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Öğe Analysis of 24-hour heart rate variations in patients with epilepsy receiving antiepileptic drugs(ACADEMIC PRESS INC ELSEVIER SCIENCE, 2011) Yildiz, Gulce Unal; Dogan, Ebru Apaydin; Dogan, Umuttan; Tokgoz, Osman Serhat; Ozdemir, Kurtulus; Genc, Bulent Oguz; Ilhan, NurhanObjective: The goal of the study described here was to evaluate interictal heart rate variability (HRV) in young patients with epilepsy, a patient population in whom sudden unexpected death in epilepsy (SUDEP) is known to be more common. Methods: Twenty-four-hour ambulatory ECG Holter recordings of 37 patients (15-40 years old) and 32 healthy controls were compared. Results: All of the time domain indices (SDNN, SDANN, RMSSD, and HRV triangular index) were significantly suppressed (P < 0.001), and there was a marked reduction in parasympathetic tone (reduced HFnu, P < 0.001) and an increase in sympathetic tone (increased LFnu and LF/HF ratio, P < 0.001) in the patient group. Stepwise linear regression analysis revealed that polytherapy and epilepsy duration > 10 years were independent variables associated with a reduction in SDNN. Conclusion: Our data suggest that the major determinants of suppressed SDNN are polytherapy and epilepsy duration > 10 years. Analysis of spectral measures of frequency domain indices suggests that an increased sympathetic tone in association with a decreased parasympathetic tone may constitute the mechanism underlying SUDEP in young people with epilepsy. (C)2010 Elsevier Inc. All rights reserved.Öğe Assessment of exercise stress testing with artificial neural network in determining coronary artery disease and predicting lesion localization(PERGAMON-ELSEVIER SCIENCE LTD, 2009) Babaoglu, Ismail; Baykan, Omer Kaan; Aygul, Nazif; Ozdemir, Kurtulus; Bayrak, MehmetThe aim of this study is to show the artificial neural network (ANN) on determination of coronary artery disease existence and localization of lesion based upon exercise stress testing (EST) data. EST and coronary angiography were performed on 330 patients. The data studied acquiring 27 verifying features was normalized employing z-score method. To select training and test data, 10-fold cross-validation methods were involved and multi-layered perceptron neural network was employed for the classification. The interpretation of EST using ANN proved 91%, 73% and 65% diagnostic accuracy for the left main coronary (LMCA), left anterior descending and left circum-flex coronary arteries, respectively. Besides, 69% for the right coronary artery is also predicted. For the LMCA, a 94% negative predictive value (NPV) was obtained. This high percentage of NPV encourages the elimination of LMCA lesions. Some knowledge call also be obtained about lesion localization, besides diagnosing of coronary artery disease by the assessment of EST via ANN. (C) 2007 Elsevier Ltd. All rights reserved.Öğe Assessment of myocardial velocities and global function of the left ventricle in asymptomatic patients with moderate-to-severe chronic aortic regurgitation: A tissue doppler echocardiographic study(WILEY, 2007) Sokmen, Gulizar; Sokmen, Abdullah; Duzenli, Akif; Soylu, Ahmet; Ozdemir, KurtulusObjective: Asymptomatic patients with chronic aortic regurgitation (AR) have an excellent prognosis in the presence of preserved systolic function. It is a challenge to recognize patients with subclinical myocardial dysfunction in AR. Conventional parameters still have many drawbacks in predicting early left ventricular (LV) dysfunction. Pulsed-wave tissue Doppler imaging (PW-TDI) is a useful noninvasive technique for evaluating global and regional LV systolic function. In this study, we aimed to assess clinical usefulness of TDI in predicting early disturbance of myocardial contractility in asymptomatic patients with significant AR and preserved left ventricular systolic function. Methods and the Results: Echocardiograms were obtained in 32 AR patients and 33 healthy subjects. In addition to conventional parameters, regional myocardial velocities, isovolumetric contraction time (mICT), isovolumetric relaxation time (mIRT), and ejection time (mET) of left ventricle were obtained by TDI and modified LV myocardial performance index (MPI) was calculated. In AR, peak systolic velocity (Sm) of septal and anterior mitral annulus, and mean Sm was significantly lower, and LVMPI was significantly higher compared to control group. Conclusion: The data obtained by TDI show that LV MPI is lengthened, and systolic myocardial velocities are shortened in patients having chronic AR with normal LV systolic function according to conventional echocardiographic parameters. This suggests that LV long-axis contraction and global LV performance are preciously and noticeably decreased in patients with moderate-to-severe chronic AR despite normal LV ejection fraction.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 The effects of spironolactone on atrial remodeling in patients with preserved left ventricular function after an acute myocardial infarction: a randomized follow-up study(LIPPINCOTT WILLIAMS & WILKINS, 2010) Kayrak, Mehmet; Bacaksiz, Ahmet; Vatankulu, Mehmet A.; Ayhan, Selim S.; Ari, Hatem; Kaya, Zeynettin; Ozdemir, KurtulusObjectives Atrial remodeling is an important part of cardiac remodeling after acute myocardial infarction (AMI). The aim of this study was to evaluate the effect of spironolactone on atria in patients with preserved left ventricular (LV) functions after AMI by using two-dimensional and tissue Doppler imaging techniques (TDI). Methods The study consisted of 110 patients with AMI, successfully revascularized with percutaneous coronary intervention, ejection fraction greater than or equal to 40%, and Killip class I-II. Patients were randomized into two groups: conventional therapy (n=55) and additional spironolactone of 25 mg/day with standard conventional therapy (n=55). Echocardiography was performed in the first 48-72 h of AMI and during 6 months of follow-up. Left atrial volume index and emptying fraction were obtained. The peak regional atrial contraction velocity, the time between the onset of p-wave on the monitor ECG and the onset, peak, and the end (TE) of the atrial contraction wave on the tissue Doppler technique curve were measured. Results The left atrial volume index and left atrium (LA) dimensions did not significantly change in either group. In the spironolactone group, left atrial emptying fraction increased compared with both baseline value ( from 53.0 +/- 0.16 to 57.0 +/- 0.13 P = 0.011) and conventional therapy group (from 50.0 +/- 0.17 to 47.0 +/- 0.16, P = 0.013). The atrial contraction velocity did not change but the LA-TE, interatrial septum-TE, and right atrium-TE were prolonged in the conventional therapy group. Conclusion Additional spironolactone therapy provided a little benefit on LA remodeling and atrial electromechanic properties in patients with AMI and preserved LV functions. Coron Artery Dis 21:477-485 (C) 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.Öğe 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, HasanObjective: 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)Öğe The evaluation of doxorubicin-induced cardiotoxicity: Comparison of Doppler and tissue Doppler-derived myocardial performance index(VIA MEDICA, 2012) Ayhan, S. Selim; Ozdemir, Kurtulus; Kayrak, Mehmet; Bacaksiz, Ahmet; Vatankulu, M. Akif; Eren, Onder; Koc, FatihBackground: Doxorubicin is a chemotherapeutic agent used in a wide spectrum of cancers. However, cardiotoxic effects have limited its clinical use. The early detection of doxorubicin-induced cardiotoxicity is crucial. The purpose of our study was to assess values of Doppler and tissue Doppler imaging (TDI) -derived myocardial performance index (MPI) in adult cancer patients receiving doxorubicin treatment. Methods: A total of 45 patients underwent echocardiographic examinations before any doxorubicin had been administered and then after doxorubicin. Doppler and TDI-derived MPI of left ventricular (LV) were determined in the evaluation of cardiotoxicity. Additionally, TDI-derived MPI of right ventricular (RV) was determined. Results: All patients underwent control echocardiographic examination after mean 5 +/- 1.7 months. The LV MPI obtained by both Doppler and TDI were increased after doxorubicin treatment (0.56 +/- 0.11, 0.61 +/- 0.10, p = 0,005 vs 0.51 +/- 0.09, 0.59 +/- 0.09, p = 0.001, respectively). There was no correlation between Doppler-derived MPI and cumulative doxorubicin dose (coefficient of correlation 0.11, p = 0.6). TDI-derived MPI was correlated with cumulative doxorubicin dose (coefficient of correlation 0.35, p = 0.015), but this correlation is weak (r = 0.38). The study population was divided into two groups according to doxorubicin dose (below and above 300 mg level). There was a moderate correlation between TDI-derived MPI and less than 300 mg of doxorubicin dose (coefficient of correlation 0.51, p = 0.028). However, Doppler-derived MPI was not correlated with less than 300 mg of doxorubicin dose (coefficient of correlation 0.38, p = 0.123). Also, there was no significant change in the TDI-derived RV-MPI (0.49 +/- 0.14, 0.50 +/- 0.12, p = 0.56). Conclusions: TDI-derived MPI is a useful parameter and an early indicator compared with Doppler-derived MPI in the detection of cardiotoxicity during the early stages. Also, doxorubicin administration does not affect RV function. (Cardiol J 2012; 19,4: 363-368)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 P-wave parameters and cardiac repolarization indices: Does menopausal status matter?(ELSEVIER IRELAND LTD, 2012) Dogan, Umuttan; Dogan, Nasuh Utku; Basarir, Ahmet Ozgur; Yildirim, Serkan; Celik, Cetin; Incesu, Feyzanur; Ozdemir, KurtulusBackground and purpose: Data regarding electrocardiographic characteristics of postmenopausal women are lacking. In this prospective, cross-sectional study, electrocardiographic P-wave parameters and cardiac repolarization indices of age-matched pre- and postmenopausal healthy women were compared. We hypothesized that menopausal status would have a significant effect on cardiac electrical activity and hence electrocardiography (ECG) recordings. Materials and methods: Twelve-lead ECG recordings were obtained from 125 consecutively recruited postmenopausal healthy women aged between 44 and 54 years. The control group consisted of 125 age-matched premenopausal women. P-wave parameters and cardiac repolarization indices were measured and compared with respect to menopausal status. Results: Demographic features of premenopausal and postmenopausal women were comparable. There were no significant differences between two groups regarding mean values of heart rate, maximum and minimum P-wave duration, P-wave dispersion, maximum and minimum QT interval, and QT dispersion. Mean values of QT interval obtained from lead V5 were also similar. Corrected values which were calculated according to Bazett and Fridericia formulas also did not differ between the groups. Mean values of Tpeak to Tend (TpTe) (p < 0.001) and corrected TpTe (p = 0.001) intervals obtained from lead V5 were significantly shorter in postmenopausal women when compared to those without menopause. Conclusion: Tpeak to Tend interval decreased significantly while QT intervals and P-wave parameters did not change in postmenopausal women when compared to premenopausal women. Association of these findings with changes in levels of sex steroids and their prognostic implications need to be elucidated with further studies. (C) 2012 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.Öğe Quinapril for treatment of hypertension in Turkey - Dose titration and diuretic combination treatment strategies(ADIS INT LTD, 2007) Yener, Gul; Aran, Sinan; Bahceci, Mithat; Ozdemir, Kurtulus; Gultekin, Fusun; Lowe, WingBackground and objective: Recently the PatenT (Prevalence, awareness, treatment and control of hypertension in Turkey) study showed that while the prevalence of hypertension in Turkey is high, effective control of BP is infrequently achieved. This study investigated the efficacy and safety of quinapril (as monotherapy or in combination with hydrochlorothiazide [HCTZ]) for achieving BP control (target < 140/90mm Hg) in Turkish subjects with mild to moderate hypertension. Methods: Two-hundred male and female outpatients aged 19-65 years with mild to moderate hypertension (stage I or II, Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 7 guidelines) entered this 12-week, open-label study. All subjects received quinapril 20 mg/day for 6 weeks. If BP targets were achieved at week 6, responders were maintained on 20 mg/day-1 if BP targets were not achieved, non-responders were randomised to quinapril 40 mg/day or quinapril 20 mg/day + HCTZ 12.5 mg/day for the remainder of the study. Results: After 6 weeks, 63% of subjects achieved BP targets, and 82% of week-6 responders who continued on quinapril 20 mg/day maintained BP targets at week 12. Of the non-responders, 50% and 52% randomised to quinapril 40 mg/day or quinapril 20 mg/day + HCTZ 12.5 mg/day, respectively, went on to achieve BP targets by week 12. Safety was not compromised with increased dosages or use of combination therapy. Conclusion: Quinapril was an effective and safe treatment for achieving and maintaining recommended BP targets in this sample population. These findings will provide clinicians in Turkey with valuable data on the use of quinapril for effective control and management of hypertension.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 Severe hypokalemia-associated rhabdomyolise and unusual poliuria in patient with primary aldosteronism(2012) Demir, Kenan; Sonmez, Osman; Kayrak, Mehmet; Ozdemir, KurtulusPrimer aldosteronizm hipertansiyon, hipopotasemi, yüksek plazma aldosteron seviyesi ve düşük plazma renin aktivitesiyle kara- kterize bir sendromdur. Bizim takdim ettiğimiz hasta proksimal kas güçsüzlüğü ve yorgunluk şikayetleriyle nöroloji kliniğine başvuran 56 yaşında bir erkek hastaydı. Kontrolsüz kan basıncı nedeniyle anti-hipertansif tedavi planlanması amacıyla kardiyoloji konsultasyonu istenmiş. Ciddi hipokalemiye bağlı (K:1.04) uzamış QT intervali ve dev U dalgaları olması nedeniyle hasta kardiy- oloji kliniğine aritmi riskleri açısından devralındı. Primer hiperaldosteronizm teşhisi konulduktan sonra tedavi başlandı ve tedavi boyunca hastada ciddi poliüri gelişti(19 L/gün).
