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Öğe Assessment of Left Ventricular Myocardial Performance by Tissue Doppler Echocardiography in Patients with Polycythemia Vera(WILEY-BLACKWELL, 2011) Kayrak, Mehmet; Acar, Kadir; Gul, Enes Elvin; Baglicaklioglu, Murat; Kaya, Zeynettin; Sonmez, Osman; Aydogdu, IsmetAims: The aim of this study was to evaluate myocardial performance index (MPI) which reflects the combined systolic and diastolic performance of the ventricles by tissue Doppler imaging (TDI) in patients with polycythemia vera (PV). Method and Materials: Twenty-eight patients with PV (17 men; mean age 60 +/- 9 years) and 30 age-matched healthy subjects were prospectively evaluated. The diagnosis of PV was performed according to the World Health Organization (WHO) criteria. Left ventricular (LV) systolic and diastolic functions were assessed by conventional echocardiography and TDI. MPI of both the LV and right ventricles (RV) were measured by TDI method. Results: The LV MPI was significantly higher in PV group than in the controls (0.61 +/- 0.16 vs. 0.49 +/- 0.05; P = 0.001). Also, the RV MPI was impaired in patients with PV compared to the control subjects (0.51 +/- 0.11 vs. 0.43 +/- 0.09; P = 0.005). RV late A filling velocity (Am) and RV isovolumetric relaxation time were significantly higher in the PV group compared to healthy subjects (P = 0.03 and 0.05, respectively). In logistic regression models, PV was determined as an independent predictor of impaired MPI (odds ratio: 3.7; CI 95%, 1.2-7.5). In addition, pulmonary arterial pressure was significantly elevated in patients with PV compared to the controls (P = 0.02). Conclusion: This study demonstrated that biventricular MPI is impaired in patients with PV. (Echocardiography 2011;28:948-954)Öğe Displacement of the heart by diaphragm: is this heart alternating?(CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS, 2011) Gul, Enes Elvin; Can, Ilknur; Ozbek, OrhanA-64-year-old man was admitted to the emergency department because of dyspnea. Twelve-lead ECG revealed alternating QRS complexes. In consequence of diagnostic tests, i.e., chest tomography showed eventration of the left diaphragm. In this case, we present an unusual case of electrical alternans due to diaphragmatic eventration. (C) 2011 Elsevier Inc. All rights reserved.Öğe Electrocardiographic Findings in Patients with Polycythemia Vera(IVYSPRING INT PUBL, 2012) Kayrak, Mehmet; Acar, Kadir; Gul, Enes Elvin; Abdulhalikov, Turyan; Baglicaklioglu, Murat; Sonmez, Osman; Kaya, ZeynettinBackground: The 12-lead surface electrocardiogram (ECG) is a useful tool to predict both atrial and ventricular arrhythmias via P-wave and QT measurements and its derivatives. Polycythemia vera (PV) is a chronic myeloproliferative disorder associated with cardiovascular events. The aim of this study was to assess ECG findings of patients with PV. Method and materials: Sixty patients with PV (34 male, mean age 58 +/- 11 years) and 60 age and gender-matched healthy volunteers were enrolled into the study. From the 12-lead surface ECG, P-wave and both conventional QT measurements and transmyocardial repolarization parameters (T-peak-T-end interval (T-p-T-e) and derivatives) were evaluated digitally by two experienced cardiologists. In addition, a novel parameter, Pi was calculated digitally as the standard deviation of the P-wave duration across the 12 ECG leads. Results: QT duration and corrected QT interval were significantly longer in the PV group compared to healthy controls (p<0.01 and p<0.01, respectively). The T-p-T-e was longer and the T-p-T-e/QT ratio was significantly higher in the PV group compared to the controls. P-wave analyses showed that all P-wave parameters including Pmax, Pmin, P dispersion, and Pi were significantly prolonged in PV patients compared to the controls. The increase of both T-p-T-e and P max in the PV group was independent of age, BMI, diabetes and hypertension, gender, systolic blood pressure, hemoglobin, hematocrit, left atrial dimension, left ventricular end-diastolic diameter and early deceleration time in a univariate analysis of co-variance model (F= 11.097, p= 0.001 and F= 31.537, p= 0.0001, respectively). Conclusion: The present study demonstrated that PV may be associated with electrocardiographic abnormalities of both atrium and ventricle.Öğe Electrocardiographic P-wave characteristics in patients with end-stage renal disease: P-index and interatrial block(SPRINGER, 2013) Solak, Yalcin; Gul, Enes Elvin; Kayrak, Mehmet; Atalay, Huseyin; Abdulhalikov, Turyan; Turk, Suleyman; Covic, AdrianP-wave parameters including P-wave dispersion (P (d)) have been examined in general population to predict development of atrial fibrillation (AF). But data on end-stage renal disease (ESRD) population are limited. P index (Pi) and interatrial block (IAB) as novel parameters may more accurately predict AF and have not been previously investigated in ESRD patients. We aimed to evaluate these novel ECG parameters in ESRD patients. Eighty-six HD, 47 CAPD, and 43 age- and gender-matched control subjects were enrolled in the study. P-wave duration was measured in all 12-leads of the surface ECG. The standard deviation of the P-wave duration across the 12 ECG leads was accepted as a Pi. P-wave duration above and equal to 110 ms was defined as IAB. All P-wave parameters were evaluated digitally by two observers. Pi was found to be significantly different among the groups in ANOVA. In post hoc analysis, P (i) was increased in HD group compared with the control group (p = 0.01). Also, P (i) tended to increase in CAPD group compared with controls (p = 0.06). The effect of ESRD on P (i) was independent of age, gender, and systolic blood pressure in univariate covariant analysis. The prevalence of IAB was 61, 55, and 32 % in patients with HD, CAPD, and controls, respectively (p = 0.001). P (d) was significantly higher in HD group compared with healthy controls. However, Pd values of CAPD patients did not show significant difference compared with controls. The present study demonstrated that IAB frequency and Pi were increased in patients with ESRD.Öğe Herbal Syncope: Ginger-Provoked Bradycardia(W B Saunders Co-elsevier Inc, 2012) Gul, Enes Elvin; Erdogan, Halil I.; Erer, Murat; Kayrak, MehmetHerbal therapies are widely used in Turkey. Especially, ginger is mostly recommended to patients with symptoms of flu by their relatives. A 59-year-old woman was admitted to the emergency department (ED) because of sudden loss of consciousness. She was recommended ginger for the relief of flu symptoms. As a result of diagnostic and laboratory evaluation, the probable cause of syncope was ginger usage. This case demonstrated that sometimes herbal therapies are harmful and clinicians must be reminded of this effect.Öğe Is diastolic dysfunction associated with atrial electrocardiographic parameters in Behcet's disease?(TAYLOR & FRANCIS LTD, 2011) Koc, Fatih; Koc, Sema; Yuksek, Jale; Vatankulu, Mehmet Akif; Ozbek, Kerem; Gul, Enes Elvin; Celik, AtacBackground The impact of Behcet's disease (BD) on the vascular bed is highly important, as this condition may lead to heart failure from asymptomatic systolic and diastolic dysfunction. Our aim was to evaluate diastolic functions using new echocardiographic parameters and the correlation of these parameters with atrial electrocardiographic (ECG) indices in patients with BD. Methods 31 patients with BD and 31 healthy control subjects were enrolled to this study. Left ventricular (LV) diastolic functions were examined with conventional and tissue Doppler echocardiography. P-wave dispersion (PD) was calculated by measuring minimum and maximum P-wave duration values on the 12-lead surface ECG, The relationship between PD and echocardiographic parameters of diastolic dysfunction were investigated. Results The mitral inflow E/A ratio and diastolic myocardial velocity ratio (Em/Am) were lower in the BD group (P < 0.001 and P < 0.001, respectively). The E/Em ratio and left atrial volume index (LAVi) were higher in the BD group (P < 0.001 and P = 0.014, respectively) compared to healthy control subjects. P max and PD were significantly higher in the BD group (P < 0.001 and P < 0.001). PD correlated positively with the duration of BD. Also, PD correlated positively with LAVi and E/Em ratio, but negatively with E/A and Em/Am ratios. Conclusion In this study, we demonstrated that LV diastolic functions are impaired in BD patients. Furthermore, P-wave abnormalities were demonstrated in BD patients and there was a significant correlation between PD and diastolic dysfunction.Öğe Quantitative Assessment of Left Ventricular Function and Myocardial Mass: A Comparison of Coronary CT Angiography with Cardiac MRI and Echocardiography(INT SCIENTIFIC INFORMATION INC, 2016) Kara, Bedia; Nayman, Alaaddin; Guler, Ibrahim; Gul, Enes Elvin; Koplay, Mustafa; Paksoy, YahyaBackground: The purpose of this study was to compare the left ventricular parameters obtained from multidetector row computed tomography (MDCT) studies with two-dimensional echocardiography (2DE), and magnetic resonance imaging (MRI), which is accepted as the gold standard in the evaluation of left ventricular functions. The study also aimed to evaluate whether or not there is a relationship between the MR-Argus and CMR tools software programs which are used in post-process calculations of data obtained by MRI. Material/Methods: Forty patients with an average age of 51.4 +/- 14.9 years who had been scanned with cardiac MDCT were evaluated with cardiac MRI and 2DE. End-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), cardiac output (CO), and myocardial mass values calculated by MDCT, MRI, and 2DE were compared with each other. Two different MR software programs were used to compare left ventricular functions. The CMR tools LV tutorials method is accepted as the gold standard because it can be used in three-dimensional functional evaluation. The Pearson Correlation and Bland-Altman analysis were performed to compare the results from the two MR methods (MR-Argus and CMR tools) and the results from both the MDCT and the 2DE with the CMR tools results. Results: Strong positive correlations for EF values were found between the MDCT and CMR tools (r=0.702 p<0.001), and between the MR-Argus and CMR tools (r=0.746 p<0.001). The correlation between the 2DE and CMR tools (r=0.449 p<0.004), however, was only moderate. Similar results were obtained for the other parameters. The strongest correlation for ESV, EDV, and EF was between the two MR software programs. The correlation coefficient between the MDCT and CMR tools is close to the correlation coefficient between the two software programs. While the correlation between 2DE and CMR tools was satisfactory for ESV, EDV, and CO values, it was at a moderate level for the other parameters. Conclusions: Left ventricular functional analysis can be performed easily and reliably with cardiac MDCT used for coronary artery evaluation and it also gives more accurate results than 2DE.Öğe A Rare and Undesirable Complication of Heparin-Induced Thrombocytopenia: Acute Massive Pulmonary Embolism(SAGE PUBLICATIONS INC, 2011) Gul, Enes Elvin; Abdulhalikov, Turyan; Aslan, Ramazan; Aydogdu, IsmetA 69-year-old woman presented to the emergency department with sudden onset of dyspnea. She reported bilateral total knee surgery 12 days prior for gonarthrosis. The patient was recommended low-molecular-weight heparin (LMWH) 0.4 cc (4 milliliter) twice a day. On evaluation, severe thrombocytopenia was detected. An echocardiogram was performed because of her dyspnea, which revealed right ventricular dilatation and hypokinesis. Due to suspicion of a pulmonary embolism (PE), a pulmonary computed tomography (CT) was performed, which revealed bilateral massive PE. This event occurred while the patient was receiving LMWH for prophylaxis of PE. Due to the presence of severe thrombocytopenia, fondaparinux and immunoglobulin were initiated. Her platelet levels improved significantly and she was discharged on warfarin.Öğe A rare human infection of Raoultella ornithinolytica in a diabetic foot lesion(K FAISAL SPEC HOSP RES CENTRE, 2011) Solak, Yalcin; Gul, Enes Elvin; Atalay, Huseyin; Genc, Nejdet; Tonbul, Halil Z.[Abstract not Available]Öğe Relationship between color M-mode echocardiography flow propagation and cardiac iron load on MRI in patients with thalassemia major(TURKISH SOC RADIOLOGY, 2012) Ozbek, Orhan; Acar, Kadir; Kayrak, Mehmet; Ozbek, Seda; Gul, Enes Elvin; Ucar, Ramazan; Paksoy, YahyaPURPOSE Myocardial iron overload remains an important problem and results in cardiac dysfunction in patients with thalassemia major (TM). The ratio of color M-mode flow propagation velocity to early diastolic transmitral flow velocity (E/Vp) in echocardiography is a marker of increased left ventricular filling pressure, which is independent of preload, afterload, and heart rate. We examined the relationship between E/Vp and iron loading in patients with TM using cardiac magnetic resonance imaging (MRI). MATERIALS AND METHODS Twenty-one TM patients and 21 age-matched healthy controls were enrolled in the study. Transmitral flow, pulmonary vein velocities, and Vp were obtained by two blinded echocardiographers. Left ventricular isovolumetric relaxation time (IVRT) was measured in the apical long axis by echocardiography. All patients also underwent MRI for cardiac T2* evaluation of iron overload. An increased E/Vp was defined as >1.5. RESULTS The E/Vp ratio was increased in TM patients compared with control subjects (1.7+/-0.4 and 1.2+/-0.2, P < 0.01, respectively). There was no correlation between E/Vp and cardiac T2* value. E/Vp was significantly correlated with IVRT (r=0.51, P = 0.02). In addition, the cardiac T2* value was comparable in patients with an E/Vp >1.5 and E/Vp <= 1.5 (21.1+/-9.8 ms vs. 22.3+/-8.0 ms, P = 0.80, respectively). CONCLUSION E/Vp may be a marker of diastolic abnormality that is independent from myocardial iron load in TM patients with preserved left ventricular function.Öğe Right coronary artery compression caused by mediastinal hematoma after aortic dissection operation(VIA MEDICA, 2011) Gul, Enes Elvin; Kaya, Zeynettin; Kartin, Mustafa; Ozbek, Orhan; Can, Ilknur[Abstract not Available]Öğe Should We Routinely Screen for Warfarin Gene Polymorphism in Patients with Coumadin Overdose?(AVES, 2016) Gul, Enes Elvin; Erdogan, Halil Ibrahim; Yazici, MehmetGenetic polymorphisms can affect an individual's response to the pharmacological agents. Warfarin has a narrow therapeutic range and dose arrangement may vary from individual to individual. An insufficient dose may fail to prevent thromboembolism and overdose may increase the risk of bleeding. Increasing evidence suggests that genetic variation of CYP2C9 and VKORC1 greatly influences effective warfarin dosing (1). In the present case report, frequently occurring warfarin toxicity was caused by a genetic mutation in the patient with mitral valve replacement.Öğe The thrombus image in the huge left atrial appendage(VIA MEDICA, 2010) Vatankulu, Mehmet Akif; Gul, Enes Elvin; Kayrak, Mehmet[Abstract not Available]
