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Brugada sendromu: İki olgu sunumu ve ailenin gözden geçirilmesi
(2004) Altunkeser, Bülent Behlül; Atar, İlyas; Özdemir, Kurtuluş; Aygül, Nazif; Yazıcı, Mehmet; Düzenli, Mehmet Akif; Ertan, Çağatay
Brugada sendromu, EKG'de sağ dal bloğu paterni ve sağ prekordiyal derivasyonlarda ST yükselmesi ile karakterize, ani ölüm riskinin yüksek olduğu bir genetik durumdur. Tüm dünyada yapılan epidemiyolojik çalışmalarda, özellikle gençlerde gözlenen, ani, beklenmedik kalp ölümlerinin önemli bir kısmından sorumludur. Tipik EKG değişiklikleri, hastalarda zaman zaman ortaya çıkıp zaman zaman kaybolabilmektedir. Sodyum kanallarını bloke eden bazı antiaritmik ajanların bu EKG değişikliklerini ortaya çıkarmada etkili oldukları bilinmektedir. Bu yazıda Brugada sendromlu bir ailenin klinik ve elektrokardiyografik özellikleri incelenmektedir.
A Case Report of an Unusual Complication of Amanita Phalloides Poisoning: Development of Cardiogenic Shock and Its Successful Treatment with Intra-Aortic Balloon Counterpulsation
(Pergamon-Elsevier Science Ltd, 2010) Aygül, Nazif; Düzenli, Mehmet Akif; Özdemir, Kurtuluş; Altunkeser, Bülent Behlül
Amanita phalloides is responsible for the majority of the fatalities caused by mushroom poisoning. It causes damage in liver, kidneys and rarely pancreas, causing encephalopathic coma, disseminated intravascular coagulation, hemorrhage and hypovolemic shock. However, its effect on cardiac functions has not been established yet. In this case report, we aimed to present a female patient poisoned by A. phalloides mushroom complicated with multi-organ failure and cardiogenic shock due to advanced left ventricular systolic dysfunction. This case report was the first to show a successful treatment of cardiogenic shock due to mushroom poisoning with intra-aortic balloon counterpulsation, whereas she did not respond to other therapies.
Comparison of traditional risk factors, angiographic findings, and in-hospital mortality between smoking and nonsmoking turkish men and women with acute myocardial infarction
(2010) Aygül, Nazif; Özdemir, Kurtuluş; Abacı, Adnan; Aygül, Meryem Ülkü; Düzenli, Mehmet Akif; Yazıcı, Hüseyin Uğur; Özdoğru, İbrahim; Karakaya, Ekrem
Background: The prevalence of smoking is high in Turkey. However, there are no data available evaluating the differences between smokers and nonsmokers according to their sex in patients with acute myocardial infarction (AMI) in Turkey. Hypothesis: The aim of the study was to determine the prevalence of smoking and its relationship to age, localization, and extension of coronary heart disease (CHD), and other risk factors in Turkish men and women with first AMI. Methods: This study included, 1502 patients with first AMI from 3 different cities in Turkey. The baseline characteristics and traditional risk factors for CHD, Coronary angiographic results, and in-hospital outcome were recorded. Results: The proportion ofmale smokers was significantly higher than that ofwomen (68%vs 18%, P < 0.001). Smokers were younger by almost a decade than nonsmokers (P < 0.001). Male nonsmokers were younger than females; however, the mean age of first AMI was similar in male and female smokers. In both genders, prevalence of hypertension and diabetes mellitus was significantly lower in smokers than in nonsmokers (P < 0.001). Smokers had lessmultivessel disease andless comorbidity as compared to nonsmokers. Although the in-hospital mortality rate was lower in smokers, smoking status was not an independent predictor of mortality. Conclusions: Smoking, by decreasing the age of first AMI in women, offsets the age difference in first AMI betweenmen and women. The mean age of first AMI is lower in Turkey than most European countries due to a high percentage of smoking. © 2010 Wiley Periodicals, Inc.
The effect of gender on the myocardial performance index
(SPRINGER, 2007) Düzenli, Mehmet Akif; Özdemir, Kurtuluş; Nazif, Aygül; Zengin, Kadriye
[Abstract not Available]
Effect of insufficient decrease in nocturnal blood pressure in essential hypertension on right ventriculair functions
(SPRINGER, 2007) Soylu, Ahmet; Düzenli, Mehmet Akif; Kadriye, Zengin
[Abstract not Available]
The Effect of Obesity and Aldosterone on Development of Left Ventricular Hypertrophy in Essential Hypertension
(Elsevier Sci Ireland Ltd, 2003) Soylu, A.; Temizhan, Ahmet; Düzenli, Mehmet Akif; Tokaç, Mehmet; Yazıcı, C.; Köylu, O.
[Abstract not Available]
Effect of postmenopausal hormone replacement therapy on cardiovascular performance
(ELSEVIER IRELAND LTD, 2004) Özdemir, Kurtuluş; Çelik, Çetin; Altunkeser, Bülent Behlül; İçli, Abdullah; Albeni, Havva; Düzenli, Mehmet Akif; Akyürek, Cemalettin; Gök, Hasan
Summ.: Postmenopausal hormone replacement therapy (HRT) has usually been evaluated the relationship with atherosclerotic disease, whereas its effect on direct cardiac functions hasn't been investigated in detail. This study was planned to investigate the long-term effects of HRT on cardiac functions and exercise performance. Methods: Thirty-six postmenopausal women (mean age: 51+/-4 years, 39-60 years) were prospectively analyzed with pulsed wave Doppler echocardiography and symptom-limited exercise stress test before HRT (oral 0.625 mg conjugated estrogen and 2.5 mg medroxyprogesteron acetate/day), and at the third and the sixth months. The effect of HRT on left ventricular ejection fraction (EF), early filling velocity (E wave) and late filling velocity (A wave), E wave deceleration time (EDT), E/A ratio, myocardial performance index (MPI), exercise duration and METS changes were examined. Results: HRT did not significantly alter the left ventricular EF. At the third month of HRT, there was an insignificant increase in E wave, EDT, and E/A ratio, whereas an insignificant decrease was noted in MPI (P > 0.05). However, at the sixth month of HRT, these changes became significant (68+/-12 vs. 75+/-13 cm/s, P < 0.01; 171+/-24 vs. 184+/-14 ms, P < 0.01; 1.01+/-0.23 vs. 1.11+/-0.27, P < 0.01, and 44+/-9 vs. 39+/-8%, P < 0.001, respectively). On the other hand, exercise duration and exercise METS values showed significant improvements at the third month of HRT (423 104 vs. 482+/-104 s, P < 0.001; 8.2+/-1.7 vs. 9.1+/-2 METS, P < 0.001). These improvements also continued at the sixth month of HRT. In conclusion, postmenopausal HRT leads to a progressive improvement on left ventricular function parameters, and in parallel, in exercise performance. (C) 2003 Elsevier Ireland Ltd. All rights reserved.
The Effect of Postmenopausal Hormone Replacement Therapy on Cardiovascular Performance
(W B SAUNDERS CO LTD, 2001) Özdemir, Kurtuluş; Çelik, Çetin; Altunkeser, Bülent Behlül; İçli, Abdullah; Albeni, Havva; Akyürek, Cemalettin; Gök, Hasan; Düzenli, Mehmet Akif
Summary: Postmenopausal hormone replacement therapy (HRT) has usually been evaluated the relationship with atheroscle- rotic disease, whereas its effect on direct cardiac functions hasn't been investigated in detail. This study was planned to investigate the long-term effects of HRT on cardiac functions and exercise performance. Methods: Thirty-six postmenopausal women (mean age: 51 ± 4 years, 39-60 years) were prospectively analyzed with pulsed wave Doppler echocardiography and symptom-limited exercise stress test before HRT (oral 0.625 mg conjugated estrogen and 2.5 mg medroxyprogesteron acetate/day), and at the third and the sixth months. The effect of HRT on left ventricular ejection fraction (EF), early filling velocity (E wave) and late filling velocity (A wave), E wave deceleration time (EDT), E/A ratio, myocardial performance index (MPI), exercise duration and METS changes were examined. Results: HRT did not significantly alter the left ventricular EF. At the third month of HRT, there was an insignificant increase in E wave, EDT, and E/A ratio, whereas an insignificant decrease was noted in MPI (P>0.05). However, at the sixth month of HRT, these changes became significant (68±12 vs. 75 ± 13 cm/s, P<0.01; 171 ±24 vs. 184 ± 14 ms, P<0.01; 1.01±0.23 vs. 1.11±0.27, P<0.01, and 44±9 vs. 39±8%, P<0.001, respectively). On the other hand, exercise duration and exercise METS values showed significant improvements at the third month of IIRT (423± 104 vs. 482±104 s. P<0.001; 8.2±1.7 vs. 9.1±2 METS, P<0.001). These improvements also continued at the sixth month of IIRT. In conclusion, postmenopausal HRT leads to a progressive improvement on left ventricular function parameters, and in parallel, in exercise performance.
Effect of preload and heart rate on the Doppler and tissue Doppler-derived myocardial performance index
(WILEY, 2007) Özdemir, Kurtuluş; Balcı, Sibel; Düzenli, Mehmet Akif; Can, İlknur; Yazıcı, Mehmet; Aygül, Nazif; Altunkeser, Bülent Behlül
Doppler-derived myocardial performance index (MPI) has been described as a noninvasive measurement of LV function. Our aim was to investigate the effect of hemodialysis related volume reduction and heart rate changes on the Doppler-derived LV MPI, and Doppler tissue imaging (DTI) derived left and right ventricular MPI. Method: The study group comprised 32 consecutive patients (mean age: 43 18 yrs) undergoing hemodialysis. Patients underwent echocardiography before and immediately after hemodialysis session. Left and right ventricular MPI derived from conventional pulsed-wave Doppler and DTI was calculated. The difference in MPI, heart rate and body weight was calculated before and after hemodialysis. Results: Doppler-derived LV MPI, and right ventricular MPI obtained by DTI were increased (p = 0.05) but the LV MPI obtained by DTI was unchanged after hemodialysis. There is a significant positive correlation between the Doppler-derived LV MPI difference and volume reduction (r = 0.38, p = 0.032). The heart rate difference was correlated with Doppler-derived LV MPI difference, and DTI derived right ventricular MPI difference (r = 0.38, p = 0.034; r = 0.48, p = 0.006, respectively). Whereas, DTI derived LV MPI difference was not correlated with heart rate difference. By the multivariate analysis, there was no correlation between Doppler-derived LV MPI difference with heart rate difference, and volume reduction. Right ventricular MPI difference correlated with heart rate difference (r = 0.41, p = 0.021) but not with volume reduction. Doppler-derived MPI is partially influenced by preload and heart rate changes. However, DTI derived LV MPI is not influenced by preload and heart rate changes.
Effect of the use of drug eluting stents on the rate of coronary arterial flow
(SPRINGER, 2007) Soylu, Ahmet; Düzenli, Mehmet Akif
[Abstract not Available]
The effects of hormone replacement therapy on myocardial performance in early postmenopausal women
(TAYLOR & FRANCIS LTD, 2010) Düzenli, Mehmet Akif; Özdemir, Kurtuluş; Sökmen, A.; Gezginç, K.; Soylu, A.; Çelik, C.; Altunkeser, Bülent Behlül
Method In a prospective, controlled study, 60 healthy postmenopausal women were assigned to two groups (32 in the HRT group and 28 in the control group). After conventional echocardiographic parameters were measured, tissue Doppler echocardiography recordings were obtained from the mitral and tricuspid annulus. Systolic myocardial velocity (Sm), early and late diastolic myocardial velocities (Em and Am) and time intervals were measured and MPI was calculated. Then the symptom-limited exercise stress test using the Bruce protocol was performed. After 3 and 6 months of HRT (oral 0.625 mg conjugated estrogen + 2.5 mg medroxyprogesterone acetate/day), the same examinations were repeated. The effects of HRT on myocardial velocities, MPI and exercise time were evaluated at the 3rd and 6th months. Results The parameters of the control group remained statistically unchanged during the study. HRT did not have any effect on segmental and mean left ventricular (LV) Sm or right ventricular (RV) Sm. However, LV Em/Am and RV Em/Am ratios significantly increased at the 6th month of HRT, and LV and RV MPI values were observed to decrease significantly as compared to basal values. Additionally, a significant increase was observed in exercise duration and metabolic equivalent values after 3 months of HRT, and this increase continued at the 6th month as well. The favorable changes in all parameters in the HRT group were significantly different from those of the control group. Conclusion Data obtained in this study suggest that HRT is not only effective for treating menopausal complaints but also increases cardiovascular performance by improving especially diastolic functions in early postmenopausal women.
Electrical Storm Associated with H1N1 Infection
(Elsevier Ireland Ltd, 2010) Doğan, Umuttan; Can, İlknur; Arıbaş, Alpay; Düzenli, Mehmet Akif; Yazıcı, Mehmet; Erayman, İbrahim
A 47-year old male was admitted to the emergency department with the complaint of recurrent shocks from his ICD. The monitorization of the patient with the ECG showed that he was experiencing recurrent ventricular tachycardia (VT) attacks which resolved successfully with the shocks of the ICD. Due to repetetive shocks at the first evaluation in the emergency department, the patient was sedated. His past medical history was remarkable for an inferior myocardial infarction 2 years ago and a cardiopulmonary arrest and a subsequent implantation of an ICD after the electrophysiologic study in which VT had been documented. He had not received any shocks after the implantation of ICD and no signs or symptoms of either acute coronary syndrome or heart failure were present at the time of presentation. No other pathologies other than a body temperature of 37.5 was found at the physical examination. The patient stated that he had been suffering from high body temperature, nasal flow, a sore throat and myalgia in the past three days. He was on aspirin, atorvastatin, ramipril and 5 mg/d bisoprolol treatments, intravenous amiodarone infusion was added to these treatments and the dose of bisoprolol was increased to 10 mg/d. The patient was hospitalized in the cardiology intensive care unit and it was documented that he had received 89 electrical shocks due to repetetive VT attacks in the last 6 hours. The frequency of the attacks subsided after the infusion of amiodarone and electrical shocks completely resolved after 8 hours of the treatment. The transthoracic echocardiography showed that left ventricular ejection fraction was 40%. Hemogram, serum electrolyte levels, kidney, liver and thyroid functions were in normal ranges, however the blood analyses showed that he had HINI infection. Coronary angiography was performed at the 10th day of treatment to rule out any ischemia which might lead to VT. Distal segments of the circumflex and right coronary arteries were totally occluded whereas LAD was patent. These findings were consistent with the coronary an- giogram which was performed 6 months ago. As new onset ischemia, heart failure, thyrotoxicosis, anemia and electrolyte disturbances were ruled out, repetetive VT attacks were thought to be associated with H1N1 infection. Ventricular tachycardia attacks are known to be associated with infectious diseases under some circumstances. To the best of our knowledge, our patient is the first case report of an electrical storm associated with HINI infection.
Hormon replasman tedavisinin kardiyovasküler performansa etkisi
(Selçuk Üniversitesi Tıp Fakültesi, 2003) Düzenli, Mehmet Akif; Özdemir, Kurtuluş
AMAÇ: Menopoz, kadın yaşamının yaklaşık üçte birini ilgilendiren fizyolojik bir süreçtir. Menopozda over yetersizliğine bağlı hormon eksikliği nedeniyle bir çok organ ve sistemde değişiklikler meydana gelir. Bu değişikliklerden en çok etkilenen sistemlerden bir tanesi de kardiyovasküler sistemdir. Son yıllarda yapılan çalışmalarda HRTnin kardiyovasküler hastalıklardan korunmada yeri olmadığı anlaşılmıştır. Fakat kardiyak fonksiyonlar üzerinde HRT'nin etkisi yeterince araştırılmamıştır. Bu çalışma sağlıklı postmenopozal kadınlarda HRT'nin kardiyak fonksiyonlar üzerinde kısa dönem etkilerinin araştırılması amacıyla planlandı. MATERYAL - METOD: Çalışmaya HRT uygulanacak 37 ve kontrol grup için de aynı özelliklere sahip 32 sağlıklı postmenopozal kadın alındı. Tüm bireylere treadmill egzersiz testi ve standart ekokardiyografi yapıldı. Ardından doku Doppler pulsed wave yöntemi uygulanarak miyokardiyal hızlar ile sistolik ve diastolik zaman intervalleri ölçülerek miyokard performans indeksi hesaplandı.Üç ay sonra aynı işlemler tekrarlanarak bazal ve üç ay sonraki değerler karşılaştırıldı. BULGULAR: HRT alan grupta üç ay sonra egzersiz süresi (pO.001) ve METS değerinde (pO.001) anlamlı artış tesbit edildi. MPİ değerlerinde HRT alan grupta üç ay sonra azalma olmasına (p<0,07) rağmen bu sonuç istatistiki olarak anlamlılığa ulaşmadı. Doku Doppler parametrelerinden SV segmenter Sm, ortalama Sm ve triküspit Sm düzeylerinde her iki grupta da 3 ay sonra istatistiki olarak anlamlı değişiklik bulunmadı.HRT grubunda ortalama SV Em artarken Am azaldı. Em/Am oram ise arttı. Fakat bu değişiklikler istatistiki anlamlılığa ulaşmadı. 61 SONUÇ: Üç aylık HRT tedavisi ile egzersize kardiyak cevapta düzelme tespit ettik. Kardiyak fonksiyonlarda düzelmeyi gösteren MPİ azalması ise istatistiki anlamlılığa ulaşmadı. Bu düzelme eğiliminin anlamlı olup olmadığının ortaya çıkarılması için uzun süreli, geniş katılımlı randomize çalışmalara ihtiyaç vardır.
Kalp yetersizliği olan hastalarda fonksiyonel kapasitenin değerlendirilmesinde doku Doppler ekokardiyografinin rolü
(2008) Düzenli, Mehmet Akif; Özdemir, Kurtuluş; Aygül, Nazif; Zengin, Kadriye; Gök, Hasan
Amaç: Kalp yetersizliği (KY) olan hastalarda, fonksiyonel kapasitenin değerlendirilmesinde yaygın olarak kullanılan New York Kalp Derneği (NYHA) fonksiyonel sınıflandırma sistemi ile klasik ekokardiyografi ve doku Doppler ekokardiyografi (DDE) parametreleri arasındaki ilişki değerlendirildi. Çalışma planı: Çalışmaya, sol ventrikül (SV) ejeksiyon fraksiyonu (EF) %50’nin altında olan KY’li 122 hasta (31 kadın, 91 erkek; ort. yaş 5911) alındı. Hastalar NYHA fonksiyonel sınıf I-II (n79; ort. yaş 58) ve III-IV (n43; ort. yaş 61) olmak üzere iki grupta değerlendirildi. Standart ikiboyutlu ekokardiyografi ve DDE parametreleri ile NYHA fonksiyonel kapasite arasındaki ilişkiler araştırıldı. Bulgular: NYHA fonksiyonel sınıf, klasik ekokardiyografi parametrelerinden SV EF, SV atım hacmi, mitral erken doluş deselerasyon zamanı ve ileri akım hızı (Vp) ile negatif ilişki gösterdi. Fonksiyonel sınıf ile mitral erken (E) ve geç (A) diyastolik zirve hızları ve E/A oranı arasında ilişki bulunmazken, sistol ve diyastol sonu çaplar ve hacimler, pulmoner arter basıncı, E/Vp oranı ile pozitif ilişki vardı. NYHA fonksiyonel sınıf DDE parametrelerinden sistolik miyokardiyal (Sm), erken (Em) ve geç (Am) diyastolik miyokardiyal hızlar ile negatif, E/Em oranı ile pozitif ilişki gösterdi; Em/Am oranı ile anlamlı ilişki bulunmadı. Çoklu lineer regresyon analizinde, Sm, EF ve pulmoner arter basıncının NYHA fonksiyonel sınıfı ile ilişkisi anlamlı ve bağımsız bulundu (sırasıyla -0.33, p0.005; -0.26, p0.05; 0.23, p0.05). Sonuç: Miyokardiyal hızlar fonksiyonel kapasite ile ilişki göstermektedir. Özellikle Sm, konvansiyonel ekokardiyografi ve diğer DDE parametrelerine göre fonksiyonel kapasiteyle daha güçlü ilişki içindedir.
Left Ventricular Apical Thrombus Secondary to Takotsubo Syndrome
(ELSEVIER IRELAND LTD, 2010) Akıllı, Hakan; Arıbaş, Alpay; Doğan, Umuttan; Karaarslan, Şükrü; Düzenli, Mehmet Akif
Objective: Takotsubo syndrome is a cardiac syndrome mimicking acute myocardial infarction and characterised by reversible left ventricular dysfunction in the absence of significant coronary disease. We present a case of left ventricular apical thrombus which might be secondary to takotsubo syndrome.
Normotansif kişilerde tuz tüketiminin sol ventrikül kitlesi ile ilişkisi
(2009) Soylu, Ahmet; Düzenli, Mehmet Akif; Yazıcı, Mehmet; Can, İlknur
Amaç: Artmış tuz alımının hipertansif kişilerde sol ventrikül kitlesini (SVK) artırdığı gösterilmiş olmasına rağmen normotansif kişilerde tuz tüketimi ile SVK arasındaki ilişki yeterince araştırılmamıştır. Bu çalışmada normotansif kişilerde diyetle alınan tuz miktarının sol ventrikül kitlesi ile ilişkisi araştırıldı. Gereç ve Yöntem: Hipertansiyon hikayesi olmayan, herhangi bir antihipertansif ilaç kullanmayan ve hem klinik hem de 24-saatlik ambulatuar kan basıncı takibi (AKBT)’ne göre normotansif olan (klinik KB 140/90 mmHg, 24-saatlik ortalama kan basıncı 130/80 mmHg) toplam 47 kişi (28 bayan, yaş: 47,07,3 yıl) çalışmaya alındı. Tüm kişilerin diyetle aldıkları tuz miktarını değerlendirebilmek amacıyla 24 saatlik idrarda sodyum miktarları ölçüldü. Ayrıca çalışmaya alınan kişiler ekokardiyografi ile değerlendirilerek SVK indeksi (SVKİ) ve rölatif duvar kalınlığı (RDK) hesaplandı. Bulgular: Yirmi dört saatlik idrarda ölçülen sodyum miktarı ile SVKİ ve RDK arasında pozitif korelasyon tespit edildi (r0,44, p0,002 ve r0,33, p0,025). SVKİ ve RDK’nı etkilemesi muhtemel faktörler lineer regresyon analizi ile değerlendirildi. SVKİ’nin diğer faktörlerden bağımsız olarak hem gündüz ortalama sistolik kan basıncı (SKB) seviyesinden hem de idrar sodyum miktarından etkilendiği (sırasıyla; ?1,12, p0,004 ve ?0,28, p0,040), RDK’nın ise sadece gündüz ortalama SKB seviyesinden etkilendiği (?0,40, p0,005) görüldü. Sonuç: Artmış SVKİ’nin kardiyovasküler morbidite ve mortaliteyi artırdığı düşünüldüğünde, normotansif kişilerde tespit edilmiş olan artmış tuz tüketimi ile SVKİ arasındaki ilişki tuz alımını kısıtlamanın hipertansiyon gelişmesi ihtimalini azaltmaktan daha fazla yararları olabileceğini düşündürmektedir.
Prevalence of risk factors of ST segment elevation myocardial infarction in Turkish patients living in Central Anatolia
(TURKISH SOC CARDIOLOGY, 2009) Aygül, Nazif; Özdemir, Kurtuluş; Abacı, Adnan; Aygül, Meryem Ülkü; Düzenli, Mehmet Akif; Vatankulu, Mehmet Akif; Yazıcı, Hüseyin Uğur
Objective: There is not enough available data in our country about the prevalence of risk factors for ST-elevation myocardial infarction (STEMI), which has the highest in-hospital mortality rate within subtypes of acute coronary syndromes. Therefore, in this study, we aimed to evaluate the prevalence of risk factors for STEMI in Central Anatolia, one of the regions with high risk for coronary heart disease (CHD). Methods: This cross-sectional observational study included 1210 patients (962 men, 248 women) with the diagnosis of STEMI in 3 tertiary-medical centers in 3 cities in Central-Anatolia (Ankara, Konya, and Kayseri). Demographic characteristics (age, gender) and risk factors known to be traditional risk factors for CHD (history of hypertension (HT), diabetes mellitus (DM), smoking, and family history) were inquired and fasting blood samples within 24 hours from onset of STEMI were taken to analyze lipid levels. Patients were divided into 3 groups based on their ages: Group A - age <= 44 years; Group B - age 45-64 years; and Group C - age >= 65 years. Prevalence of risk factors and differences within age-groups and genders were evaluated. Results: The mean age was 58+/-11 years (range 24-96 years). Although the percentage of female patients increased in relation to increasing age, 80% of the total patients were male. While prevalence of smoking and family history was observed to decrease with aging, there was a statistically significant increase in prevalence of HT and DIM (p<0.001). Prevalence of smoking was the highest in young patients and males (p<0.001). Prevalence of HT and DM, on the other hand, was significantly higher in women than in men (p<0.001). Although the number of modifiable risk factors was found to be significantly smaller in men, male patients with STEMI were 8 years younger than females on average. Conclusions: The results of our study, in which modifiable risk factors and especially smoking were found to have a high prevalence in patients with STEMI living in Central Anatolia, suggested that most STEMI cases especially at younger ages might be prevented by the modification of these risk factors. (Anadolu Kardiyol Derg 2009; 9: 3-8)
Relationship between systolic myocardial velocity obtained by tissue Doppler imaging and left ventricular ejection fraction: Systolic myocardial velocity predicts the degree of left ventricular dysfunction in heart failure
(BLACKWELL PUBLISHING, 2008) Düzenli, Mehmet Akif; Özdemir, Kurtuluş; Aygül, Nazif; Altunkeser, Bülent Behlül; Zengin, Kadriye; Sizer, Murat
This study was planned to research the relationship between systolic myocardial velocity (Sm) obtained by tissue Doppler imaging (TDI) and left ventricular ejection fraction (LVEF) measured according to conventional Simpson's method in healthy subjects and patients with heart failure (HF). Two hundred eight patients with HF whose LVEF < 50% (mean age 59 +/- 11 years) and 187 healthy subjects (mean age 57 +/- 11 years) were enrolled in this study. LVEF was measured and TDI recordings were obtained at the septal, lateral, inferior, and anterior of the mitral annulus, and Sm was measured. LV mean Sm was calculated. In patients with HF, a significant correlation was detected between LVEF and Sm (r = 0.71, P < 0.0001), while no relationship was found between these parameters in healthy subjects (r = 0.16, not significant). The cutoff value of Sm < 8 cm/s for identifying patients with LVEF between 30% and 49% had a sensitivity of 86%, a specificity of 93%, and a negative predictive value of 92%, and the cutoff value of Sm < 6.0 cm/s for identifying patients with LVEF < 30% had a sensitivity of 92%, a specificity of 84%, and a negative predictive value of 97%. The time required to calculate the LVEF was significantly longer than that of LV mean Sm (327 +/- 98 sec vs. 110 +/- 29 sec, P < 0.0001), and LVEF had higher inter- and intraobserver variability. LV mean Sm obtained by TDI, a parameter that is reproducible, easily obtained, reliable, and practical, can be used to evaluate LV systolic function in patients with HF.
Serum Immünoglobulin E'nin Akut Miyokard Infarktüsünün Hastane İçi Dönem Seyri Üzerine Etkisi
(2004) Yazıcı, Mehmet; Tokaç, Mehmet; Yazıcı, Raziye; Düzenli, Mehmet Akif; Soylu, Ahmet; Altunkeser, Bülent Behlül; Özdemir, Kurtuluş
Amaç: Ateroskleroz gelişimi ve akut miyokard infarktüsü (AMİ) fizyo-patolojisinde immün mekanizmaların önemli rol oynadığı bilinmektedir. Serum immünoglobulin E'nin (IgE) mast hücre aracılı mekanizmalarla AMİ seyri üzerine etkileri olabileceği düşünülmektedir. Bu çalışmada serum IgE düzeylerinin AMİ'ın hastane içi klinik seyri, infarktın genişliği, aterosklerotik damar tutulumu üzerine etkileri araştırıldı. Gereç ve Yöntem: Çalışmaya AMİ tanısıyla koroner yoğun bakım ünitesine yatırılan 82 hasta alındı. Hastalardan hastaneye kabulde serum IgE, C-reaktif protein (CRP), fibrinojen seviyesi ve lökosit sayısı için venöz kan alındı. Yine hastaneye kabulden itibaren 6 saatlik aralıklarla kan alınıp pik kreatin kinaz-MB (CK-MB) ve troponin-I değerleri çalışıldı. Başvuru sırasındaki serum IgE seviyeleri 200 IU/mL'nin altında olanlar grup 1 (n62) ve üzerinde olanlar grup 2 (n20) olarak ikiye ayrıldı. Hastaların taburcu edilmeden önce standart ekokardiyografileri yapıldı ve her iki gruptan toplam 58 hastanın koroner anjiyografisi yapılarak koroner arter hastalığı (KAH) yaygınlık Reardon şiddet skoru belirlendi. Yine hastalar hastane içi dönemde konjestif kalp yetmezliği (KKY), malign aritmiler, post miyokard infarktüs (Mİ) angina, acil revaskülarizasyon, ölüm ve toplam major kardiyovasküler istenmeyen olay (MACE) gelişimi açısından takip edildi. Bulgular: Grup 1'de CRP, pik CK-MB, pik troponin-I, lökosit, fibrinojen düzeyleri grup 2'ye göre anlamlı yüksekti (sırasıyla p0.001, p0.01, p0.05, p0.01, p0.05). Sol ventrikül ejeksiyon fraksiyonu grup 2'de daha yüksekti (p0.05). Hastane içi dönemde gelişen malign ventriküler aritmiler, post Mİ anjina, MACE grup 2'de belirgin olarak daha düşüktü (sırasıyla p0.05, p0.05, p0.05) Sonuç: Serum IgE düzeyi yüksekliğinin AMİ'da nekrotik alan genişliği ve infarktüsün hastane içi dönem seyri üzerine olumlu etkileri mevcuttur. IgE yüksekliği AMİ'de olumlu prognostik marker olarak kullanılabilir.
Sol ventrikül genişliği ve fonksiyonunun değerlendirilmesinde kardiyotorasik oranın değeri
(2008) Düzenli, Mehmet Akif; Karabağ, Turgut; Sökmen, Abdullah; Soylu, Ahmet; Aygül, Nazif; Emlik, Dilek; Arıbaş, Alpay
Amaç: Telekardiyografiden hesaplanan kardiyotorasik oran (KTO) kalp genişliğinin değerlendirilmesinde sıklıkla kullanılmaktadır. Bu çalışma KTO ile ekokardiyografiden elde edilen sol ventrikül (SV) çapları ve ejeksiyon fraksiyonu (EF) arasındaki ilişkinin değerlendirilmesi amacıyla planlandı. Gereç ve Yöntem: Çalışmaya farklı kardiyak şikayetlerle kardiyoloji polikliniğine başvuran 159 hasta alındı. Hastaların telekardiyografileri çekildi ve KTO hesaplandı. Ekokardiyografi ile sistol ve diyastol sonunda sol ventrikül sistolik ve diyastolik çapları (SVSÇ, SVDÇ) ölçüldü ve SV EF modifiye Simpson’s kuralına göre hesaplandı. Bulgular: KTO ile ekokardiyografi parametrelerden SVDÇ ile orta derecede korelasyon tespit edilirken, SVSÇ ve SVEF arasında zayıf korelasyon tespit edildi (r0.48, p0.0001; r0.31, p0.005, r-29, p0.01 sırasıyla). Çoklu lineer regresyon analizinde sadece SVDÇ ile KTO arasında bağımsız ilişki bulundu (?0.57, p0.005). KTO’nın sol ventrikül genişlemesini göstermesi açısından; duyarlılığı % 94, özgüllüğü % 40, negatif öngörü değeri % 93, pozitif öngörü değeri % 44 iken; sol ventrikül sistolik fonksiyon bozukluğunu göstermesi yönünden duyarlılığı %82, özgüllüğü %35, negatif öngörü değeri %70, pozitif öngörü değeri %52 bulundu. Sonuç: Kolay ulaşılabilen ucuz ve pratik olan telekardiyografi, genel hasta populasyonunda SV büyüklüğünün belirlenmesinde tarama testi olarak kullanılabilir.

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