Publications by authors named "Ugur Aksu"

83 Publications

Effects of upper limb ischemia-reperfusion on regional oxidative stress during aortic surgery with moderate hypothermia.

J Card Surg 2021 Apr 10;36(4):1361-1369. Epub 2021 Feb 10.

Department of Anaesthesiology and Reanimation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.

Introduction: This study aims to evaluate the effect of acute, iatrogenic right arm ischemia and reperfusion (I/R) due to right axillary cannulation on regional oxidative stress using tissue perfusion markers such as central venous oxygen saturation, lactate, the difference between central venous and arterial CO pressure, near-infrared spectroscopy (NIRS) measurements, and biomarkers like sialic acid, malondialdehyde, advanced oxidative protein products in aortic surgery with moderate hypothermia.

Methods: Adult patients undergoing ascending aorta repair with antegrade cerebral perfusion via the axillary artery participated. Blood samples were collected from the internal jugular vein, right arm cubital vein, and left arm cubital vein, and analysis was performed at intraoperative time points.

Results: Right-arm venous oxygen saturation levels are significantly lower than left arm and central venous, as expected in iatrogenic ischemia. Right arm lactate levels are significantly higher. Somatic right arm NIRS values are significantly lower than somatic left arm. There are no significant differences for biomarkers throughout the time points.

Conclusions: We have concluded that well-known markers reflect the results of ischemia-reperfusion more rapidly, and are more valuable than novel biomarkers. NIRS is a promising monitor in terms of providing information about tissue oxygenation. Oxidative stress biomarkers do not change quickly enough to give useful information in a short enough period of time; moreover, their costs are high and laboratory studies take time. Although axillary cannulation is controlled limb ischemia, the local effects of I/R did not completely normalize at the end of the surgery, and this regional I/R did not affect the global body organism.
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http://dx.doi.org/10.1111/jocs.15409DOI Listing
April 2021

St. Thomas and del Nido cardioplegia are superior to Custodiol cardioplegia in a rat model of donor heart.

Scand Cardiovasc J 2021 Apr 13;55(2):122-128. Epub 2020 Nov 13.

Faculty of Science, Department of Biology, Istanbul University, Istanbul, Turkey.

Objectives: Cardiac transplantation is an effective treatment for advanced heart disease and protection of the donor organ is directly associated with post-transplantation outcomes. Cardioplegic strategies intend to protect the donor heart against ischemic injury during transplantation procedures. In our study, the effects of three different cardioplegia solutions were evaluated in a rat heart donor model in terms of cellular base. Cardioplegia solutions as St. Thomas, del Nido or Custodiol were administered to male Wistar albino rats until cardiac arrest. Arrested hearts were excised and incubated in cold cardioplegia solutions for 4 h. Organ bath experiments were performed using the right ventricular free wall strips of the heart tissues. ATP, sialic acid, TNF-α levels and MMP-9 activities were measured in heart tissues. Incubation media were also used to measure TNF-α and troponin-I levels following organ baths experiments. Custodiol administration led to reduced myocardial contraction ( < .05), decreased ATP levels ( < .001) and increased both TNF-α levels ( < .05), and MMP-9 activity ( < .05). Additionally, troponin-I and TNF-α levels in media were significantly increased ( < .05), TNF-α levels were positively correlated with MMP-9 activities ( = .93,  = .007) and negatively correlated with ATP levels ( = -.91,  = .01) in the Custodiol group. Also, MMP-9 activities were negatively correlated with ATP levels ( = -.90,  = .01) Custodiol cardioplegia cannot prevent functional and cellular damage in donor heart tissue. St. Thomas or del Nido cardioplegia could result in superior functional and biochemical improvement during transplantation procedures. In this respect, these cardioplegic solutions may be more advantageous as cellular and functional.
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http://dx.doi.org/10.1080/14017431.2020.1846772DOI Listing
April 2021

An investigation into hemodynamically significant coronary artery lesions predictors assessed by fractional flow reserve: A propensity score matching analysis.

North Clin Istanb 2020 10;7(1):35-39. Epub 2019 Mar 10.

Department of Cardiology, Ataturk University Faculty of Medicine, Erzurum, Turkey.

Objective: Fractional flow reserve (FFR) provides more useful information regarding myocardial metabolism and demand-supply convenience as compared to anatomical measurements. In this study, we aimed to investigate FFR predictors after propensity score matching (PSM) analysis in patients with intermediate coronary lesions.

Methods: Patients who underwent coronary angiography between January 2014 and March 2015 due to suspicion of coronary artery disease were included in this study. Patients were divided into two groups according to the FFR status and predictors of FFR before and after PSM analysis were investigated.

Results: A total of 290 patients (a total of 310 lesions) were included in this study (61±12 years, 75.5% male). In univariate analysis, after PSM analysis, Diameter stenosis (DS) and proximal LAD lesion (PLL) were associated with lower FFR values.

Conclusion: This study indicated that the majority of traditional FFR predictors did not reach the limit of significance after PSM analysis and we suggest that DS and PLL are one step ahead of predicting lesion severity compared to other traditional risk factors.
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http://dx.doi.org/10.14744/nci.2019.79058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103741PMC
March 2019

Snapshot evaluation of acute and chronic heart failure in real-life in Turkey: A follow-up data for mortality.

Anatol J Cardiol 2020 Feb;23(3):160-168

Department of Cardiology, Faculty of Medicine, Hacettepe University; Ankara-Turkey.

Objective: Heart failure (HF) is a progressive clinical syndrome. SELFIE-TR is a registry illustrating the overall HF patient profile of Turkey. Herein, all-cause mortality (ACM) data during follow-up were provided.

Methods: This is a prospective outcome analysis of SELFIE-TR. Patients were classified as acute HF (AHF) versus chronic HF (CHF) and HF with reduced ejection fraction (HFrEF), HF with mid-range ejection fraction, and HF with preserved ejection fraction and were followed up for ACM.

Results: There were 1054 patients with a mean age of 63.3±13.3 years and with a median follow-up period of 16 (7-17) months. Survival data within 1 year were available in 1022 patients. Crude ACM was 19.9% for 1 year in the whole group. ACM within 1 year was 13.7% versus 32.6% in patients with CHF and AHF, respectively (p<0.001). Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta blocker, and mineralocorticoid receptor antagonist were present in 70.6%, 88.2%, and 50.7%, respectively. In the whole cohort, survival curves were graded according to guideline-directed medical therapy (GDMT) scores ≤1 versus 2 versus 3 as 28% versus 20.2% versus 12.2%, respectively (p<0.001). Multivariate analysis of the whole cohort yielded age (p=0.009) and AHF (p=0.028) as independent predictors of mortality in 1 year.

Conclusion: One-year mortality is high in Turkish patients with HF compared with contemporary cohorts with AHF and CHF. Of note, GDMT score is influential on 1-year mortality being the most striking one on chronic HFrEF. On the other hand, in the whole cohort, age and AHF were the only independent predictors of death in 1 year.
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http://dx.doi.org/10.14744/AnatolJCardiol.2019.87894DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7222636PMC
February 2020

Evaluation of acute kidney injury with oxidative stress biomarkers and Renal Resistive Index after cardiac surgery.

Acta Chir Belg 2019 Dec 13:1-9. Epub 2019 Dec 13.

Department of Anesthesiology and Reanimation, School of Medicine, Acibadem University, Istanbul, Turkey.

We investigated whether cardiopulmonary bypass (CPB) related oxidative stress mediated glycocalyx degradation can cause an increase in renal resistive index (RRI) or postoperative AKI. Additionally, to evaluate whether RRI and early postoperative serum cystatin C levels could improve the prediction sensitivity of acute kidney injury (AKI). Forty-two patients undergoing cardiac surgery were included in this prospective observational study. RRI was measured pre-operatively and in the cardiac intensive care unit. Blood samples were collected for analyzing of cellular injury biomarkers at preoperative and postoperative second hours. We determined areas under the receiver operating characteristic curve (AUC) and odds ratios for postoperative biomarkers and RRI to predict AKI. While postoperative cystatin C level (AUC: 0.902, 95% CI = 0.79-1.00,  < .001) and RRI (AUC: 0.748, 95% CI = 0.56-0.93,  = .023) have diagnostic and predictive value in the prediction of AKI, we could not identify any relation between products of oxidative stress and the glycocalyx degradation and AKI. These data suggest that CPB leads to structural and oxidative changes at the protein level and the integrity of glycocalyx is disturbing, but these changes are not specific to kidney injury. Our data suggest that serum cystatin C level and RRI could be used as an early biomarker for postoperative AKI after cardiac surgery.
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http://dx.doi.org/10.1080/00015458.2019.1702371DOI Listing
December 2019

Assessment of right ventricular dysfunction in patients with mitral stenosis: A speckle tracking study.

J Clin Ultrasound 2020 Jun 3;48(5):269-274. Epub 2019 Dec 3.

Department of Cardiology, University of Health Sciences, Erzurum Education and Research Hospital, Erzurum, Turkey.

Purpose: Although it is affected at an early stage, there is a lack of studies investigating right ventricular (RV) function in patients with mitral stenosis (MS). We aimed to investigate the correlation between conventional echocardiographic variables and tricuspid annular plane systolic excursion (TAPSE), used as an indicator of RV dysfunction.

Methods: We enrolled 59 consecutive patients with MS and assigned them in group 1 if TAPSE ≤16, or group 2 if: TAPSE >16.

Results: The mean age of the patients was 42.2 ± 8 years, and 74.6% were females. In univariate analysis, maximal mitral valve gradient, mean mitral valve gradient, systolic pulmonary arterial pressure, RV strain, and RV strain rates were associated with RV dysfunction. In multivariate analysis, both strain variables were found to be independent predictors of RV dysfunction. Kaplan Maier survival analysis showed that patients with lower RV strain had more rehospitalization rate during the one-year follow-up period.

Conclusions: RV dysfunction is common in patients with MS and is associated with higher rehospitalization rate and morbidity. Evaluation of RV strain and strain rate for early detection of RV dysfunction and prediction of rehospitalization may be an appropriate approach in mitral stenosis.
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http://dx.doi.org/10.1002/jcu.22798DOI Listing
June 2020

The prognostic value of altitude in patients with heart failure with reduced ejection fraction.

Anatol J Cardiol 2019 Nov;22(6):300-308

Department of Cardiology, Hisar Intercontinental Hospital; İstanbul-Turkey.

Objective: It is well known that the altitude may affect the cardiovascular system. However, there were a few data related to the effect of altitude on the adverse outcome in patients with heart failure with reduced ejection fraction (HFREF). The aim of the present study was to investigate the role of intermediate high altitude on the major adverse cardiovascular outcome in patients with HFREF.

Methods: Patients with HFREF admitted to the outpatient clinics at the first center at sea level and the second center at 1890 m were prospectively enrolled in the study. HFREF was defined as symptoms/signs of heart failure and left ventricular ejection fraction <40%. The major adverse cardiac outcome (MACE) was defined as all-cause death, stroke, and re-hospitalization due to heart failure. The median follow-up period of the study population was 27 months.

Results: The study included 320 (58.55% male, mean age 65.7±11.2 years) patients. The incidence of all-cause death was 8.5%, stroke 6.1%, re-hospitalization due to decompensated heart failure 34.3%, and MACE 48.9%. In Kaplan-Meier analysis, patients with HFREF living at high altitude had more MACE (71.1% vs. 25.3%, log rank p=0.005) and presented with more stroke (11.3% vs. 2.1%, log rank p=0.001) and re-hospitalization due to heart failure (65.1% vs. 20.1%, log rank p<0.001) rates than those at low altitude in the follow-up; however, the rate of all-cause death was similar (9.4% vs. 8.1%, log rank p=0.245).

Conclusion: In the present study, we demonstrated that the intermediate high altitude is the independent predictor of MACE in patients with HFREF. High altitude may be considered as a risk factor in decompensating heart failure.
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http://dx.doi.org/10.14744/AnatolJCardiol.2019.81535DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6955054PMC
November 2019

The Protective Effects of Thymosin-β-4 in a Rat Model of Ischemic Acute Kidney Injury.

J Invest Surg 2019 Nov 8:1-9. Epub 2019 Nov 8.

Department of Physiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.

Despite the progress in the treatment of acute kidney injury (AKI), current curative approaches fail to provide adequate treatment. In this study, we aimed to investigate the possible protective effects of thymosin-β-4(Tβ4) on an ischemic AKI model in rats. Rats were randomly assigned into four groups ( 8/group): The control group (sham-operated), the ischemia-reperfusion (I/R) group; renal ischemia (90 min) by infrarenal abdominal aortic occlusion followed by reperfusion (3 h), the Tβ4 + I/R group; treated with Tβ4 before I/R, and the I/Tβ4/R group; treated with Tβ4 just before reperfusion. Besides renal function determination (creatinine (Cr) and blood urea nitrogen (BUN)); histological evaluation was also conducted. Renal tissue caspase-9, matrix metalloproteinase (MMP-9) activities, and hyaluronan levels were measured. Additionally, renal tissue oxidative stress (lipid hydroperoxide, malondialdehyde, superoxide dismutase, glutathione, pro-oxidant-antioxidant balance, ferric reducing antioxidant power, nitric oxide), inflammation (tumor necrosis factor-α, interleukin-1β, interleukin-6, nuclear factor-κβ) were evaluated. I/R increased the level of caspase-9, MMP-9 activity, and hyaluronan ( 0.001) and these were significantly decreased in both Tβ4 groups. Moreover, I/R led to increases in oxidative stress and inflammation parameters ( 0.001) while the levels of antioxidants were decreased. Nevertheless, Tβ4 in both groups were able to restore oxidative stress and inflammation parameters. Furthermore, Tβ4 attenuated histologic injury caused by I/R ( 0.01) and diminished serum urea-creatinine levels ( 0.001). These results suggest that Tβ4 has significant improving effects in ischemic acute kidney injury. This beneficial effect might be a result of the inhibition of extracellular matrix remodeling and apoptosis cascade via modulation in renal redox status and inflammation.
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http://dx.doi.org/10.1080/08941939.2019.1672841DOI Listing
November 2019

Relationship between epicardial adipose tissue thickness and coronary thrombus burden in patients with ST-elevation myocardial infarction.

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020 Jun 16;164(2):141-146. Epub 2019 Sep 16.

Department of Cardiology, Bursa Education and Research Hospital, Health Sciences University, Bursa, Turkey.

Background: Epicardial fat reflects abdominal visceral adiposity and visceral fat plays an important role in the development of an unfavorable metabolic and atherosclerosis risk profile. Intracoronary thrombus burden is an important factor affecting the success of the procedure particularly in patients undergoing percutaneous coronary intervention (PCI). Therefore, determining the factors predicting thrombus burden has great importance in predicting adverse cardiovascular events as well as determining the most appropriate treatment strategy to prevent failure in PCI.

Aim: The aim of the current study was to evaluate the relationship between Epicardial adipose thickness (EAT) and thrombus burden in the patients with ST-elevation myocardial infarction (STEMI) who undergo primary PCI (pPCI).

Methods: The study was prospective and included patients (n=156) who were referred to Kosuyolu Research and Education hospital with STEMI between 2016 and 2017. Thrombus burden was scored as follows: 0 (no thrombus), 1 (possible thrombus), 2 (definite thrombus <0.5xreference vessel diameter), 3 (definite thrombus 0.5-2xreference vessel diameter), 4 (definite thrombus >2xreference vessel diameter), and 5 (complete vessel occlusion). According to thrombus grade the patients were grouped as low thrombus burden (grades 0-3) and high thrombus burden (grades 4 and 5). EAT, identified as an echo-free space between the myocardium and visceral pericardium, was measured perpendicularly, on the free wall of the right ventricle at both parasternal long- and short-axis views at end-diastole in three cardiac cycles.

Results: Fifty-one subjects were in the low thrombus burden group and 105 in the high thrombus burden group. There were no differences in the two groups for LVEF, smoking status, family history of coronary artery disease (CAD), diabetes mellitus (DM), hypertension (HT), and hypercholesterolemia and for total cholesterol, triglyceride, GFR, LDL-C and HDL-C. In multivariate logistic regression analysis the EAT (odds ratio: 2.53, 95% CI: 1.76-3.67; p < .001) was found as an independent predictor of high thrombus burden.

Conclusions: The present study showed that EAT was an independent predictor of coronary thrombus burden in STEMI.
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http://dx.doi.org/10.5507/bp.2019.038DOI Listing
June 2020

Hemodynamic Stability and Contrast Nephropathy Development in Patients With Acute Myocardial Infarction.

Angiology 2020 03 10;71(3):289. Epub 2019 Sep 10.

Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey.

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http://dx.doi.org/10.1177/0003319719873805DOI Listing
March 2020

Biochemical markers decrease and increase disproportionally in A1 pulley tissue of type 2 diabetic trigger finger patients.

Eklem Hastalik Cerrahisi 2019 Aug;30(2):117-23

Department of Orthopedics and Traumatology, Istanbul Bahçelievler State Hospital, 34186 Bahçelievler, Istanbul, Turkey.

Objectives: This study aims to detect the levels of some biochemical markers in A1 pulley tissue of type 2 diabetic trigger finger patients to enlighten the mechanisms leading to cellular complications.

Patients And Methods: The study included 35 trigger finger patients (5 males, 30 females; mean age 53.9±9.15 years; range, 37 to 71 years). We measured total thiol (total-SH) levels to determine the status of the non-enzymatic antioxidant defense system and advanced oxidation protein product (AOPP) levels to determine levels of oxidative protein modification in pulley tissues of trigger finger patients with or without diabetes. Extracellular matrix degradation was assessed by measuring levels of sialic acid (SA) in the pulley tissue.

Results: Total-SH values for the groups with and without diabetes were 22.7±1.6 vs. 38.9±5.2 nmol/mg protein, respectively, while AOPP values were 472.5±131.6 vs.175.6±9.9 mmol/g protein, respectively. The SA levels of diabetic and nondiabetic patients were 0.4±0.0 vs. 0.63±0.1 nmol/mg protein, respectively.

Conclusion: Our results revealed that tissue SA levels and tissue SH levels decreased and AOPP levels increased disproportionally in the A1 pulley tissue of diabetic patients, which may indicate the role of oxidative protein damage and extracellular matrix changes in diabetic trigger finger etiology.
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http://dx.doi.org/10.5606/ehc.2019.66112DOI Listing
August 2019

Can Partial Oxygen Pressure of Urine be an Indicator for Tissue Perfusion?

Turk J Anaesthesiol Reanim 2019 Jun 29;47(3):187-191. Epub 2019 Jan 29.

Department of Anaesthesiology and Reanimation, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey.

Objective: None of the advanced monitorisation procedures, which are focusing only on the haemodynamic and blood gas parameters, are sufficient to estimate tissue perfusion adequately. The search for new parameters that are non-invasive and reliable to provide information about tissue hypoperfusion is significant. The purpose of the present study was to evaluate the relationship between urine partial pressure of oxygen (PuO) and routine systemic tissue perfusion parameters in patients with sepsis-like syndrome and impaired cardiac pressure-volume relationship after an open cardiac surgery.

Methods: The study was designed in 50 patients who had elective coronary bypass surgery. Patients were assessed for arterial lactate levels, arterial partial oxygen pressure (PaO), cardiac output (CO) and PuO in bladder urine at 180, 360 and 540 min postoperatively.

Results: Tissue perfusion parameters were found to be similar throughout the surgery in addition to no significant rise in plasma creatinine levels. PuO was found to be 91±22, 99±22 and 97±13 mmHg, respectively, at the time points described above. Any correlation between PuO and other measurements was not determined at any time points.

Conclusion: The present study suggests that urine PuO has no relationship with routine systemic tissue perfusion parameters, such as PaO, lactate levels and CO. In our opinion, since the COs of the patients were within the normal limits, and none of the patients developed renal injury, the present study might have been unable to determine any correlation. Further studies focused on patients with transient renal ischaemia are needed.
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http://dx.doi.org/10.5152/TJAR.2019.89083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537952PMC
June 2019

Peripartum cardiomyopathy and thrombotic complications.

North Clin Istanb 2019 20;6(1):102. Epub 2019 Jan 20.

Department of Pathology, Ataturk University Faculty of Medicine, Erzurum, Turkey.

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http://dx.doi.org/10.14744/nci.2018.54815DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6526991PMC
January 2019

Protective Effect of Thymosin β4 against Abdominal Aortic Ischemia-Reperfusion-Induced Acute Lung Injury in Rats.

Medicina (Kaunas) 2019 May 22;55(5). Epub 2019 May 22.

Department of Physiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, 34098 Istanbul, Turkey.

: Ischemia-reperfusion (IR) caused by infrarenal abdominal aorta cross-clamping is an important factor in the development of ischemia-reperfusion injury in various distant organs. We investigated potential antioxidant/anti-inflammatory effects of thymosin beta 4 (Tβ4) in a rat model of abdominal aortic surgery-induced IR. Tβ4 (10 mg/kg, intravenous (i.v.)) was administered to rats with IR (90-min ischemia, 180-min reperfusion) at two different periods. One group received Tβ4 1 h before ischemia, and the other received 15 min before the reperfusion period. Results were compared to control and non-Tβ4-treated rats with IR. Serum, bronchoalveolar lavage fluid and lung tissue levels of oxidant parameters were higher, while antioxidant levels were lower in the IR group compared to control. IR also increased inflammatory cytokine levels. Tβ4 reverted these parameters in both Tβ4-treated groups compared to the untreated IR group. Since there is no statistical difference between the prescribed results of both Tβ4-treated groups, our study demonstrates that Tβ4 reduced lung oxidative stress and inflammation following IR and prevented lung tissue injury regardless of timing of administration.
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http://dx.doi.org/10.3390/medicina55050187DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6572620PMC
May 2019

The role of the right atrium in development of postoperative atrial fibrillation: A speckle tracking echocardiography study.

J Clin Ultrasound 2019 Oct 17;47(8):470-476. Epub 2019 May 17.

Department of Cardiology, Atatürk University Faculty of Medicine, Erzurum, Turkey.

Purpose: Atrial fibrillation (AF) is relatively frequent in the postoperative period, and is associated with an increased frequency of adverse events. The role of right atrial (RA) volume and functions in the development of AF is unknown. In this study, we investigated the effect of RA echocardiographic indices on AF development in the postoperative period.

Method: We enrolled 142 consecutive patients who underwent coronary artery bypass surgery, and assigned them into two groups depending on the occurrence or not of AF development in the postoperative period.

Results: A propensity score matching analysis was performed to balance the groups, and 37 pairs were eventually included in the analysis. The median age was 67.5 (63-75) years and 73.3% of them were males. In the univariate analysis, right atrial volume index (RAVi), right atrial strain during reservoir phase (RASr), left ventricular global longitudinal strain, right ventricular strain, left atrial volume index, left atrial strain during reservoir phase, and systolic pulmonary artery pressure were associated with AF development. In the regression analysis, we found that RAVi (OR: 3.1, 95% CI: 2.2-6.3, P: .033) and RASr (OR: 0.82, 95% CI: 0.67-0.93, P: .048) were independent predictors of AF development.

Conclusions: RA structure and functions are closely associated with AF development in the postoperative period, and screening of RA functions prior to surgery may be useful for preventing AF development.
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http://dx.doi.org/10.1002/jcu.22736DOI Listing
October 2019

Acute cardiac effects of high dose steroid treatment: A speckle tracking echocardiography study.

J Clin Ultrasound 2019 Jul 20;47(6):351-355. Epub 2019 Feb 20.

Department of Cardiology, Atatürk University Faculty of Medicine, Erzurum, Turkey.

Purpose: High-dose steroid therapy (HDST) has frequent side-effects that appear at its cessation and depend on its dose. However, there is a lack of studies about the acute effects of HDST on cardiac function in adult patients.

Methods: We included in this study 30 patients who underwent HDST (intravenously at doses ranging from 250 to 1000 mg) and 30 healthy control subjects with similar demographic and clinical characteristics, between September and December 2016. Echocardiographic measurements were made before and during the first 3 hours after the end of treatment, and results were compared between patients and controls.

Results: There was no difference in baseline biochemical and echocardiographic characteristics between the patient and control groups. While left ventricular global longitudinal strain (LVGLS) and strain rate E were higher after treatment, no significant change was observed in conventional echocardiographic variables.

Conclusions: LVGLS, but not conventional echocardiographic variables, showed an increase in cardiac systolic function at the acute phase of HDST.
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http://dx.doi.org/10.1002/jcu.22716DOI Listing
July 2019

Endocan and Major Adverse Cardiovascular Events: Understanding Regression Methods.

Angiology 2019 11 10;70(10):982. Epub 2019 Feb 10.

1 Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey.

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http://dx.doi.org/10.1177/0003319719828911DOI Listing
November 2019

Perioperative risk factors of acute kidney injury after non-cardiac surgery: A multicenter, prospective, observational study in patients with low grade American Society of Anesthesiologists physical status.

Am J Surg 2019 09 31;218(3):457-461. Epub 2019 Jan 31.

Department of Anesthesiology and Reanimation, School of Medicine, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey. Electronic address:

Background: The aim of this study was to determine the incidence and the perioperative risk factors of acute kidney injury (AKI) using "Kidney Disease: Improving Global Outcomes" (KDIGO) guidelines, in patients with low grade American Society of Anesthesiologists physical status (ASA-PS) undergoing non-cardiac surgery.

Methods: In this multicenter, prospective, observational study, 870 surgical patients older than 40 years with ASA-PS I-II who underwent noncardiac surgery, were included. The primary outcome of this study was perioperative AKI defined by the KDIGO criteria.

Results: AKI was detected in 49 (5.63%) of the patients. Multivariate analysis detected the presence of preoperative hypertension (aOR = 0.130; CI = 0.030-0.566; p = 0.007) and intraoperative transfusion of erythrocytes (aOR = 0.076; CI = 0.008-0.752; p = 0.028) as independent predictors of postoperative AKI development.

Conclusion: Approximately, 6% of patients with ASA I-II presenting for noncardiac surgery developed postoperative AKI. Preoperative hypertension and intraoperative erythrocyte transfusion are independent predictors of AKI after non-cardiac surgery in this patient population.
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http://dx.doi.org/10.1016/j.amjsurg.2019.01.031DOI Listing
September 2019

The association between CRP / Albumin ratio and in-stent restenosis development in patients with ST-segment elevation myocardial infarction.

J Clin Lab Anal 2019 May 8;33(4):e22848. Epub 2019 Feb 8.

Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey.

Background: Although interventional methods are the first-line treatment options in ST-segment elevation myocardial infarction (STEMI), the incidence of stent restenosis (SR) is frequent. We investigated the relationship between CRP/albumin ratio (CAR), a novel indicator of inflammatory response, and SR in this study.

Method: This study was carried out on the patients who underwent coronary angiography in our clinic between January 2017 and September 2017. Two groups were generated according to restenosis status (group 1: restenosis (-), group 2: restenosis (+)), and clinical biochemical and angiographical features were compared. As baseline demographic and angiographic characteristics are slightly different in two groups, propensity score matching analysis was performed to reduce bias. 45 SR patients were matched on a 1:1 basis were enrolled final cohort.

Results: The mean age of the patients was 55 ± 5.1 and 80% were male; Cox regression model was performed to demonstrate independent predictor of restenosis development; and during the one-year follow-up period, CAR (P < 0.001) was found an independent predictor of SR CONCLUSION: In this study, we demonstrate that there may be a strong relationship between SR development and CAR. We implied that inflammatory reaction may be an important diagnostic tool for prediction of SR development in STEMI patients.
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http://dx.doi.org/10.1002/jcla.22848DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528603PMC
May 2019

Evaluation of ventricular repolarization parameters during migraine attacks.

J Electrocardiol 2019 Mar - Apr;53:66-70. Epub 2018 Dec 21.

Department of Cardiology, University of Health Sciences, Erzurum Education and Research Hospital, Erzurum, Turkey.

Aims: Migraine is a chronic neurovascular disorder characterized by intermittent episodes of severe headache. Abnormalities in the autonomic nervous system (sympathetic and parasympathetic nervous systems) have been detected during migraine-free periods in patients with migraine. In these patients, disrupted autonomic innervations of the heart and coronary arteries may lead to electrocardiographic changes during a migraine attack. T-wave peak-to-end interval (Tp-e interval) and Tp-e/QT ratio are relatively new markers of ventricular arrhythmogenesis and repolarization heterogeneity. In the present observational study, we investigated the changes in ventricular repolarization during migraine attacks and attack-free periods by performing 12‑lead electrocardiography (ECG).

Methods: This study included 63 patients (54 [86%] women; mean age: 33.3 ± 9.9 years) with migraine. The QT and corrected QT (QTc) intervals, Tp-e interval, and Tp-e/QT ratio of the patients during migraine attacks and attack-free periods were measured by performing 12‑lead ECG.

Results: The QT and QTc intervals, Tp-e interval, and Tp-e/QT ratio were higher during migraine attacks than during attack-free periods (P < 0.001 for all).

Conclusion: These results indicate that migraine attacks are associated with an increase in ventricular repolarization parameters compared with attack-free periods possibly because of the dysregulation of the autonomic nervous system.
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http://dx.doi.org/10.1016/j.jelectrocard.2018.12.014DOI Listing
July 2020

Long-Term Mortality and Contrast-Induced Nephropathy.

Angiology 2019 09 7;70(8):783. Epub 2019 Jan 7.

2 Department of Cardiology, Atatürk University, Erzurum, Turkey.

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http://dx.doi.org/10.1177/0003319718823628DOI Listing
September 2019

Evaluating the Association Between the Three Different Ejection Fraction Measurement Techniques and Left Ventricle Global Strain.

Eurasian J Med 2018 Oct;50(3):173-177

Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey.

Objective: The prognosis of cardiovascular diseases (CVDs) is directly associated with systolic function based on the measurement of ejection fraction (EF), and many studies have indicated that the left ventricular global strain (LVGS) provides better predictivity than the EF measurement in the diagnosis, prognosis, survival, and CVD staging. However, these studies did not investigate the correlation between the EF measurement and the LVGS parameters, or which parameters are better correlated with LVGS, but we analyzed the association between three EF measurement methods and LVGS.

Materials And Methods: This study included 62 patients that applied to the clinic between October 2015 and March 2016. An echocardiography examination of these patients was performed. The exclusion criteria were atrial fibrillation and suboptimal image quality.

Results: Sixty-two patients (the average age 61.0±12.6 years; 56% male and 44% female) were enrolled in the study. A statistically significant association was found between the visual EF and Simpson EF measurements and the LVGS parameters (p<0.001). While the visual EF was moderately correlated with the LVGS parameters (r=0.44), there was a good correlation between the Simpson EF and the LVGS parameters (r=0.710).

Conclusion: In this study, we demonstrate that the Simpson's rule LVEF correlates better with LVGS than the Teicholtz method or visual EF and that it has a better area under the curve value for determining an abnormal LVGS. Therefore, we recommend the use of the Simpson EF for the EF measurement that has a better correlation with the LVGS values in the patients whose ventricle functions should be evaluated.
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http://dx.doi.org/10.5152/eurasianjmed.2018.17409DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6263235PMC
October 2018

Peripartum cardiomyopathy and ventricular thrombus: A case report and review of literature.

North Clin Istanb 2018 30;5(2):145-147. Epub 2018 Mar 30.

Department of Cardiology, Atatürk University Faculty of Medicine, Erzurum, Turkey.

Peripartum cardiomyopathy (PPCMP) is a rare and life-threatening condition. Intracardiac thrombus is characteristically associated with increased adverse events, mortality, and a high risk of thromboembolic events, and has been associated with PPCMP. Early diagnosis and treatment play a critical role. Although echocardiography is the first-line diagnostic method, other imaging modalities may provide useful information in appropriate patients. Presently described is a case in which an apical intracardiac thrombus coexisting with PPCMP was identified and managed using multimodality imaging studies.
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http://dx.doi.org/10.14744/nci.2017.53254DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6191556PMC
March 2018

Comparative Effects of Blood and Crystalloid Cardioplegia on Cellular Injury and Oxidative Stress in Cardiovascular Surgery.

Ann Thorac Cardiovasc Surg 2019 Feb 28;25(1):10-17. Epub 2018 Aug 28.

Department of Anesthesiology and Reanimation, Acibadem University, School of Medicine, Istanbul, Turkey.

Purpose: The purpose of this study was to evaluate the effect of different cardioplegic solutions on endothelial integrity and oxidative stress in cardiovascular surgery.

Methods: In this randomized prospective study, after ethics approval and informed consent, 60 surgical patients were included. Patients undergoing coronary bypass surgery were randomized into two groups as warm blood cardioplegia (n = 30) and cold crystalloid cardioplegia (n = 30) following the cross-clamping. Measurements were performed at three time points: before induction of anesthesia (T1), at admission to intensive care unit (ICU) (T2) and at the 24th postoperative hour (T3). Besides biochemical routine hemodynamic monitoring, patients were assessed for the sialic acid (SA), ischemic-modified albumin (IMA), advanced oxide protein products (AOPPs), total thiol (SH), and free hemoglobin (fHb) level.

Results: Neither crystalloid nor blood cardioplegia led to significant changes in the AOPPs, T-SH, and SA level (p >0.05). Crystalloid cardioplegia, however, increased IMA level compared to both baseline (p <0.01) and blood cardioplegia group (p <0.05). fHb levels were transiently increased in both groups at the second-time point (p <0.001). fHb level was lower in the crystalloid group compared to that in the other group (p <0.05) at T2.

Conclusion: Cardioplegia type creates similar effects on glycocalyx integrity. However, myocardial protection could be provided with warm blood cardioplegia.
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http://dx.doi.org/10.5761/atcs.oa.18-00113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6388305PMC
February 2019

Effects of Alprazolam and Melatonin Used for Premedication on Oxidative Stress, Glicocalyx Integrity and Neurocognitive Functions.

Turk J Anaesthesiol Reanim 2018 Jun 1;46(3):233-237. Epub 2017 Jun 1.

Department of Anaesthesiology and Reanimation, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey.

Objective: The purpose of this investigation was to compare the effect of alprazolam and melatonin on oxidative stress, glicocalyx integrity and neurocognitive function in patients undergoing coronary artery bypass grafting (CABG).

Methods: Overall, 42 patients undergoing CABG were retrospectively included in this study. Blood samples which preserved at -70°C for a previous study were used for this study. The participants were divided into two groups. Patients in the Group A were administered alprazolam before the operation, whereas melatonin was used for premedication in the Group M. Blood samples were collected at three time points [T0: before anaesthesia induction, T1: admittance to intensive care unit (ICU), T2: 24 h after ICU admission], and oxidative stress parameters and glicocalyx integrity were evaluated. Furthermore, Mini-Mental State Examination was recorded to measure neurocognitive function.

Results: The total thiol levels which were measured as an antioxidant parameter were significantly higher, and free Hb values were significantly lower in the Group M compared to the Group A (p<0.05). No significant differences were found in order to oxidative stress parameter levels, extubation time, length of hospital stay, durations of cross-clamp, cardiopulmonary bypass and operation and Mini-Mental State Examination results between the two groups (p>0.05).

Conclusion: In light of positive effects on oxidatif stress parameters, melatonin may be considered as a good and safe premedication agent with its anxiolytic, antioxidant and minimal haemodynamic and respiratory effects.
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http://dx.doi.org/10.5152/TJAR.2018.65475DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6097860PMC
June 2018

Visceral oxidative stress during antegrade cerebral perfusion and lower body circulatory arrest.

Acta Chir Belg 2019 Aug 14;119(4):217-223. Epub 2018 Aug 14.

a Department of Cardiovascular Surgery , Turkey Yuksek Ihtisas Training and Research Hospital , Ankara , Turkey.

Antegrade cerebral perfusion (ACP) is the standard neuroprotection method in aortic surgery. Visceral ischemia during this modality brings out some controversies. We aimed to investigate the level of oxidative stress at the lower part of body during ACP. Thirty consecutive patients underwent elective ascending aorta and hemiarch repair with ACP (without distal perfusion) were enrolled to study. The patients were enrolled into two groups which were based on 50th percentile of ACP duration (15 patients in each group). Blood samples from inferior vena cava at the end of ACP were collected to assess oxidative stress with biochemical parameters such as lactate, advanced oxidative protein products (AOPP) and thiol levels. Clinical follow-up parameters regarding to visceral and spinal cord ischemia were recorded. There were no clinical complications at both groups. Mean ACP duration for the study group was found to be 15 min (10-28 min). Lactate, AOPP, and thiol levels were found to be similar between two groups. Furthermore, correlation analysis revealed only low level of correlation between ACP duration and lactate levels. Renal and liver function tests were found to be similar between groups. Immediate parameters (such as lactate, AOPP, and thiol) that show alterations in response to oxidative stress were not affected by the duration of ACP. Therefore, ACP without distal perfusion may not be harmful when conducted for short duration.
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http://dx.doi.org/10.1080/00015458.2018.1500798DOI Listing
August 2019

Investigation of PhiKZ phage therapy against Pseudomonas aeruginosa in mouse pneumonia model

Turk J Med Sci 2018 Jun 14;48(3):670-678. Epub 2018 Jun 14.

Background/aim: The aim of this study was to investigate the effects of PhiKZ phage therapy and meropenem alone or combined treatments in a pneumonia mouse model induced by the Pseudomonas aeruginosa PAO1 strain. The cross-talk between lungs and kidneys was also determined. Materials and methods: The systemic, lung-specific, and kidney-specific inflammation levels and the bacterial load in lung tissue and biochemical parameters were investigated after PhiKZ phage therapy and meropenem alone or combined treatments in a pneumonia mouse model induced by the P. aeruginosa PAO1 strain. The cross-talk between lungs and kidneys was also determined by measuring plasma levels of glycocalyx components. Results: The greatest reduction in lung bacterial load was obtained with the combined use of the PhiKZ phage and meropenem. The C-reactive protein level in the patient group was significantly higher than in the treatment groups and decreased after treatment. Serum interleukin IL-6 levels were statistically significantly higher than in the phage serum and phage + meropenem groups. Pulmonary infection can trigger proinflammatory cytokines such as IL-6, TNF-α, and IL-1ß. Increased cytokines trigger insulin resistance in the liver. Lung infection triggers liver inflammation because there is communication between the lungs and liver. Conclusion: Elevated proinflammatory cytokines due to infection were decreased because of the reduced burden of bacterial load after treatment. This study might have proved communication between lungs and kidneys related to proinflammatory cytokines.
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http://dx.doi.org/10.3906/sag-1711-22DOI Listing
June 2018

Identification and quantification of human microcirculatory leukocytes using handheld video microscopes at the bedside.

J Appl Physiol (1985) 2018 06 8;124(6):1550-1557. Epub 2018 Mar 8.

Department of Translational Physiology, Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands.

Leukocyte recruitment and adhesion to the endothelium are hallmarks of systemic inflammation that manifest in a wide range of diseases. At present, no method is available to directly measure leukocyte kinetics at the bedside. In this study, we validate a new method to identify and quantify microcirculatory leukocytes observed by handheld vital microscopy (HVM) using space-time diagram (STD) analysis. Video clips ( n = 59) containing one capillary-postcapillary venule unit where leukocytes could be observed emanating from a capillary into a venule in cardiac surgery patients ( n = 20) were included. STD analysis and manual counting were used to quantify the number of leukocytes (total, rolling, and nonrolling). Pearson's correlation and Bland-Altman analysis were used to determine agreement between the STDs and manual counting. For reproducibility, intra- and interobserver coefficients of variation (CVs) were assessed. Leukocyte (rolling and nonrolling) and red blood cell velocities were assessed. The STDs and manual counting procedures for the quantification of rolling leukocytes showed good agreement ( r = 0.8197, P < 0.0001), with a Bland-Altman analysis mean difference of -0.0 (-6.56; 6.56). The overall intraobserver CV for the STD method was 1.5%. The overall interobserver CVs for the STD and the manual method were 5.6% and 9.4%, respectively. The nonrolling velocity was significantly higher than the rolling velocity (812 ± 519 µm/s vs. 201 ± 149 µm/s, P = 0.001). STD results agreed with the manual counting procedure results, had a better reproducibility, and could assess the leukocyte velocity. STD analysis using bedside HVM imaging presented a new methodology for quantifying leukocyte kinetics and functions in the microcirculation. NEW & NOTEWORTHY In this study, we introduce space-time diagram analysis of sublingual microcirculation imaging using handheld vital microscopy to identify and quantify the presence and kinetics of human microcirculatory leukocytes. We validated the methodology by choosing anatomical units consisting of a capillary connected to a venule, which allowed precise identification of leukocytes.
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http://dx.doi.org/10.1152/japplphysiol.00962.2017DOI Listing
June 2018

Discerning the relationship between left ventricular geometry, high-sensitivity troponin T, and nondipper hypertension.

Blood Press Monit 2018 Feb;23(1):12-18

Department of Cardiology, Adiyaman Training and Research Hospital, Adiyaman.

Introduction: Hypertension can cause anatomic changes in the left ventricle, generally leading to abnormal geometry. High-sensitivity cardiac troponin T (hs-cTnT) values have been shown to be positively correlated with left ventricular hypertrophy in hypertensive patients. The current study investigated the diagnostic value of hs-cTnT in patient with nondipper hypertension (NDH) as well as determined the correlation between left ventricular geometric patterns and hs-cTnT values in hypertensive patients.

Patients And Methods: A total of 100 consecutive patients (58 women and 42 men) who were referred to our clinic between 1 October 2015 and 1 March 2016 with elevated blood pressure (BP) were included. Of the patients, 63 had dipper hypertension [nocturnal decline in mean BP (≥10%)], whereas the remaining 37 had NDH [nocturnal decline in mean BP (<10%)]. Of note, hs-cTnT levels were measured only once during admission. Echocardiographic examinations were performed at baseline month and repeated at the sixth month.

Results: Hs-cTnT was significantly increased in those with NDH (P<0.001). The NDH group experienced significant decreases in concentric hypertrophy pattern over 6 months (P=0.014). Hs-cTnT was significantly related with nondipping status (r=0.747, P<0.001). Hs-cTnT was also an independent predictor of NDH (odds ratio=1.034, 95% confidence interval: 1.018-1049, P<0.001). Hs-cTnT value of more than 0.95 ng/l predicted NDH with a sensitivity of 75% and specificity of 98% (area under the curve: 0.86; 95% confidence interval: 0.782-0.925; P<0.001).

Conclusion: Our current results indicate that patients with NDH had higher hs-cTnT levels than the patients with dipper hypertension. Hs-cTnT was an independent predictor of NDH and was significantly related with nondipping status. Hence, hs-cTnT may be used as diagnostic biomarker in NDH.
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http://dx.doi.org/10.1097/MBP.0000000000000297DOI Listing
February 2018

The effect of dialysis type on left atrial functions in patients with end-stage renal failure: A propensity score-matched analysis.

Echocardiography 2018 03 11;35(3):308-313. Epub 2017 Dec 11.

Department of Cardiology, Ataturk University Medical School, Erzurum, Turkey.

Introduction: Despite the widespread use of both hemodialysis (HD) and peritoneal dialysis (PD), there is no study comparing the effects of these dialysis methods on the left atrial (LA) volume and functions. In this study, we investigated the impact of different dialysis methods on the LA volume and function in the patients exposed to chronic pressure overload and volume overload.

Method: This study was carried out on the patients who received dialysis treatment at our healthcare center between March, 2015 and January, 2016. Twenty-eight patients receiving hemodialysis (HD) treatment and 24 patients under PD treatment were enrolled into the study. Patients were divided into 2 groups according to the dialysis therapy, and the atrial volumetric and mechanical functions were investigated.

Results: As the basal demographical characteristics of patients in the PD and HD groups were significantly different, 44 patients matched on a 1:1 basis were taken for final analysis (22 HD, 22 PD, and the average age of 42.4 ± 4.8; 73% was male). After propensity score matching analysis, it was determined that left atrial volume index (LAVi) was higher in the HD group while peak LA strain and LA contraction strain were higher in the PD group. Additionally, both strain parameters showed a good negative correlation with LAVi.

Conclusion: We demonstrated that the left atrial structure and functions were better in the PD group suggesting that PD may be a relatively better option for the preservation and maintenance of the left atrial functions as compared to HD.
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http://dx.doi.org/10.1111/echo.13774DOI Listing
March 2018