shortening (FS) were within normal limits for all patients before and after ANT therapy. EF, FS and LV dimensions were measured using M-mode echocardiography and found to be similar in both groups before and after ANT therapy. The mean EF, FS, and LV echocardiograph baseline and control dimensions were similar in both groups after 6 months. Though baseline SI parameters were similar between the groups, there was a significant decrease in LV basal septal and basal lateral peak systolic strain in the control group compared to the carvedilol group. CONCLUSIONS These results indicate that carvedilol has a protective effect against the cardiotoxicity induced by ANT.
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Affiliation(s)
| | - Fahrettin Oz
- Medical doctor. Department of Cardiology, School of Istanbul medicine, Istanbul University.
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Guney M, Ozkok A, Caliskan Y, Pusuroglu H, Yazici H, Tepe S, Oflaz H, Yildiz A. QT dispersion predicts mortality and correlates with both coronary artery calcification and atherosclerosis in hemodialysis patients. Int Urol Nephrol 2013; 46:599-605. [PMID: 24036935 DOI: 10.1007/s11255-013-0549-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 08/21/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE QT dispersion (QTd) was shown to be an independent predictor of mortality in hemodialysis (HD) patients. It may be hypothesized that coronary artery calcification is related to QTd in HD patients because widespread calcification may also involve the cardiac conducting system in these patients. In this study, we aimed to investigate the relationships of corrected QTd (QTcd) with coronary artery calcification score (CACS), carotid plaque score (CPS) and possible influence of these parameters on survival of HD patients. METHODS Seventy-two HD patients (33 male, 39 female) were enrolled into the study. Mean age of the patients was 44 ± 12 years. Mean follow-up duration was 77 ± 24 months. CACS was determined by computed tomography. QTcd values were calculated as the difference of maximum and minimum QT intervals. Left ventricular mass index (LVMI) and CPS were measured by echocardiography. RESULTS QTcd was significantly correlated with CACS (r = 0.233, p = 0.049), CPS (r = 0.354, p = 0.003) and LVMI (p = 0.011, r = 0.299). CPS was found to be significantly higher in the group with high QTcd (>60 ms) [2 (1-4) versus 0 (0-1), p = 0.02]. CACS was significantly correlated with age (r = 0.44, p < 0.001), LVMI (r = 0.52, p < 0.001) and CPS (r = 0.32, p = 0.003). In Kaplan-Meier analysis, survival of patients with high QTcd was significantly lower than the patients with low QTcd. In Cox regression analysis for predicting mortality, age, serum albumin and QTcd were found to be the independent predictors of mortality. CONCLUSIONS QTcd independently predicted mortality, and it was significantly associated with coronary artery calcification, left ventricular hypertrophy and atherosclerosis in HD patients.
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Affiliation(s)
- Murat Guney
- Division of Nephrology, Department of Internal Medicine, Istanbul School of Medicine, Istanbul University, Fatih, 34093, Istanbul, Turkey
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Sen F, Yildiz I, Basaran M, Ekenel M, Oz F, Kilic L, Toz B, Gurdal A, Camlica H, Bavbek S, Oflaz H. Impaired coronary flow reserve in metastatic cancer patients treated with sunitinib. J BUON 2013; 18:775-781. [PMID: 24065498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE Hypertension is one of the major side effects of sunitinib, an angiogenesis inhibitor used in the treatment of metastatic renal cell carcinomas (mRCC) and gastrointestinal stromal tumors (GIST). Endothelial dysfunction, an early and reversible event in the pathogenesis of atherosclerosis, is suggested to be one of the possible underlying mechanisms of hypertension caused by angiogenesis inhibitors. Coronary flow reserve (CFR) measurement by trans-thoracic Doppler echocardiography (TTDE) reflects coronary microvascular and endothelial functions, as a cheaper and an easy screening test. We have used TTDE to evaluate endothelial function and coronary microvascular function in mRCC and GIST patients under sunitinib treatment. METHODS Eighteen metastatic cancer patients (16 mRCC and 2 GIST) on sunitinib treatment and 27 healthy subjects were enrolled in this cross-sectional study. Thyroid stimulating hormone (TSH), lipid profile, creatinine, hemoglobin, glucose, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), anthropometric and physical parameters of patients were recorded. CFR recordings were performed by the Vivid 7 echocardiography device. RESULTS CFR was significantly lower in patients when compared with controls (1.82±0.4 vs 2.71±0.8, respectively; p < 0.001). Impaired CFR was found in 13 (72%) patients whereas all controls had normal CFR values. CFR was inversely correlated with the duration of sunitinib treatment (r=-0.36, p =0.01), high sensitivite (hs) CRP (r = -0.574, p =0.01) and ESR (r = - 0.5, p = 0.02). CONCLUSION Our findings indicate that CFR is significantly impaired in cancer patients on sunitinib treatment. There is an inverse correlation between CFR and duration of sunitinib treatment and inflammation markers.
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Affiliation(s)
- F Sen
- Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
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17
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Turkmen K, Tufan F, Selçuk E, Akpınar T, Oflaz H, Ecder T. Neutrophil-to-lymphocyte ratio, insulin resistance, and endothelial dysfunction in patients with autosomal dominant polycystic kidney disease. Indian J Nephrol 2013; 23:34-40. [PMID: 23580803 PMCID: PMC3621236 DOI: 10.4103/0971-4065.107195] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Endothelial dysfunction (ED), insulin resistance (IR), and inflammation are risk factors for increased cardiovascular morbidity and mortality in autosomal dominant polycystic kidney disease (ADPKD). ADPKD patients may have increased carotid intima-media thickness (CIMT) and decreased coronary flow velocity reserve (CFVR). The neutrophil-to-lymphocyte ratio (NLR) was introduced as a marker to determine inflammation in various disorders. We aimed to investigate the relationship between NLR and IR, CFVR, CIMT, and the left ventricular mass index (LVMI) in normotensive ADPKD patients. Twentynine ADPKD patients (age 38.8 ± 10.2 years; 8 men and 21 women) and 19 healthy controls (age 33.8 ± 7.4 years; 8 men and 11 women) were included in this cross-sectional study. CFVR was calculated with echocardiography as the ratio of hyperemic to baseline diastolic peak coronary flow velocities. CIMT was measured in the distal common carotid artery by using a 10-MHz linear echocardiography probe. HOMA-IR was calculated NLR was calculated as the ratio of the neutrophil and lymphocyte counts. Age, sex, body mass index, and levels of glucose, creatinine, low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol, triglycerides, C-reactive protein (CRP), microalbuminuria, and creatinine clearance were similar between ADPKD patients and healthy subjects. NLR, CIMT, LVMI, and HOMA-IR were significantly higher and CFVR values were significantly lower in patients with ADPKD compared to that in healthy subjects. NLR showed positive correlation with CIMT, HOMA, insulin, glucose, and HDL cholesterol levels, while it was inversely correlated with CFVR and albumin level in all subjects. In patients with ADPKD, NLR showed positive correlation with HDL cholesterol level and inverse correlation with LVMI and albumin level. NLR that was found to be increased in patients with ADPKD may be a readily available marker of inflammation and ED.
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Affiliation(s)
- K Turkmen
- Department of Internal Medicine, Selcuk University, Meram School of Medicine, Division of Nephrology, Konya, Turkey
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Oz F, Elitok A, Bilge AK, Mercanoglu F, Oflaz H. Relationship Between Brachial Artery Flow-Mediated Dilation, Carotid Artery Intima-Media Thickness and Coronary Flow Reserve in Patients With Coronary Artery Disease. Cardiol Res 2012; 3:214-221. [PMID: 28348690 PMCID: PMC5358134 DOI: 10.4021/cr219w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2012] [Indexed: 12/17/2022] Open
Abstract
Background The aim of this study was to assess the relationship between brachial artery flow mediated dilation (FMD), carotid artery intima-media thickness (IMT) and coronary flow reserve (CFR) in patients with coronary artery disease (CAD). Methods Fifty patients with coronary artery disease, except left anterior descending artery (LAD), who showed no cardiac symptoms and 45 control subjects underwent assessment of brachial artery FMD, carotid artery intima-media thickness by high-resolution ultrasound. In addition, transthoracic second harmonic Doppler echocardiography was used to measure CFR. Results All of the parameters were found to be correlated with each other. CFR correlated with brachial artery FMD (r = 0.232, P < 0.05) and with carotid IMT (r = -0.403, P < 0.001). Carotid IMT correlated with brachial artery FMD (r = -0.211, P < 0.05). Conclusion Transthoracic CFR correlated with well-established noninvasive predictors of atherosclerosis and we suggest that it can be used as a surrogate for coronary atherosclerosis.
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Affiliation(s)
- Fahrettin Oz
- Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ali Elitok
- Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ahmet Kaya Bilge
- Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Fehmi Mercanoglu
- Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Huseyin Oflaz
- Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Turkmen K, Tufan F, Alpay N, Kasıkcıoglu E, Oflaz H, Ecder SA, Ecder T. Insulin resistance and coronary flow velocity reserve in patients with autosomal dominant polycystic kidney disease. Intern Med J 2012; 42:146-53. [DOI: 10.1111/j.1445-5994.2010.02404.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Akagun T, Caliskan Y, Alpay N, Ozkok A, Yazici H, Polat N, Guz G, Oflaz H, Turkmen A, Sukru Sever M. Long-Term Prognostic Value of Coronary Flow Velocity Reserve in Renal Transplant Recipients. Transplant Proc 2011; 43:2612-6. [DOI: 10.1016/j.transproceed.2011.05.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 05/02/2011] [Indexed: 12/31/2022]
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Aslanger E, Altun I, Guz G, Kiraslan O, Polat N, Golcuk E, Oflaz H. The preoperative cardiology consultation: goal settings and great expectations. Acta Cardiol 2011; 66:447-52. [PMID: 21894800 DOI: 10.1080/ac.66.4.2126592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Despite the availability of guidelines for preoperative cardiology consultations, their efficacy in real clinical practice remains unknown. Furthermore, there are concerns that overused cardiology consultations can lead to unnecessary investigations, prolonged hospital stays, and even cancellation of necessary surgery. In this retrospective study, we investigated: (i) the potential impact of the American Heart Association/American College of Cardiology algorithm and (ii) the potential of this algorithm for preventing unnecessary evaluation. METHODS We examined the cardiology consultation requests for 712 patients scheduled for elective surgery. Our analysis included: (i) patient characteristics, (ii) abnormalities revealed by the consultant, (iii) impact of these abnormalities on clinical decision making and therapy modification. RESULTS The most common reason for consultation was 'pre-operative evaluation' (80.9%). Although our cardiologists revealed an abnormality in 67.8% and recommended further work up in 58.7% of our patients, they contributed to the clinical course in only 36.9%. Moreover, when the algorithm was applied to 'routine pre-operative evaluation' requests lacking a specific question, only 7.6% of these consultation requests required further investigation. CONCLUSION Preoperative cardiology consultation seems to be overused. Although the fear of missing important issues leads surgeons to use a decreased threshold for pre-operative consultation requests, such a non-specific manner of pre-operative consultation request causes unnecessary investigations and decreased cost-effectiveness. Furthermore, the detection of any clinical abnormality by cardiologists surprisingly adds little to clinical decision making.
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Affiliation(s)
- Emre Aslanger
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University
| | - Ibrahim Altun
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University
| | - Goksel Guz
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University
| | - Omer Kiraslan
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University
| | - Nihat Polat
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University
| | - Ebru Golcuk
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University
| | - Huseyin Oflaz
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University
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Ozyigit T, Ozben B, Oflaz H, Serdaroglu P. Evaluation of biventricular functions with tissue Doppler imaging in patients with myotonic dystrophy. Clin Cardiol 2011; 33:126-31. [PMID: 20235214 DOI: 10.1002/clc.20712] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Myotonic dystrophy (MD) is characterized by myotonia with dystrophic involvement of the muscles. Cardiac involvement is usually not evident in the early stages of MD. HYPOTHESIS We investigated biventricular functions by tissue Doppler imaging (TDI) in MD patients with no overt cardiac involvement to explore the value of TDI in the early detection of myocardial dysfunction. METHODS A total of 21 MD patients (15 male, age: 32.2 +/- 12.3 yrs) and 21 healthy controls (13 male, age: 32.2 +/- 7.8 yrs) were included. In addition to conventional echocardiography, pulsed Doppler and TDI were performed including measurement of myocardial performance index (MPI); peak systolic (Sm) and early (Em) and atrial (Am) diastolic myocardial velocities at the basal mitral and tricuspid annulus. RESULTS All patients and controls had normal ejection fraction. Transmitral E peak velocity was significantly lower while both deceleration time of E velocity and isovolumic relaxation time were significantly longer in MD patients (P = 0.007, P = 0.001, and P < 0.001, respectively). Sm, Em and Am peak velocities were significantly lower in MD patients in all segments except for Em of the mitral anterior annulus and Am of the tricuspid lateral annulus. Both left and right ventricular MPI were significantly higher in MD patients (P < 0.001 and P = 0.013, respectively). CONCLUSION There are changes in myocardial systolic and diastolic functions in MD patients although they have no overt heart failure. Myocardial tissue velocities and MPI are useful in identifying subclinical biventricular involvement in these patients.
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Affiliation(s)
- Tolga Ozyigit
- American Hospital, Department of Cardiology, Istanbul, Turkey
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Sen F, Yildiz I, Oflaz H, Oz F, Kilic L, Gurdal A, Basaran M, Bavbek SE. Impaired coronary flow reserve in patients with metastatic cancer treated with sunitinib. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e15136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
We have studied the biomechanical stability in vitro of three different Kirschner (K) wire configurations in three types of simulated scaphoid waist fractures. The fractures were created with a saw in Sawbones models. There were three fracture patterns: perpendicular to the long axis of the scaphoid model; and 30° and 20° oblique to that. Two 1.2 mm. K-wires were used in each scaphoid. The three configurations were: parallel; 20° oblique; and crossing. The oblique or crossing configurations of K-wires were the most stable depending on the fracture pattern.
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Affiliation(s)
- V Gokce
- Department of Orthopedics, State Hospital; the Departments of Biomechanics and Orthopedics, Dokuz Eylul University Hospital, Izmir, Turkey
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Yilmaz Y, Kurt R, Gurdal A, Alahdab YO, Yonal O, Senates E, Polat N, Eren F, Imeryuz N, Oflaz H. Circulating vaspin levels and epicardial adipose tissue thickness are associated with impaired coronary flow reserve in patients with nonalcoholic fatty liver disease. Atherosclerosis 2011; 217:125-9. [PMID: 21513939 DOI: 10.1016/j.atherosclerosis.2011.03.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 03/18/2011] [Accepted: 03/20/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with nonalcoholic fatty liver disease (NAFLD) have a reduced coronary flow reserve (CFR) and an increased risk of cardiovascular disease. The fat cells that surround coronary arteries may play a central and underrecognized role in development of cardiovascular disease through the systemic secretion of adipokines. We therefore evaluated the relation of epicardial fat thickness, serum levels of epicardial fat-related adipokines (chemerin and vaspin), and CFR in patients with NAFLD. METHODS We investigated 54 patients with biopsy-proven NAFLD and 56 age- and sex-matched controls. CFR and epicardial fat thickness (EFT) were measured by transthoracic echocardiography. Serum levels of chemerin and vaspin were measured by ELISA. RESULTS EFT was significantly higher (0.64 ± 0.13 vs. 0.54 ± 0.10 cm, P<0.001) and CFR significantly lower (2.11 ± 0.45 vs. 2.52 ± 0.62, P < 0.001) in patients with NAFLD than in controls. Serum levels of vaspin and chemerin were both significantly increased in patients with NAFLD compared with controls. Stepwise regression analysis showed that EFT (β=-0.53, t=-3.7, P<0.001), serum vaspin levels (β=-0.30, t=-2.5, P=0.014), and liver fibrosis (β=-0.31, t=-2.11, P=0.041), in the order they entered into the model, were independent predictors of CFR in NAFLD patients. CONCLUSION Our data suggest the presence of a complex interplay between EFT, serum vaspin, and liver histology in promoting an impaired hyperemic stimulation of coronary blood flow in patients with NAFLD.
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Affiliation(s)
- Yusuf Yilmaz
- Department of Gastroenterology, Marmara University, School of Medicine, Pendik, 34899 Istanbul, Turkey.
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Abstract
Background: Cigarette smoking may increase platelet aggregation and cause atherothrombotic cardiovascular events. We aimed to investigate the impact of cigarette smoking on platelet function in patients with ischemic coronary heart disease (CHD).Methods: Twenty patients with ischemic stable CHD under aspirin therapy (300 mg/d), who continue to smoking despite all warnings, and 20 nonsmokers with CHD are enrolled in the study. Platelet function is studied at the morning, before and 15 minutes after the first cigarette, by the Platelet Function Analyzer (PFA)-100, with collagen and epinephrine and collagen and adenosine diphosphate cartridges. Post aspirin platelet hyperactivity is defined as having a closure time (CT) shorter than 186 seconds despite regular aspirin intake. Serial CT measurements are analyzed by paired samples t test.Results: Persistent platelet activity was present in 4 smoker (20%) and 3 nonsmoker (15%) patients at the beginning. Platelet activity measured by the PFA-100 is been increased significantly after cigarette smoking ( P = .004). Shorter CTs were determined after smoking in all patients with and without baseline persistent platelet activity, and 4 more participants became aspirin nonresponder ( P = .004). No significant differences in demographic, hematological, and biochemical parameters were determined between aspirin responders and nonresponders.Conclusions: We determined that cigarette smoking may increase platelet aggregation in patients with ischemic CHD in an aspirin nonresponsive manner. Our results emphasize the importance of quitting cigarette smoking in patients with CHD.
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Affiliation(s)
- Burak Pamukcu
- Istanbul University, Istanbul Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Huseyin Oflaz
- Istanbul University, Istanbul Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Imran Onur
- Istanbul University, Istanbul Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Arif Cimen
- Istanbul University, Istanbul Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Yilmaz Nisanci
- Istanbul University, Istanbul Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
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Kurt R, Yilmaz Y, Ermis F, Kalayoglu Besisik S, Polat N, Elitok A, Oflaz H, Karan MA. Folic Acid and vitamin B12 supplementation improves coronary flow reserve in elderly subjects with vitamin B12 deficiency. Arch Med Res 2011; 41:369-72. [PMID: 20851295 DOI: 10.1016/j.arcmed.2010.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 07/14/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS Major cardiovascular risk factors including hyperhomocysteinemia are frequently associated with decreased coronary flow reserve (CFR), an important physiological parameter of the coronary circulation. This study was designed to determine whether folate (5 mg) and vitamin B12 (500 μg) supplementation in elderly patients with vitamin B12 deficiency improved CFR, while reducing homocysteine levels. METHODS Forty-four patients aged >65 years showing serum vitamin B12 concentrations <180 mg/dL were randomized to take either oral folate (5 mg) plus vitamin B12 (500 μg) supplementation (n = 24) or placebo (n = 20) for 8 weeks. The study course consisted of two visits: visit 1 (pretreatment) included the baseline assessment of laboratory profile and CFR values with trans-thoracic Doppler echocardiography. Visit 2 was scheduled 8 weeks later to repeat CFR and laboratory tests after therapy. RESULTS In the treatment arm, oral supplementation with folate and vitamin B12 significantly improved total cholesterol, serum folate, serum vitamin B12, homocysteine, and insulin resistance. At 8 weeks, the treatment group had a significant increase from baseline in CFR values (baseline: 1.7 ± 0.2; postttreatment: 2.1 ± 0.2, p <0.001) that was not seen in the placebo group (baseline: 1.6 ± 0.2; posttreatment: 1.6 ± 0.2; P = ns). CONCLUSIONS In this study of elderly subjects with vitamin B12 deficiency, supplementation with folate and vitamin B12 was associated with a significant improvement in CFR values.
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Affiliation(s)
- Ramazan Kurt
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
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Caliskan Y, Demirturk M, Ozkok A, Yelken B, Sakaci T, Oflaz H, Unsal A, Yildiz A. Coronary artery calcification and coronary flow velocity in haemodialysis patients. Nephrol Dial Transplant 2010; 25:2685-90. [PMID: 20190240 DOI: 10.1093/ndt/gfq113] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Decreased coronary flow reserve (CFR) is a marker of endothelial dysfunction, coronary artery calcification and inflammation, well-known cardiovascular risk factors in haemodialysis (HD) patients. In this study, we aimed to investigate the correlation of coronary artery calcification scores (CACS) with CFR in HD patients. METHODS Sixty-four end-stage renal failure patients were enrolled in this study (38 males, 26 females). Thirty-nine healthy subjects (22 males, 17 females) were included in the control group. Biochemical parameters and acute-phase inflammation marker [high-sensitivity C-reactive protein (hs-CRP)] of patients were recorded before dialysis. The CACS were measured by electron beam computerized tomography method. CFR recordings were performed by trans-thoracic Doppler echocardiography. The relationship between CACS and CFR was evaluated. RESULTS The mean CACS was 281 +/- 589 and 29 patients had CACS < 10. Patients with CACS > 10 had significantly lower CFR values compared to patients with CACS < 10 (1.56 +/- 0.38 vs 1.84 +/- 0.53, P = 0.024). However, there was no difference in hs-CRP values between the groups. CFR was negatively correlated with CACS (r = -0.276, P = 0.030). In multiple stepwise regression analysis, CACS was found to be an independent variable for predicting CFR (P = 0.048). During a follow-up of 18 months, 10 patients had experience of cardiovascular events. Patients with CACS > 10 had significantly higher event rate [34.5% (10/29) vs 0% (0/24)] compared to those with CACS < 10 (P = 0.001). Patients who developed cardiovascular events had significantly higher mean CACS and lower CFR values than the remaining group (P = 0.019 and P = 0.039). All of four patients who died during follow-up were in the CFR < 2 and CACS > 10 groups. CONCLUSIONS CACS was associated with CFR in HD patients. However, we did not find any association of inflammation with CACS and CFR. This association between CFR and CACS might indicate two different (anatomical and functional) aspects of the common pathophysiology of the arterial system in HD patients.
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Affiliation(s)
- Yasar Caliskan
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Yilmaz Y, Kurt R, Yonal O, Polat N, Celikel CA, Gurdal A, Oflaz H, Ozdogan O, Imeryuz N, Kalayci C, Avsar E. Coronary flow reserve is impaired in patients with nonalcoholic fatty liver disease: association with liver fibrosis. Atherosclerosis 2010; 211:182-6. [PMID: 20181335 DOI: 10.1016/j.atherosclerosis.2010.01.049] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 01/27/2010] [Accepted: 01/28/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is associated with an increased risk of cardiovascular disease. Coronary flow reserve (CFR) is widely used to examine the integrity of coronary microvascular circulation. We evaluated the prevalence of impaired CFR in patients with biopsy-proven NAFLD. We also investigated the independent clinical, biochemical, and liver histology predictors of CFR in the setting of NAFLD. METHODS Fifty-nine consecutive patients with NAFLD and 77 age- and gender-matched controls were evaluated. CFR recordings were performed by transthoracic Doppler harmonic echocardiography. CFR>or=2.0 was considered normal. RESULTS CFR was significantly lower in patients with NAFLD than in controls (2.11+/-0.45 vs. 2.52+/-0.62, P<0.001). An impaired CFR (i.e. <2) was found in 25 NAFLD patients (42.4%) whereas all controls had normal CFR values (P<0.001). A stepwise linear regression analysis in NAFLD patients identified liver fibrosis scores as the only independent predictor of CFR values (beta=-0.60; t=-2.44, P=0.021). CONCLUSION Our findings indicate that in patients with biopsy-proven NAFLD: (a) an abnormal CFR is found in approximately 42.4% of cases, and (b) liver fibrosis scores are an independent predictor of depressed CFR.
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Affiliation(s)
- Yusuf Yilmaz
- Department of Gastroenterology, Marmara University School of Medicine, Tophanelioglu Cad. No: 13/15 Altunizade, 34662 Istanbul, Turkey.
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Abstract
BACKGROUND Functional and morphological changes of endothelium were risk factors for mortality attributed to atherosclerosis. Studies investigating early atherosclerotic alterations and the effect of the treatment of acromegaly on these alterations gave conflicting results. OBJECTIVE Surrogate markers of early atherosclerotic changes, i.e. brachial artery flow-mediated dilation (FMD) and carotid artery intima-media-thickness (IMT) in active and inactive acromegalic patients were compared with control subjects matched to patients for age, sex and cardiovascular risk factors to find out the direct effects of growth hormone (GH)/insulin-like growth factor-1 excess. METHODS In 14 active acromegalics and their 14 matched controls, 14 inactive acromegalics and their 14 matched controls, carotid artery IMT and FMD of brachial artery were measured. Inactive acromegalics were in remission for at least 1 year. RESULTS Active acromegalics had higher IMT than matched controls and inactive acromegalics (0.85 +/- 0.20 mm, 0.64 +/- 1.77 mm, 0.66 +/- 0.20 mm respectively; p < 0.005, p < 0.05) and IMT of inactive acromegalics was not different from their matched controls (0.61 +/- 0.12 mm). FMD was significantly lower in active acromegalics than in matched controls and inactive acromegalics (2.910 +/- 2.00 mm, 6.5 +/- 2.81 mm, 5.68 +/- 2.9 mm respectively; p < 0.005, p < 0.05). FMD of inactive acromegalics was not significantly different from their matched controls (7.96 +/- 3.12 mm). A significant inverse relationship was found between GH and FMD in active acromegalics (r = -0.659, p = 0.010). CONCLUSION In active acromegalics, early atherosclerotic changes are not only attributed to the high prevalence of risk factors, but also to the abnormal GH secretion itself.
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Affiliation(s)
- I Kartal
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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31
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Civilibal M, Caliskan S, Oflaz H, Sever L, Candan C, Canpolat N, Kasapcopur O, Arisoy N. Left ventricular function by 'conventional' and 'tissue Doppler' echocardiography in paediatric dialysis patients. Nephrology (Carlton) 2009; 14:636-42. [PMID: 19796022 DOI: 10.1111/j.1440-1797.2009.01124.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Cardiovascular abnormalities are common in children with chronic kidney disease (CKD). Left ventricular (LV) structure and functions have been extensively studied by conventional pulse-wave Doppler echocardiography (cPWD), however, tissue Doppler imaging (TDI) is a relatively new echocardiography method. The aims of this study were to evaluate LV diastolic function in paediatric dialysis patients using cPWD and TDI methods, and to compare the findings obtained with two modalities. METHODS This study included 38 children and adolescents on dialysis (14 haemodialysis and 24 peritoneal dialysis, duration of dialysis 58.0 +/- 32.8 months) and 16 age- and sex-matched healthy subjects. RESULTS The mean left ventricular mass index (LVMI) was significantly higher in the patient group (P < 0.001) and the most common cardiac geometry was concentric LV hypertrophy (55%). There was no significant difference in LV systolic function between patient and control groups. However, dialysis patients had worse LV diastolic function both according to cPWD (lower E/A ratio) and TDI (lower Em/Am ratio) than the healthy subjects (P < 0.001 and P = 0.001, respectively). Also, the index of LV filling pressure (E/Em ratio) obtained by the combination of cPWD and TDI was significantly higher in the patients (P < 0.001). Cumulative dose of calcium-based phosphate binder (CBPB), diastolic blood pressure and LVMI were the independent predictors of E/Em ratio. CONCLUSION Our study shows that LV diastolic dysfunction is common in paediatric dialysis patients and TDI findings correlate well with cPWD findings. Similarly, higher dose intake of CBPB, hypertension and LV hypertrophy have a negative effect on LV filling pressure suggesting diastolic function.
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Affiliation(s)
- Mahmut Civilibal
- Department of Paediatric Nephrology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
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32
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Caliskan Y, Gorgulu N, Yelken B, Yazici H, Oflaz H, Elitok A, Turkmen A, Bozfakioglu S, Sever MS. Plasma Ghrelin Levels Are Associated with Coronary Microvascular and Endothelial Dysfunction in Peritoneal Dialysis Patients. Ren Fail 2009; 31:807-13. [DOI: 10.3109/08860220903151419] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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33
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Gorgulu N, Yelken B, Caliskan Y, Elitok A, Cimen AO, Yazici H, Oflaz H, Golcuk E, Ekmekci A, Turkmen A, Yildiz A, Sever MS. Endothelial dysfunction in hemodialysis patients with failed renal transplants. Clin Transplant 2009; 24:678-84. [DOI: 10.1111/j.1399-0012.2009.01160.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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34
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Sozen AB, Cefle K, Kudat H, Ozturk S, Oflaz H, Akkaya V, Palanduz S, Demirel S, Ozcan M, Goren T, Guven O. Left Ventricular Thickness Is Increased in Nonhypertensive Turner's Syndrome. Echocardiography 2009; 26:943-9. [DOI: 10.1111/j.1540-8175.2009.00902.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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35
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Ekmekci A, Abaci N, Colak Ozbey N, Agayev A, Aksakal N, Oflaz H, Erginel-Unaltuna N, Erbil Y. Endothelial function and endothelial nitric oxide synthase intron 4a/b polymorphism in primary hyperparathyroidism. J Endocrinol Invest 2009; 32:611-6. [PMID: 19574729 DOI: 10.1007/bf03346518] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIM Patients with symptomatic primary hyperparathyroidism (pHT) have increased cardiovascular morbidity and mortality. Endothelial nitric oxide synthase (eNOS) intron 4a/b polymorphism is associated with coronary artery disease and hypertension in various populations. Our aim is to evaluate endothelial function in patients with pHT during pre-operative hypercalcemic and post-operative normocalcemic periods and to determine whether intron 4a/b polymorphism of eNOS gene influences endothelial function. SUBJECTS AND METHODS Forty patients with pHT (age 48.48+/-11.64 yr) were examined pre-operatively and reexamined 5.8+/-1.9 months after parathyroidectomy. Forty-three healthy subjects (age 47.13+/-8.14 yr) were served as control group. Endothelial function was determined by flow-mediated dilation of brachial artery (FMD). eNOS4a/b polymorphism was detected by polymerase chain reaction. RESULTS FMD was significantly lower in patients pre-operatively compared with controls (8.48+/-1.78% vs 19.49+/-2.34%, p<0.001). FMD improved significantly after parathyroidectomy (16.19+/-2.16%, p<0.001 compared with pre-operative measurements), but was still significantly lower than controls (p<0.001). The distribution of eNOS4a/b genotype frequencies was not significantly different between patients and controls. Logistic regression analysis showed that increased serum calcium (>2.47 mmol/l) and PTH concentrations (>7.75 pmol/l) were significant independent predictors of lower FMD (<16.7%). ENOS4a/b polymorphism did not enter in this model. CONCLUSION Impaired endothelial function in patients with pHT improves after successful parathyroid surgery. No compelling data are evident to suggest that eNOS4a/b polymorphism modifies the endothelial function in patients with pHT.
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Affiliation(s)
- A Ekmekci
- Department of Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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36
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Caliskan Y, Oflaz H, Demirturk M, Yazici H, Turkmen A, Cimen A, Elitok A, Yildiz A. Coronary flow reserve dysfunction in hemodialysis and kidney transplant patients. Clin Transplant 2009; 22:785-93. [PMID: 19040561 DOI: 10.1111/j.1399-0012.2008.00879.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The assessment of coronary flow reserve (CFR) by trans-thoracic echocardiography has recently been introduced into clinical studies. Impairment of coronary microvascular functions and decreased CFR detected by trans-thoracic Doppler harmonic echocardiography (TTDE) has recently been reported in hemodialysis (HD) patients, but there is no comparative study between HD patients and renal transplant recipients. METHODS The aim of our study was to evaluate coronary microvascular circulation in chronic HD patients and renal transplant recipients. Forty-eight chronic HD patients, 27 renal transplant patients and 39 normotensive healthy controls were studied for the assessment of CFR by TTDE. The carotid artery intima media thickness (IMT) and areas of focal plaque formation were also evaluated in all subjects. RESULTS CFR values were significantly lower in both the HD and renal transplant groups than in the control group (p = 0.00). CFR values (1.57 +/- 0.32 vs. 1.89 +/- 0.50, p = 0.01) were also significantly lower in the HD group than in the renal transplant group. In 43 of 48 (89.6%) HD patients, CFR was <2.0; however, in 16 of 27 (59.3%) renal transplant recipients it was <2.0 (p = 0.00). When the HD and renal transplant groups were divided into two subgroups, according to CFR measurements (CFR < 2 and > or =2), no significant differences were found with respect to coronary risk factors and left ventricular echocardiographic measurements. The IMT of the control group (0.586 +/- 0.163 mm) was significantly lower than the HD (0.799 +/- 0.218 mm) and renal transplant groups (0.681 +/- 0.148 mm; p = 0.00). The IMT of the HD patients (0.799 +/- 0.218 mm) was significantly higher than the renal transplant recipients (0.681 +/- 0.148 mm; p = 0.01). CONCLUSIONS Renal transplant and HD patients had lower CFR values detected by TTDE, which may be regarded as an early finding of an affected cardiovascular system. CFR is more impaired in HD patients than renal transplant recipients. Uremia-associated microvascular disease may be responsible for CFR impairment in HD patients.
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Affiliation(s)
- Yasar Caliskan
- Division of Nephrology, Department of Internal Medicine, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
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37
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Aslanger E, Golcuk E, Oflaz H, Yilmaz A, Mercanoglu F, Bugra Z, Umman B, Nisanci Y. Intraaortic balloon occlusion during refractory cardiac arrest. A case report. Resuscitation 2009; 80:281-3. [DOI: 10.1016/j.resuscitation.2008.10.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Revised: 10/08/2008] [Accepted: 10/10/2008] [Indexed: 11/15/2022]
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Oflaz H, Sen F, Bayrakli SK, Elitok A, Cimen AO, Golcuk E, Kasikcioglu E, Tukenmez M, Yazici H, Turkmen A. Reduced coronary flow reserve and early diastolic filling abnormalities in patients with nephrotic syndrome. Ren Fail 2009; 30:914-20. [PMID: 18925532 DOI: 10.1080/08860220802353819] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Increased cardiovascular disease risk is very well known in nephrotic syndrome. Coronary flow reserve measurement by trans-thoracic echocardiography reflects coronary microvascular and endothelial function. However, diastolic filling abnormalities by echocardiography may indicate diastolic dysfunction. Our aim was to evaluate endothelial and diastolic functions by trans-thoracic echocardiography in nephrotic syndrome. METHODS Eighteen patients with nephrotic syndrome (five females, 34 +/- 17 years) and 30 controls (10 females, 35 +/- 10 years) were evaluated in this cross-sectional observational study. Age, weight, lipid profile, glucose, blood urea nitrogen, creatinine, serum albumin, total protein, C-reactive protein, erythrocyte sedimentation rate, blood pressures, 24-hour urine volume, and protein were recorded. Glomerular filtration rate was estimated by Cockcroft-Gault Formula. Doppler flow and other echocardiographic parameters were measured by Vivid 7 echocardiography. RESULTS Coronary flow reserve was significantly lower in patients than controls (p < 0.001) and was negatively correlated with proteinuria (p < 0. 001), creatinine levels (p = 0.03), total cholesterol (p = 0.02), C-reactive protein (p = 0.02), and erythrocyte sedimentation rate (p = 0.005). E/A ratio was significantly lower in patients than in controls (p = 0.005). DT was significantly higher in patients than in controls (p = 0.01) and isovolumic relaxation time was similar in both groups. CONCLUSION Coronary flow reserve and left ventricular diastolic filling are significantly impaired in nephrotic syndrome. Proteinuria, serum creatinine, total cholesterol and inflammation may have all contributory effects on endothelial dysfunction. Early evaluation of patients with nephrotic syndrome should include coronary flow and diastolic function by echocardiography.
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Affiliation(s)
- Huseyin Oflaz
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. huseyinoflaz@ yahoo.com
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Göksel O, Tireli E, El H, Oflaz H, Dayioglu E. Coronary artery bypass grafting in a 12-year-old girl with familial hypercholesterolemia. Acta Chir Belg 2009; 109:117-8. [PMID: 19341213 DOI: 10.1080/00015458.2009.11680388] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We present the case of a 12-year-old girl with familial hypercholesterolemia and coronary artery disease. She underwent triple-vessel coronary artery bypass grafting with bilateral pedicled internal mammary artery grafting without adverse events. Pediatric patients with familial hypercholesterolemia may present with premature coronary atherosclerosis requiring coronary artery bypass grafting. In situ internal mammary artery grafts should be the graft of choice.
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Kasikcioglu E, Oflaz H, Oncul A, Kayserilioglu A, Umman S, Nisanci Y. The trivest in overreaching syndrome: Cardiac fatigue, muscular weakness, and vascular dysfunction. Int J Cardiol 2008; 127:417-9. [PMID: 17643516 DOI: 10.1016/j.ijcard.2007.04.089] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2007] [Accepted: 04/12/2007] [Indexed: 11/25/2022]
Abstract
Although the underlying mechanisms responsible for cardiac dysfunction after prolonged exercise remains to be elucidated, it has reported cardiac deterioration following exhaustive exercise in the absence of underlying cardiovascular diseases, which has been attributed to cardiac fatigue. The objective of this study was to evaluate cardiac functions, exercise capacity, and flow-mediated dilatation in overreaching syndrome. We studied 13 male marathon runners who took part in a marathon. Cardiopulmonary exercise testing, transthoracic echocardiography and endothelium-dependent vasodilatation of the brachial artery were performed at before- and after-race. Peak oxygen consumption, left ventricular tissue Doppler imaging parameters and flow-mediated dilatation were decreased after-race values compared with before-race values. Overreaching syndrome could arise involves a physio-pathological trivest, cardio-vasculo-muscular axis, which include three vicious cycles.
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Kadehci Z, Dagoglu N, Ucar A, Oflaz H, Dizdar Y, Altun M. Carotid vessel changes and risk factors in patients receiving radiotherapy for head and neck cancers. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)71404-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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42
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Sen F, Demirturk M, Abaci N, Golcuk E, Oflaz H, Elitok A, Kutluturk F, Issever H, Unaltuna NE, Ozbey NC. Endothelial nitric oxide synthase intron 4a/b polymorphism and early atherosclerotic changes in hypopituitary GH-deficient adult patients. Eur J Endocrinol 2008; 158:615-22. [PMID: 18426819 DOI: 10.1530/eje-07-0704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Endothelial nitric oxide synthase (eNOS) intron 4a/b polymorphism is associated with plasma NO concentrations and coronary artery disease/hypertension in various populations. GH deficiency in adulthood predisposes to reduced NO concentrations and premature atherosclerosis. Our aim was to determine whether intron 4a/b polymorphism of eNOS gene influences endothelial function and early atherosclerotic changes in GH-deficient hypopituitary patients. DESIGN Thirty-three hypopituitary GH-deficient patients on conventional replacement therapy other than GH and 43 age-, sex-, and body mass index (BMI)-matched controls were studied in this cross-sectional case-control study. METHODS Early atherosclerotic changes were determined by flow-mediated dilation (FMD) of brachial artery and carotid artery intima-media thickness (IMT). eNOS4a/b polymorphism was detected by PCR. RESULTS Hypopituitary patients had significantly higher total/low-density lipoprotein cholesterol and fat mass and lower IGF-I concentrations compared with controls. IMT was significantly higher in patients (0.777+/-0.23 vs 0.639+/-0.17 mm, P<0.01). No significant difference was observed with respect to FMD measurements. eNOS4a/b genotype frequencies were similar between patients and controls. Patients carrying 'a' allele (a/a and a/b) had significantly higher IMT compared with controls carrying 'a' allele and bb genotype (P<0.05). However, logistic regression analysis revealed that presence of hypopituitarism, age> or =45 years, and BMI> or =27.9 kg/m(2) were significant independent predictors of IMT> or =0.65 mm. CONCLUSION No compelling data are evident to suggest that eNOS4a/b polymorphism modifies the atherosclerotic process in GH-deficient situations. A large case-control study is needed to confirm our findings.
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Affiliation(s)
- Fatma Sen
- Division of Endocrinology, Department of Medicine, Istanbul Faculty of Medicine, Istanbul University, 34390 Capa, Istanbul, Turkey
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43
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Turkmen K, Oflaz H, Uslu B, Cimen AO, Elitok A, Kasikcioglu E, Alisir S, Tufan F, Namli S, Uysal M, Ecder T. Coronary flow velocity reserve and carotid intima media thickness in patients with autosomal dominant polycystic kidney disease: from impaired tubules to impaired carotid and coronary arteries. Clin J Am Soc Nephrol 2008; 3:986-91. [PMID: 18354076 DOI: 10.2215/cjn.02330607] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND OBJECTIVES Cardiovascular problems are a major cause of morbidity and mortality in patients with autosomal dominant polycystic kidney disease. Endothelial dysfunction, an early and reversible feature in the pathogenesis of atherosclerosis, is associated with increased vascular smooth muscle tone, arterial stiffening, and increased intima-media thickness. Coronary flow velocity reserve is a noninvasive test showing endothelial function of epicardial coronary arteries and coronary microcirculatory function. The aim of the study was to investigate the carotid intima-media thickness and coronary flow velocity reserve in patients with autosomal dominant polycystic kidney disease. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Thirty normotensive patients with autosomal dominant polycystic kidney disease (10 male, 20 female) with well-preserved renal function and 30 healthy subjects (12 male, 18 female) were included in the study. Coronary flow velocity reserve was measured at baseline and after dipyridamole infusion by echocardiography. Coronary flow velocity reserve was calculated as the ratio of hyperemic to baseline diastolic peak velocities. RESULTS Carotid intima-media thickness was significantly higher in patients than in control subjects (0.80 +/- 0.29 versus 0.54 +/- 0.14 mm, respectively; P < 0.001). Moreover, coronary flow velocity reserve was significantly lower in patients than in control subjects (1.84 +/- 0.39 versus 2.65 +/- 0.68, respectively; P < 0.001). CONCLUSIONS Normotensive patients with autosomal dominant polycystic kidney disease with well-preserved renal function have significantly increased carotid intima-media thickness and significantly decreased coronary flow velocity reserve compared with healthy subjects. These findings suggest that atherosclerosis starts at an early stage in the course of their disease in patients with autosomal dominant polycystic kidney disease.
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Affiliation(s)
- Kultigin Turkmen
- Department of Internal Medicine, Istanbul School of Medicine, Istanbul, Turkey
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44
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Farsidfar F, Kasikcioglu E, Oflaz H, Kasikcioglu D, Meric M, Umman S. Effects of different intensities of acute exercise on flow-mediated dilatation in patients with coronary heart disease. Int J Cardiol 2008; 124:372-4. [PMID: 17368830 DOI: 10.1016/j.ijcard.2006.11.243] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2006] [Accepted: 11/25/2006] [Indexed: 11/29/2022]
Abstract
It is known that regular exercise training improves endothelial dysfunction in coronary artery disease, but, little is known concerning different intensities of acute exercise on endothelial function. We evaluated anaerobic threshold and peak oxygen uptake level of acute exercise on flow-mediated dilatation in patients with stable coronary artery disease. Endothelium-independent vasoreactivity in patients showed a trend with increase at threshold level exercise; however, it was significantly decreased at peak level exercise. Moderate intensity exercise (nearly anaerobic threshold level) should be recommended a therapeutic and preventative strategy for starting of cardiac rehabilitation program in patients with coronary artery disease.
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Kasikcioglu E, Oflaz H, Umman B, Bugra Z. Androgenic anabolic steroids also impair right ventricular function. Int J Cardiol 2008; 134:123-5. [PMID: 18272244 DOI: 10.1016/j.ijcard.2007.12.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Accepted: 12/11/2007] [Indexed: 11/28/2022]
Abstract
Chronic anabolic steroid use suppresses left ventricular functions. However, there is no information regarding the chronic effects of anabolic steroids on right ventricular function which also plays a key role in global cardiac function. The main objective of the present study was to investigate the effects of androgenic anabolic steroids usage among athletes on remodeling the right part of the heart. Androgenic-anabolic steroids-using bodybuilders had smaller diastolic velocities of both ventricles than drug-free bodybuilders and sedentary counterparts. This study shows that androgenic anabolic steroids-using bodybuilders exhibited depressed diastolic functions of both ventricles.
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Pamukcu B, Oflaz H, Onur I, Midilli K, Yilmaz G, Yilmaz E, Nisanci Y. Relationship Between the Serum sCD40L Level and Aspirin-Resistant Platelet Aggregation in Patients With Stable Coronary Artery Disease. Circ J 2008; 72:61-6. [DOI: 10.1253/circj.72.61] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Burak Pamukcu
- Department of Cardiology, Istanbul Faculty of Medicine
| | - Huseyin Oflaz
- Department of Cardiology, Istanbul Faculty of Medicine
| | - Imran Onur
- Department of Cardiology, Istanbul Faculty of Medicine
| | - Kenan Midilli
- Department of Microbiology, Cerrahpasa Faculty of Medicine
| | - Gulden Yilmaz
- Department of Microbiology, Istanbul Faculty of Medicine, Istanbul University
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Oflaz H, Kurt R, Sen F, Onur I, Cimen AO, Elitok A, Turkmen K, Pamukcu B, Kasikcioglu E, Bugra Z, Mercanoglu F, Ozbey N. Coronary flow reserve after L-thyroxine therapy in Hashimoto's thyroiditis patients with subclinical and overt hypothyroidism. Endocrine 2007; 32:264-70. [PMID: 18224461 DOI: 10.1007/s12020-008-9037-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Revised: 12/24/2007] [Accepted: 01/08/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND/AIMS Overt and subclinical hypothyroidism are reported to be associated with increased cardiovascular disease risk. We have used coronary flow reserve (CFR) measurement by trans-thoracic Doppler echocardiography (TTDE) to determine coronary microvascular function in Hashimoto's thyroiditis patients with overt and subclinical hypothyroidism and to evaluate effects of L-thyroxine replacement on coronary endothelial function. METHODS In total, 10 overt hypothyroid patients, 10 subclinical hypothyroid patients, and 10 controls were enrolled. FT4, TSH, anti-thyroid antibodies, lipid profile, insulin, glucose, HOMA-IR, physical parameters, and CFR measured by TTDE were recorded before and after 6 months of L: -thyroxine replacement in all groups. RESULTS CFR values of all hypothyroid patients at baseline were significantly lower than those in controls. After L: -thyroxine, CFR increased significantly in overt and subclinical hypothyroidism with respect to the baseline measurements (P < 0.05). When baseline and second measurements were evaluated collectively for patients and controls, CFR was positively correlated with FT4 levels (r = 0.31, P = 0.01) and negatively correlated with TSH and HOMA-IR (r = -0.38, P = 0.002 and r = -0.42, P < 0.001, respectively). CONCLUSION Subclinical as well as overt hypothyroid patients have impaired coronary microvascular function which improved after L: -thyroxine therapy. Treatment of Hashimoto's thyroiditis patients with subclinical hypothyroidism should be considered to improve cardiovascular disease risk.
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Affiliation(s)
- Huseyin Oflaz
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Arpaemini M. Tatlipinar C., No: 64 D:5, Fatih, Istanbul, Turkey.
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Tirnaksiz E, Pamukcu B, Oflaz H, Nisanci Y. Effect of high dose statin therapy on platelet function; statins reduce aspirin-resistant platelet aggregation in patients with coronary heart disease. J Thromb Thrombolysis 2007; 27:24-8. [PMID: 17917708 DOI: 10.1007/s11239-007-0154-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2007] [Accepted: 09/17/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Current evidence supports the preventive role of statins on platelet aggregation in patients with coronary heart disease. AIM Our aim was to determine the effects of aggressive statin therapy on platelet function in patients with coronary heart disease. MATERIAL AND METHODS A total of 178 consecutive patients (37-68 years old, 35.9% women) with stable coronary artery disease (CAD) was enrolled in the study. Platelet function assays were realized by the Platelet Function Analyzer (PFA)-100 with collagen and epinephrine (Col/Epi) and collagen and ADP (Col/ADP) cartridges. Aspirin resistance was defined as having a closure time (CT) of <186 s with Col/Epi cartridges despite regular aspirin therapy. A statin therapy protocol applied to the patients with aspirin resistance for 3 months. RESULTS We determined that 20 (11.2%) of patients had aspirin resistance by the PFA-100. Mean closure time measured with the Col/ADP cartridges was 83 +/- 18 s (53-162 s). Of the patients 12 were not on a statin therapy and eight were taking 10 mg daily atorvastatin. After 3 months of 40 mg daily atorvastatin therapy 13 subjects with aspirin resistance became aspirin sensitive by PFA-100 (P < 0.0001). There was also a significant decrease in total and LDL cholesterol levels and an increase in HDL cholesterol at the third month of statin therapy (P < 0.0001 for all). CONCLUSION Statin therapy reduced the in vitro aspirin resistance in 65% of the patients after a therapy of 3 months. Further studies are needed to elucidate the mechanism of statins' effects on platelet reactivity.
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Affiliation(s)
- Ebru Tirnaksiz
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, 34093, Turkey
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Oflaz H, Kurt R, Cimen A, Elitok A, Onur I, Golcuk E, Demirturk M, Batmaz S, Kasikcioglu E. Coronary flow reserve is also impaired in patients with subclinical hypothyroidism. Int J Cardiol 2007; 120:414-6. [PMID: 17092581 DOI: 10.1016/j.ijcard.2006.08.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2006] [Accepted: 08/01/2006] [Indexed: 10/23/2022]
Abstract
The diagnosis of subclinical hypothyroidism and detection of its effects on cardiovascular system is important. Also, the patients with subclinical hypothyroidism even at the very early stage are at increased risk for developing atherosclerosis. We evaluated coronary microvascular circulation and endothelial dysfunction of epicardial coronary arteries by the measurement of coronary flow velocity reserve via a non invasive technique, transthoracic Doppler echocardiography in subclinical hypothyroidism. Coronary flow reserve in patients with subclinical hypothyroidism such as in overt hypothyroidism was lower than that of euthyroid subject. As a conclusion, endothelial and microvascular dysfunction, which are early harbingers of atherosclerosis, are shown in overt and subclinical hypothyroidism.
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Kasikcioglu E, Elitok A, Onur I, Cimen A, Ucar A, Oflaz H. Acute effects of smoking on coronary flow velocity reserve and ventricular diastolic functions. Int J Cardiol 2007; 129:e18-20. [PMID: 17720262 DOI: 10.1016/j.ijcard.2007.06.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Accepted: 06/15/2007] [Indexed: 10/22/2022]
Abstract
Although it is well known that chronic effect of smoking on cardiovascular system, relation between coronary vascular reactivity and ventricular functions after acute smoking has not been well understood. The purpose of this study was to assess the relation between coronary flow velocity reserve and ventricular diastolic functions measured by tissue Doppler imaging after acute smoking. We found that coronary flow velocity and diastolic functions of right ventricle were decreased. Also, there was a correlation between coronary flow velocity reserve and diastolic ratio of the ventricle. Acute smoking may affect diastolic functions of the ventricles, especially right ventricle via changes of coronary flow.
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