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    Effect of Remote Ischemic Postconditioning on Left Ventricular Mechanics
    (Wiley, 2015) Nacar, Alper Bugra; Topcu, Selim; Kurt, Mustafa; Tanboga, Ibrahim Halil; Karakas, Mehmet Fatih; Buyukkaya, Eyup; Aksakal, Enbiya
    BackgroundRemote ischemic postconditioning (RIPC) decreases infarct size and prevents left ventricular (LV) remodeling in patients with myocardial infarction. However, there is no study that evaluates the effect of RIPC on LV mechanics assessed by speckle tracking echocardiography. Therefore, we aimed to test the effects of RIPC on LV deformation parameters such as strain, strain rate, rotation, and twist in healthy subjects. MethodsThe study group consisted of 22 healthy subjects. To test the effects of RIPC, 3 cycles of reperfusion followed by ischemia (each lasting 10 or 30seconds) were applied immediately after 20minutes of nondominant arm ischemia. Transthoracic echocardiography (TTE) was obtained at baseline and repeated 30minutes after the completion of these cycles. In TTE images, apical 4-3-2 chamber longitudinal strain (LS)/strain rate, basal and apical circumferential strain/strain rate, and rotational parameters, such as basal rotation, apical rotation, and LV twist, were recorded. ResultsApical 4-3-2 chamber LS and apical circumferential strain/strain rate measurements were comparable before and after RIPC, whereas basal circumferential strain was significantly decreased after RIPC (-233.4 vs. -18.9 +/- 6.9, P=0.017). After RIPC, apical rotation was significantly increased (11.6 +/- 3.7 vs. 16.7 +/- 4.0, P<0.001) and basal rotation was significantly decreased (-6.1 +/- 2.1 vs. -4.7 +/- 2.4, P=0.03).Consequently, net LV twist was significantly increased (17.4 +/- 4.5 vs. 21.7 +/- 4.7). ConclusionsWe proposed that RIPC affects the rotational mechanics of the heart rather than longitudinal mechanics. These results might give new insights into understanding the favorable effects of the post- conditioning.
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    Left ventricular systolic dysfunction in patients with ankylosing spondylitis without clinically overt cardiovascular disease by speckle tracking echocardiography
    (Springer Heidelberg, 2015) Ustun, Nilgun; Kurt, Mustafa; Nacar, Alper Bugra; Karateke, Hacer Paksoy; Guler, Hayal; Turhanoglu, Ayse Dicle
    The aim of this study was to evaluate left ventricular systolic and diastolic function using speckle tracking echocardiography (STE) in order to detect subclinical left ventricular dysfunction in patients with ankylosing spondylitis (AS). Twenty-six AS patients (age 43.7 +/- A 11.8 years, disease duration 11.83 +/- A 10.98 years) and 26 healthy controls, matched for age, sex, body mass index, and smoking, were enrolled in this cross-sectional study. All patients underwent two-dimensional, Doppler, tissue Doppler, and speckle tracking echocardiography. The mitral early/late diastolic inflow velocity ratio (1.0 +/- A 0.4 vs. 1.5 +/- A 0.5; p < 0.001) and the mitral E-wave velocity (8.1 +/- A 2 vs. 11.1 +/- A 3; p < 0.001) were lower in the AS patients than in the controls. The ejection fraction did not differ between the patients and controls (64 +/- A 4.2 vs. 64.8 +/- A 2.3; p = 0.402). All segments showed a significant decrease in left ventricular diastolic and systolic strain values in the patients with AS when compared with the healthy controls (p < 0.001). Despite no clinical evidence of cardiovascular disease, patients with AS may have impaired left ventricular systolic function as assessed by STE.
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    Mitral Valve Resistance Correlates More Closely with Left Atrial Deformation than with Conventional Indices of Rheumatic Mitral Stenosis
    (I C R Publishers, 2013) Kurt, Mustafa; Tanboga, Ibrahim Halil; Karakas, Mehmet Fatih; Buyukkaya, Eyup; Nacar, Alper Bugra; Akcay, Adnan Burak; Aksakal, Enbiya
    Background and aim of the study: The relationship between mitral valve (MV) resistance and left atrial (LA) mechanical function is unknown. Hence, the study aim was to investigate the relationship between LA mechanics and MV resistance, compared to conventional indices such as mitral valve area (MVA) and transmitral gradient, in patients with rheumatic mitral stenosis (MS). Methods: The study population consisted of 73 patients with MS and 30 age- and gender-matched controls. MV resistance was calculated and LA strain parameters were assessed from the apical four-chamber view by speckle tracking echocardiography (LA reservoir strain, LA pump strain, LA strain rate (SR)) in all subjects. Results: The MS group has a markedly higher MV resistance (94 +/- 46 versus 67 +/- 22 dynes.s.cm(-5), p = 0.003) and lower LA reservoir strain (24.5 +/- 7.4% versus 36.6 +/- 3.8%, p <0.001), LA pump strain (12.0 +/- 5.0% versus 17.1 +/- 3.4%, p <0.001) and SR (1.23 +/- 0.33 versus 1.4 +/- 0.29, p = 0.017) values compared to controls. Moreover, both LA reservoir strain and LA pump strain correlated with MV resistance more closely than did MVA and transmitral gradients. Multiple linear regression analysis revealed only MV resistance to be an independent predictor of LA reservoir strain, while MV resistance, indexed left atrial volume and mean gradient were independent predictors of LA pump strain. Conclusion: It can be concluded that, in patients with MS, mitral valve resistance was more closely related to LA mechanics measurements than were conventional indices of MS.
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    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.
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    Relation of Fragmented QRS to Tissue Doppler-Derived Parameters in Patients with Familial Mediterranean Fever
    (Elsevier Science Inc, 2013) Celik, Muhammet Murat; Buyukkaya, Eyup; Ustun, Nilgul; Nacar, Alper Bugra; Kurt, Mustafa; Karakas, Mehmet Fatih; Bilen, Perihan
    [Abstract Not Available]
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    Relation of fragmented QRS to tissue Doppler-derived parametersin patients with familial Mediterranean fever
    (Springer Wien, 2015) Celik, Muhammet Murat; Buyukkaya, Eyup; Ustun, Nilgul; Nacar, Alper Bugra; Kurt, Mustafa; Karakas, Mehmet Fatih; Bilen, Perihan
    Familial Mediterranean fever (FMF) may pose a risk for cardiovascular diseases due to continuous inflammatory status observed during the course of the disease. Recently, the presence of fragmented QRS (fQRS) has been recognized as a predictor of myocardial fibrosis. In this study, we aim to investigate the frequency of fQRS and its relation to Doppler-based indices. This study consisted of 80 FMF patients and 30 healthy control subjects. fQRS pattern was defined as the presence of additional R waves or RSR', evidenced by notched R or S wave on electrocardiography (ECG). The patient and the control groups underwent conventional echocardiography and tissue Doppler echocardiography. There was no significant difference between groups regarding age (29 +/- 12 vs 29 +/- 15). FMF patients exhibited a statistically higher frequency of fQRS (% 56 vs % 13) (p < 0.01). E/Em ratio showed a statistically significant increase in the FMF group with fQRS (p < 0.0001), while the mean Em value was markedly lower (p < 0.0001). FMF patients displayed a statistically significant increase in frequency of fQRS. Doppler-derived diastolic index was statistically significantly impaired in FMF patients with fQRS as compared with the patients without fQRS. In conclusion, fQRS might be a new noninvasive marker for cardiac involvement in FMF patients.
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    Relation of red cell distribution width with dipper and non-dipper hypertension
    (Medical Association of Zenica-Doboj Canton, 2016) Buyukkaya, Eyup; Erayman, Ali; Karakas, Esra; Nacar, Alper Bugra; Kurt, Mustafa; Buyukkaya, Sule; Akcay, Adnan Burak
    Aim Red cell distribution width (RDW), an index of erythrocyte size, is associated with high risk for cardiovascular disease. Nondipping hypertension (HT) is lack of nocturnal fall in blood pressure (BP). The association between RDW and non-dipping BP in normotensive and hypertensive patients was investigated. Methods A total of 170 patients were categorized into 4 groups: Normotensive-Dipper (NT-D), Normotensive-Non-dipper (NTND), Hypertensive-Dipper (HT-D) and Hypertensive-Non-dipper (HT-ND). RDW and hs-CRP levels were measured. Results Hypertensive patients had higher RDW and hs-CRP levels (14.5 ± 0.87 vs.12.7 ± 0.66, p<0.001 for RDW; 0.99 ± 0.52 vs.0.63 ± 0.43, p<0.001 for hs-CRP). Besides, the RDW levels were higher in non-dippers (13.0 ± 0.63 vs.12.4 ± 0.55, p<0.001 for NT-ND and NT-D; 14.9 ± 0.78 vs.14.2 ± 0.82, p<0.001 for HT-ND and HT-D) Conclusion RDW is elevated in non-dipping BP both in normotensive and hypertensive subjects, which may be related with increased inflammatory state. © 2016, Medical Association of Zenica-Doboj Canton. All rights reserved.
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    The Relationship between Coronary Collateral Circulation and Neutrophil/Lymphocyte Ratio in Patients with Coronary Chronic Total Occlusion
    (Karger, 2015) Nacar, Alper Bugra; Erayman, Ali; Kurt, Mustafa; Buyukkaya, Eyup; Karakas, Mehmet Fatih; Akcay, Adnan Burak; Buyukkaya, Sule
    Objectives: To investigate the relationship between neutrophil/lymphocyte ratio (NLR) and coronary collateral circulation (CCC) in patients with coronary chronic total occlusion. Subjects and Methods: Our study population consisted of 275 consecutive patients with chronic total occlusion. One hundred and thirty-eight patients with chronic total occlusion were included in the study. They were classified into 2 groups as follows: impaired CCC (group 1: Rentrop grades 0-1) and good CCC (group 2: Rentrop grades 2-3). The NLR was calculated from the complete blood count. Results: The NLR values of the patients with impaired CCC (4.5 +/- 0.7) were significantly higher than of those with good CCC (2.7 +/- 0.6, p < 0.001). In the multivariate logistic regression test, NLR (OR 33.36, 95% CI 8.189-135.7, p < 0.001), high-sensitivity C-reactive protein (hs-CRP; OR 2.152, 95% CI 1.226-3.777, p = 0.008), estimated glomerular filtration rate (OR 1.167, 95% CI 1.049-1.298, p = 0.004) and systolic blood pressure (OR 1.068, 95% CI 1.009-1.1310, p = 0.025) were independent predictors of impaired CCC. The NLR value > 3.55 yielded an area under the curve value of 0.957 (95% CI 0.921-0.992, p < 0.001) and demonstrated a sensitivity of 95% and a specificity of 90% for the prediction of CCC. A moderate correlation between NLR and hs-CRP was observed (r = 0.443; p < 0.001). Conclusion: Our findings reveal that NLR correlates with the impaired development of coronary collaterals. (C) 2014 S. Karger AG, Basel