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Öğe Aort darlığında anjiyotensin dönüştürücü enzim geni insersiyon/delesyon polimorfizminin fonksiyonel kapasite belirteçleri ve ekokardiyografik parametrelerle ilişkisi(2012) Tulmaç, Murat; Şimşek, Vedat; Şimşek, Fadime; Yazıcı, Hüseyin Uğur; Poyraz, Fatih; Turfan, Murat; Çengel, AtiyeAmaç: Fonksiyonel durumda bozulma aort darlığının doğal seyrinde kritik bir nokta olup kapak değişimi operasyonun en önemli endikasyonunu oluşturur. Bu çalışmada hafif ve orta dereceli aort darlığı (AD) olan hastalarda anjiyotensin dönüştürücü enzim (ADE) geni insersiyon/delesyon (I/D) polimorfizminin fonksiyonel kapasite belirteçleri ve ekokardiyografide sol ventrikül fenotipi ile ilişkisi araştırıldı. Gereç ve Yöntem: Ekokardiyografi ile doğrulanmış hafif-orta dereceli AD’si olan 22 asemptomatik hastanın ADE gen polimorfizmleri ile fonksiyonel kapasiteleri New York Kalp Cemiyeti sınıflaması, 6 dakika yürüme testi, plazma NT-proBNP ölçümleri yapılarak değerlendirildi. Bulgular: Yaş, hipertansiyon, dejeneratif darlık ve aort kapak kalsifikasyonu daha kötü fonksiyonel kapasiteyle ilişkili bulundu (p0.05). ADE gen polimorfizmi ile fonksiyonel kapasite arasında ilişki saptanmadı. DD genotipi normotansif hastalarda egzantrik şekillenmeyle ilişkili bulundu (p:0,03) Hipertansif hastalarda ve 40 yaş üzeri DD genotipli hastalarda daha belirgin sol ventrikül hipertrofisi saptandı (sırasıyla 190,122,2g/m2 vs 132,112,8g/m2; p:0,004 ve 181,929,6g/m2 vs 143,836,3g/m2; p:0,02) . Sonuç: Yaşlı, hipertansif, dejeneratif veya kalsifik hafif orta dereceli AD’si olan hastaların fonksiyonel kapasitenin bozulması açısından daha yakın takip edilmeleri uygun olabilir. DD genotipli hipertansif ve 40 yaş üstünde hafif-orta dereceli aort darlığı olan hastalarda sol ventrikül hipertrofisi daha belirgindir.Öğe Depresyon Hastalarında Endotel Fonksiyonları, Ekokardiyografik Parametreler ve Damar Sertliğine Antidepresan Tedavinin Etkisi(Kırıkkale Üniversitesi, 2013) Tulmaç, Murat; Özdemir, Hatice; Şahin, Ömer; Poyraz, Fatih; Şimşek, Vedat; Canlı, DeryaIncreasing evidence reveals that depression is emerging as an independent cardiovascular disease (CVD) risk factor. We investigated whether treating depression with seratonin reuptake inhibitors (SSRI) would effect echocardiographic systolic and diastolic functions, in addition endothelial function and arterial stiffnes indexes which are known CVD risk factors Fourtyone patients who were prescribed SSRI therapy for the first time due to major depression without known CVD and between 16-65 years of age were included. At the beginning of the study and after 8 weeks of SSRI therapy patients were underwent echocardiographic analysis of systolic and diastolic parameters, myocardial performance index (MPI) and aortic strain (Ao strain). Also by finger plethysmography with the aid of an auto-analyser pulse wave analysis were done and pulse propagation time (PPT), stiffness index (SI) and reflection index (RI) were measured. Endothelial functions were estimated with flow mediated dilatation method. Nineteen patients (46.3%) came to control visit after 8 weeks of therapy and the final analysis was done with their results. Compared to beginning, 8 weeks of therapy with SSRI resulted in an increase in systolic ejection fraction (%64,83±4,54 vs %66,80±3,3, p=0,020) and fractional shortening (%35,39±3,53 vs %37,11±2,49, p=0,013) and decrease in MPI (0,60±0,21 vs 0,45±0,15, p=0,004). The other parameters including left ventricular diastolic functions, aortic strain, endothelial function and aortic stiffness parameters were not significantly effected. Our results imply that short term therapy with SSRI in patients with newly diagnosed depression might favorably effect the left ventricular systolic functions whereas left ventricular diastolic functions, endothelial functions and aortic stifness parameters remain unchanged.Öğe The effect of dexmedetomidine on myocardial ischemia reperfusion injury in streptozotocin induced diabetic rats(Anaesthesia Pain & Intensive Care, 2015) Arslan, Mustafa; Poyraz, Fatih; Kiraz, Hasan Ali; Alkan, Metin; Kip, Gülay; Erdem, Özlem; Çomu, Faruk MetinObjective: Ischemia/reperfusion (I/R) injury is an important cause of myocardial damage by means of oxidative, inflammatory, and apoptotic mechanisms. The aim of the present study was to examine the potential cardio-protective effects of dexmedetomidine in a diabetic rat model of myocardial I/R injury. Methodology: A total of 18 streptozotocin (55 mg/kg) induced diabetic Wistar Albino rats were randomly divided into three equal groups as follows: the diabetic I/R group (DIR) in which myocardial I/R was induced by ligating the left anterior descending (LAD) coronary artery for 30 min, followed by 2 hours of reperfusion following left thoracotomy, the diabetic I/R dexmedetomidine group (DIRD) which were given 100 mu g/kg dexmedetomidine intraperitoneally 30 min before I/R induction by the same method and the diabetic control group (DC) which underwent sham operations without tightening of the coronary sutures. As a control group (C), 6 healthy age-matched Wistar Albino rats underwent sham operations similar to DC group. After the operation the rats were sacrificied and the myocardial tissues were histopathologically examined. Results: Microscopic myonecrosis findings were significantly different among groups (p= 0.008). Myonecrosis findings were significantly higher in DIR compared to C, DC and DIRD groups (p= 0.001, p=0.007 and p=0.037 respectively). Similarly microscopic inflammatory cell infiltration degrees showed significant differences among groups (p<0.0001). Compared to C, DC and DIRD groups, the microscopic inflammatory cell infiltration was significantly higher among DIR group (p<0.0001, p<0.0001 and p=0.009 respectively). Also myocardial tissue edema was significantly different among groups (p=0.002). The microscopic myocardial tissue edema levels were significantly higher in DIR group than C and DIRD groups (p<0.0001 and p=0.022 respectively). Tissue edema was also more prominent in DC compared to C group (p=0.022) Conclusion: Taken together our data indicate that dexmedetomidine may be helpful in reducing myocardial necrosis, myocardial inflammation and myocardial tissue edema resulting from ischemia/reperfusion injury.Öğe The effect of levosinnendan on myocardial ischemia reperfusion injury in streptozotocin-induced diabetic rats(Co-Action Publishing, 2015) Kiraz, Hasan Ali; Poyraz, Fatih; Kip, Gulay; Erdem, Ozlem; Alkan, Metin; Arslan, Mustafa; Comu, Faruk MetinObjective: Ischemia/reperfusion (I/R) injury is an important cause of myocardial damage by means of oxidative, inflammatory, and apoptotic mechanisms. The aim of the present study was to examine the potential cardio protective effects of levosimendan in a diabetic rat model of myocardial I/R injury. Methods: A total of 18 streptozotocin-induced diabetic Wistar Albino rats (55 mg/kg) were randomly divided into three equal groups as follows: the diabetic I/R group (DIR) in which myocardial I/R was induced following left thoracotomy, by ligating the left anterior descending coronary artery for 60 min, followed by 2 h of reperfusion; the diabetic I/R levosimendan group (DIRL), which underwent I/R by the same method while taking levosimendan intraperitoneal 12 mu g kg(-1); and the diabetic control group (DC) which underwent sham operations without tightening of the coronary sutures. As a control group (C), six healthy age-matched Wistar Albino rats underwent sham operations similar to the DC group. Two hours after the operation, the rats were sacrificed and the myocardial tissue samples were examined by light microscopy for evidence of myonecrosis and inflammatory cell infiltration. Results: Myonecrosis findings were significantly different among groups (p = 0.008). Myonecrosis was more pronounced in the DIR group compared with the C, DC, and DIRL groups (p = 0.001, p = 0.007 and p = 0.037, respectively). Similarly, the degree of inflammatory cell infiltration showed significant difference among groups (p < 0.0001). Compared with C, DC, and DIRL groups, the inflammatory cell infiltration was significantly higher among the DIR group (p < 0.0001, p < 0.0001, and p = 0.020, respectively). Also, myocardial tissue edema was significantly different among groups (p = 0.006). The light microscopic myocardial tissue edema levels were significantly higher in the DIR group than the C, DC, and DIRL groups (p = 0.001, p = 0.037, and p = 0.014, respectively). Conclusion: Taken together, our data indicate that levosimendan may be helpful in reducing myocardial necrosis, myocardial inflammation, and myocardial tissue edema resulting from ischemia reperfusion injury.Öğe Son Dönem Böbrek Yetmezliği Olan Olgularda B-Tipi Natriüretik Peptidin Sessiz Miyokard İskemisini Öngördürmedeki Rolü(Kırıkkale Üniversitesi, 2013) Poyraz, Fatih; Şimşek, Vedat; Turfan, Murat; Ayerden Ebinç, Fatma; Timurkaynak, TimurThe aim of this study was to evaluate the value of BNP for detecting silent myocardial ischemia in dialysis patients. 53 hemodialysis patients with no anginal symptoms were included. Ambulatory electrocardiographic monitorisation were done to all patients in order to determine silent myocardial ischemia. BNP assays were done to all patients before the second hemodialysis session of the week. The median age of the participants was 50 (60 % male). Male sex and hyperlipidemia were more frequent in the silent ischemia group. Other demographic and echocardiographic parameters were similar in both groups. The median BNP concentration was significantly higher in the silent ischemia group (682,7 pg/mL vs 503,2, p= 0,006). Left ventricular mass index (r=0,502, pÖğe Usefulness of Monocyte Chemoattractant Protein-1 to Predict No-Reflow and Three-Year Mortality in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention(Excerpta Medica Inc-Elsevier Science Inc, 2013) Buyukkaya, Eyup; Poyraz, Fatih; Karakas, Mehmet F.; Kurt, Mustafa; Akcay, Adnan B.; Akpinar, Ibrahim; Gibson, C. MichaelAlthough monocyte chemoattractant protein-1 (MCP-1) levels are increased in patients with ST-segment elevation myocardial infarction, the prognostic value of MCP-1 in primary percutaneous coronary intervention (pPCI) is not clear. The goal of the present study was to investigate the association of MCP-1 levels with myocardial perfusion and prognosis in patients with ST-segment elevation myocardial infarction undergoing pPCI. Consecutive pPCI patients (n = 192) were assigned to tertiles according to their admission serum MCP-1 levels. Angiographic no-reflow, Thrombolysis In Myocardial Infarction flow grade, myocardial blush grade, and ST-segment resolution were assessed. Mortality and major adverse cardiac events were evaluated during hospitalization and at the 3-year clinical follow-up visit. Failure of ST resolution was associated with greater admission MCP-1 levels. The risk of no-reflow (Thrombolysis In Myocardial Infarction flow <= 2 or Thrombolysis In Myocardial Infarction flow 3 with final myocardial blush grade <= 2 after pPCI and ST resolution <30%) increased as the admission MCP-1 increased. The 3-year mortality increased as the MCP-1 level increased (8% vs 22% vs 28% for the 3 tertiles, p <0.01). Multivariate logistic regression analysis demonstrated that MCP-1 levels at admission are a significant independent correlate of 3-year mortality in patients with no-reflow as detected by myocardial blush grade. A receiver operating characteristics analysis identified an optimum cut point of >= 254 pg/ml, which was associated with a negative predictive value of 95% in association with 1-year mortality. In conclusion, the plasma MCP-1 levels at admission are independently associated with the development of no-reflow and 3-year mortality in patients with ST-segment elevation myocardial infarction undergoing pPCI. Crown Copyright (C) 2013 Published by Elsevier Inc. All rights reserved.
