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  • [ N/A ]
    Öğe
    Abnormal Left Ventricular Mechanics in isolated Bicuspid Aortic Valve Disease may be independent of aortic distensibility: 2D Strain Imaging Study
    (I C R Publishers, 2012) Kurt, Mustafa; Tanboga, Ibrahim Halil; Bilen, Emine; Isik, Turgay; Kaya, Ahmet; Karakas, Mehmet Fatih; Buyukkaya, Eyup
    Background aim of the study: In this study, we hypothesized that subclinical impairment of left ventricular (LV) mechanical function in bicuspid aortic valve (BAV) patients is independent of valvular hemodynamics represented by valvuloarterial impedance and aortic elastic characteristics. Therefore, we aimed to test left ventricular mechanics in cases of isolated non-stenotic BAV with non-dilated aorta. Methods: Thirty-three patients with isolated BAV exhibiting non-dilated aorta, and 25 age-and gender-matched healthy subjects were included in the study. Patients with aortic valve velocity > 1.5 m/s and mild-to-moderate aortic regurgitation or ascending aorta diameter >3.5 cm were excluded from the study. Aortic elasticity parameters and valvulo-arterial impedance were calculated. Strain measurements were reported as the peak longitudinal strain (LS) for four chamber (4C), long axis (LAX) and two chamber (2C) views. Strain rate (Sr) measurements were reported as the peak systolic strain rate (Sr-sm), early diastolic strain rate (Sr-ern) and late diastolic strain rate (Sr-am) for 4C, LAX and 2C views. Results: Systolic and diastolic diameters of the ascending aorta, aortic elastic properties (aortic strain, aortic distensibility, aortic stiffness and aortic elastic modulus), and valvulo-arterial impedances were found to be comparable between the BAV and control groups. BAV group was observed to have statistically significantly lower 4C (18.9 +/- 1.7 vs 17.8 +/- 1.5, p=0.02), LAX (19.7 +/- 1.7 vs 17.7 +/- 1.3, p=0.001) and 2C (20.1 +/- 1.8 vs 17.7 +/- 1.2, p<0.001) peak longitudinal strain values compared with the control group. Moreover, LV-GS values were found to be significantly lower in the BAV group than in the control group (19.6 +/- 1.1 vs 17.7 +/- 0.9, p<0.001). However, there was no statistically significant difference between the groups in terms of Sr-sm, Sr-em ye Sr-am values in the 4C, LAX, and 2C views. Conclusion: BAV might affect LV systolic functions, assessed by 2D strain imaging, in a fashion independent from the valvular dynamics and aortic elasticity. This might show that BAV is not only a valvular disease, but possibly a ventricular disease as well. The Journal of Heart Valve Disease 2012;21:608-614
  • Küçük Resim
    Öğe
    The correlation between infarct size and the QRS axis change after thrombolytic therapy in ST elevation acute myocardial infarction
    (2012) Karakaş, Mehmet Fatih; Bilen, Emine; Kurt, Mustafa; Arslantaş, Uğur; İpek, Göktürk; Karakaş, Esra; Yüksel, İsa Öner; Saatçi Yaşar, Ayşe
    Amaç: Elektrokardiyografi (EKG) ST yükselmeli akut miyokard infarktüsü (STYAMİ) ile gelen hastalarda prognostik infarkt genişliğini belirlemede pratik ve yönlendirici bir araç olabilir. Bu çalışma ile infarkt genişliği ile trombolitik tedavi sonrası QRS aks değişim miktarı arasında bir ilişki olup olmadığını bulmaya çalıştık. Gereç ve Yöntem: Bu çalışmada trombolitik tedavi alan STYAMİ hastaları retrospektif olarak seçildi. İki EKG’de (trombolitik tedavi öncesindeki ve tedavi sonrası 90. dakikadaki) ortalama QRS aksı bir formül yardımıyla hesaplandı. İnfarkt genişliğini belirlemede belirteç olarak kreatinin kinaz MB (CKMB) kullanıldı. Bulgular: Tüm Mİ altgrupları gözönüne alındığında infarkt genişliği ile QRS aksı değişimi arasında korelasyon saptamadık (p=0.80). Sadece izole inferior Mİ grubunda CKMB ile QRS aksı değişimi arasında iyi derece korelasyon saptadık (r=-0.52 p=0.049). Sonuç: QRS aksı değişimi, trombolitik tedavinin etkinliğinin değerlendirilmesinde ve prognostik infarkt genişliğinin belirlenmesinde çok vurgulanmamış, pratik ve gelecek vadeden bir araç gibi gözükmektedir.
  • Küçük Resim
    Öğe
    The Correlation between Infarct Size and the QRS Axis Change after Thrombolytic Therapy in ST Elevation Acute Myocardial Infarction
    (Aves, 2012) Karakas, M. Fatih; Bilen, Emine; Kurt, Mustafa; Arslantas, Ugur; Ipek, Gokturk; Karakas, Esra; Yuksel, Isa Oner
    Objective: Electrocardiography (ECG) may be a practical guiding tool for prognostic infarct sizing in ST elevation acute myocardial infarction (STEAMI). In this study, we sought to find a relation between the infarct size and the change in the QRS axis after thrombolytic therapy. Materials and Methods: Patients with STEAMI who received thrombolytic therapy were selected retrospectively. The mean QRS axes of two ECGs (before and 90 minutes after thrombolytic therapy) were calculated. Creatinine kinase MB (CKMB) was used as the marker of infarct size. Results: We did not detect any correlation between infarct size and change in the QRS axis with respect to any myocardial infarction MI localizations (p=0.80). However, in the isolated inferior MI group, there was a good correlation between CKMB and change in the QRS axis (r=-0.52 p=0.049). Conclusion: The change in the QRS axis is rarely emphasized, providing a practical and promising tool for evaluating both the efficiency of the thrombolytic therapy and prognostic infarct sizing.
  • [ N/A ]
    Öğe
    Optimal Timing of Valve Replacement in Asymptomatic Severe Aortic Stenosis
    (I C R Publishers, 2014) Bilen, Emine; Ipek, Gokurk; Ayhan, Huseyin; Nacar, Alper Bugra; Kasapkara, Haci Ahmet; Sari, Cenk; Basbug, Serdar
    Patients with asymptomatic severe aortic stenosis (AS) constitute a heterogeneous group which includes not only certain cases who are at high risk of sudden death and valve-related heart failure, but also those at low risk for these events. Degenerative AS, which includes a majority of patients with AS, is characterized by stricture of the valve, increased arterial stiffness, and diverse left ventricular response to the valvular plus arterial vascular load. In addition to using traditional primary parameters, the severity of AS and the total left ventricular load should be assessed using new measures such as energy loss index and valvulo-arterial impedance. Natriuretic peptide levels and global longitudinal strain imaging may also be used as secondary parameters to obtain information about left ventricular systolic function, although these parameters do not correlate with the severity of AS. Exercise stress testing and exercise echocardiography are also beneficial when assessing the patient if they are symptomatic, and for determining valvular and left ventricular contractile reserves. The aim of this review was to emphasize the importance of risk stratifications in asymptomatic severe AS cases, and to assess the severity of AS using not only conventional methods but also new methods on which much emphasis has been placed during recent years.
  • Küçük Resim
    Öğe
    Relation of presence and severity of metabolic syndrome with left atrial mechanics in patients without overt diabetes: a deformation imaging study
    (2014) Kurt, Mustafa; Tanboğa, İbrahim Halil; Büyükkaya, Eyüp; Karakaş, Mehmet Fatih; Akçay, Adnan Burak; Şen, Nihat; Bilen, Emine
    Objective: We aimed to investigate left atrium (LA) function by speckle tracking echocardiography in patients with metabolic syndrome (MetSyn) and to show a possible relationship between the severity of MetSyn and LA function and to determine the predictors of low strain in MetSyn patients. Methods: Our study design was observational and cross-sectional design consisted of 80 MetSyn patients without overt diabetes and 50 con- trols. The patients were classified into three groups based on the number of MetSyn criteria. The peak LA strain at the end of the ventricular systole (LAs-strain) as well as the LA strain with LA contraction (LAa-strain) was obtained. Correlation analysis performed to assess the asso- ciation of LA strain parameters with the severity of MetSyn and logistic regression analysis performed to assess the relationship of low LA strain with MetSyn. Results: Both LAs (37.5±8.7 vs. 26.0±10.2, p<0.001) and LAa (19.9±6.3 vs. 13.0±6.4, p<0.001) strain measurements were found to be significantly decreased in patients with MetSyn when compared to the control group. Moreover, both LAs and LAa were found to be significantly decreased with the increasing severity of the MetSyn. A multiple logistic regression analysis demonstrated that the presence of MetSyn [OR:0.26 (95% CI 0.06-0.89), p=0.032] and left ventricular ejection fraction [OR:1.14 (95% CI 1.03-1.27), p=0.021] were independent predictors of LAs strain. Conclusion: MetSyn is associated with reduced LAs strain and LAa strain representing LA reservoir and pump function, respectively. Furthermore, LA mechanical function decreases even more with the increasing severity of the MetSyn. (Anadolu Kardiyol Derg 2014; 14: 128-33)
  • Küçük Resim
    Öğe
    The relationship between atrial electromechanical delay and P-wave dispersion with the presence and severity of metabolic syndrome
    (2012) Kurt, Mustafa; Tanboğa, İbrahim Halil; Karakaş, Mehmet Fatih; Büyükkaya, Eyüp; Akcay, Adnan Burak; Şen, Nihat; Bilen, Emine
    Amaç: Bu çalışmada, atriyum içi ve atriyumlar arası elektromekanik gecikme (AEMG) ve P dalga dispersiyonu (PDD) ile metabolik sendrom (MetS) varlığı ve şiddeti arasındaki ilişki incelendi. Çalışma planı: Çalışmaya MetS olan (n=72) ve olmayan (kontrol grubu, n=72) toplam 144 hasta alındı. MetS ciddiyetinin belirlenmesi için hastalar MetS ölçütlerinin sayısına göre üç gruba ayrıldı: Grup 1 (üç ölçütlü hastalar), Grup 2 (dört ölçütlü hastalar) ve Grup 3 (beş ölçütlü hastalar). Hastaların 12 derivasyonlu elekrokardiyografilerinden PDD ve doku Doppler parametrelerinden kulakçıklar arası ve kulakçıklar içi AEMG hesaplandı. Bulgular: Kulakçılar arası AEMG (22.9±15 ve 11.5±14, p<0.001) ve kulakçık içi AEMG değerleri (23.6±12 ve 8.3±19, p<0.001) MetS’li hastalarda, kontrol grubuna göre anlamlı olarak daha uzun bulundu. Benzer şekilde, PDD değerleri kontrol grubu ile karşılaştırıldığında MetS’li hastalarda anlamlı olarak daha uzun bulundu (49±25 ve 36±24, p=0.001). Ancak, kulakçıklar arası ve içi AEMG ve PDD’nin MetS şiddeti ile ilişkisi gösterilemedi. Korelasyon analizinde, atriyumlar arası AEMG ve atriyum içi AEMG daha çok sol ventrikül kitle indeksi ve sol atriyum hacim indeksi ile, P dalga dispersiyonu ise daha çok mitral Doppler parametreleri ile ilişkili bulundu. Çoklu değişken analizi sonucu, atriyumlar arası AEMD için, HDL-K, sistolik ve diyastolik kan basıncı bağımsız öngördürücüler olarak bulunurken; E/A ve LDL için bu değerler istatistiksel anlamlılık sınırında kaldı. Kulakçık içi AEMD için ise sistolik ve diyastolik kan basıncı, beden kitle indeksi ve E/A bağımsız öngördürücüler olarak bulundu. Sonuç: MetS’li hastalarda kulakçıklar arası ve kulakçık içi AEMG ve PDD, kontrol grubuna kıyasla daha uzundur. Fakat bu uzamanın MetS ciddiyeti ile ilişkisi yoktur.