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Öğe Differences in left ventricular structure, functions and elastance in the patients with normotensive blood pressure(Turkish Soc Cardiology, 2008) Dogru, Mehmet Tolga; Tireli, Emine; Gueneri, Mahmut; Iyisoy, Atila; Celik, TurgayObjective: We aimed in this study to investigate the differences in left ventricular (LV) structure, function and elastance parameters in the patients with normotensive blood pressure (BP) levels. Methods: A total of 294 normotensive patients (< 140/90 mmHg) (135 males, mean age: 45 +/- 11 years; 159 females, mean age 38 +/- 10 years) were enrolled into the present cross-sectional study. Patients were categorized into three groups according to their BP levels as optimal BP (< 120/80 mmHg), normal BP (120-129 / 80-84 mmHg) and high normal BP (129-139 / 84-89 mmHg) groups. We evaluated LV structure and functions by using Doppler echocardiography in all participants, Afterwards we compared the measurements for revealing the echocardiographic differences among the BP groups. In this study, one-way ANOVA Kruskal-Wallis, one-way ANCOVA and partial correlation analysis tests were used for the statistically evaluation of the data. In addition, relative risk ratios (FIR) were also calculated for determination of the effects of BP levels to echocardiographic parameters. Results: There were significant statistical differences in left atrial diameter(LA) (p=0.002),transmitral A wave velocity (A) (p=0.002), meridional wall stress (MWS) (p < 0.001), pulmonary capillary wedge pressure (PCW) (p=0.029) among BP groups. After the correction of the data for anthropometric measurements, multiple comparisons have shown that only end-systolic (Es) and end-diastolic elastance (Ed) were different between the normal and high-normal BP groups (for Es, p=0.013; for Ed, p=0.007). But it was found that optimal BP group had significant differences in LV structure and function parameters when compared to high normal BP group (for LA, p=0.028; for A, p=0.035; for MWS, p=0.002; for Es, p < 0.001; for Ed, p < 0.001). Besides, increased FIR were detected for increased left atrial diameter index and pulmonary capillary wedge pressure values in high-normal BP group (RR: 1.537, 95% Cl (1.197-1.974), p=0.005 and RR: 1.272, 95% Cl (1.089-1.485), p=0.032, respectively). Conclusion: Pathologic changes in LV due to increasing BP begin at below-hypertensive BP levels. It could be possible that normal BP stage is the beginning level of these changes. (Anadolu Kardiyol Derg 2008; 8: 473-21)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 Obstruktif uyku apne sendromlu hastalarda sürekli pozitif hava yolu basıncı tedavisinin endotel fonksiyonlarına akut etkisinin brakiyal arterde akım bağımlı genişleme ölçümleri ile değerlendirilmesi(Kırıkkale Üniversitesi, 2010) Tireli, Emine; Tulmaç, MuratEndotel, damar duvarının sağlığının sürdürülmesi, vasküler tonusun ve yapısının lokal regülasyonu ve homeostaz için gereklidir. Endotel işlev bozukluğu ile bu işlevlerdeki dengenin bozulması belirtilmektedir. Bu çalışmada obstrüktif uyku apnesi sendromlu (OUAS) hastalarda akım bağımlı genişleme (ABG) yöntemi kullanılarak nazal sürekli pozitif havayolu basıncı (CPAP) tedavisinin endotel fonksiyonlarına akut etkilerini göstermeyi amaçladık.Çalışmaya yaşları 29-72 arasında olan yeni OUAS tanısı konmuş 30 hasta alındı. Hastaların CPAP titrasyonu tetkiki öncesi ve sonrası ABG ve hsCRP değerleri karşılaştırıldı.CPAP tedavisi ile apne/hipopne indeksi (AHİ) düştü (60.6±24.9, 9.6±7.9; p<0.001). Hastaların oksijen desatürasyon indeksleri düzeldi (50±27, 6±7; p<0.001). CPAP tedavisi sonrası hastaların kalp hızı azaldı (80±10, 73±8 p=0.003). CPAP titrasyonu öncesi ABG değerlerinde CPAP titrasyonu sonrası anlamlı artış oldu (%8.55±5.82 vs. %12.08±7.17 p=0.003). AHI düşüş miktarı ile ABG değerlerinin düzelişi arasında yapılan korelasyon analizinde anlamlı ilişki tespit edilmedi. CPAP titrasyonu öncesi ve sonrası yüksek duyarlıklı CRP (hsCRP) değerleri karşılaştırıldığında fark saptanmadı.SONUÇ: OUAS hastalarında CPAP tedavisi endotel fonksiyonlarına olumlu akut etki göstermiştir. CPAP tedavisinin orta derecede ve şiddetli OUAS olması muhtemel hastalarda endotel disfonksiyonuyla ilişkili hastalıkların akut tedavisinde kullanılabilirliği araştırılmalıdır.Öğe QT interval and dispersion differences between normal and prehypertensive patients: effects of autonomic and left ventricular functional and structural changes(Aves Yayincilik, 2009) Dogru, Mehmet Tolga; Gueneri, Mahmut; Tireli, Emine; Sahin, Oemer; Celik, Turgay; Iyisoy, AtilaObjective: We aimed to investigate the effects of autonomic and left ventricular functional and structural changes on QT interval and dispersion differences between normal and prehypertensive patients. Methods: A total of 291 normotensive patients (<140/90 mmHg) (135 males, age range: 16-75 years, mean age: 45 11 years; 156 females, age range: 17-71 years, mean age 38 10 years) were enrolled into this cross-sectional case-controlled study. Patients were categorized into two groups according to their blood pressure (BP) levels as Group 1 - patients with normal BP (<120/80 mmHg) or Group 2 - patients with prehypertensive BP (120-139/80-89 mmHg). We evaluated autonomic states by using heart rate variability measurements. Left ventricular structure and functions were evaluated by using Doppler echocardiography in both normal and prehypertensive BP groups regarding their effect on QT intervals and QT dispersion. Statistical analyses (Student's t and Mann-Whitney U tests) were used to evaluate the differences in QT intervals and QT dispersion between the BP groups. Results: There were statistically significant differences between the two BP groups with respect to QT intervals and QT dispersion (for QT min, p<0.001, QTc min, p<0.001 and QT dispersion, p<0.001). We also detected that prehypertensive patients had increased sympathetic activity and slightly impaired left ventricular systolic and diastolic function (for low frequency power / high frequency power ratio -p=0.029, left ventricular ejection fraction - p=0.054, and transmitral peak A wave velocity - p<0.001). Conclusion: QT interval and dispersion differences are present in prehypertension. Moreover, these differences are independent of left ventricular mass. Autonomic changes can be effective on these differences between the patient groups. (Anadolu Kardiyol Derg 2009; 9: 15-22)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 Transient global amnesia after ventricular fibrillation during acute myocardial infarction(2013) Tulmaç, Murat; Şimşek, Vedat; Dağ, Ersel; Tireli, Emine; Eser, Özer; Ebinç, Haksun; Doğru, Mehmet TolgaBurada akut inferolateral miyokard infarktüsü seyrinde anında tedavi edilen ventrikül fibrilasyonu sonrası geçici global amnezi gelişen 48 yaşında bir erkek hastayı bildiriyoruz. Hekimler ventrikül fibrilasyonu ile komplike olan miyokard infarktüsü ile gelen hastalarda geçici global amnezi varlığını araştırmaya özellikle dikkat etmelidir.
