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Öğe Atrial Electromechanical Coupling Interval and P-Wave Dispersion in Patients With White Coat Hypertension(Taylor & Francis Inc, 2012) Yildirim, Nesligul; Simsek, Vedat; Tulmac, Murat; Ebinc, Haksun; Dogru, Mehmet Tolga; Alp, Caglar; Simsek, FadimeBackground. The aim of our study was to investigate the effect of white coat hypertension (WCH) to atrial conduction abnormalities by electrocardiographic P-wave analysis and echocardiographic electromechanical coupling (EMC) interval measurement. Methods. The study consisted of sex-, age-, and body mass index-matched 24 patients with WCH, 24 patients with sustained hypertension (SH), and 24 subjects with normotension (NT). The difference between the maximum (Pmax) and minimum P-wave durations on 12-lead electrocardiography was defined as P-wave dispersion (PD). Intra- and inter-atrial EMC were measured by tissue Doppler imaging. Results. Pmax and PD of subjects with WCH were significantly higher than those of normotensives and lower than those of patients with SH. Inter-atrial EMC and left atrial EMC values of WCH group were intermediate between NT and SH groups. There was a significant correlation between left atrial diameter, PD, Pmax, left ventricle mass index, left atrial EMC, and inter-atrial EMC. Conclusion. White coat hypertension is an intermediate group between SH and NT in terms of atrial electromechanical abnormalities which may be associated with the risk of atrial fibrillation.Öğe The comparison of the relationships about the presence of branch retinal vein occlusion and endothelial functions between diabetic and non-diabetic patients(Lippincott Williams & Wilkins, 2019) Demir, Vahit; Dogru, Mehmet Tolga; Onaran, Zafer; Kandemir, Huseyin; Alp, CaglarObjectives The aim of this study was to investigate the endothelial functions in both patients with diabetics and non-diabetics with branch retinal vein occlusion by using pulse wave analysis and flow-mediated dilatation methods. Patients and methods This cross-sectional study included a total of 136 participants (47 diabetic patients with branch retinal vein occlusion, 43 non-diabetic patients with branch retinal vein occlusion, and 46 otherwise healthy subjects). Evaluation of endothelial functions was performed by flow-mediated dilatation and pulse wave analysis methods. Stiffness index, reflection index (RI), and pulse propagation time were calculated. Results The mean stiffness index and RI were significantly higher in the diabetic branch retinal vein occlusion group compared with the non-diabetic branch retinal vein occlusion and the healthy controls (for stiffness index: 11.5 +/- 2.8 vs. 10.1 +/- 2.5 and 8.3 +/- 2.0, P < 0.001; and for RI: 75.1 +/- 11.7 vs. 65.4 +/- 8.4 and 60.2 +/- 18.8, P < 0.001, respectively), whereas the pulse propagation time was significantly lower in the diabetic group (156.4 +/- 32.3 vs. 174.4 +/- 46.5 and 205.0 +/- 58.5, P < 0.001, respectively). There was a significant negative correlation between visual acuity and stiffness index (r = -0.512, P < 0.001). Besides, there was also a significant positive correlation between visual acuity and pulse propagation time (r = 0.398, P < 0.001). Conclusion This study demonstrated that the stiffness index and RI values were higher in patients with branch retinal vein occlusion compared to the healthy subjects. Copyright (C) 2019 Wolters Kluwer Health, Inc. All rights reserved.Öğe The effects of treatment with atorvastatin versus rosuvastatin on endothelial dysfunction in patients with hyperlipidaemia(Clinics Cardive Publ Pty Ltd, 2018) Demir, Vahit; Dogru, Mehmet Tolga; Ede, Huseyin; Yilmaz, Samet; Alp, Caglar; Celik, Yunus; Yidirim, NesligulIntroduction: Statins can reduce cardiovascular events and improve endothelial function, However. differences in the effect of statins on endothelial dysfunction have not been researched sufficiently. Here. we aimed to compare the effects of atorvastatin Versus rosuvastatin on endothelial function via flow-mediated ',aid endothelial-independent dilation. Methods: Hyperlipidaemic subjects on treatment with statins for one year (either 20 mg/day atorvastatin or 10 mg/day rosuvastatin) were enrolled in the study. In accordance with the literature, flow-mediated dilation (FMD) and nitrate-mediated endothelium-independent dilation (EID) were measured by ultrasonography on the right brachial artery of each subject. Baseline and final measurements were compa red to each group and between the groups. Results: One hundred and four subjects (50 atorvastatin and 54 rosuvastatin users) were enrolled in the study. Fifty-eight subjects were female. The groups were statistically similar in terms of age and body mass index, and haemoglobin, creatinine, total cholesterol, triglyceride, high-density lipoprotein and low-density lipoprotein cholesterol levels. In each group, the mean final FMD and LID values were higher compared to their respective baseline values. but the mean changes in FMD and EID were statistically similar in both groups (p = 0.958 for FMD and 0.827 for EID). There was no statistically significant difference between the atorvastatin and rosuvastatin groups in terms of final FMD and EID values (p = 0.122 and 0.115. respectively). Conclusion: This study demonstrated that both one-year atorvastatin and rosuvastatin treatments significantly improved endothelial function, when assessed with FMD and FAD and measured by ultrasonography. However, the amount of improvement in endothelial dysfunction was similar in the two treatments.Öğe Endothelial and Autonomic Functions in Patients with Migraine(OXFORD UNIV PRESS, 2020) Dogru, Mehmet Tolga; Dilekoz, Ergin; Alpua, Murat; Eroglu, Oguz; Kandemir, Hilseyin; Alp, Caglar; Bolay, HayrunnisaObjective It has been shown that patients with migraine have endothelial dysfunction. Migraine patients with aura, especially, have more clinical manifestations of autonomic nervous system dysfunction. We aimed to evaluate the endothelial and autonomic functions in migraine patients during both migraine headache attack and headache-free periods. Design This was a cross-sectional, randomized study. Subjects and Methods A total of 130 participants (67 male and 63 female patients, minimum age = 19 years, maximum age = 71 years, mean age = 38.812.2years) were enrolled into the study. For the statistical evaluation of data, we classified the participants of the study as follows: group 1: headache (+) aura (+); group 2: headache (+) aura (-); group 3: headache (-) aura (+); group 4: headache (-) aura (-). Noninvasive evaluation of endothelial function was performed by flow-mediated dilation (FMD) and pulse wave analysis methods. Heart rate variability measurements were used for noninvasive evaluation of autonomic functions. Results Group 1 had a higher FMD ratio than the control group, group 3, or group 4 (P<0.001, P<0.001, and P=0.003, respectively). Group 4 had lower FMD ratio levels than the other migraine groups and or the control group (P<0.001). Group 3 had the highest high-frequency (HF) power levels among all migraine groups (P<0.001). Group 2 had higher low-frequency/HF ratio values than other migraineurs (P<0.001). Conclusions We concluded that endothelial dysfunction and headache are closely related. Additionally, higher parasympathetic tonus might be associated with the presence of aura.Öğe Heart rate turbulence measurements in patients with dipper and non-dipper hypertension: the effects of autonomic functions(Tubitak Scientific & Technological Research Council Turkey, 2021) Alp, Caglar; Dogru, Mehmet Tolga; Demir, VahitBackground/aim: Hypertensive patients have shown autonomic dysfunction that is closely associated with the measurements of heart rate variability (HRV) and heart rate turbulence (HRT). We aimed to show the alterations of HRV and HRT measurements in patients with both dipper and non-dipper hypertension. Materials and methods: This was a retrospective study consisting of one hundred and twenty-three participants (mean age +/- SD, 55.7 +/- 14.8 years; range, 18-90 years). The participants were divided into two groups: Group1: The patients with dipper hypertension, Group2: The patients with non-dipper hypertension. Two cardiologists performed HRV and HRT using 24-h electrocardiography (ECG) Holter and ambulatory blood pressure monitoring (ABPM) of patients. Results: The results indicated that patients in group 2 had higher low frequency power/high frequency power ratio (LF/HF), lower high frequency power (HF) , root mean square of standard deviation (RMSSD) values than group 1 (p = 0.007, p = 0.008, and p = 0.002, respectively). Group 2 also showed higher heart rate turbulence onset (HRTTO) and lower heart rate turbulence slope (HRTTS) values than Group 1 (p = 0.004, p = 0.001, respectively). We performed multivariate analysis and observed that HRTTS and HRTTO have statistically significant associations with the presence of dipper or non-dipper hypertension [F = 7.755, p = 0.001], LF/HF [F = 7.868, p = 0.001], and HF [F = 4.081, p = 0.020]. Conclusion: This study shows a statistically significant difference in HRT measurements between dipper and non-dipper hypertensive patients. Deteriorated autonomic circadian rhythm and autonomic functions may contribute to these results.Öğe Hyperhomocysteinemia Predicts the Severity of Coronary Artery Disease as Determined by the SYNTAX Score in Patients with Acute Coronary Syndrome(Taiwan Soc Cardiology, 2018) Karadeniz, Muhammed; Sarak, Toner; Duran, Mustafa; Alp, Caglar; Kandemir, Huseyin; Celik, Ibrahim Etem; kilic, AlparslanBackground: Hyperhomocysteinemia is a known risk factor for acute coronary syndrome (ACS) and is related with the severity of coronary artery disease (CAD). Previous studies have used less quantifiable scoring systems for assessing the severity of CAD. Therefore, we aimed to assess the relationship between homocysteine levels and SYNTAX score (SXscore), which is currently more widely used to grade the severity of CAD. Methods: A total of 503 patients with adiagnosis of ACS were examined angiographically with SXscore. The patients were divided into three groups according to SXscore; Group 1 a low SXscore <= 22), Group 2 a moderate SXscore (23-32), and Group 3 a high SXscore (>= 33). Results: Plasma homocysteine levels were 16.3 +/- 6.2 nmol/mL in Group 1, 18.1 +/- 9.6 nmol/mL in Group 2, and 19.9 +/- 9.5 nmol/mL in Group 3. Homocysteine levels were significantly higher in Group 2, and Group 3 compared to Group 1 (p = 0.023 and 0.007, respectively). In the correlation analysis, homocysteine levels were correlated with SXscore (r: 0.166, p < 0.01). Conclusions: Serum homocysteine levels on admission were associated with an increased severity of CAD in the patients with ACS.Öğe Influence of circadian blood pressure alterations on serum SCUBE-1 and soluble CD40 ligand levels in patients with essential hypertension(E-Century Publishing Corp, 2019) Guzel, Murat; Dogru, Mehmet Tolga; Simsek, Vedat; Demir, Vahit; Alp, Caglar; Kandemir, Huseyin; Kisa, UclerBackground: Dipper and non-dipper hypertension are different clinical forms of essential hypertension. In this study, the effect of circadian blood pressure changes on serum SCUBE-1 and soluble CD40 ligand (sCD40L) levels was investigated in patients with hypertension. Methods: A total of 100 participants aged 23-89 years were included in the study. Patients with essential hypertension were followed up by ambulatory blood pressure measurement. Results: Serum SCUBE1 levels were significantly higher in the non-dipper group than in the normal group (P < 0.001). Dipper and non-dipper patients had significantly higher serum sCD40L levels when compared to the normal group (P = 0.048 and P = 0.035, respectively). We also found a positive correlation between SCUBE1, sCD40L levels and 24-hour mean systolic blood pressure levels (r: 0.232, p: 0.034 and r: 0.241, p: 0.027, respectively). Conclusion: Serum SCUBE1 and sCD40L levels were higher in hypertensive patients than normal participants. Serum SCUBE1 levels were higher in patients with non-dipper compared to other participants.Öğe Investigation of heart rate variability and heart rate turbulence in chronic hypotensive hemodialysis patients(SPRINGER, 2020) Yalim, Zafer; Demir, Mehmet Emin; Yalim, Sumeyra Alan; Alp, CaglarBackground Sudden cardiac death is the leading cause of cardiac-related death in hemodialysis patients. Hypotensive episodes in pre-, intra-, and post-dialytic periods can present serious clinical challenges that affect a patient's quality of life and prognosis. The aim of the present study was to evaluate cardiac autonomic control and arrhythmogenic risk by analyzing 24-h heart rate variability (HRV) and heart rate turbulence (HRT) in hypotensive hemodialysis patients. Methods A total of 79 patients on maintenance hemodialysis treatment, 39 normotensive and 40 with frequent hypotension episodes during non-dialysis periods, were included in the study. Dialysis-free periods were recorded with a 24-h Holter rhythm and ambulatory blood pressure monitor device. The time-domain parameters of HRV and HRT, including turbulence onset (TO) and turbulence slope (TS), were calculated. Results Values for SDNN (105.5 +/- 7.02, 127.6 +/- 6.2 p < 0.001), SDANN (95.1 +/- 5.9, 111.8 +/- 5.01 p < 0.001), and SDNN index (50.04 +/- 2.7, 55.6 +/- 3.7 p = 0.03), in the hypotensive group were significantly lower than in the normotensive group, respectively. Values for RMSSD (26.5 +/- 2.5, 27.3 +/- 2.7 p = 0.178), pNN50 (17 +/- 1.7, 55.6 +/- 3.7 p = 0.03), and TI (35.1 +/- 3.1, 34.7 +/- 2.6 p = 0.542) in both groups were not significantly different; however, there was a significant difference between HRT parameters, TO (- 1.8 +/- 0.37, - 2.4 +/- 0.39 p < 0.001) and TS (6.9 +/- 0.71, 8.2 +/- 0.97 p < 0.001), respectively, hypotensive and normotensive group. Conclusion Dialysis patients that experience frequent hypotensive episodes may also undergo significant changes in HRT and HRV which may be indicative of serious cardiac sequela. Thus, in such cases, a complete cardiologic evaluation is warranted.Öğe Predictors of Severity of Coronary Artery Disease in Patients with Acute ST-elevation Myocardial Infarction(Galenos Publ House, 2024) Karadeniz, Muhammed; Aydin, Cihan; Demirkiran, Aykut; Alp, CaglarAim: Our study aims to investigate the relationship between platelet-lymphocyte ratio (PLR), neutrophil/lymphocyte ratio (NLR), and the correlation between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) scores. Materials and Methods: The patients were divided into three groups according to their SYNTAX score. Group 1 included patients with a SYNTAX score <23, group 2 with a SYNTAX score of 23-32, and group 3 with a SYNTAX score of >33. PLR was calculated as the ratio of platelet count to lymphocyte count. Results: In multivariate logistic regression analysis, high PLR and NLR ratios and older age were independent predictors of high SYNTAX score II [odds ratio (OR): 1.052; 95% confidence interval (CI): (0.998-1.119), p=0.011; OR: 1.093; 95% CI: (1.016-1.175), p=0.016; OR:1.023; 95% CI: (1.0101.038), p=0.001, respectively. Patients with high PLR had significantly higher SYNTAX scores [121.7 (114.2-129.3) in group 1; 139.4 (125.9-153.0) in group 2, 187.0 (141.8-232.2) in group 3; p<0.001], and there was a positive correlation between PLR, NLR and SYNTAX scores (r=0.52, p<0.001; r=0.58, p<0.001, respectively). Conclusion: PLR and NLR were associated with the severity and complexity of coronary artery disease in patients with acute ST-elevation myocardial infarction.Öğe Serum pentraxin-3 levels and flow-mediated dilation in dipper and non-dipper hypertension(Wiley, 2019) Alp, Caglar; Dogru, Mehmet Tolga; Karadeniz, Muhammed; Sarak, Taner; Demir, Vahit; Celik, Yunus; Kisa, UclerBackground Endothelial dysfunction is one of the main pathological processes of hypertension. The association of serum pentraxin-3 (PTX3) levels and endothelial dysfunction becomes a more interesting scientific research issue due to high potential of PTX3 as a diagnostic and prognostic biomarker. We aimed to investigate the relationship between serum PTX3 levels and flow-mediated dilation results in patients with dipper and non-dipper hypertension. Methods This study included 90 hypertensive patients were divided into two groups based on 24 hours ambulatory blood pressure monitoring (ABPM): 38 patients with a dipper pattern and 52 patients with non-dipper pattern. Noninvasive evaluation of the endothelial functions was performed using flow-mediated dilation (FMD) method. Results Serum pentraxin-3 levels were higher in patients with non-dipper HT compared to dipper hypertension (P = 0.028). In addition, we found negative correlation between serum PTX3 and FMD basal/FMD hyperemia ratio (r = -0.297, P = 0.05 for FMD basal/FMD hyperemia ratio, respectively). Conclusions Serum PTX3 levels are closely related with the measures of indirect noninvasive evaluation methods (FMD) in both DH and NDH patients.Öğe The effects of trastuzumab therapy on endothelial functions of breast cancer patients(Assoc Medica Brasileira, 2024) Alp, Caglar; Dogru, Mehmet Tolga; Yalcin, Selim; Karal, Ali OguzhanOBJECTIVE: Breast cancer is among the highest causes of morbidity and mortality in women. Trastuzumab therapy, which is known to be significantly cardiotoxic, is mainly used to treat patients with resistant breast cancer, including estrogen receptor-positive type. We aimed to show the effects of METHODS: In this study, a total of 26 participants (24 female and 2 male patients, minimum age: 38 years, maximum age: 79 years, and mean age 57.3 +/- 12.7 years) were enrolled in the study. For the statistical evaluation of data, we classified the participants of the study as follows: Pretreatment: Before trastuzumab therapy; Treatment Period 1: 1 month after the first dose of trastuzumab; Treatment Period 2: 4 months after the first dose of trastuzumab; Treatment Period 3: 12 months after the first dose of trastuzumab. We conducted repeated-measures analysis of variance (Greenhouse-Geisser) and paired-sample t-tests to statistically compare the groups using flow-mediated dilation measurements. RESULTS: We determined that there are statistically significant differences between flow-mediated hyperemia and ratio values (flow-mediated dilation) of the groups (p<0.009 and p<0.001, respectively). CONCLUSION: Our data indicate that trastuzumab therapy could have negative effects on endothelial functions in breast cancer patients.
