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Öğe Combined anterior and inferior ST segment elevation during the exercise stress testing(ELSEVIER IRELAND LTD, 2008) Aygul, Nazif; Ozdemir, Kurtulus; Aydin, Meryem Ulku; Duzenli, Mehmet AkifExercise induced ST elevation, especially in anterior derivations, does localize the ischemic region. We describe a patient who presented with exercise induced ST elevation in both anterior and inferior leads without prior myocardial infarction. Coronary angiography showed a "wrap around LAD" with significant proximal lesion. (C) 2007 Elsevier Ireland Ltd. All rights reserved.Öğe The Comparative Effects of Long-Term Carvedilol versus Bisoprolol Therapy on QT Dispersion in Patients with Chronic Heart Failure(KARGER, 2009) Aygul, Nazif; Ozdemir, Kurtulus; Duzenli, Mehmet Akif; Aygul, Meryem UlkuObjectives: Carvedilol and bisoprolol reduce QT dispersion (QTD) in chronic heart failure (CHF). However, it is unclear whether there is a difference between the effects of the two drugs. The aim of the present study was to compare the long-term effects of carvedilol and bisoprolol on QTD in patients with CHF. Methods: Eighty-one patients with CHF with no previous beta-blocker therapy were included in this prospective study. The patients were randomly allocated to carvedilol or bisoprolol therapy. Left ventricular ejection fraction (LVEF), heart rate (HR), QTD, and corrected QTD (QTcD) were calculated at baseline and at the 6th month of therapy. Results: In comparison to baseline values in both therapy groups, LVEF was significantly improved, and a statistically significant decrease was found in HR ( carvedilol from 76 +/- 12 to 65 +/- 10 beats/min, p < 0.001; bisoprolol from 78 +/- 13 to 65 +/- 8 beats/min, p < 0.001) and QTcD ( carvedilol from 85 +/- 28 to 65 +/- 22 ms, p < 0.001; bisoprolol from 83 8 22 to 61 8 20 ms, p ! 0.001). In our study, carvedilol and bisoprolol were found to have similar effects on LVEF, HR, and QTcD. Conclusions: Carvedilol and bisoprolol decrease HR and QTcD in patients with CHF, and there is no meaningful difference between the two beta-blockers as regards their effects on these parameters. Copyright (c) 2008 S. Karger AG, BaselÖğe Comparison of increased aspirin dose versus combined aspirin plus clopidogrel therapy in patients with diabetes mellitus and coronary heart disease and impaired antiplatelet response to low-dose aspirin(EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC, 2008) Duzenli, Mehmet Akif; Ozdemir, Kurtulus; Aygul, Nazif; Soylu, Ahmet; Tokae, MehmetThe effects of therapy with aspirin 300 mg/day and with combined aspirin 100 mg/day plus clopidogrel 75 mg/day on platelet function were compared in patients with diabetes mellitus and coronary artery disease and impaired antiplatelet responses to aspirin 100 mg/day. The study population consisted of 151 outpatients with type 11 diabetes mellitus and coronary artery disease who were taking aspirin 100 mg/day. Of the 151 patients, a subgroup of subjects with impaired aspirin response were selected on the basis of the results of platelet aggregometry. Nonresponsiveness to aspirin was defined as mean aggregation >= 69% with 3 mu mol/L adenosine diphosphate and mean aggregation >= 70% with 2 mu mol/L collagen. Aspirin semiresponders were defined as meeting I but not both of these criteria. Nonresponders and semiresponders were randomized equally to aspirin 300 mg/day and aspirin 100 mg/day plus clopidogrel 75 mg/day, and aggregation tests were repeated after 2 weeks. Sixty of the 151 patients with diabetes (40%) were found to respond to aspirin inadequately. Platelet aggregation induced by adenosine diphosphate and collagen decreased significantly after aspirin 300 mg/day or combined therapy. Combined treatment was found to have a stronger inhibitory effect on platelet aggregation induced by adenosine diphosphate than aspirin 300 mg/day (p = 0.002). Impaired aspirin response was resolved by increasing the aspirin dose or adding clopidogrel to aspirin (p < 0.0001 for each). However, desired platelet inhibition was achieved in significantly more patients by combined treatment than by aspirin 300 mg/day (p < 0.05). In conclusion, aspirin 100 mg/day does not inhibit platelet function adequately in a significant number of patients with diabetes mellitus and coronary artery disease. Increasing the aspirin dose to 300 mg/day or adding clopidogrel to aspirin can provide adequate platelet inhibition in a significant number of those patients with impaired responses to low-dose aspirin. (C) 2008 Elsevier Inc. All rights reserved.Öğe Comparison of myocardial performance index obtained either by conventional echocardiography or tissue Doppler echocardiography in healthy subjects and patients with heart failure(SPRINGER, 2009) Duzenli, Mehmet Akif; Ozdemir, Kurtulus; Aygul, Nazif; Soylu, Ahmet; Aygul, Meryem Ulku; Goek, HasanThis study was planned to investigate the normal reference values of myocardial performance index (MPI) obtained by tissue Doppler echocardiography (TDE) and the agreement between MPI measured by TDE and conventional MPI measured by pulsed-wave Doppler (PWD) in healthy subjects and patients with heart failure (HF). Two hundred and three patients with HF and 190 healthy subjects were enrolled in this study. Isovolumic contraction and relaxation time (ICT and IRT) and ejection time (ET) were measured from mitral inflow and left ventricular (LV) outflow. Tissue Doppler echocardiography recordings were obtained at the septal, lateral, inferior, and anterior of the mitral annulus and same time intervals were measured. Myocardial performance index was calculated. The functional capacity of the patients with HF was determined according to New York Heart Association classification. TDE-MPI values were higher than conventional PWD-MPI values in both groups (53% +/- 8% vs 48% +/- 11%, P < 0.0001 in the healthy subjects; 84% +/- 21% vs 72% +/- 19%, P < 0.0001 in the patients with HF). Moderate agreement was found between PWD-MPI and LV mean TDE-MPI in both groups. In identifying patients with moderately or severely decreased LV ejection fraction, TDE-MPI had higher cutoff values than conventional PWD-MPI, and TDE-MPI had higher specificity, sensitivity, negative predictive value, and diagnostic accuracy. In patients with HF, TDE-MPI had a stronger correlation with LV ejection fraction and functional capacity than did PWD-MPI. TDE-MPI is an alternative to conventional PWD-MPI in assessment of cardiac function. However, the higher MPI cutoff points should be considered when this method is used for the evaluation of cardiac function.Öğe The effect of isolated left bundle branch block on the myocardial velocities and myocardial performance index(WILEY, 2008) Duzenli, Mehmet Akif; Ozdemir, Kurtulus; Soylu, Ahmet; Aygul, Nazif; Yazici, Mehmet; Tokac, MehmetObjectives: This study was planned in order to investigate the effect of left bundle branch block (LBBB) on myocardial velocities obtained by tissue Doppler echocardiography (TDE) and myocardial performance index (MPI). Methods: Subjects with LBBB (n = 61) and age-matched healthy subjects (n = 60) were enrolled in the study. Left ventricular (LV) ejection fraction (EF), mitral inflow velocities (E-wave and A-wave), isovolumetric contraction and relaxation time (ICT and IRT), ejection time (ET), and flow propagation velocity (Vp) were measured by conventional echocardiography. Systolic velocity (Sm), early and late diastolic velocities (Em and Am) and time intervals were measured by TDE. MPI was calculated by the formula (ICT + IRT)/ET. Results: LVEF and mitral E/A ratio were similar in both groups. Vp was lower in the LBBB group than in the control group, whereas the E/Em and the E/Vp ratio was higher. LV Sm and Em/Am ratio were lower in LBBB group. Right ventricular Sm and Em/Am ratio were similar in both groups. LV mean and RV MPI were significantly increased in LBBB group. Conclusion: These findings obtained by TDE show that isolated LBBB impairs the ventricular functions. Both of the LV and RV dysfunctions shown by the new parameters may contribute to increased morbidity and mortality in cases with isolated LBBB.Öğe The Effect of Nondipping Blood Pressure Patterns on Cardiac Structural Changes and Left Ventricular Diastolic Functions in Normotensives(WILEY, 2009) Soylu, Ahmet; Duzenli, Mehmet Akif; Yazici, Mehmet; Ozdemir, Kurtulus; Tokac, Mehmet; Gok, HasanBackground: Cardiac structural changes have been reported to be more prominent in nondipper normotensives than the dipper ones. But the influence of nondipping status on cardiac diastolic functions of normotensives has not been studied yet. In this study, we investigated the effect of nondipping status on both cardiac structural changes and left ventricular (LV) diastolic functions in normotensives. Methods: We performed ambulatory blood pressure (BP) monitoring (ABPM) and echocardiography in 62 normotensive subjects with the following criteria: (1) office BP < 140/90 mmHg; (2) average 24-hour ambulatory BP < 130/80 mmHg. Results: In the evaluation by tissue Doppler imaging (TDI), the early diastolic myocardial peak velocity (Em) and Em/late diastolic myocardial peak velocity (Am) ratio (Em/Am ratio) were lower in nondippers than those in dippers (P = 0.009 and P < 0.001, respectively). Isovolumic relaxation time (IRT) and myocardial performance index (MPI) were higher in nondippers than those in dippers (P = 0.036 and P = 0.026, respectively). Nondipping status, independent of other factors, was observed to cause both a decrease in the Em and Em/Am ratio and an increase in IRT. However, its effect on IRT was not statistically significant (coefficient = -0.27, P = 0.027; coefficient = -0.37, P = 0.002; coefficient = 0.20, P = 0.082, respectively). Conclusions: Nondipping of nocturnal BP seems to be a determinant of cardiac remodeling and LV diastolic dysfunction (LVDD) and may result in a cardiovascular (CV) risk independent of the increase in LV mass (LVM) in normotensives. (ECHOCARDIOGRAPHY, Volume 26, April 2009).Öğe Effects of menopause on the myocardial velocities and myocardial performance index(JAPANESE CIRCULATION SOC, 2007) Duzenli, Mehmet Akif; Ozdemir, Kurtulus; Sokmen, Abdullah; Soylu, Ahmet; Aygul, Nazif; Gezginc, Kazim; Tokac, MehmetBackground Although menopause is known to increase cardiovascular risk and mortality, the effect of menopause on cardiac functions has not been investigated in detail. This study investigates the effect of menopause on cardiac functions by tissue Doppler echocardiography (TDE) and myocardial performance index (MPI). Methods and Results A total of 72 postmenopausal and 71 age-matched premenopausal women were enrolled in the study. After conventional echocardiographic parameters were measured, TDE recordings were obtained at the septal, lateral, anterior and inferior side of the mitral annulus, and tricuspid lateral annulus. Systolic velocity (Sm), early and late diastolic velocities (Em and Am) and time intervals were measured and MPI was calculated. A sequentially symptom-limited exercise stress test was performed. Although left ventricular (LV) ejection fraction and end-diastolic and end-systolic diameter were similar in both groups, LV septum and posterior wall thickness were higher in postmenopausal women. Mitral early inflow velocity and mitral early inflow velocity:mitral late inflow velocity ratio were significantly lower in postmenopausal women compared to premenopausal women. LV Sm, and LV and right ventricular (RV) Em:Am ratios were lower in postmenopausal women. MPI calculated by TDE was significantly increased in postmenopausal women. In addition, exercise duration and metabolic equivalent values were significantly lower in postmenopausal women than in premenopausal women. Conclusions Menopause negatively affects MPI and myocardial velocities, both of which provide more quantitative data about myocardial functions. These findings indicate that the hormonal changes in menopause impair LV systolic and diastolic functions and RV diastolic function.Öğe Impact on Diabetes Mellitus on the Epicardial Coronary Flow Velocity Assessed by the Thrombolysis in Myocardial Infarction Frame Count(SAGE PUBLICATIONS INC, 2009) Soylu, Ahmet; Ozdemir, Kurtulus; Duzenli, Mehmet Akif; Yazici, Mehmet; Tokac, MehmetThe aim of this study is to evaluate the effect of type 2 diabetes mellitus on epicardial coronary flow velocity assessed by the thrombolysis in myocardial infarction frame count. The thrombolysis in myocardial infarction Frame count was measured in 272 coronary arteries from 101 patients with type 2 diabetes mellitus and in 271 coronary arteries from 104 age- and gender-matched patients without type 2 diabetes mellitus referred for coronary angiography. The thrombolysis in myocardial infarction frame count was measured only in normal arteries or in arteries Without significant lesion. By both univariate and multivariate analysis, the thrombolysis in myocardial infarction frame count was not related with either type 2 diabetes mellitus or the duration and glycated hemoglobin levels in the patients with type 2 diabetes mellitus. The thrombolysis in myocardial infarction Frame Count Was significantly associated with body surface area, heart rate, and proximal coronary artery diameter. Type 2 diabetes mellitus did not affect epicardial coronary flow velocity assessed by the thrombolysis in myocardial infarction frame count.Öğe Influence of menstrual cycle on cardiac performance(ELSEVIER IRELAND LTD, 2007) Zengin, Kadriye; Tokac, Mehmet; Duzenli, Mehmet Akif; Soylu, Ahmet; Aygul, Nazif; Ozdemir, KurtulusObjectives: The purpose of this study was to investigate the relationship between endogen sex hormone levels and myocardial performance in two different phases of menstrual cycle. Background: The relationships between cardiac performance and sex hormone levels in menstrual cycle have not yet been clearly identified. Methods: Twenty-seven women at the age of 19-42 years (mean 24.11 +/- 6.02) with regular menstrual cycles (28-31 days) were enrolled in this study. Cardiac performance was evaluated by tissue Doppler imaging (TDI) derived myocardial performance index (MPI) in the menstrual and the luteal phases of the menstrual cycle. Results: Left ventricular MPI were statistically significant between the menstrual phase and luteal phase of the menstrual cycle (Inferior 0.53 +/not superset of 0.10 versus 0.44 +/not superset of 0.09, P < 0.001; Anterior 0.54 +/not superset of 0.13 versus 0.45 +/not superset of 0.10, P < 0.008; Lateral 0.50 +/not superset of 0.09 versus 0.44 +/not superset of 0.12, P < 0.03; Septum 0.54 +/not superset of 0.07 versus 0.46 +/not superset of 0.10, P < 0.005; Global 0.52 +/not superset of 0.06 versus 0.44 +/not superset of 0.09, P < 0.001). Right ventricle MPI between the two periods was also significantly different (0.49 +/not superset of 0.10 versus 0.42 +/not superset of 0.10, P < 0.01). There was a moderate correlation between estrogen levels and global NIPI (r=0.46, P=0.001), but no correlation was found between progesterone levels and global MPI (r = 0.22, P = NS). Conclusion: We firstly demonstrated that endogen estrogen or progesterone improved the combined systolic and diastolic function in both left and right ventricle during luteal phases of menstrual cycle. Considering the previous studies and our results, estrogen may be responsible for this improvement. (c) 2007 Elsevier Ireland Ltd. All rights reserved.Öğe Is there any relationship between metabolic parameters and left ventricular functions in type 2 diabetic patients without evident heart disease?(BLACKWELL PUBLISHING, 2008) Yazici, Mehmet; Ozdemir, Kurtulus; Gonen, Mustafa Sait; Kayrak, Mehmet; Ulgen, Mehmet Siddik; Duzenli, Mehmet Akif; Yazici, RaziyeBackground: The aim of the present study was to evaluate left ventricle (LV) systolic and diastolic function, using tissue Doppler echocardiography (TDE) and color M-mode flow propagation velocity, in relation to blood glucose status in normotensive patients with type 2 diabetes mellitus (T2DM) who had no clinical evidence of heart disease. Methods: Seventy-two patients with T2DM (mean age 49.1 +/- 9.8 years) without symptoms, signs or history of heart disease and hypertension, and 50 ages matched healthy controls (mean age 46.1 +/- 9.8 years) had echocardiography. Systolic and diastolic LV functions were detected by using conventional echocardiography, TDE and mitral color M-mode flow propagation velocity (V-E). Fasting blood glucose level (FBG) after 8 hours since eating a meal, postprandial blood glucose level (PPG), and HbA(1C) level were determined. The association of FBG, PPG and HbA(1C) with the echocardiographic parameters was investigated. Results: It was detected that although systolic functions of two groups were similar, diastolic functions were significantly impaired in diabetics. No relation of FBG and PPG with systolic and diastolic functions was determined. However, HbA(1C) was found to be related to diastolic parameters such as E/A, Em/Am, V-E and E/V-E (beta = -0.314, P = < 0.05; beta = -0.230, P < 0.05; beta = -0.602, P < 0.001, beta = 0.387, P < 0.005, respectively). In addition to HbA(1C), LV, diastolic functions were also correlated with age and diabetes duration. Conclusion: Diastolic LV dysfunction may develop even in absence of ischemia, hypertension, and LVH in T2DM. FBG and PPG have no effect on LV functions, but HbA(1C) levels may affect diastolic parameters.Öğe Platelet glycoprotein Ib alpha gene polymorphism and massive or submassive pulmonary embolism(SPRINGER, 2009) Soylu, Ahmet; Tokac, Mehmet; Cora, Tuelin; Duzenli, Mehmet Akif; Acar, HasanObjective The -5T/C polymorphism in the Kozak sequence of glycoprotein Ib alpha, a component of the platelet glycoprotein Ib-IX-V receptor complex, is associated with an increase in this receptor density on the surface of the platelet. This study was designed to investigate the effect of platelet glycoprotein Ib alpha Kozak polymorphism on the clinical presentation of the patients with acute pulmonary embolism. Methods Forty-two patients with pulmonary embolism were genotyped for Kozak polymorphism of the glycoprotein Ib alpha by polymerase chain reaction/restriction fragment length polymorphism. Results Carriers of the -5T/C polymorphism of glycoprotein Ib alpha were significantly over-represented in the patient group with clinically massive or submassive pulmonary embolism (odds ratio 5.5, 95% confidence interval 1.4 to 22.2, P = 0.023). Also the association between this polymorphism and massive or submassive pulmonary embolism still existed even after being adjusted for conventional risk factors. Conclusion The -5T/C polymorphism in the Kozak sequence of glycoprotein Ib alpha may present as a risk factor for clinical manifestation of pulmonary embolism in which clot burden plays an important role.Öğe Relation Between Abnormalities in Circadian Blood Pressure Rhythm and Target Organ Damage in Normotensives(JAPANESE CIRCULATION SOC, 2009) Soylu, Ahmet; Yazici, Mehmet; Duzenli, Mehmet Akif; Tokac, Mehmet; Ozdemir, Kurtulus; Gok, HasanBackground: To determine the individual effect of abnormalities in blood pressure (BP) circadian rhythm (non-dipping status (NDS), increased morning BP (MBP) or increased MBP surge (MBPS)) on target organ damage (TOD) and which of these is more closely related to TOD in normotensives. Methods and Results: The 24-h ambulatory BP monitoring (ABPM) and echocardiography were performed and urinary albumin excretion (UAE) was measured in 47 dipper (28 women, mean age 45.8 +/- 9.3) and 32 non-dipper (25 women, mean age 49.1 +/- 8.3 years) normotensive subjects. The left ventricular mass index (LVMI) was higher in non-dipper group (103.8 +/- 24.1 vs 91.6 +/- 23.5 g/m(2), 12, P=0.03). UAE in non-dipper group was higher, but the difference between the two was not statistically significant (18.9 [10.3, 28.9] vs 14.1 [7.5, 23.8], P=0.11). In multivariate analysis, both LVMI and UAE were affected by NDS and MBP independent of other confounding variables (for LVMI; Coefficient=0.27, P=0.01 and Coeffcient=0.37, P=0.001, respectively, and for UAE; Coefficient=0.27, P=0.02 and Coefficient =0.28, P=0.01, respectively). Conclusions: It may be Postulated that increased night and MBP are the factors that cause TOD, and it seems reasonable to attempt to restore normal diurnal rhythm of the BP even in normotensive Subjects. (Circ J 2009; 73: 899-904)Öğe SPECIAL ATTENTION FOR ELDERLY WOMEN: ATYPICAL LEFT VENTRICULAR APICAL BALLOONING SYNDROME INDUCED BY DOBUTAMINE STRESS TEST: A CASE REPORT(WILEY-BLACKWELL PUBLISHING, INC, 2009) Sonmez, Osman; Duman, Cetin; Duzenli, Mehmet Akif; Tokac, Mehmet[Abstract not Available]
