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Öğe Autonomic dysfunction and cardiac repolarization abnormalities in patients with migraine attacks(Int Scientific Information, Inc, 2007) Melek, Ismet M.; Seyfeli, Ergun; Duru, Mehmet; Duman, Taskin; Akgul, Ferit; Yalcin, FatihThe clinical symptoms of migraine are widely accepted to be related to the involvement of the autonomic nervous system, and especially to dysfunction in the regulation of the circulatory system and autonomic balance. Disturbance of the autonomic nervous system is a primary characteristic of migraine Therefore, patients with migraine have a variety of symptoms, such as vasodilatation (flushing), pilo-erection, nausea, vomiting, diarrhea, cutaneous vasoconstriction (pallor), and diaphoresis. The electrocardiographic changes seen during a migraine attack compared with the pain-free period could be secondary to reversible disturbances of the state of autonomic innervation of the heart and coronary arteries. Dysfunction of ANS may affect atrial and ventricular repolarization. For instance, increased sympathetic activity causes sinus tachycardia, but increased parasympathetic activity causes sinus bradycardia, atrioventricular block, and ST-segment and T-wave abnormalities. Comprehensive electrocardiographic analyses have been providing more details in terms of the detection of abnormalities in atrial and ventricular repolarization which potentially may result in arrhythmias in patients with migraine. However, there is no information in literature reporting the frequency of cardiac arrhythmias in migraine patients who had cardiac repolarization abnormalities. In this review, detailed electrocardiographic findings and their relation with the autonomic nervous system, including recent observations, have been evaluated. However, further studies are needed to investigate the association between autonomic dysregulation and cardiac repolarization abnormalities in patients with migraine.Öğe CT assessment of main pulmonary artery diameter(Turkish Soc Radiology, 2008) Karazincir, Sinem; Balcı, Ali; Seyfeli, Erguen; Akoglu, Sebahat; Babayigit, Cenk; Akgul, Ferit; Yalcin, FatihPURPOSE The purpose of this study was to determine the normal range of the main pulmonary artery diameter (MPAD) by computed tomography (CT) in persons with normal pulmonary artery pressure, and then to evaluate the relationship of the diameter with age, gender, and body surface area (BSA). MATERIALS AND METHODS Between October 2005 and June 2007, among patients who had previously undergone a contrast-enhanced thorax CT scan, 112 persons (47 females, 65 males) without pulmonary pathology were selected for the study. A patients had normal mean pulmonary artery pressure. The widest diameter perpendicular to the long axis of the main pulmonary artery was measured at the pulmonary artery bifurcation level. The outer limits of the contrast were used to determine vessel diameter. RESULTS Pulmonary artery diameters showed a homogeneous distribution; the CT-determined mean pulmonary artery diameter was 26.6 +/- 2.9 mm. The mean MPAD in males was 27 2,8 mm, and 25.9 +/- 3.0 mm in females. This difference was considered to be statistically significant (P = 0.048). There was a significant relationship between the MAPD and age and BSA (P = 0.043, P < 0.001). CONCLUSION The present study demonstrated that in individuals with normal pulmonary artery pressure, the upper limit of the MPAD is 32.6 mm and that MPAD is well-correlated with BSA.Öğe Elastic properties of the aorta in patients with erectile dysfunction: assessment by conventional and color tissue Doppler echocardiography(Turkish Soc Cardiology, 2006) Seyfeli, Ergun; Gorur, Sadik; Akgul, Ferit; Gur, Mustafa; Seydaliyeva, Tunzale; Yalcin, Fatih; Kiper, Ahmet NamikObjectives: It has been suggested that erectile dysfunction (ED) may be the first clinical reflection of vascular disease. We investigated the stiffness and elastic properties of the aorta by conventional and color tissue Doppler echocardiography (TDE) in patients with ED of vascular origin. Study design: Thirty male patients with ED (mean age 52 +/- 8 years; range 41 to 73 years) were studied. Systolic and diastolic aortic diameters were measured by M-mode echocardiography to asses elastic properties of the aorta. Tissue Doppler velocities (S, E, and A cm/sec) of the upper and inferior aortic wall were measured by color TDE. Aortic strain and elasticity, and aortic stiffness index (ASI) were calculated. The results were compared with those of 30 healthy male controls (mean age 49 years). Results: Systolic and diastolic pressures and aortic systolic and diastolic diameters differed significantly between the two groups (p=0.001, p=0.034, p=0.045, p=0.004, respectively). Compared to controls, ASI was significantly higher (p=0.007), and aortic strain (p=0.002) and S wave velocity of the upper wall (p=0.001) were significantly lower in patients with ED. Significant correlations were found between S wave velocity of the upper wall with ASI (r=0.389, p=0.004), aortic strain (r=0.444, p=0.001) and elasticity (r=0.504, p<0.001), and between S wave velocity of the mitral lateral annulus and ASI (r=-0. 472, p<0.001) and aortic elasticity (r=0.533, p<0.001). Conclusion: Erectile dysfunction of vascular origin is associated with increased aortic stiffness and decreased aortic elasticity, this may foreshadow other vascular system diseases having a silent course.Öğe Emergency stenting of unprotected left main coronary artery after acute catheter-induced occlusive dissection(Texas Heart Inst, 2006) Akgul, Ferit; Batyraliev, Talantbek; Besnili, Fikret; Karben, ZaremaLeft main coronary artery dissection occurs very rarely during selective coronary angiography, but it generally progresses to complete coronary occlusion. The traditional treatment of occlusive dissection of the unprotected left main coronary artery has been surgical. Percutaneous treatment has been sporadic and controversial. We report a case of iatrogenic occlusive dissection of the unprotected left main coronary artery during diagnostic coronary angiography, followed by successful stenting of the lesion.Öğe Erratum: Giant left atrium mimicking a right thoracic mass: Case report (Journal of the American Geriatrics Society (2006) 54, (183-184))(2006) Seyfeli, Ergun; Akoglu, Sebahat; Karazincir, Sinem; Akgul, Ferit; Seydaliyeva, Tunzale; Yalcin, Fatih; Duru, Mehmet[No abstract available]Öğe Giant left atrium mimicking a right thoracic mass: Case report (vol 54, pg 183, 2006)(Blackwell Publishing, 2006) Seyfeli, Ergun; Akoglu, Sebahat; Karazincir, Sinem; Akgul, Ferit; Seydaliyeva, Tunzale; Yalcin, Fatih; Duru, Mehmet[Abstract Not Available]Öğe High Prevalence of Pulmonary Hypertension in Homozygous Sickle Cell Patients with Leg Ulceration(Taylor & Francis Inc, 2009) Serarslan, Gamze; Akgul, Ferit; Babayigit, CenkPulmonary hypertension is a common complication and is a risk factor for death in adult patients with sickle cell disease. Chronic leg ulceration is a major cause of morbidity in homozygous sickle cell disease. We aimed to determine prevalence of pulmonary hypertension in homozygous sickle cell patients and if there is any relation of pulmonary hypertension with leg ulceration. A total of 88 patients, asymptomatic for pulmonary hypertension, were enrolled in the study. Doppler echocardiography was performed on homozygous sickle cell patients with and without leg ulceration. 12 patients (10 male, 2 female) had active ulcer or healed scar (group I) and 76 patients (40 male, 36 female) had no active leg ulcer or history of (group II). The prevalence of pulmonary hypertension in group I and group II were 91.6% (n = 11) and 31.6% (n = 24), respectively (p = 0.0001). Patients with leg ulceration had increased left atrium and right ventricular diameters at diastole and also had increased left ventricular end-diastolic and end-systolic diameters. We determined an increased prevalence of pulmonary hypertension in patients with leg ulceration. Patients with homozygous sickle cell disease, especially those with leg ulcers should be screened for pulmonary hypertension, since pulmonary hypertension is a frequent and generally asymptomatic complication and a risk factor of mortality.Öğe Increased QT dispersion in sickle cell disease(Karger, 2007) Akgul, Ferit; Seyfeli, Ergun; Melek, Ismet; Duman, Taskin; Seydaliyeva, Tunzale; Gali, Edip; Yalcin, FatihBackground: QT dispersion has been proposed to be a predictor of adverse outcomes in a variety of cardiac disease states. The objective of this study was to examine QT dispersion in patients with sickle cell disease (SCD) and to assess the effect of pulmonary hypertension (PHT) on QT dispersion. Methods: We performed Doppler echocardiographic assessments of pulmonary artery systolic pressure in 73 (mean age 18.5 +/- 8.0 years) steady-state SCD patients and 25 (mean age 19.6 +/- 7.2 years) healthy subjects. Resting 12-lead electrocardiogram was recorded and QT dispersion was calculated as the difference between maximum and minimum QT intervals. Bazett's formula was used to obtain a rate-corrected value of the QT interval (QTc). Results: Maximum QTc, minimum QTc and QTc dispersion were significantly increased in SCD patients compared to the control subjects (p < 0.0001, p < 0.05, p < 0.0001, respectively). Among SCD patients, patients with PHT had higher maximum QTc and QTc dispersion than patients without PHT (p < 0.0001). However, minimum QTc showed no significant differences between the two patient groups. Conclusion: QTc dispersion is significantly increased in SCD patients, especially those with PHT indicating regional inhomogeneity of ventricular repolarization. Copyright (c) 2007 S. Karger AG, Basel.Öğe Neurological soft signs as the stroke risk in sickle cell disease(Tohoku Univ Medical Press, 2006) Melek, Ismet; Akgul, Ferit; Duman, Taskin; Yalcin, Fatih; Gali, EdipSickle cell disease (SCD) is a common form of hemoglobinopathy and is highly prevalent worldwide. Silent cerebral infarction, which represents infarction without clinical signs, is a risk factor for clinical stroke in patients with SCD. It is well known that silent infarction predisposes patients with SCD to overt stroke. The aim of the present study is to investigate the effect of silent infarction on neurological soft signs (NSS), which demonstrate subtle impairments in sensory integration, motor coordination and the sequencing of complex motor acts and to evaluate whether NSS can be used in clinical practice to evaluate the patients at risk of stroke in SCD patients with silent infarction. Fifty-nine SCD patients without any documented history of cerebrovascular accident and 28 healthy controls were included in this study. All the patients with SCD were evaluated with cerebral magnetic resonance imaging. We found that the NSS scores were significantly higher in patients with silent cerebral infarction than those in patients without silent infarction and control subjects (p < 0.05). Importantly, there was no significant difference in the NSS scores between the patients without silent infarction and control subjects. These results indicate that high NSS scores represnt an important finding for diagnosis of silent infarction in SCD patients. As silent infarction increases the risk for stroke in patients with SCD, NSS can be used to provide additional information in diagnosis of the patients with possible stroke risk during the course of SCD.Öğe P wave dispersion in patients with rheumatoid arthritis: its relation with clinical and echocardiographic parameters(Springer, 2007) Guler, Hayal; Seyfeli, Ergun; Sahin, Gunsah; Duru, Mehmet; Akgul, Ferit; Saglam, Hayrettin; Yalcin, FatihP wave dispersion (PWD) is a sign for the prediction of atrial fibrillation (AF). The aim of this study was to assess P wave dispersion and its relation with clinical and echocardiographic parameters in patients with rheumatoid arthritis (RA). Thirty RA patients (mean age 49 +/- 10 years) and 27 healthy controls (mean age 47 +/- 8 years) were included in the study. We performed electrocardiography and Doppler echocardiography on patients and controls. Maximum and minimum P wave duration were obtained from electrocardiographic measurements. PWD defined as the difference between maximum and minimum P wave duration was also calculated. Maximum P wave duration and PWD was higher in RA patients than controls (P = 0.031 and P = 0.001, respectively). However, there was no significant difference in minimum P wave duration between the two groups (P = 0.152). There was significant correlation between PWD and disease duration (r = 0.375, P = 0.009) and isovolumetric relaxation time (r = 0.390, P = 0.006). P wave duration and PWD was found to be higher in RA patients than healthy control subjects. PWD is closely associated with disease duration and left ventricular (LV) diastolic dysfunction.Öğe Pulmonary hypertension in sickle-cell disease(Karger, 2007) Akgul, Ferit; Yalcin, Fatih; Seyfeli, Ergun; Ucar, Edip; Karazincir, Sinem; Balcı, Ali; Gali, EdipBackground: Our aim is to determine comorbidities associated with pulmonary hypertension (PHT) in clinically stable sickle-cell disease (SCD) patients and to evaluate left ventricular (LV) and right ventricular (RV) function in those patients. Methods: Echocardiography was performed in 87 SCD patients that were divided into group I (without PHT) and group II (with PHT). Both groups were compared with healthy controls. Results: A history of retinopathy and leg ulcer was more frequent in group II than group I (p < 0.01). Haemoglobin levels were lower (p < 0.05), whereas blood urea nitrogen, lactate dehydrogenase and total bilirubin levels were higher in group II (p < 0.01). Although group II patients had larger LV end-diastolic, LV end-systolic and RV diastolic diameters compared with group I patients and controls (p < 0.05), LV ejection fraction was similar in the three groups. The mitral peak early diastolic inflow velocity to peak late diastolic inflow velocity (E/A) ratio was similar in group I, group II and the control group. The tricuspid E/A ratio was lower in group II than group I and controls (p < 0.05). Conclusion: End organ damage occurs more often and haemolysis is severer in SCD patients with PHT than SCD patients without PHT. Although LV systolic and diastolic function is well preserved, RV diastolic function is disturbed in those patients with PHT. Copyright (c) 2007 S. Karger AG, Basel.Öğe Right ventricular and pulmonary function in sickle cell disease patients with pulmonary hypertension(Springer, 2006) Akgul, Ferit; Yalcin, Fatih; Babayigit, Cenk; Seyfeli, Ergun; Seydaliyeva, Tunzale; Gali, EdipThe effects of sickle cell disease (SCD) on right ventricular (RV) and pulmonary function in SCD patients with pulmonary hypertension is not well-known. The aim of this study was to investigate RV and pulmonary functions in patients suffering from SCD with or without pulmonary hypertension using color tissue Doppler imaging and spirometry. We evaluated 48 asymptomatic patients with SCD. All patients underwent echocardiography with tissue Doppler imaging and pulmonary function test. Patients were divided into two groups: Group 1 consisted of 27 patients (age, 18.1 +/- 7.1 years) with normal pulmonary artery pressure, and group 2 consisted of 21 patients (age, 21.4 +/- 7.4 years) with pulmonary hypertension. Both groups were compared with a sex- and age-matched control group including 24 normal healthy subjects (age, 19.8 +/- 9.2 years). Tricuspid lateral annular systolic (S-m) and early diastolic velocity (E-m) were higher in group 1 than group 2 and the control group (p < 0.05). Tricuspid lateral annular late diastolic velocities (A(m)), isovolumetric contraction time, and myocardial performance index (MPI) were higher and the E-m/A(m) ratio was lower in group 2 than group 1 and the control group (p < 0.05). However, no differences were found in the tricuspid lateral annular E-m deceleration time, ejection time, and isovolumetric relaxation time between group 1, group 2, and the control group. Tricuspid lateral annular S-m and E-m were similar in group 2 and the control group. Forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and the diffusion capacity of the lung for carbon monoxide were decreased in both groups of patients compared to the control group (p < 0.05). However, there was no difference in respiratory rate, FEV1/FVC ratio, peak expiratory flow, and total lung capacity between group 1, group 2, and the control group. There were no differences in any indices of lung function between the two groups of patients. MPI is useful index to evaluate RV function in patients with SCD. RV diastolic function was disturbed in only SCD patients with pulmonary hypertension. On the other hand, the restrictive pattern of pulmonary function abnormalities had developed in both groups of patients.Öğe Right ventricular diastolic abnormalities in rheumatoid arthritis and its relationship with left ventricular and pulmonary involvement. A tissue Doppler echocardiographic study(Springer, 2006) Seyfeli, Ergun; Guler, Hayal; Akoglu, Sebahat; Karazincir, Sinem; Akgul, Ferit; Saglam, Hayrettin; Seydaliyeva, TunzaleObjectives To investigate right ventricular diastolic function in rheumatoid arthritis (RA) and its relationship with left ventricular and pulmonary involvement. Methods Thirty-five RA patients and 30 healthy subjects were submitted to conventional Doppler (CE) and tissue Doppler echocardiography (TDE) to assess left and right systolic and diastolic function and to estimate maximal arterial systolic pulmonary pressure (PAP). To detect pulmonary involvement, pulmonary function tests and high-resolution computed tomography (HRCT) scans were performed in all RA patients. Results An abnormal RV filling, as expressed byan inverted tricuspid (Tr.) E/A ratio, was detected in 12 (34%) of the 35 RA patients and in 2 (7%) of the 30 controls (P < 0.004). If compared to CE findings, prevalence of RV diastolic abnormalities were found higher in patients with RA by TDE (RV annulus Em/Am ratio < 1 (in 31 (89%) of 35 patients) (P=0.002). Twenty-two (63%) of 35 patients had abnormal HRCT findings. Pulmonary involvement with pulmonary hypertension (PHT) (36 +/- 5 mmHg) was detected in 10 (29%) of 35 RA. In this group, increase of RV annulus and basal Am wave, decrease of Tr. E/A ratio and RV annulus Em/Am ratio were statistically significant compared to RA (12 (34%) of 35) patients with pulmonary involvement who had normal PAP (19 +/- 5 mmHg), (P=0.014, P=0.006, P=0.015, P=0.049, respectively). Conclusions This study points out an impaired RV filling in a significant part of RA patients without overt heart failure. Impairment of RV diastolic function may be a predictor of subclinic myocardial and pulmonary involvement in patients with RA.Öğe Stress-induced hypercontractility in patients with hypertension: An interesting imaging finding(Elsevier Ireland Ltd, 2010) Yalcin, Fatih; Yalcin, Hulya; Seyfeli, Ergun; Akgul, FeritExcessive sympathetic activity and stress-induced LV hypercontractility may be detected in hypertensives or hypertensive LV hypertrophy. Recent quantitative data support that hypertensive patients may be associated with stress-induced LV hypercontractility. Stress-induced hypercontractility may also be related to basal LV cavity obliteration and dynamic LV outflow tract obstruction in hypertensives. In contrast to LV cavity dilation, stress-induced LV cavity obliteration may be associated with favorable outcome, however it has not been completely elucidated. Hypertensives with dynamic LVOT obstruction may clinically present with acute heart failure and normal systolic function. LV contractility may change and evaluation of LV geometry, contractility and volume by imaging techniques may be important in disease progression. (C) 2009 Elsevier Ireland Ltd. All rights reserved.Öğe Subclinical left ventricular dysfunction in multiple sclerosis(Blackwell Publishing, 2006) Akgul, Ferit; Mclek, Ismet; Duman, Taskin; Seyfeli, Ergun; Seydaliyeva, Tunzale; Yalcin, FatihObjectives: To investigate the left (LV) and right ventricular (RV) function in multiple sclerosis (MS) using standard echocardiography and Doppler tissue imaging (DTI). Materials and methods: A total of 41 patients with definite MS and 32 healthy controls were included in the study. Results: LV end-systolic dimension was increased and LV ejection fraction was decreased in MS patients compared with controls (P < 0.05). LV end-diastolic dimension was increased in MS patients, however, did not reach significance. Among DTI parameters, mitral annular peak early diastolic velocity to peak late diastolic velocity ratio (Em/Am) was decreased in MS patients, but not reach statistical significance. No significant differences in tricuspid annular Em/Am ratio was found between MS patients and controls. A statistically significant increase of DTI derived LV myocardial performance index was found in MS patients as compared with controls. RV myocardial performance index showed a tendency to be increased in MS patients, however, did not reach significance. Conclusions: These findings suggest subclinical LV dysfunction and preserved RV function in patients with MS.
