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Öğe Atorvastatin Given prior to Electrical Cardioversion Does Not Affect the Recurrence of Atrial Fibrillation in Patients with Persistent Atrial Fibrillation Who Are on Antiarrhythmic Therapy(KARGER, 2011) Demir, Kenan; Can, Ilknur; Koc, Fatih; Vatankulu, Mehmet Akif; Ayhan, Selim; Akilli, Hakan; Aribas, AlpayObjective: In this study, our aim was to evaluate the effect of a higher dose of atorvastatin on the recurrence rate of atrial fibrillation (AF) after electrical cardioversion (EC) in addition to antiarrhythmic therapy. Subjects and Methods: 48 patients with persistent AF were included in this study. The patients were randomized to an atorvastatin 40-mg treatment group and a control group. Atorvastatin was started 3 weeks before EC and was continued for 2 months after EC. EC was performed using biphasic shocks after 3 weeks of treatment with the orally administered anticoagulant warfarin. Lipid and inflammatory parameters (high-sensitivity C-reactive protein, white blood cell count and fibrinogen level) were evaluated at the baseline and before EC. The endpoint of this study was electrocardiographically confirmed recurrence of AF of >10 min. Results: There were no significant differences in baseline characteristics and lipid and inflammatory marker levels between the treatment and control groups. Total cholesterol and low-density lipoprotein levels were significantly decreased in patients taking atorvastatin for 2 months compared with baseline values (174 +/- 31 vs. 129 +/- 25 mg/dl, p = 0.001, and 112 +/- 23 vs. 62 +/- 20 mg/dl, p = 0.001, respectively), while no significant change occurred in control patients (168 +/- 26 vs. 182 +/- 29 mg/dl, p = 0.07, and 99 +/- 18 vs. 108 +/- 26 mg/dl, p = 0.1, respectively). At the end of the 2-month follow-up period, 9 patients (20.5%) experienced AF recurrence, and there was no significant difference in AF recurrence rate between the treatment and control groups (26 vs. 13%; p = 0.2). Conclusion: Atorvastatin therapy prior to EC does not prevent the recurrence of arrhythmia in patients with persistent AF who are receiving antiarrhythmic therapy. Copyright (C) 2011 S. Karger AG, BaselÖğe Can neutrophil/lymphocyte ratio predict recurrence of non-valvular atrial fibrillation after cardioversion?(TURKISH SOC CARDIOLOGY, 2013) Aribas, Alpay; Akilli, Hakan; Gul, Enes Elvin; Kayrak, Mehmet; Demir, Kenan; Duman, Cetin; Alibasic, HajrudinObjective: High neutrophil/lymphocyte ratio (NLR) has been associated with post-operative AF development in patients who underwent cardiac surgery. In this study, effectiveness of NLR for prediction of recurrence after electrical cardioversion (CV) in non-valvular AF was investigated. Methods: A total of 149 patients who underwent a successful CV were included in this prospective cohort study. Baseline complete blood cell count, routine biochemical tests, high sensitive C-reactive protein (hs-CRP), and echocardiographic measurements were examined. After CV, patients were monitored over six months for recurrence. Baseline characteristics of recurrence group were compared with sinus rhythm group by using Student's t -test. Logistic regression analysis was used to determine predictors of recurrence. Results: Recurrence occurred in a total of 46 patients (30.9%). Median AF duration [16 (IQR:14.25) vs. 12 (IQR: 11) months, p=0.01], baseline hs-CRP [9.80 (IQR:8.50) mg/dL vs. 4.28 (IQR:5.65) mg/dL, p=0.002] and left atrium (LA) diameter (4.5 +/- 0.4 cm, 4.3 +/- 0.5 cm, p=0.023) were significantly higher in the recurrence group than sinus rhythm group. Median NLR was comparable in recurrence and sinus groups [2.38 (IQR:2.09) vs. 2.23, (IQR: 1.23) p=0.96, respectively]. There was a weak correlation between NLR and hs-CRP (r=0.22, p=0.05) and age (r=0.24, p=0.02). In multiple logistic regression analysis, hs-CRP [OR: 1.34 (1.09-1.65 95% CI) p=0.006], LA diameter [OR: 11.92 (1.84-77.07 95% CI) p=0.01], spontaneous echo contrast positivity, [OR: 5.40 (1.04-12.02 95% CI) p=0.045] and systolic blood pressure [OR: 1.05 (1.01-1.10 95% CI) p=0.03] were independent predictors of AF recurrence. Conclusion: NLR failed to predict AF recurrence after a successful electrical CV, but hs-CRP remained an inflammatory marker of AF recurrence. (Anadolu Kardiyol Derg 2013; 13: 123-30)Öğe The Effect of Smoking on Myocardial Performance Index in Middle-Aged Males after First Acute Myocardial Infarction(WILEY, 2013) Bacaksiz, Ahmet; Kayrak, Mehmet; Vatankulu, Mehmet Akif; Ayhan, Selim S.; Sonmez, Osman; Akilli, Hakan; Aribas, AlpayBackground: Cigarette smoking is associated with increased rates of coronary artery disease and acute myocardial infarction (MI). Paradoxically, smokers had lower mortality after MI. The purpose of this study was to evaluate the effect of chronic smoking on myocardial performance index (MPI) in middle-aged men after an acute MI. Material and methods: A total of 429 patients (325 smokers vs. 104 nonsmokers) presenting with acute ST elevation MI were enrolled in this study. Thrombolysis in myocardial infarction (TIMI) flow of the infarct related artery was measured before and after the primary percutaneous coronary intervention (PCI), and Gensini score was also calculated. Conventional echocardiography and tissue Doppler echocardiography (TDI) were performed within 4872hours after onset of chest pain. Peak early (Em) and late (Am) diastolic velocities, peak systolic (Sm) mitral annular velocities and time intervals were recorded with TDI. The MPI, ratio of Em/Am, and E/Em were calculated. Results: Baseline demographic and angiographic characteristics such as Gensini score, pre and, post PCI TIMI flow were similar in 2 groups. In contrast, LV MPI was preserved among smokers (0.59 +/- 0.15 vs. 0.66 +/- 0.14, P=0.01), and Em/Am values were also higher in smokers (0.84 +/- 0.28 vs. 0.75 +/- 0.31, P=0.01). Independent predictors of impaired MPI (0.60) were determined as nonsmoking status (odds ratio 2.940, 95% CI 0.985.83, P=0.05), left anterior descending artery stenosis (odds ratio 3.196, 95% CI 1.735.91 P=0.001), and, age (odds ratio 1.12, 95% CI 1.031.22, P=0.01). Conclusions: Despite similar demographic and angiographic characteristics, smoker males had a paradoxically better MPI after acute MI.Öğe Epicardial Adipose Tissue and Atherosclerosis In Patients With Familial Mediterranean Fever(WILEY-BLACKWELL, 2013) Kucuk, Adem; Solak, Yalcin; Akilli, Hakan; Yildirim, Oguzhan; Guler, Ibrahim; Ucar, Ramazan; Aribas, Alpay[Abstract not Available]Öğe Gender-Related Changes of the Epicardial Fat Thickness and Leptin in Obstructive Sleep Apnea(WILEY, 2014) Akilli, Hakan; Kayrak, Mehmet; Bekci, Taha Tahir; Erdogan, Halil Ibrahim; Aribas, Alpay; Yildirim, Oguzhan; Taner, AlpaslanBackgroundEpicardial fat thickness (EFT), an indicator of visceral obesity, and leptin are 2 novel markers for studying the obstructive sleep apnea (OSA) population. This study aimed to investigate the effects of gender on leptin levels and EFT, and the relation with OSA severity. MethodsA total of 149 patients with OSA (female/male 55/94 and mean age 50.89.2 years) and 50 control patients (female/male 24/26 and mean age 48.98.8 years) were included in the study. The study population was divided into 4 groups according to apnea/hypopnea index (AHI) as control (AHI <5), the mild OSA (AHI 5-14), the moderate OSA (AHI 15-29), and the severe OSA (AHI 30). EFT was obtained from parasternal long-axis and parasternal short-axis echocardiographic images. ResultsLeptin levels among females were significantly higher than among males (10.5 [7.8] vs. 5.4 [4.5] ng/mL, P=0.001, respectively). Among women, leptin levels were significantly higher in the severe OSA group compared to the control group (9.8 [9.0] vs. 15.5 [10.1] ng/mL, P=0.05, respectively). Conversely, no relation was observed between OSA severity and the leptin levels among men. EFT was not significantly different between the 2 genders (P>0.05). EFT was thicker in the severe OSA group than in the control and mild OSA groups among women, whereas EFT was not changed according to OSA severity among males (P>0.05). ConclusionLeptin and EFT may be a valuable parameter in the evaluation of OSA severity in women than in men.Öğe P-wave Dispersion for Predicting Paroxysmal Atrial Fibrillation in Acute Ischemic Stroke(IVYSPRING INT PUBL, 2012) Dogan, Umuttan; Dogan, Ebru Apaydin; Tekinalp, Mehmet; Tokgoz, Osman Serhat; Aribas, Alpay; Akilli, Hakan; Ozdemir, KurtulusBackground: Detection of paroxysmal atrial fibrillation (PAF) in acute ischemic stroke patients poses diagnostic challenge. The aim of this study was to predict the presence of PAF by means of 12-lead ECG in patients with acute ischemic stroke. Our hypothesis was that P-wave dispersion (P-d) might be a useful marker in predicting PAF in patients with acute ischemic stroke. Methods: 12-lead resting ECGs, 24-hour Holter recordings and echocardiograms of 400 patients were analyzed retrospectively. PAF was detected in 40 patients on 24-hour Holter monitoring. Forty out of 360 age and gender matched patients without PAF were randomly chosen and assigned as the control group. Demographics, P-wave characteristics and echocardiographic findings of the patients with and without PAF were compared. Results: Maximum P-wave duration (p=0.002), P-d (p<0.001) and left atrium diameter (p=0.04) were significantly higher in patients with PAF when compared to patients without PAF. However, in binary logistic regression analysis P-d was the only independent predictor of PAF. The cut-off value of P-d for the detection of PAF was 57.5 milliseconds (msc). Area under the curve was 0.80 (p<0.001). On a single 12-lead ECG, a value higher than 57.5 msc predicted the presence of PAF with a sensitivity of 80% and a specificity of 73%. Conclusion: P-d on a single 12-lead ECG obtained within 24 hours of an acute ischemic stroke might help to predict PAF and reduce the risk of recurrent strokes.Öğe PACEMAKER STRESS ECHOCARDIOGRAPHY FOR DIFFERANTIAL DIAGNOSIS OF LOW OUTPUT, LOW GRADIENT AORTIC STENOSIS(ELSEVIER IRELAND LTD, 2010) Doğan, Umuttan; Akilli, Hakan; Arıbaş, Alpay; Arslan, Ramazan; Soylu, Ahmet; Tokaç, Mehmet[Abstract not Available]Öğe The Relationship among Thiazide Like Diuretic, Uric Acid and Erectile Dysfunction in Hypertensive Subjects(ELSEVIER SCIENCE INC, 2013) Aribas, Alpay; Kayrak, Mehmet; Ulucan, Seref; Keser, Ahmet; Demir, Kenan; Alibasic, Hayrudin; Akilli, Hakan[Abstract not Available]Öğe The relationship between serum asymmetric dimethylarginine levels and subjective sleep quality in normotensive patients with type 2 diabetes mellitus(KOREAN ASSOC INTERNAL MEDICINE, 2015) Aribas, Alpay; Kayrak, Mehmet; Tekinalp, Mehmet; Akilli, Hakan; Alibasic, Hayrudin; Yildirim, Serkan; Gunduz, MehmetBackground/Aims: Poor sleep quality (SQ) is associated with increased cardiovascular mortality and morbidity. Additionally, asymmetric dimethylarginine (ADMA) is an independent predictor of cardiovascular mortality and morbidity. However, no sufficient data regarding the relationship between ADMA levels and SQ have been reported. The goal of the current study was to evaluate the association between SQ and ADMA levels in normotensive patients with type 2 diabetes mellitus. Methods: The study participants consisted of 78 normotensive type 2 diabetics. The SQ of all participants was assessed using the Pittsburgh Sleep Quality Index (PSQI). Patients with a global PSQI score > 5 were defined as "poor sleepers." Factors associated with poor SQ were analyzed using a multiple regression model. Serum ADMA levels were measured using high performance liquid chromatography. Results: The median ADMA levels of the poor sleepers were increased compared with patients defined as good sleepers (5.5 [4.2 to 6.6] vs. 4.4 [2.9 to 5.4], p < 0.01, respectively). However, the L-arginine/ADMA ratio was decreased in poor sleepers (p < 0.01). Global PSQI scores were positively correlated with ADMA levels (p < 0.01) and negatively correlated with the L-arginine/ADMA ratio (p = 0.02). ADMA levels were correlated with sleep latency (p < 0.01) and sleep efficiency (p = 0.01). Logistic regression analysis showed that ADMA levels (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.16 to 2.44; p = 0.01) and body mass index (OR, 1.15; 95% CI, 1.01 to 1.31; p = 0.04) were associated with poor SQ independently of glomerular filtration rate, sex, age, duration of diabetes, hemoglobin A1c, total cholesterol, and systolic blood pressure. Conclusions: Self-reported SQ was independently associated with ADMA levels in normotensive patients with diabetes mellitus.Öğe The relationship between uric acid and erectile dysfunction in hypertensive subjects(TAYLOR & FRANCIS LTD, 2014) Aribas, Alpay; Kayrak, Mehmet; Ulucan, Seref; Keser, Ahmet; Demir, Kenan; Alibasic, Hayrudin; Akilli, HakanBackground. Endothelial dysfunction plays a major role in erectile dysfunction (ED). Uric acid (UA) is a marker of endothelial dysfunction. We hypothesized that increased UA levels may be associated with ED and aimed to investigate whether there is a relationship between, UA and ED in hypertensive patients. Methods. A total of 200 hypertensive patients who have a normal treadmill exercise test were divided into two groups based on the Sexual Health Inventory for Men (SHIM) test (<21 defi ned as ED n = 110, and >= 21 defi ned as normal erectile function n = 90). The differences between the ED and normal erectile function groups were compared and determinants of ED were analyzed. Main results. The prevalence of ED was found to be 55.0%. Office blood pressure level was comparable between groups. UA levels were significantly increased in the ED group (6.20 +/- 1.56 vs 5.44 +/- 1.32, p = 0.01). In a regression model, age [odds ratio (95% confidence interval): 1.08 (1.04-1.14), p = 0.001], smoking [odds ratio: 2.33 (1.04-5.20), p = 0.04] and UA [odds ratio: 1.76 (1.28-2.41), p = 0.04] were independent determinants of ED. An UA level of >5.2 mg/dl had 76.2% sensitivity, 43.7% specificity, 62.9% positive and 59.4% negative predictive value for determining ED. Conclusion. UA is an independent determinant of ED irrespective of blood pressure control and questioning erectile function for hypertensive patients with increased UA levels may be recommended.Öğe The relationship between white coat hypertension and sleep quality(SPRINGER JAPAN KK, 2014) Kaya, Zeynettin; Kayrak, Mehmet; Demir, Kenan; Gunduz, Mehmet; Alibasic, Hayruddin; Karanfil, Mustafa; Akilli, HakanImpaired sleep quality is frequently associated with hypertension. The present study aims to examine self-reported sleep quality of patients with white coat hypertension. A total of 74 subjects who were evaluated in a cardiology outpatient clinic, including 39 normotensive subjects and 35 patients with white coat hypertension between the ages of 20 and 65 were included in this study. Patients with elevated office blood pressure (>= 140/90 mm Hg) and normal 24-h and daytime ambulatory blood pressure (<125/80 mm Hg and <130/85 mm Hg, respectively) were defined as white coat hypertension. Patient's sleep quality was evaluated using the Pittsburgh sleep quality index. Global Pittsburgh sleep quality index score was significantly higher in patients with white coat hypertension than normotensive subjects (7.2 +/- 3.7 vs. 5.1 +/- 3.8, P = 0.01). Poor sleep quality was present in 65% of patients with white coat hypertension, and in 30% of the normotensive group (P = 0.003). A multiple logistic regression analysis showed that white coat hypertension (odds: 6.7 (95% confidence interval [CI] 1.22-36.64), P = 0.03) and female gender (odds: 10.1(95% CI 1.35-76.32), P = 0.02) were independent predictors of poor sleep quality. In conclusion, white coat hypertension seems to be associated with impaired sleep quality.Öğe Severity of coronary artery disease and symptoms of erectile dysfunction in males with a positive exercise treadmill test(BLACKWELL PUBLISHING, 2007) Akilli, Hakan; Gok, Hasan; Soylu, Ahmet; Kayrak, MehmetAim: The objective of this study is to investigate the significance of erectile dysfunction in males with a positive exercise treadmill test (ETT) to predict the severity of coronary artery disease (CAD). Materials and Method: With no previous marked CAD, and applying to our clinic with chest pain, 105 male patients (mean age: 56 +/- 8 years) underwent coronary angiography after the ETT. These patients met our criteria and were included in our study. All patients were requested to complete a brief, 5-item form by the International Index of Erectile Function, and the Sexual Health Inventory for Men (SHIM), and were classified into four groups according to coronary angiography results as follows: normal coronary artery (NCA), single-vessel CAD (1 V), two-vessel CAD (2 V) and three-vessel CAD (3 V). The relation between SHIM scores and the number of arteries with significant lesions was evaluated. Results: The median SHIM score was found to be significantly lower in both the 2 V, 15 (IQR: 12-20) and 3 V, 13 (IQR: 11-16) groups compared to the NCA, 22 (IQR: 17-23) and the 1 V, 22 (IQR: 17-23) groups (P < 0.05). Grouped as group I (NCA + 1 V) and group II (2 V + 3 V), the patients were recompared. The SHIM score is an independent parameter to define the presence of significant lesions in two or more coronary arteries (odds ratio, 0.84; 95% CI, 0.73-0.97; P = 0.019). COnclusion: The fact that the SHIM score is < 18 in ETT positive males may suggest that the probability of multivessel CAD should be high.Öğe White Coat Hypertension and Poor Sleep Quality(ELSEVIER SCIENCE INC, 2013) Kaya, Zeynettin; Kayrak, Mehmet; Demir, Kenan; Gunduz, Mehmet; Alibasic, Hayruddin; Karanfil, Mustafa; Akilli, Hakan[Abstract not Available]