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    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, Hasan
    Background: 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).
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    Evaluation of clinical and demographic characteristics and their association with length of hospital stay in patients admitted to cardiac intensive care unit with the diagnosis of acute heart failure
    (TURKISH SOC CARDIOLOGY, 2012) Sahin, Sami; Dogan, Umuttan; Ozdemir, Kurtulus; Gok, Hasan
    Objective: Despite increasing incidence, data regarding clinical and demographic characteristics of patients with acute heart failure (AHF) admitted to cardiac intensive care unit (ICU) are inconclusive. The aim of this study was to assess the presentation characteristics and factors determining the length of hospital stay in this particular patient population. Methods: We conducted a single-center, prospective study involving 150 patients hospitalized to cardiac ICU with the primary diagnosis of AHF. Chi-square and Student t tests were used for the analysis of categorical and continuous variables, respectively. Linear regression analysis (LRA) was used to determine the factors affecting the length of hospital stay. Results: Forty-nine percent of the patients had new-onset AHF and 25% had preserved left ventricular ejection fraction (LVEF). In 25.3% of all patients and 46.6% of the patients with new-onset HF the precipitating factor was acute coronary syndrome. Atrial fibrillation and valvular heart disease as precipitating factors were more common in patients with preserved EF, when compared to low EF group. LRA showed that presence of anemia [beta=1.62; 95% CI 0.08-3.15; p=0.039)] and severe mitral regurgitation (beta=2.55; 95% CI 0.06-5.05; p=0.045) and systolic blood pressure (beta=-0.03; 95% CI -0.06 - -0.002; p=0.039) and blood urea nitrogen (beta=0.034; 95% CI 0.006 - 0.06; p=0.016) were the independent predictors of length of stay. Conclusion: Underlying cardiovascular risk factors, comorbidities and precipitating pathologies were diverse and highlighted the inhomogeneous characteristics of AHF syndromes. However, in-hospital mortality was high and initial clinical presentation characteristics were significantly associated with in-hospital outcome. (Anadolu Kardiyol Derg 2012; 12: 123-31)
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    Investigation of Oxidative Stress Markers in Essential Hypertension
    (CLIN LAB PUBL, 2013) Toker, Aysun; Mehmetoglu, Idris; Yerlikaya, F. Humeyra; Nergiz, Suleyman; Kurban, Sevil; Gok, Hasan
    Background: The main goal of this study was to evaluate ischemia modified albumin (IMA), total antioxidant status (TAS), and total oxidant status (TOS) levels in treated essential hypertensive patients and to compare them with levels of normotensive subjects. Methods: In 45 hypertensive and 30 control subjects, serum levels of IMA were determined manually using a spectrophotometric Co(II)-albumin binding assay. TAS and TOS levels were evaluated spectrophotometrically. Lipid profile was estimated by routine methods. Results: Hypertensive patients had significantly higher levels of TOS and IMA (p = 0.020 and p = 0.034, respectively) and lower levels of TAS (p = 0.016) in comparison with control subjects. Serum levels of TAS were negatively correlated with TOS and IMA levels in the patient group. Serum levels of TOS were also positively correlated with IMA levels. There was no significant correlation between blood pressure and TAS, TOS, and IMA levels. Conclusions: Our results showed higher levels of IMA in hypertensive patients. We suggest that higher levels of IMA may result from increased oxidative stress and decreased antioxidant status in hypertensive patients.
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    Pericardial Hemorrhage Due to Acetylsalicylic Acid in a Patient With Essential Thrombocythemia
    (SAGE PUBLICATIONS INC, 2009) Kayrak, Mehmet; Acar, Kadir; Yazici, Mehmet; Kaya, Coskun; Ayhan, S. Selim; Gok, Hasan
    Essential thrombocythemia is a clonal myeloproliferative disorder that Causes thrombocytosis. Essential thrombocythemia is characterized by increased incidence of thrombosis with arterial event more than venous events and hemorrhagic complications. Acetylsalicylic acid enhances both minor and major bleedings. The authors describe pericardial hemorrhage, which is related to the use of low-dose acetylsalicylic acid in a patient with essential thrombocythemia. The patient was Successfully managed with clopidogrel therapy during the 16 Months follow-up without recurrent thrombotic or hemorrhagic events.
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    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, Hasan
    Background: 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)