Publications by authors named "Tarık Kivrak"

43 Publications

An accurate valvular heart disorders detection model based on a new dual symmetric tree pattern using stethoscope sounds.

Comput Biol Med 2022 07 10;146:105599. Epub 2022 May 10.

Ngee Ann Polytechnic, Department of Electronics and Computer Engineering, 599489, Singapore; Department of Biomedical Engineering, School of Science and Technology, SUSS University, Singapore; Department of Biomedical Informatics and Medical Engineering, Asia University, Taichung, Taiwan. Electronic address:

Background And Purpose: Valvular heart disease (VHD) is an important cause of morbidity and mortality. Echocardiography is the reference standard for VHD diagnosis but is not universally accessible. Manual cardiac auscultation is inadequate for screening VHD. Many machine learning models using heart sounds acquired with an electronic stethoscope may improve the accuracy of VHD diagnosis. We aimed to develop an accurate sound classification model for VHD diagnosis.

Materials And Methods: A new large stethoscope sound dataset containing 10,366 heart sounds divided into ten categories (nine VHD and one healthy) were prospectively collected. We developed a handcrafted learning model that comprised multilevel feature extraction based on a dual symmetric tree pattern (DSTP) and multilevel discrete wavelet transform (DWT), feature selection, and classification. The multilevel DWT was used to create subbands to extract features at both high and low levels. Then, iterative neighborhood component analysis was used to select the most discriminative 512 features from among the extracted features in the generated feature vector. In the classification phase, a support vector machine (SVM) was used with 10-fold cross-validation (CV) and leave-one-subject-out (LOSO) CV.

Results: Our proposed DSTP-based model attained 99.58% and 99.84% classification accuracies using SVM classifier with 10-fold CV and LOSO CV, respectively.

Conclusions: The presented DSTP-based classification model attained excellent multiclass classification performance on a large prospective heart sound dataset at a low computational cost.
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http://dx.doi.org/10.1016/j.compbiomed.2022.105599DOI Listing
July 2022

Automated COVID-19 and Heart Failure Detection Using DNA Pattern Technique with Cough Sounds.

Diagnostics (Basel) 2021 Oct 22;11(11). Epub 2021 Oct 22.

Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore 599489, Singapore.

COVID-19 and heart failure (HF) are common disorders and although they share some similar symptoms, they require different treatments. Accurate diagnosis of these disorders is crucial for disease management, including patient isolation to curb infection spread of COVID-19. In this work, we aim to develop a computer-aided diagnostic system that can accurately differentiate these three classes (normal, COVID-19 and HF) using cough sounds. A novel handcrafted model was used to classify COVID-19 vs. healthy (Case 1), HF vs. healthy (Case 2) and COVID-19 vs. HF vs. healthy (Case 3) automatically using deoxyribonucleic acid (DNA) patterns. The model was developed using the cough sounds collected from 241 COVID-19 patients, 244 HF patients, and 247 healthy subjects using a hand phone. To the best our knowledge, this is the first work to automatically classify healthy subjects, HF and COVID-19 patients using cough sounds signals. Our proposed model comprises a graph-based local feature generator (DNA pattern), an iterative maximum relevance minimum redundancy (ImRMR) iterative feature selector, with classification using the k-nearest neighbor classifier. Our proposed model attained an accuracy of 100.0%, 99.38%, and 99.49% for Case 1, Case 2, and Case 3, respectively. The developed system is completely automated and economical, and can be utilized to accurately detect COVID-19 versus HF using cough sounds.
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http://dx.doi.org/10.3390/diagnostics11111962DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8620352PMC
October 2021

Angiotensin receptor neprilysin inhibitor for patients with heart failure and reduced ejection fraction: Real-world experience from Turkey (ARNi-TR).

Turk Kardiyol Dern Ars 2021 07;49(5):357-367

Department of Cardiology, Ege University School of Medicine, İzmir, Turkey.

Objective: Heart failure (HF) is a growing public health problem with high morbidity and mortality. Recently, angiotensin receptor neprilysin inhibitor (ARNi) has emerged as a promising treatment for HF with reduced ejection fraction (HFrEF). Here, we shared our experience with the use of ARNi in HFrEF from multiple centers in Turkey.

Methods: The ARNi-TR is a multicenter, noninterventional, retrospective, observational study. Overall, 779 patients with HF from 22 centers in Turkey who were prescribed sacubitril/valsartan were examined. Initial clinical status, biochemical and echocardiographic parameters, and New York Heart Association functional class (NYHA-FC) values were compared with follow-up values after 1 year of ARNi use. In addition, the effect of ARNi on number of annual hospitalizations was investigated, and the patients were divided into 2 groups, depending on whether ARNi was initiated at hospitalization or under outpatient clinic control.

Results: N-terminal pro-brain natriuretic peptide (NT-proBNP), left-ventricle ejection fraction (LV-EF), and NYHA-FC values improved significantly in both groups (all parameters, p<0.001) within 1-year follow-up. In both groups, a decrease in hemoglobin A1c (HbA1c) values was observed in ARNi use (p<0.001), and a decrease in daily diuretic doses and hospitalizations owing to HF were observed after ARNi use (all comparisons, p<0.001). Hypotension (16.9%) was the most common side effect in patients using ARN.

Conclusion: The ARNi-TR study offers comprehensive real-life data for patients using ARNi in Turkey. The use of ARNi has shown significant improvements in FC, NT-proBNP, HbA1c levels, and LV-EF. Likewise, reductions in the number of annual hospitalizations and daily furosemide doses for HF were seen in this study.
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http://dx.doi.org/10.5543/tkda.2021.63099DOI Listing
July 2021

Gender-related clinical and management differences in patients with chronic heart failure with reduced ejection fraction.

Int J Clin Pract 2021 Mar 13;75(3):e13765. Epub 2020 Nov 13.

Department of Cardiology, Başkent University Istanbul Hospital, Istanbul, Turkey.

Aim: Gender-related differences have been described in the clinical characteristics and management of patients with chronic heart failure with reduced ejection fraction (HFrEF). However, published data are conflictive in this regard.

Methods: We investigated differences in clinical and management variables between male and female patients from the ATA study, a prospective, multicentre, observational study that included 1462 outpatients with chronic HFrEF between January and June 2019.

Results: Study population was predominantly male (70.1%). In comparison to men, women with chronic HFrEF were older (66 ± 11 years vs 69 ± 12 years, P < .001), suffered more hospitalisations and presented more frequently with NYHA class III or IV symptoms. Ischaemic heart disease was more frequent in men, whereas anaemia, thyroid disease and depression were more frequent in women. No difference was seen between genders in the use rate of renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, or ivabradine, or in the proportion of patients achieving target doses of these drugs. Regarding device therapies, men were more often treated with an implantable cardioverter-defibrillator (ICD) and women received more cardiac resynchronisation therapy.

Conclusion: In summary, although management seemed to be equivalent between genders, women tended to present with more symptoms, require hospitalisation more frequently and have different comorbidities than men. These results highlight the importance of gender-related differences in HFrEF and call for further research to clarify the causes of these disparities. Gender-specific recommendations should be included in future guidelines in HFrEF.
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http://dx.doi.org/10.1111/ijcp.13765DOI Listing
March 2021

Adherence to guideline-directed medical and device Therapy in outpAtients with heart failure with reduced ejection fraction: The ATA study.

Anatol J Cardiol 2020 07;24(1):32-40

Department of Cardiology, Başkent University Istanbul Hospital, Istanbul, Turkey.

Objective: Despite recommendations from heart failure guidelines on the use of pharmacologic and device therapy in patients with heart failure with reduced ejection fraction (HFrEF), important inconsistencies in guideline adherence persist in practice. The aim of this study was to assess adherence to guideline-directed medical and device therapy for the treatment of patients with chronic HFrEF (left ventricular ejection fraction ≤40%).

Methods: The Adherence to guideline-directed medical and device Therapy in outpAtients with HFrEF (ATA) study is a prospective, multicenter, observational study conducted in 24 centers from January 2019 to June 2019.

Results: The study included 1462 outpatients (male: 70.1%, mean age: 67±11 years, mean LVEF: 30%±6%) with chronic HFrEF. Renin-angiotensin system (RAS) inhibitors, beta-blockers, mineralocorticoid receptor antagonists (MRAs), and ivabradin were used in 78.2%, 90.2%, 55.4%, and 12.1% of patients, respectively. The proportion of patients receiving target doses of medical treatments was 24.6% for RAS inhibitors, 9.9% for beta-blockers, and 10.5% for MRAs. Among patients who met the criteria for implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT), only 16.9% of patients received an ICD (167 of 983) and 34% (95 of 279) of patients underwent CRT (95 of 279).

Conclusion: The ATA study shows that most HFrEF outpatients receive RAS inhibitors and beta-blockers but not MRAs or ivabradin when the medical reasons for nonuse, such as drug intolerance or contraindications, are taken into account. In addition, most eligible patients with HFrEF do not receive target doses of pharmacological treatments or guideline-recommended device therapy.
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http://dx.doi.org/10.14744/AnatolJCardiol.2020.91771DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7414820PMC
July 2020

Effect of Repeated Remote Ischemic Preconditioning on Peripheral Arterial Disease in Patients Suffering from Intermittent Claudication.

Cardiovasc Ther 2019 10;2019:9592378. Epub 2019 Dec 10.

Department of Cardiology, Firat University, School of Medicine Hospital, Elazığ, Turkey.

Background/objective: Intermittent claudication (IC) is the symptom of peripheral artery disease (PAD) and causes functional disability. Remote ischemic preconditioning (RIPC), is a phenomenon in which a short period of sub-critical ischemia, protects tissues against ischemia/reperfusion/injury. We considered to test the hypothesis that RIPC in PAD patients suffering from IC would increase muscle resistance to ischemia and thus improve walking-capacity.

Materials/methods: A total of 63 patients with proven-IC underwent two treadmill tests (graded treadmill protocol) with a 28-day interval in between. Patients were consecutively assigned for the non/RIPC-group and RIPC-group procedure one by one. Patients received 5-cycles of alternating 5-minute inflation and 5-minute deflation of blood-pressure cuffs on nondominant upper-limb every day for four weeks. Initial claudication distance (ICD), total walking distance (TWD) and time to relief of claudication (TRC) were recorded during procedure.

Results: Patients receiving-RIPC exhibited a marked increase in ICD and TWD between basal and last tests: 209.1 ± 15.4 m vs. 226 ± 15.0 m and 368.8 ± 21.0 m vs. 394 ± 19.9 m, respectively ( < 0.001). In addition, patients receiving-RIPC represented a significant decrease in TRC between basal and last tests: 7.8 ± 1.3 min vs. 6.4 ± 1.1 min, respectively ( < 0.001). Patients not receiving-RIPC did not exhibit improvement in ICD, TWD, and TRC between basal and last tests: 205.2 ± 12.1 min vs. 207.4 ± 9.9 min, 366.5 ± 24.2 min vs. 369.4 ± 23.2 min and 7.9 ± 1.4 min vs. 7.7 ± 1.3 min, respectively ( > 0.05).

Conclusion: A significant increase in ICD and TWD were observed in last/treadmill test in RIPC-group. In addition, a significant decrease in TRC was observed in last/treadmill test in RIPC-group. In non/RIPC-group, no improvement was observed in ICD, TWD and TRC.
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http://dx.doi.org/10.1155/2019/9592378DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6925938PMC
February 2020

The role of SCUBE1 in the development of late stent thrombosis presenting with ST-elevation myocardial infarction.

Rev Port Cardiol (Engl Ed) 2018 May 10;37(5):375-381. Epub 2018 May 10.

Sivas Cumhuriyet University, Neurology Department, Sivas, Turkey.

Introduction And Aim: There is an important link between platelets and inflammation, thrombosis, and vascular and tissue repair mechanisms. SCUBE1 (signal peptide-CUB-EGF domain-containing protein 1) may function as a novel platelet-endothelial adhesion molecule and play pathological roles in cardiovascular biology. Stent thrombosis (ST) following percutaneous coronary intervention is an uncommon and potentially catastrophic event that can manifest as myocardial infarction and sudden death. High platelet reactivity is a risk factor for thrombotic events, including late ST. For this reason, in the current study, we researched the role of SCUBE1 in the development of late coronary ST.

Methods: We included 40 patients admitted to our hospital with a diagnosis of ST-elevation myocardial infarction (STEMI) and signs of late ST on a coronary angiogram. For the control group, we recruited 50 healthy gender- and age-matched individuals who were seen for health check-ups. We also randomly included 100 patients with a diagnosis of STEMI without ST.

Results: There were no significant differences between the groups in terms of baseline and demographic characteristics. The mean SCUBE1 level in patients with STEMI with late ST at admission and the STEMI without ST group was significantly higher than in the control group (p<0.01). The mean SCUBE1 level in the STEMI with late ST group was significantly higher than in the STEMI without ST group (p=0.03). In multivariate regression analysis, serum SCUBE1 (odds ratio [OR]: 1.022; 95% confidence interval [CI]: 1.011-1.033, p<0.001) remained an independent predictor for the presence of late ST. In addition, receiver operating characteristic curve analysis was used to determine the optimal SCUBE1 cut-off value for predicting late ST. The area under the curve was 0.972 (95% CI 0.95-0.98). The SCUBE1 cut-off value was 59.2 ng/ml, with a sensitivity of 95.4% and specificity of 82.9%.

Conclusion: The present work is the first clinical study to demonstrate that serum SCUBE1 levels are significantly higher in patients with late ST and serum SCUBE1 was an independent predictor for the presence of late ST in our study population.
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http://dx.doi.org/10.1016/j.repc.2017.07.015DOI Listing
May 2018

Adropin and circadian variation of blood pressure.

Kardiol Pol 2018 9;76(4):776-782. Epub 2018 Jan 9.

Sivas Numune Hospital.

Background: Nocturnal hypertension and non-dipping pattern are often associated with endothelial dysfunction. Previous studies suggested that adropin, a novel secreted energy homeostasis protein, has the unique ability to regulate endothelial cell function.

Aim: This study aims to investigate the association between absolute night-time blood pressure (BP) and circadian BP pat-tern with serum adropin and high-sensitivity C-reactive protein (hsCRP) levels in patients with newly diagnosed untreated arterial hypertension.

Methods: Twenty-four-hour ambulatory BP monitoring was recorded in 100 hypertensives (50 dippers, 50 non-dippers) and 50 healthy controls. Serum levels of adropin and hsCRP were measured and recorded.

Results: A strong correlation was found between night-time BP levels with adropin and hsCRP levels (p < 0.001). On the other hand, the non-dipper group demonstrated lower adropin levels compared to the dipper and normotensive groups: non dipper group, 2580 ± 457 pg/mL; dipper group, 3298 ± 530 pg/mL; normotensive group, 3681 ± 411 pg/mL; p < 0.001). HsCRP levels were significantly higher in the non-dipper group than in the two other groups (p = 0.017). In a multivariate logistic regression analysis, adropin (p = 0.012) and hsCRP (p = 0.039) were independently associated with a non-dipping pattern.

Conclusions: Decreased adropin levels were found in the nocturnal hypertensive and non-dipper groups. Adropin and hsCRP were found to be independently associated with a non-dipping pattern. We suggest that decreased levels of adropin in non-dipper hypertensive patients might be associated with a longer duration of exposure to high BP. These results point to a possible future role of adropin in identifying hypertensive patients at higher risk of target organ damage.
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http://dx.doi.org/10.5603/KP.2018.0006DOI Listing
December 2018

The association between serum serglycin level and coronary artery disease severity in patients with stable angina pectoris.

Kardiol Pol 2018 9;76(4):783-790. Epub 2018 Jan 9.

Sivas Numune Hospital.

Background: Serglycin plays a key role in the inflammatory status however the relationship between coronary artery disease (CAD) and serglycin is still unknown.

Aim: In this study, we aimed to investigate association of serglycin levels with CAD severity in patients with stable angina pectoris (SAP).

Methods: In total, 100 SAP patients diagnosed by coronary angiography and clinical manifestations, and 100 control subjects matched for age and sex were enrolled in this case-control study. Plasma levels of serglycin, high-sensitivity C-reactive protein (hsCRP), lipid profiles, and clinical parameters were assayed for all participants. The severity of coronary lesions was evaluated based on the SYNTAX score (SS) assessed by coronary angiography.

Results: Positively correlated with the SS (r = 0.564, p < 0.001), the plasma serglycin level in the SAP group was higher than that in the control group (11.17 ± 1.82 vs. 19.28 ± 1.88 ng/mL, p < 0.001). The plasma serglycin level was an inde-pendent predictor for both SAP (odds ratio [OR] 1.037, 95% confidence interval [CI] 1.020-1.054, p < 0.001) and a high SS (OR = 1.087, 95% CI 1.051-1.124, p < 0.001) in a multivariate logistic regression model. In the receiver operating characteristic curve analysis, the plasma serglycin level was found to have a better predictive value for a high SS (area under the curve [AUC] 0.858, 95% CI 0.788-0.929, p < 0.001) compared with hsCRP (AUC 0.665, 95% CI 0.557-0.773, p = 0.006; Z = 2.94, p < 0.001), with an optimal cut-off value of 17.25 ng/mL (sensitivity 94.3%, specificity 68.2%).

Conclusions: Plasma serglycin levels correlate with both the presence and severity of coronary stenosis in patients with SAP, suggesting that it could be a potential predictive marker of severe stenosis in SAP patients.
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http://dx.doi.org/10.5603/KP.2018.0007DOI Listing
December 2018

Demonstration of Ischemia in Myocardial Perfusion Scintigraphy before Coronary Revascularization Decreases Acute Coronary Syndrome-related Hospitalizations.

World J Nucl Med 2017 Jul-Sep;16(3):212-217

Department of Cardiology, Cumhuriyet University Medical School, Sivas, Turkey.

In this study, we compared the patients who underwent coronary angiography (CAG), followed by revascularization by coronary artery stent implantation according to the CAG results without any evidence of ischemia with myocardial perfusion scintigraphy (MPS), and the patients who underwent revascularization by coronary artery stent implantation following the detection of ischemia in MPS before CAG in terms of the mortality and hospitalization due to acute coronary syndrome (ACS). Between January 2009 and January 2016, a total of 407 patients (52% males, 48% females; mean age: 66 ± 9 years; range: 40-85 years) who underwent CAG following diagnosis of stable angina and underwent coronary artery stenting were retrospectively analyzed. The patients were divided into two groups: Group 1 ( = 200) included those who had MPS before CAG and in whom ischemia was detected and stent was implanted, and Group 2 ( = 207) included those who had stent implantation according to the CAG results without prior MPS. The mean follow-up was 40 ± 18 months. Although there was no significant difference in the mortality rates between the groups, the rate of hospitalization due to ACS was significantly lower in Group 1 ( = 0.112 vs. = 0.022, respectively). According to the multivariate Cox-regression analysis, demonstration of ischemia in MPS before revascularization, statin use, clopidogrel use, and higher high-density lipoprotein cholesterol levels were found to be associated with a reduced risk of ACS-related hospitalization, whereas the presence of diabetes mellitus and smoking was found to be associated with an increased risk of ACS-related hospitalization.
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http://dx.doi.org/10.4103/1450-1147.207279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5460305PMC
July 2017

The role of SCUBE1 in the pathogenesis of no-reflow phenomenon presenting with ST segment elevation myocardial infarction.

Anatol J Cardiol 2017 Aug 24;18(2):122-127. Epub 2017 May 24.

Department Cardiology, Sivas Numune Hospital; Sivas-Turkey.

Objective: SCUBE1 [signal peptide-CUB (complement C1r/C1 s)-EGF (epidermal growth factor)-like domain-containing protein 1] might function as a novel platelet-endothelial adhesion molecule and play pathological roles in cardiovascular biology. Acute myocardial infarction is one of the most common causes of death in modern society. The concept of "no reflow" (NR) refers to a state of myocardial tissue hypoperfusion in the presence of a patent epicardial coronary artery. The main mechanisms of this phenomenon are thought to be high platelet activity and much thrombus burden. So, we researched the role of SCUBE1 in the pathogenesis of NR.

Methods: A total of 142 patients with ST elevation myocardial infarction (STEMI) (n=42 with NR and n=100 without NR) and 50 healthy individuals were prospectively case-control recruited between March 2015 and October 2016 from our outpatient clinics of cardiology department. Patients with STEMI were diagnosed according to American Heart Association (AHA) guideline for the management of STEMI.

Results: The mean SCUBE1 levels of the control subjects were 34±8.4 ng/mL, the mean SCUBE1 levels of patients with STEMI who were treated successfully with primary percutaneous coronary intervention (PCI) were 51±6.2, and the mean SCUBE1 levels of patients with STEMI who had NR phenomenon after primary PCI procedure were 97.2±8.9 ng/mL.

Conclusion: In our opinion, SCUBE1 might contribute to NR phenomenon via thrombus activation and aggregation. The pathophysiology of NR phenomenon is unclear. The present study is the first clinical study that demonstrated that serum SCUBE1 level was significantly higher in patients with NR and that serum SCUBE1 was an independent predictor for the presence of NR in our study population.
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http://dx.doi.org/10.14744/AnatolJCardiol.2017.7705DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5731261PMC
August 2017

Relationship between endothelial dysfunction and microalbuminuria in familial Mediterranean fever.

Eur J Rheumatol 2016 Jun 5;3(2):61-64. Epub 2016 Apr 5.

Department of Cardiology, Cumhuriyet University Hospital, Sivas, Turkey.

Objective: The aim of our study is to investigate the relationship between microalbuminuria and flow-mediated dilatation in familial Mediterranean fever (FMF) patients.

Material And Methods: In our study, there were two groups consisting of 54 patients who were out of the attack period (43 of whom had no microalbuminuria and 11 of whom had microalbuminuria) and 40 healthy controls (M/F: 12/28).

Results: There was no statistically difference between patient and control groups'age (25.06±8.07, 22.89±6.00 years, respectively). Flow-mediated dilatation (FMD) percentages were significantly different between the three groups (p=0.01). It was observed that there was a correlation between microalbuminuria and FMD percentage.

Conclusion: Endothelial dysfunction and renal damage occurred as a result of low-grade chronic inflammation. Microalbuminuria, which is the indicator of renal damage and endothelial dysfunction, and FMD show that endothelial functions can be used in the following of early detection of renal damage and endothelial functions in FMF patients.
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http://dx.doi.org/10.5152/eurjrheum.2016.15079DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5042232PMC
June 2016

Reply.

Arq Bras Cardiol 2016 Mar;106(3):266

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March 2016

[Effect of pulmonary endarterectomy on six-minute walking test and echocardiography in the early stage].

Turk Kardiyol Dern Ars 2016 Jun;44(4):300-5

Department of Cardiology, Marmara University Faculty of Medicine, İstanbul, Turkey.

Objective: Pre- and postoperative changes in echocardiographic parameters and results of 6-minute walking test (6-MWT) were investigated in the present study.

Methods: Seventy-six patients (32 males, 44 females; mean age 45.9±15.1 years) were included. Before and after surgery, 6-MWT and echocardiography were performed. Changes in postoperative parameters were compared to basal walking test and other basal parameters.

Results: Distance covered in 6-MWT significantly increased after surgery (p<0.001). Significant decrease in right ventricular diameter and pressure, and significant increase in left ventricular diameter were also observed. While changes in ejection fraction (EF) were not significant, significant reduction in systolic pulmonary artery pressure (sPAP) and tricuspid regurgitation were observed. No statistically significant correlation was observed between baseline 6-MWT results and echocardiographic parameters.

Conclusion: The present study was the first to investigate the correlation between baseline 6-MWT results and right ventricular echocardiographic parameters. Myocardial performance index (MPI) and TAPSE were important parameters in follow-up after pulmonary endarterectomy. Improvement in quality of life parameters was also important.
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http://dx.doi.org/10.5543/tkda.2015.76363DOI Listing
June 2016

Increased arterial stiffness parameters in panic disorder patients in long term treatment period.

Ann Gen Psychiatry 2016 8;15:14. Epub 2016 Jun 8.

Department of Psychiatry, Marmara University School of Medicine, Istanbul, Turkey.

Background: The relationship between mental stress and cardiovascular disease has been shown in several studies. Panic disorder (PD) is also associated with cardiovascular disease due to increased risk of myocardial infarction. The aim of this study is to evaluate the association between arterial stiffness parameters and depression/anxiety scores in patients with PD.

Methods: The study population consisted of 25 patients with PD and 25 age-sex-matched healthy controls. Depression and anxiety levels were evaluated by Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), respectively. Determination of arterial stiffness parameters was conducted using a Mobil-O-Graph arteriograph system that detected signals from the brachial artery.

Results: While baseline characteristics were similar between two groups, BDI and BAI scores were significantly higher in patients with PD (p < 0.005). The pulse wave velocity (PWV) and Augmentation Index (AIx) were also significantly higher in patients with PD (p = 0.001, p = 0.006). There was a moderate correlation between PWV and AIx with BAI scores (r = 0.442, p = 0.001, r = 0.441, p = 0.001). AIx was also positively correlated with BDI scores (r = 0.415, p = 0.03).

Conclusion: We demonstrated a significant relationship between arterial stiffness parameters and anxiety/depression scores in patients with PD who receive antidepressant treatment.
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http://dx.doi.org/10.1186/s12991-016-0102-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898398PMC
June 2016

Higher cancer antigen 125 level is associated with the presence of permanent atrial fibrillation in systolic heart failure patients.

Acta Cardiol 2016 Feb;71(1):61-6

Introduction: Atrial fibrillation (AF) is a common arrhythmia in heart failure (HF). Recent studies have shown that serum cancer antigen-125 (CA-125) levels are elevated in HF, and high levels of CA-125 in HF patients with sinus rhythm have been shown to be associated with the development of new onset AF. However, the relation between CA-125 levels and the presence of AF in HF is unknown. In this study we investigated whether plasma CA-125 levels in patients with systolic HF could predict the presence of AF.

Methods: The study was a retrospective cohort design including 205 stable systolic HF patients who were selected during outpatient clinic visits and who had CA-125 measurement and an electrocardiogram within the last one month before admittance to cardiology clinic. Patients were classified into two groups based on the presence of AF (n = 67) or sinus rhythm (n = 138).

Results: The mean age of the patients was 68 ± 11 years. CA-125 levels were significantly higher in patients with AF than patients with SR [33 (3-273) vs 102 (7-296) U/ml, P < 0.001]. CA-125 level, presence of right ventricular dilatation, pericardial effusion, moderate to severe TR and MR, and left atrial diameter were found to be associated with the presence of AF in univariate analysis. In a multivariate logistic regression model, only the CA-125 level remained associated. Also, according to the ROC curve analysis, the optimal cut-off level of CA-125 for predicting AF was ≥ 91 U/mL with a specificity of 84% and a sensitivity of 54%.

Conclusion: We have shown that the CA-125 levels can be used to predict AF in patients with systolic HF.
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http://dx.doi.org/10.2143/AC.71.1.3132099DOI Listing
February 2016

Eltrombopag Induced Thrombosis: A Case with Acute Myocardial Infarction.

Curr Drug Saf 2016 ;11(2):174-6

Sivas State Hospital, Turkey.

Eltrombopag is a non-peptide thrombopoietin receptor agonist. Eltrombopag has originally been developed for conditions where therapy for thrombocytopenia is needed. Secondary to eltrombopag have been reported thrombotic events, chest pain, acute renal failure, neutropenia, ascites, retinal exudates, antiphospholipid syndrome. In this case, we present a 53 year-old patient who had diagnosis of Idiopathic Thrombocytopenic Purpura (ITP) for 30 years with splenectomy. He's still having low thrombocyte counts despite the classical ITP therapy. He was treated with eltrombopag for the last 2 months and had inferior myocardial infarction despite that having no additional risk factors for coronary heart disease.
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http://dx.doi.org/10.2174/1574886311207040255DOI Listing
April 2017

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio are Predictors of Heart Failure.

Arq Bras Cardiol 2015 Dec 3;105(6):606-13. Epub 2015 Nov 3.

Department of Cardiology, Faculty of Medicine, Marmara University, Istanbul, Turkey.

Background: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are inflammatory markers used as prognostic factors in various diseases. The aims of this study were to compare the PLR and the NLR of heart failure (HF) patients with those of age-sex matched controls, to evaluate the predictive value of those markers in detecting HF, and to demonstrate the effect of NLR and PLR on mortality in HF patients during follow-up.

Methods: This study included 56 HF patients and 40 controls without HF. All subjects underwent transthoracic echocardiography to evaluate cardiac functions. The NLR and the PLR were calculated as the ratio of neutrophil count to lymphocyte count and as the ratio of platelet count to lymphocyte count, respectively. All HF patients were followed after their discharge from the hospital to evaluate mortality, cerebrovascular events, and re-hospitalization.

Results: The NLR and the PLR of HF patients were significantly higher compared to those of the controls (p < 0.01). There was an inverse correlation between the NLR and the left ventricular ejection fraction of the study population (r: -0.409, p < 0.001). The best cut-off value of NLR to predict HF was 3.0, with 86.3% sensitivity and 77.5% specificity, and the best cut-off value of PLR to predict HF was 137.3, with 70% sensitivity and 60% specificity. Only NLR was an independent predictor of mortality in HF patients. A cut-off value of 5.1 for NLR can predict death in HF patients with 75% sensitivity and 62% specificity during a 12.8-month follow-up period on average.

Conclusion: NLR and PLR were higher in HF patients than in age-sex matched controls. However, NLR and PLR were not sufficient to establish a diagnosis of HF. NLR can be used to predict mortality during the follow-up of HF patients.
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http://dx.doi.org/10.5935/abc.20150126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4693665PMC
December 2015

Nonalcoholic Steatohepatitis Score is an Independent Predictor of Right Ventricular Dysfunction in Patients with Nonalcoholic Fatty Liver Disease.

Cardiovasc Ther 2015 Oct;33(5):294-9

Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey.

Objective: Nonalcoholic fatty liver disease (NAFLD) is associated with increased risk of cardiovascular disease and impaired left ventricular (LV) function, yet the impact of NAFLD on right ventricular (RV) function remains unclear. We investigate the RV functional properties in patients with NAFLD.

Methods: Ninety consecutive patients with the diagnosis of biopsy-proven NAFLD and 45 age- and sex-matched controls were included. All patients underwent an echocardiographic examination. RV function was evaluated by two-dimensional (2D) speckle-tracking echocardiography (STE).

Results: Mean fibrosis stage and nonalcoholic steatohepatitis (NASH) scores were 1.3 ± 1.1 and 5.2 ± 1.6, respectively. NAFLD patients displayed decreased RV function compared to controls. NAFLD patients with liver fibrosis (67 patients) had significantly lower RV function assessed by GLS (global longitudinal strain) compared to patients without liver fibrosis (18.9 ± 3.4% vs. 21.6 ± 2.3%, P < 0.001). NASH score ≥5 was associated with lower RV-GLS (18.9 ± 3.1% vs. 21.0 ± 3.4%, P = 0.006). NASH score inversely correlated with RV-GLS (r = -0.370, P < 0.001) such as patients with impaired RV-GLS (<19%) showed significantly higher NASH score compared to normal RV-GLS group (5.8 ± 1.4 vs. 4.8 ± 1.7, P = 0.009). Logistic regression analysis revealed that NASH score was an independent predictor of impaired RV function in patients with NAFLD.

Conclusions: Patients with NAFLD have impaired RV function. NASH score inversely correlates with RV-GLS and independently predicts impaired RV function in patients with NAFLD.
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http://dx.doi.org/10.1111/1755-5922.12145DOI Listing
October 2015

Relation of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio with coronary artery disease severity in patients undergoing coronary angiography.

Kardiol Pol 2015 19;73(12):1310-6. Epub 2015 May 19.

Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey.

Background: Atherosclerosis is a chronic systemic inflammatory disease. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are systemic inflammatory markers that are correlated with poor cardiovascular outcomes.

Aim: To explore the relation of NLR and PLR with severity of coronary artery disease (CAD).

Methods: The study population consisted of 180 consecutive patients who underwent elective coronary angiography (CAG). While 100 patients (22 female, mean age: 60.6 ± 12.6 years) had abnormal CAG, 80 patients (44 female, mean age: 57.2 ± 10.9 years) had normal CAG. NLR and PLR were calculated as the ratio of neutrophil count to lymphocyte count and as the ratio of platelet count to lymphocyte count, respectively.

Results: Although age distribution was similar between the two groups (p = 0.073), female gender was significantly higher in the normal CAG group (p < 0.001). Patients with abnormal CAG had significantly higher NLR and PLR when compared to patients with normal CAG (3.7 ± 2.6 vs. 2.2 ± 1.7, p < 0.001 and 125.9 ± 72.3 vs. 102.6 ± 33.8, p = 0.027, respectively). NLR and PLR were significantly correlated with SYNTAX score and GENSINI score. In logistic regression analyses, only NLR (odds ratio: 1.576, confidence interval: 1.198-2.072, p = 0.001) was an independent predictor of CAD. An NLR of 2.3 or higher predicted the CAD with a sensitivity of 66% and specificity of 70%.

Conclusions: NLR and PLR seem to be a simple method to predict severity of CAD in patients undergoing elective CAG, and it may be part of cardiovascular examination before CAG.
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http://dx.doi.org/10.5603/KP.a2015.0098DOI Listing
February 2017

Cancer antigen-125 levels predict long-term mortality in chronic obstructive pulmonary disease.

Biomarkers 2015 Mar 19;20(2):162-7. Epub 2015 May 19.

Department of Cardiology and.

Background: Cancer antigen-125 (CA-125) might be a useful biomarker to predict long-term mortality in patients with recent exacerbation of chronic obstructive pulmonary disease (COPD).

Methods: A total of 87 consecutive patients with COPD were evaluated prospectively. Mean age of patients was 68 ± 10 years (55% males, 45% females) with a median follow-up period of 49 months. Optimal cut-off value of CA-125 to predict mortality was found as >93.34 U/ml, with 91% specificity and 40% sensitivity.

Results: After follow-up, 20 out of 87 (23%) experienced cardiovascular death. CA-125 levels were higher among those who died compared to those who survived [55 (12-264) versus 28 (5-245) U/ml, p = 0.013]. In multivariate Cox proportional-hazards model with forward stepwise method, only CA-125 > 93.34 U/ml on admission (HR = 3.713, 95% CI: 1.035-13.323, p = 0.044) remained associated with an increased risk of death.

Conclusions: For the first time, we demonstrated that CA-125 helps the risk stratification of patients with COPD.
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http://dx.doi.org/10.3109/1354750X.2015.1045033DOI Listing
March 2015

Evaluation of right and left heart mechanics in patients with chronic thromboembolic pulmonary hypertension before and after pulmonary thromboendarterectomy.

Int J Cardiovasc Imaging 2015 Aug 16;31(6):1159-67. Epub 2015 May 16.

Department of Cardiology, Marmara University School of Medicine, Fevzi Cakmak Mahallesi, Muhsin Yazicioglu Caddesi, No: 10, Ustkaynarca/Pendik, Istanbul, Turkey,

The aim of the present study was to evaluate of the right and left heart mechanics by two-dimensional (2D) speckle tracking echocardiography (STE) in chronic thromboembolic pulmonary hypertension (CTEPH) patients before and after pulmonary thromboendarterectomy (PTE). A total of 40 consecutive CTEPH patients (mean age 49.3 ± 13.5 years, 27 female) were included. 2D STE was performed in all patients before, and 3 months, after PTE. 12 months of prognostic data were also recorded via the use of telephone calls. Postoperative 6-minute walk test (6MWT) distances were significantly longer than preoperative values (410.5 ± 61.5 vs. 216.6 ± 131.4 m, p < 0.001). Postoperative left ventricular (LV) and right ventricular (RV) systolic functions (LV EF, TAPSE, RVS) were similar compared to preoperative values. While postoperative RV, right atrial (RA) and systolic pulmonary artery pressure measurements were significantly lower, LV and left atrial (LA) measurements were higher than preoperative values. Postoperative LV and RV global longitudinal strain (GLS) measurements were significantly higher than preoperative values. Postoperative LV global radial and circumferential strain measurements were similar to preoperative values. While postoperative RA reservoir and conduit functions were significantly higher, postoperative LA reservoir and conduit functions were similar to preoperative values. Correlation analysis revealed that baseline 6MWT distances were correlated with LV GLS, RV GLS, and RA reservoir and conduit functions in the preoperative and postoperative periods. 2D STE indices may help the clinician in assessing the effect of PTE on cardiac functions and may also be used for follow-up data in CTEPH patients.
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http://dx.doi.org/10.1007/s10554-015-0682-2DOI Listing
August 2015

Arterial stiffness in patients with non-alcoholic fatty liver disease is related to fibrosis stage and epicardial adipose tissue thickness.

Atherosclerosis 2014 Dec 17;237(2):490-3. Epub 2014 Oct 17.

Department of Gastroenterology, School of Medicine, Marmara University, Fevzi Cakmak Mah, Mimar Sinan Cad. No. 41 Ust Kaynarca, Pendik, Istanbul, Turkey; Institute of Gastroenterology, Marmara University, Basibuyuk, Maltepe, Istanbul 34840, Turkey. Electronic address:

Objective: Non-alcoholic fatty liver disease (NAFLD) is associated with atherosclerosis and reduced vascular compliance. The purpose of this study was to examine the relationships between arterial stiffness measures, the histological severity of NAFLD, and epicardial fat thickness (EFT).

Methods: A total of 100 patients with biopsy-proven NAFLD and 50 age- and sex-matched controls were enrolled. The histological severity was assessed in all NAFLD patients. Measurements of arterial stiffness [pulse-wave velocity (PWV) and augmentation index (AIx)] were carried out using a Mobil-O-Graph arteriograph system. EFT was assessed by means of echocardiography.

Results: Compared with controls, NAFLD patients had significantly higher PWV and AIx values. Stepwise linear regression analysis demonstrated that the liver fibrosis score and EFT were independent predictors of both PWV and AIx values in NAFLD patients.

Conclusions: Patients with NAFLD have an increased arterial stiffness, which reflects both the severity of liver fibrosis and increased EFT values.
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http://dx.doi.org/10.1016/j.atherosclerosis.2014.10.004DOI Listing
December 2014

Burden and depressive symptoms associated with adult-child caregiving for individuals with heart failure.

ScientificWorldJournal 2014 5;2014:641817. Epub 2014 Nov 5.

Department of Cardiology, Marmara University Faculty of Medicine, Fevzi Cakmak Mahallesi, Mimar Sinan Caddesi No. 41, Ustkaynarca, Pendik, 34899 Istanbul, Turkey.

Background: The primary purpose of this study was to investigate adult-child caregiver burden in heart failure (HF) patients. Secondary purpose of the study was to identify the possible influencing factors for caregiver burden and depressive symptoms in a young adult-child caregiver group.

Methods: A total of 138 adult-child caregivers and 138 patients with HF participated in this study. Caregivers' burden, depressive symptoms, and anxiety levels were assessed by using Zarit Caregiver Burden Scale (ZCBS), Beck Depression Inventory, and State-Trait Anxiety Inventory, respectively.

Results: The mean ZCBS scores of the female caregivers were significantly higher than male caregivers. Approximately one-third of the adult-child caregivers had at least mild depressive symptoms. Caregivers with higher depressive symptoms had higher levels of caregiver burden. There were positive correlations between caregiving time, severity of depressive symptoms, and perceived caregiver burden. There was a negative correlation between education level of caregivers and perceived caregiver burden. Age, socioeconomic level, and marital status of patients were affecting factors for depressive symptoms in caregivers. Among caregiver characteristics, gender, marital status, and ZCBS scores seem to influence the depression in caregivers.

Conclusions: The study findings suggest significant levels of burden and depressive symptoms even in adult-child caregivers of HF patients.
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http://dx.doi.org/10.1155/2014/641817DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4238174PMC
November 2015

Acute effect of zoledronic acid infusion on atrial fibrillation development in patients with osteoporosis.

Anatol J Cardiol 2015 Apr 28;15(4):320-4. Epub 2014 Apr 28.

Clinic of Cardiology, Fatih Sultan Mehmet Training and Research Hospital; İstanbul-Turkey.

Objective: There is ongoing controversy related to the relationship between bisphosphonates and atrial fibrillation (AF). Our aim in this study was to evaluate the potential acute effect of zoledronic acid (ZA) infusion on AF development by using 24-hour Holter recordings.

Methods: The study was designed to be a self-controlled case series study, and 33 consecutive patients with osteoporosis (29 females, age: 62.3±9.0 years) who were scheduled to receive ZA infusion constituted the study population. Patients underwent 24-hour Holter rhythm recordings at two different times; the first one was 48 hours before the planned ZA infusion, and the second one was on the morning of the infusion day. Heart rate, frequency and type of arrhythmias, as well as heart rate variability (HRV) from the two recordings were compared.

Results: There were no episodes of AF greater than 30 sec in any of the 24-hour Holter recordings obtained before and on the day of drug infusion. Holter recordings before drug infusion showed that only 1 patient had an atrial run of 3 beats long. Holter recordings obtained on the day of drug infusion revealed that 5 patients (15.2%) had atrial runs with lengths ranging between 3 and 12 beats (p=0.046). Regarding HRV variables, SDANN values were found to be significantly depressed on the day of ZA infusion (113.6±26.9 vs. 98.2±29.9, p=0.007).

Conclusion: None of the patients developed AF during or early after ZA infusion. However, there was an increase in atrial ectopy in some patients, which might be due to alterations in cardiac autonomic activity.
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http://dx.doi.org/10.5152/akd.2014.5333DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5336843PMC
April 2015

Effects of diabetes mellitus on left atrial volume and functions in normotensive patients without symptomatic cardiovascular disease.

J Diabetes Complications 2014 Nov-Dec;28(6):858-62. Epub 2014 Jul 30.

Marmara University Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey.

Purpose: Left atrial (LA) size has been shown to be a predictor of adverse cardiovascular outcomes. The aim of the study was to evaluate the direct effect of diabetes mellitus (DM) on left atrial volume and phasic functions by using real-time three-dimensional echocardiography (RT3DE) in a population of patients free of symptomatic cardiovascular disease and hypertension.

Methods: Comprehensive transthoracic echocardiographic examination was performed on 40 consecutive patients with DM (20 male, age: 50.5±7.3 years) and 40 healthy controls (20 male, age: 48.4±6.7 years). In addition to conventional 2D echocardiographic measurements RT3DE was performed to assess LA volumes and phasic functions.

Results: There were no significant difference between groups regarding parameters reflecting LV systolic function as LV diameters and ejection fraction. However, regarding parameters reflecting LV diastolic function; transmitral deceleration time and E/E' ratio values were significantly higher and majority of early diastolic tissue Doppler velocity values were significantly lower in diabetic patients compared with controls. RT3DE demonstrated significantly higher LA maximum and minimum volumes for diabetic patients compared with controls (40.9±11.9 vs 34.6±9.3 mL, p: 0.009 and 15.6±5.9 vs 11.9±4.6 mL, p: 0.002, consecutively). LA total emptying fraction (TEF), expansion index (EI) and active emptying fraction (AEF) were found to be significantly lower in diabetics reflecting depressed LA reservoir and pump functions. There was no significant difference between groups regarding passive emptying fraction (PEF) which is assumed to be a marker of left atrial conduit function.

Conclusion: Patients with type 2 diabetes mellitus were found to have increased LA volume and impaired atrial compliance and contractility. Evaluation of asymptomatic diabetic patients by using RT3DE atrial volume analysis may facilitate recognition of subtle myocardial alterations related with type 2 diabetes.
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http://dx.doi.org/10.1016/j.jdiacomp.2014.07.010DOI Listing
August 2015

Regional myocardial dysfunction assessed by two-dimensional speckle tracking echocardiography in systemic sclerosis patients with fragmented QRS complexes.

J Electrocardiol 2014 Sep-Oct;47(5):677-83. Epub 2014 Jul 8.

Marmara University Faculty of Medicine, Department of Cardiology, Istanbul, Turkey.

Background: The aim of the study was to explore the relation between regional myocardial dysfunction and fragmented QRS (fQRS) complexes in systemic sclerosis (SSc).

Methods: Fifty-three SSc patients and 26 controls were included. All subjects underwent speckle tracking echocardiography for evaluation of left ventricular (LV) function and ECG to check for fQRS complexes.

Results: SSc patients had significantly lower LV global longitudinal, radial and circumferential strain and twist compared to controls. Thirteen SSc patients had fQRS (DII, DIII, aVF leads in eleven patients and V1 to V5 leads in two patients) and they had significantly lower global longitudinal and circumferencial strain compared to SSc patients with normal QRS. The SSc patients with fQRS in DII, DIII, and aVF leads had impaired longitudinal strain and delay in time to peak longitudinal strain in inferior LV segments compared to those with normal QRS.

Conclusion: fQRS is associated with lower strain measures in SSc patients indicating impairment in LV function.
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http://dx.doi.org/10.1016/j.jelectrocard.2014.07.008DOI Listing
May 2015

Evaluation of cardiac function by two-dimensional speckle tracking echocardiography in ulcerative colitis patients.

Dig Dis Sci 2014 Dec 15;59(12):3004-11. Epub 2014 Jul 15.

Department of Cardiology, Faculty of Medicine, Marmara University, Istanbul, Turkey,

Purpose: Although ulcerative colitis (UC) shows obvious similarities with other autoimmune diseases, cardiac consequences have not adequately introduced. The aim of our study was to evaluate left ventricular (LV) function in UC patients by using novel echocardiographic parameters.

Results: Forty-five UC patients (mean age 37, 18 female) and 90 age- and sex-matched healthy volunteers (mean age 40, 38 female) included in the study. The mean disease activity score according to partial Mayo score was 2.16 ± 2.13. Mean global longitudinal strain (GLS) and global longitudinal strain rate (GLSR) measurements were significantly lower (-21.16 ± 2.71 vs. -23.36 ± 3.34; p < 0.001 and -1.33 ± 0.24 vs. -1.43 ± 0.24; p = 0.037, respectively), whereas global circumferential (-22.67 ± 3.66 vs. -23.37 ± 3.99; p = 0.140) and global radial strain (43.07 ± 8.58 vs. 44.12 ± 9.32; p = 0.545) measurements of the LV were similar in patients with UC compared with controls. The correlation coefficient (r) between GLS and partial Mayo score was -0.578 (p < 0.001).

Conclusion: Our study suggests that systolic cardiac deformation values are impaired in UC patients. Reduced GLS and GLSR might be an early indicator of cardiac involvement in this population.
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http://dx.doi.org/10.1007/s10620-014-3274-4DOI Listing
December 2014

Evaluation of alexithymia, somatosensory sensitivity, and health anxiety levels in patients with noncardiac chest pain.

Biomed Res Int 2014 25;2014:896183. Epub 2014 May 25.

Department of Cardiology, Marmara University Faculty of Medicine, Fevzi Çakmak Mahallesi, Mimar Sinan Caddesi, No. 41, Üstkaynarca, Pendik, 34899 Istanbul, Turkey.

Objective: Noncardiac chest pain (NCCP) is seen more frequently in young population and in these patients loss of function is evolving in social and professional areas. The aim of the study is to evaluate the levels of anxiety and somatic perception in patients with chest pain presenting to cardiology clinic.

Methods: Fifty-one patients with noncardiac chest pain and 51 healthy controls were included in the study. All participants performed self-report based health anxiety inventory (HAI), somatosensory amplification scale (SAS), and Toronto alexithymia scale (TAS).

Results: The patient group had significantly higher scores on the SAS, HAI-1, and HAI-T scales compared to controls (P < 0.001, P = 0.006, and P = 0.038, resp.). SAS, HAI-1, and HAI-T scores were significantly higher in female patients than male (P = 0.002, 0.036, and 0.039, resp.). There were significant differences in all TAS subscale scores between two groups. Patients, who had total TAS score more than 50, also presented higher levels of health anxiety (P = 0.045).

Conclusions: Anxiety, somatic symptoms, and the exaggerated sense of bodily sensations are common in patients with NCCP. These patients unnecessarily occupy the cardiology outpatient clinics. These negative results can be eliminated when consultation-liaison psychiatry evaluates these patients in collaboration with cardiology departments.
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http://dx.doi.org/10.1155/2014/896183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4055647PMC
February 2015

Assessment of arterial stiffness and cardiovascular hemodynamics by oscillometric method in psoriasis patients with normal cardiac functions.

Heart Vessels 2015 May 15;30(3):347-54. Epub 2014 Mar 15.

Marmara University Faculty of Medicine, Department of Cardiology, Istanbul, Turkey.

Arterial stiffness is associated with increased cardiovascular risk. Pulse wave velocity (PWV) and augmentation index (AIx) are non-invasive markers for assessment of arterial stiffness. Increased arterial stiffness is associated with atherosclerosis in patients with psoriasis. Previous studies have shown that high neutrophil-to-lymphocyte ratio (NLR) predicts poor cardiovascular outcome. The aim of this study was to evaluate arterial stiffness and cardiovascular hemodynamics by oscillometric method in psoriasis patients with normal cardiac functions. Fifty consecutive patients with the diagnosis of psoriasis and 50 controls were included in the study. NLR was calculated as the ratio of neutrophil count to lymphocyte count. All patients underwent echocardiographic examination. Measurements of arterial stiffness were carried out using a Mobil-O-Graph arteriograph system. Fifty patients with psoriasis (26 male, mean age 43.3 ± 13.2 years) and 50 controls (33 male, mean age 45.0 ± 6.1 years) were included into the study. The distribution of cardiovascular risk factors was similar between the two groups, and NLR was significantly higher in patients with psoriasis (2.74 ± 1.78 versus 1.82 ± 0.52, p = 0.002). There was a weak correlation between NLR and PASI score without reaching statistical significance (r = 0.300, p = 0.060). While echocardiographic and hemodynamic parameters were comparable between psoriasis and control groups, heart rate was significantly higher in psoriasis group (81.5 ± 15.1 and 75.2 ± 11.8 beats/min, p = 0.021). Psoriasis patients had significantly higher AIx and PWV values as compared to controls (25.8 ± 13.1 versus 17.4 ± 12.3%, p = 0.001 and 6.78 ± 1.42 versus 6.18 ± 0.80 m/s, p = 0.011, respectively). AI and PWV were significantly associated with psoriasis when adjusted by heart rate (p = 0.005, odds ratio 1.04, 95% confidence interval 1.01-1.08 and p = 0.035, odds ratio 1.52, 95 % confidence interval 1.02-2.26, respectively). PWV significantly correlated with blood pressure, lipid levels, and several echocardiographic indices. AIx only correlated with left atrial diameter (r = 291, p = 0.040). Linear regression analysis was performed to find predictors of PWV. Central systolic blood pressure, left atrial diameter, and total cholesterol were independent predictors of PWV. PWV and AIx were significantly higher in patients with psoriasis. Assessment of arterial stiffness parameters may be useful for early detection of cardiovascular deterioration in psoriasis patients with normal cardiac functions. Novel inflammatory biomarkers such as NLR may elucidate the mechanism of vascular dysfunction in such patients.
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http://dx.doi.org/10.1007/s00380-014-0490-yDOI Listing
May 2015
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