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Öğe The association of paraoxonase 1 gene L55M polymorphism with the extent and severity of coronary artery disease in the Turkish population and its dependence on gender(Turkish Soc Cardiology, 2016) Kocakap, Derya Beyza Sayin; Dogru, Mehmet Tolga; Simsek, Vedat; Cabuk, Feryal; Yildirim, Nesligul; Celik, Yunus; Erdem, SolmazObjective: Coronary artery disease (CAD) is a common, complex, and progressive disorder characterized by the accumulation of lipids and fibrous elements in the arteries. It is one of the leading causes of death in industrialized nations. Oxidative modification of low-density lipoprotein (LDL) in the arterial wall plays an important role in the initiation and progression of atherosclerosis. Paraoxonase1 (PON1) is involved in lipid metabolism and is believed to protect LDL oxidation. In our study, we aimed to clarify the relationship between PON1 gene L55M polymorphism and the extent and severity of CAD. Methods: In total, 114 patients (54 males, mean age: 56.7 +/- 12.0 years; 60 females, mean age: 55.7 +/- 13.2 years) with stable angina or angina equivalent symptoms were enrolled in this prospective study. Cardiological evaluation was performed with electrocardiogram and transthoracic echocardiogram. The presence of hypertension, dyslipidemia, diabetes, and smoking status were ascertained. The patients were grouped according to their Gensini scores and gender. Genetic analysis of the PON1 gene L55M polymorphism was performed by polymerase chain reaction-restriction fragment length polymorphism. Results: We determined that the LL genotype was more prevalent in patients with Gensini score higher than or equal to 20 (p=0.026) and that this correlated with severe atherosclerotic coronary artery lesions in both gender groups, reaching a statistical significance in the female subjects (p=0.038). Conclusion: It was thought that the PON1 gene L55M polymorphism plays a significant role in CAD progression, especially in females.Öğe Atrial electromechanical coupling interval and P-wave dispersion in healthy elderly(Springer, 2012) Yildirim, Nesligul; Tulmac, Murat; Simsek, Vedat; Dogru, Mehmet Tolga; Ebinc, Haksun; Guzel, Murat; Eser, OzerBackground and aims: The aim of our study was to investigate the potential effect of natural aging on atrial fibrillation (AF) by means of electrocardiographic P-wave analysis and measurement of the transthoracic echocardiographic electromechanical coupling interval (EMC). Methods: The study comprised 25 healthy individuals aged >= 65 years (group 1) and 25 control subjects <65 years (group 2). The difference between maximum (Pmax) and minimum (Pmin) P-wave durations on 12-lead electrocardiography were defined as P-wave dispersion (PD). Intra- and inter-atrial EMC were measured by tissue Doppler imaging. Results: Pmax (107.2 +/- 3.58 msec vs 100.0 +/- 3.56 msec, p<0.001) and PD (43.6 +/- 4.98 msec vs 36.5 +/- 3.56 msec, p<0.001) were significantly higher in group 1 than in group 2. Left atrial EMC [24.6 (15.20) vs 13.3 (4.50), p<0.001] and inter-atrial EMC [43.2 (16.05) vs 33.3 (4.75), p<0.001] were significantly delayed in group 1 compared with group 2. There was a significant correlation between left atrial diameter, PD, Pmax, left atrial EMC, and inter-atrial EMC. Conclusion: Aging is correlated with increased left atrial size and impaired diastolic relaxation, which may contribute to a greater risk of AF in terms of prolonged PD and atrial EMC. (C)2012, Editrice KurtisÖğe 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 Differences in autonomic activity in individuals with optimal, normal, and high-normal blood pressure levels(Kare Publ, 2010) Dogru, M. Tolga; Simsek, Vedat; Sahin, Omer; Ozer, NurtacObjectives: We investigated differences in autonomic activity in normotensive individuals having optimal, normal and high-normal blood pressure (BP) levels according to the guidelines of the European Society of Hypertension and European Society of Cardiology (ESH/ESC). Study design: The study included 294 normotensive subjects (135 males, 159 females; age range 16 to 75 years) with similar clinical, morphometric, biochemical, electrocardiographic, and echocardiographic features. The subjects were classified into the following BP groups: group 1 (n=113) with optimal BP (<120/80 mmHg); group 2 (n=104) with normal BP (120-129/80-84 mmHg), and group 3 (n=77) with high-normal BP (130-139/85-89 mmHg). All the subjects underwent 24-hour Holter monitoring to obtain heart rate variability (HRV) parameters of 24-hour, daytime, and nighttime periods. Normalized low (LFn) and high (HFn) frequency powers, and logarithmic (Log) values of HRV parameters were also calculated. Results: On 24-hour Holter monitoring, heart rates were similar in three groups. Compared to group 1 and 2, group 3 exhibited significantly higher LF/HF (p<0.001) and LFn (p=0.001) values, and significantly lower HFn (p=0.001), pNN50 (p=0.001), and rMSSD (p=0.005) values. There were no significant differences between the groups with respect to daytime HRV parameters; however, nighttime LF/HF, LFn, and HFn values were significantly different between the groups. Log LF/HF values obtained during the 24-hour and nighttime periods showed significant differences between group 1 and group 3 (for 24 hours, p<0.001; for night, p=0.001) and between group 2 and group 3 (for 24 hours, p<0.001; for night, p=0.009), but group 1 and group 2 did not differ significantly in this respect (p>0.05). Conclusion: These findings suggest that subjects with high-normal BP have increased sympathetic activity and decreased parasympathetic activity, possibly making them more liable to hypertension.Öğe Effect of Diurnal Blood Pressure on Endothelial Functions in Essential Hypertensive Patients(Elsevier Science Inc, 2013) Sahin, Omer; Ebinc, Haksun; Simsek, Vedat; Tulmac, Murat; Dogru, Mehmet Tolga…Öğe Effect of Diurnal Blood Pressure on Myocardial Performance Index and Aortic Elasticity Parameters in Essential Hypertensive Patients(Elsevier Science Inc, 2013) Sahin, Omer; Ebinc, Haksun; Simsek, Vedat…Öğe Effect of overnight nasal continuous positive airway pressure treatment on the endothelial function in patients with obstructive sleep apnea(Aves Yayincilik, 2012) Tulmac, Murat; Tireli, Emine; Ebinc, Haksun; Simsek, Vedat; Dogru, Mehmet Tolga; Yildirim, Nesligul; Ekici, Mehmet SavasObjective: In this prospective study, we aimed to investigate acute effect of nasal continuous positive airway pressure (CPAP) therapy on the endothelial function of patients with obstructive sleep apnea syndrome (OSA) by using brachial artery flow mediated dilatation (FMD) method. Methods: Newly diagnosed thirty OSA patients with ages between 29 and 72 years were included in this study. FMD and high sensitivity C-reactive protein (hsCRP) values of patients obtained before and after CPAP dose titration test were compared with paired samples t test or Wilcoxon signed ranks test. Results: With CPAP therapy apnea hypopnea indices were reduced (60.6 +/- 24.9/h vs. 9.6 +/- 7.9/h; p<0.001) and oxygen desaturation indices recovered (50 +/- 27/h vs. 6 +/- 7/h; p<0.001). Heart rates of patients decreased after CPAP therapy (80 +/- 10/min vs. 73 +/- 8/min; p=0.003). FMD values significantly increased after CPAP (8.55 +/- 5.82 percent vs. 12.08 +/- 7.17 percent; p=0.003). HsCRP values after CPAP were not different from baseline values Conclusion: Acute improvement of the endothelial function with one night CPAP therapy suggests endothelial dysfunction in OSA patients to be result of acute pathophysiologic factors. In intermediate and severe OSA patients, CPAP therapy may be considered in acute treatment of diseases associated with endothelial dysfunction. (Anadolu Kardiyol Derg 2012; 12: 560-5)Öğe Effects of Coronary Angiography and Femoral Arterial Access on Endothelial Functions(Lippincott Williams & Wilkins, 2011) Tulmac, Murat; Ozer, Nurtac; Simsek, Vedat; Dogru, Mehmet Tolga; Ebinc, HaksunBackground: Impairment of endothelial function is an independent predictor of coronary events. The aim of this study was to clarify the influence of arterial access and coronary angiography on endothelial function. Methods: Eighteen patients with stable angina pectoris who underwent coronary angiography were included in this study. Brachial artery flow-mediated dilatation of patients was measured before angiography, after femoral arterial sheath insertion, and after coronary angiography. Results: Of 18 patients, 11 had angiographically apparent atherosclerosis. Flow-mediated dilatation after femoral arterial sheath insertion (mean +/- SD, 6.62% +/- 3.87%) was found to be significantly lower than either before (10.62% +/- 5.18%) or after coronary angiography (11.66% +/- 5.30%; P = 0.007 and P = 0.001, respectively). Basal and postangiographic flow-mediated dilatation values were similar. Flow-mediated dilatation significantly decreased after sheath insertion in the group with angiographically normal coronary arteries (14.47% +/- 4.34% vs 5.98 +/- 4.00%, respectively; P = 0.006), whereas the difference was not significant in patients with CAD (8.17% +/- 4.16% vs 7.03% +/- 3.92%, respectively). Conclusions: Coronary angiography did not result in endothelial vasomotor dysfunction. Femoral arterial sheath insertion during coronary angiography was associated with a short-lived endothelial dysfunction. Larger studies are needed to interpret the effect of coronary atherosclerosis on attenuation of endothelial response against arterial wall injury.Öğe The Effects of Nocturnal Blood Pressure Patterns and Autonomic Alterations on Erectile Functions in Patients with Hypertension(Urol & Nephrol Res Ctr-Unrc, 2019) Yuvanc, Ercan; Dogru, Mehmet Tolga; Simsek, Vedat; Kandemir, Huseyin; Tuglu, DevrimPurpose: Hypertension (HT) is known to be of the main risk factors for erectile dysfunction (ED). But non-dipping (<%10 drop in the night) of HT is not investigated truly. The aim of this study was to test the hypothesis that the non-dipper hypertensive patients are more prone to develop erectile dysfunction. Materials and Methods: This was a cross-sectional clinical study. 70 HT patients diagnosed by Ambulatory blood pressure monitoring (ABPM) were classified into 3 groups (No ED, mild to moderate and severe) according to their International Index of Erectile Function (IIEF) scores. All three groups were compared for their dipping status by ABPM, heart rate variability (HRV) by holter monitoring. Results: In our study non-dipper hypertensives had statistically more erectile dysfunction (P = 0.004). Also severe ED patients with non-dipping pattern had decreased dipping blood pressure levels then those of ED(-) patients with non-dipping HT (P = .003) Conclusion: Autonomic dysfunction especially sympathetic overactivity is associated with both non dipping pattern of HT and erectile dysfunction as a common pathologic pathway, besides there might be an association between ED and non dipping HT.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 The relationship between orthostatic differences in arterial blood pressure and autonomic tone: gender variability(Aves, 2007) Dogru, Tolga; Gunaydin, Serdar; Simsek, Vedat; Tulmac, Murat; Tireli, EmineObjectives: The differences in orthostatic blood pressure result from dynamic changes in the sympathovagal balance. We studied sex-related variations in autonomic tone regulation. Study design: The study included 237 individuals (114 males, 123 females) who were asymptomatic and had no abnormal laboratory or physical findings. The mean age was 47 years (range 20 to 79 years) for men, and 39 years (range 20 to 71 years) for women. All the participants were subjected to a careful history taking, physical examination, routine biochemical examinations, electrocardiographic recording, 24-hour Holter monitoring, and orthostatic tests. Results: In heart rate variability analysis, parasympathetic tone parameters, in particular the high frequency (HF) component was significantly high in females, whereas sympathetic tone parameters, in particular the low frequency (LF)/HF ratio was significantly high in males (p< 0.001). The normalized LF component in males showed positive correlations with systolic (r= 0.308, p= 0.001) and diastolic (r= 0.301, p= 0.002) blood pressures during the rapid stand test; this correlation was not seen in females. Blood pressures obtained in the second minute of the rapid supine test following the stand test were in positive correlation with the LF/HF ratio in both sexes. In males, variations in systolic and diastolic blood pressures during rest, stand, and supine positions were primarily influenced by the LF component and HF component, respectively. In females, variations in systolic blood pressure during the three positions were not correlated with autonomic tone components, but variations in diastolic blood pressure were primarily affected by the LF/HF ratio. Conclusion: Autonomic system works through varying priorities in both sexes and this causes sex-related differences in orthostatic tolerance.Öğe The relationship between serum sex steroid levels and heart rate variability parameters in males and the effect of age(Aves, 2010) Dogru, M. Tolga; Basar, M. Murad; Yuvanc, Ercan; Simsek, Vedat; Sahin, OmerObjectives: We evaluated the relationships between sex steroid levels and heart rate variability (HRV) parameters. Study design: The study included 114 male subjects (mean age 46.6 +/- 11.3 years) presenting to our department for cardiologic evaluation. Hormonal analysis included serum levels of luteinizing hormone, prolactin, total testosterone (TT), free testosterone, estradiol (E2), and dehydroepiandrosterone sulfate (DHEA-S). Parameters of HRV were derived from 24-hour Holter monitoring. The associations between serum sex steroid levels and HRV parameters were investigated in three age groups (20-39 years; 40-59 years; >60 years). Results: All the participants had normal biochemical results. The three age groups were similar in terms of anthropometric measurements. Among sex steroids analyzed, only serum DHEA-S level was significantly different among the groups (p=0.026), showing a decreasing trend with age. In the evaluation of HRV, all parasympathetic activities decreased (for HFn, pNN50, and rMSDD: p=0.001, p=0.000, and p=0.000, respectively), while only LF/HF among sympathetic activities increased (p=0.000) with age. Partial correlation analysis with control of age and waist circumference showed that TT and DHEA-S were positively correlated with HFn (parasympathetic parameter), and were in negative correlation with LF/HF24 hours and global sympathetic index (GSI) (sympathetic parameters). Serum E2 level was negatively correlated with the parasympathetic parameter of rMSSD, and positively correlated with LF/HF24 hours and GSI. Among serum sex steroids, DHEA-S was the most correlated parameter with autonomic functions. Conclusion: Our results showed positive correlations between androgens and parasympathetic activity and between estradiol and sympathetic activity in men, independent from anthropometric factors.Öğe The relationship between the QT interval and autonomous and anthropometric features(Aves, 2007) Dogru, Tolga; Gunaydin, Serdar; Simsek, Vedat; Tulmac, Murat; Guneri, MahmutObjectives: We investigated the effect of anthropometric and autonomous factors on the QT interval in both sexes. Study design: The study included 237 individuals (114 males, 123 females) who were asymptomatic and had no abnormal laboratory or physical findings. The mean age was 47 years (range 20 to 79 years) for men, and 39 years (range 20 to 71 years) for women. All the participants were subjected to a careful history taking, physical examination, routine biochemical examinations, electrocardiographic recording, 24-hour Holter monitoring, and when necessary, color Doppler echocardiography and treadmill exercise test. Serum estrogen levels, serum free and total testosterone levels were also measured in males. Results: The minimum QT interval was significantly lower in males (p=0.043). The mean QT (p=0.022) and QTc (p< 0.001) intervals in females, and QT dispersion in males (p=0.025) were significantly higher. In male participants, the maximum QT interval (p=0.049) and QT dispersion (p=0.043) were significantly different between age groups of 20-44 years and 45-69 years. Parasympathetic activity played a determinant role in the mean and maximum QT intervals. Anthropometric features were not correlated with the QT interval in females, whereas in males, waist-hip ratio was positively correlated with the mean QT and minimum QTc intervals (r=0.188, p=0.049 and r=0.236, p=0.013, respectively). Serum sex hormone levels were significantly effective on the QT interval in males. Conclusion: Concerning anthropometric and autonomic factors, the QT interval is significantly influenced by gender-related features.Öğe Uncomplicated retainment of metal coronary bulldog clips recognized five years after coronary artery bypass graft surgery(Ekin Tibbi Yayincilik Ltd Sti-Ekin Medical Publ, 2011) Tulmac, Murat; Ozer, Nurtac; Ebinc, Haksun; Simsek, Vedat; Dogru, M. TolgaWe report a patient with retained metal coronary bulldog clips in the mediastinum during coronary artery bypass surgery which was recognized during coronary angiography following the diagnosis of unstable angina pectoris after an uncomplicated period of five years. This case suggests that conservative management of patients with postoperatively recognized retained foreign material should be kept in mind as an alternative to reoperation.
