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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 Bilirubin Levels and the Burden of Coronary Atherosclerosis in Patients With STEMI(Sage Publications Inc, 2013) Şahin, Ömer; Akpek, Mahmut; Elçik, Deniz; Karadavut, Serhat; Şimşek, Vedat; Tulmaç, Murat; Kaya, Mehmet G.We investigated whether serum bilirubin level (a marker of heme oxygenase activity) is a predictor of high levels of SYNTAX score (SXscore) in patients with acute myocardial infarction. Patients (n = 281; male 77%; mean age 60 +/- 12) who were admitted with ST-elevation myocardial infarctions (STEMIs) were enrolled. Patients were divided into 2 groups. Group 1 was defined as SXscore <22 and group 2 was defined as SXscore >= 22. Total bilirubin levels were significantly higher in the high-SXscore group than in the low-SXscore group (0.86 +/- 0.42 vs 1.02 +/- 0.51, P = .005). A significant correlation was detected between total bilirubin and SXscore (r = .42; P = .001). At multivariate analysis, total bilirubin (odds ratio: 1.86, 95% confidence interval 1.04-3.35; P = .038) was an independent risk factor for high SXscore in patients with STEMI. In conclusion, serum bilirubin level is independently associated with SXscore in patients with STEMI.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 Drug abuse and myocardial infarction(Anestezi Dergisi, 2016) Yaman, Ferda ; Çolak, Selim; Bakkal, Gülcan; Gençay, Işın; Aktürk, Ennur; Tulmaç, Murat; Büyükkoçak, ÜnaseAmongst the illicit drugs, heroin, cocaine and cannabis have been studied and documented well to cause sudden death by different mechanisms. Cocaine-related myocardial infarction is a well-known phenomenon. Heroin-induced myocardial infarction has seldom beenreported. In this article we presented a case of drug abuse such as heroin, cocaine, bonsai and arrest after heroin injection with literature. A 28-year-old young male was brought to the emergency with sudden cardiac arrest after eroin injection intravenously. Myocardial infarction with left ventricular failure was diagnosed. Coronary angiography showed 100% occlusion of left ascending coronary artery. On day 7, cardiac arrest was occured after recurrent attacks of ventricular fibrillation and ressussitation was unsuccessful.Öğe The Effects of Metformin, Ethinyl Estradiol/Cyproterone Acetate, and Metformin Ethinyl Estradiol/Cyproterone Acetate Combination Therapy on Carotid Artery Intima-media Thickness in Patients with Polycystic Ovary Syndrome(2020) Ünal, Derya; Demirci, Hüseyin; Yılmaz, Murat; Kısa, Üçler; Tulmaç, Murat; Güliter, SefaIntroduction: Patients with polycystic ovary syndrome (PCOS) are in the risk group for early-onset cardiovascular disease. There are few studies evaluating physiological and inflammatory cardiovascular risk factors in PCOS. Our study aimed to measure carotid intima-media thickness (IMT) in PCOS cases and to assess the effects of metformin, ethinyl estradiol/cyproterone acetate (EE/CA) and metformin + EE/ CA combination therapy on carotid IMT, insulin resistance, C-reactive protein (CRP), apelin and adiponectin. Methods: Basal carotid IMT, insulin resistance [Homeostasis model assessment insulin resistance (HOMA-IR)], apelin, adiponectin, and CRP values were evaluated in 60 women with PCOS and 43 healthy volunteers between the ages of 18 and 45. After baseline evaluation, patients were divided into metformin (n=20), EE/CA (n=20) and metformin + EE/CA (n=20) treatment groups. Treatment regimens were administered for six months. At the end of the treatment, the same parameters were reevaluated. Results: Compared with the control group, CRP (p=0.003), HOMA-IR (p=0.004) and IMT (p=0.049) were significantly higher, and adiponectin (p=0.002) and apelin (p=0.031) levels were significantly lower in patients with PCOS. At the end of the six-month treatment, the adiponectin level in the metformin (p=0.012) and metformin + EE/CA groups (p=0.012), and the apelin level in the metformin (p=0.024), EE/CA (p=0.024) and metformin + EE/CA groups (p=0.024) were significantly higher. There was no statistically significant change in CRP level in all treatment groups (p>0.05). There was no statistically significant change in carotid IMT value in all treatment groups (p>0.05). Conclusion: According to these results, we can say that women with PCOS have subclinical atherosclerosis and that metformin treatment has a positive effect on subclinical atherosclerosis.Öğe The effects of statin therapy on pulse wave velocity measurements(Cardiology Academic Press, 2014) Şimşek, Vedat; Doğru, Mehmet Tolga; Demir, V.; Şahin, Ö.; Tulmaç, Murat; Ebinç, Haksun; Yıldırım, NiyaziSeveral studies have shown that positive effects of statins on pulse wave velocity parameters. However, there is few study about the comparison of the effectivity of statins on pulse wave velocity parameters. In the present study, we aimed to show the difference about the effects of long term atorvastatin and rosuvastatin therapy on aortic stiffness in patients with hyperlipidemia. A total of 104 hyperlipidemic patients were enrolled into the study. There were 50 patients in Group 1 (The patients treated with Atorvastatin 20 mg/day) (23 male and 27 female, mean age: 55.8 ± 10.3 years;, mean age: 52.7 ± 9.4 years) and 54 patients in Group 2 (The patients treated with Rosuvastatin 10 mg/day) (23 male and 31 female, mean age: 52.7 ± 9.4 years). All patients followed up to 12 months about their lipid profile and pulse wave analysis data. After 12 months, we found that rosuvastatin was of higher positive effects on arterial stiffness and reflection index parameters (Student T test, p=0.049 and =0.041, respectively ) We considered that, rosuvastatin was of greater ameliorative effect on vascular stiffness than that of atorvastatin in the patients with hyperlipidemia.Öğe Fondaparinux used for severe heparin induced thrombocytopenia with subacute instent thrombosis(2008) Tulmaç, Murat; Ebinç, Haksun; Doğru, Mehmet Tolga; Özer, Murat; Çeneli, Özcan; Şimşek, VedatHeparin induced thrombocytopenia (HIT) is an immune mediated event that may result in life and limb threatening complications. We report a 52 year old diabetic woman with subacute instent thrombosis and severe heparin induced thrombocytopenia treated successfully with fondaparinux. Not only platelet count returned to normal but also thromboembolic or hemorrhagic events were prevented under treatment. The low rate of de novo antibody formation and the scarce cross-reactivity with HIT antibodies offer fondaparinux as a relatively safe alternative anticoagulant agent for use in patients with HIT. Fondaparinux should be kept in mind in severe HIT if direct thrombin inhibitors are unavailable.Öğe Lack of Association Between Matrix Metalloproteinase-9 and Endothelial Nitric Oxide Synthase Gene Polymorphisms and Coronary Artery Disease in Turkish Population(Mary Ann Liebert, Inc, 2009) Alp, Ebru; Menevşe, Sevda; Tulmaç, Murat; Kan, Derya; Yalçın, Rıdvan; Erkan, Aycan F.; Çengel, AtiyePolymorphic variants of genes encoding proteins involved in vascular remodeling may genetically diverge among different populations and play a role in the susceptibility to the coronary artery disease (CAD). MMP-9-1562 C/T (rs3918242), eNOS T-786C (rs2070744), and Glu298Asp (rs1799983) are among the most studied of these polymorphisms. The aim of this study was to determine the relationship between CAD and these polymorphisms in the Turkish population. The analysis included 146 CAD+ and 122 CAD- individuals. Genomic DNA was isolated from whole blood and genotyping was performed by the PCR-RFLP method. No significant associations were found between -1562 C/T (p=0.557), Glu298Asp (p=0.432), and -786 T/C (p=0.055) polymorphisms and CAD. The distribution of each haplotype also did not differ between CAD+ and the CAD- samples (p>0.05). The present investigation is the first to study an association between -1562 C/T polymorphism and CAD in the Turkish population. In conclusion, no appreciable differences between CAD+ and CAD- samples were found in terms of polymorphisms mentioned above.Öğe Massive Systemic Air Embolism During Aortic Root Angiography A Dire Complication(Lippincott Williams & Wilkins, 2012) Tulmaç, Murat; Şimşek, Vedat; Şahin, Ömer; Ebinç, Haksun…Öğe The relationship between the QT interval and autonomous and anthropometric features(2007) Doğru, Tolga; Günaydın, Sedar; Şimşek, Vedat; Tulmaç, Murat; Güneri, 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 Serum orexin-a level and the severity of coronary artery disease: Original article(Cardiology Academic Press, 2014) Şimşek, Vedat; Doğru, Mehmet Tolga; Boyunağa, Hakan; Çağlayan, Osman; Yıldırım, Niyazi; Tulmaç, Murat; Ebinç, HaksunIn this study, we aimed to investigate the correlations of serum Orexin-A level (SOAL) and the severity of coronary artery disease (CAD). A total of 80 participants (mean age: 55.7±12.7 years) were enrolled into the study. SOAL, electrocardiography and transthoracic echocardiography and 24 Hour Holter monitoring (24HHM) and coronary angiography were performed in all participants. Autonomic functions were assessed using the data of Heart Rate Variability measurements. Patients were categorized into three groups according to their Gensini scores as: Group 1: The patients with normal coronary angiogram, Group 2: The patients with mild CAD (Gensini <20) and Group 3: The patients with severe CAD (Gensini ?20). A total of 28 patients were Group 1 (mean age 51.8±12.0 years), 25 patients were Group 2 (mean age 57.7±11.6 years) and 27 patients were Group 3 (mean age 57.6±13.6 years). There were statistically significant differences in SOAL (p=0.004) among the groups. We found that SOAL had statistically significant associations with Gensini score and LF/HF (Sympathetic activity) values. (F= 15.299; p=0.004 and F= 15.470; p=0.004, respectively). Serum Orexin-A levels are positively correlated with severity of CAD and sympathetic activity.Öğe The relationship between orthostatic differences in arterial blood pressure and autonomic tone: gender variability(Aves, 2007) Doğru, Tolga; Günaydın, Serdar; Şimşek, Vedat; Tulmaç, 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 the QT interval and autonomous and anthropometric features(Aves, 2007) Dogru, Tolga; Günaydın, Serdar; Şimşek, Vedat; Tulmaç, Murat; Güneri, 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 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.
