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Analysis of MMP-7 and TIMP-2 gene polymorphisms in coronary artery disease and myocardial infarction: A Turkish case-control study
(Elsevier Taiwan, 2017) Alp, Ebru; Yilmaz, Akin; Tulmac, Murat; Dikmen, Atiye Ugras; Cengel, Atiye; Yalcin, Ridvan; Menevse, Emine Sevda
Matrix metalloproteinase (MMP) and tissue inhibitors of metalloproteinase (TIMP) have a significant role in tissue remodeling related to cardiac function. In earlier studies, MMP-7A-181G (rs11568818), C-153T (rs11568819), C-115T (rs17886546), and TIMP-2 G-418-C (rs8179090) polymorphisms have been studied in various diseases. However, association between coronary artery disease (CAD) and these polymorphisms has been poorly studied. The goal of this study is to investigate the association of CAD and myocardial infarction (MI) with MMP-7 or TIMP-2 polymorphisms. This study included 122 CAD patients and 132 control individuals. DNA was extracted from whole blood. Polymerase chain reaction-restriction fragment length polymorphism and automated direct sequencing method were used for genotyping of these polymorphisms. No significant differences were found between MMP-7 A-181G, C-115T, and TIMP-2 G-418C polymorphism and CAD or MI in a Turkish population. Despite the fact that the genotypes of MMP-7C-153T polymorphism had no significant differences among MI and control groups, allele frequencies of C-153T polymorphism were significantly different between the two groups. Our study is the first report to clarify the appreciable relationship between MMP-7 C-153T polymorphism and MI development in CAD patients. However, these findings also need to be confirmed in other populations so we can improve our knowledge about the genetic factors affecting the development of CAD. Copyright (C) 2017, Kaohsiung Medical University. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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, Ozer
Background 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 Kurtis
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, Fadime
Background. 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.
Conservative treatment of femoral neuropathy following retroperitoneal hemorrhage: a case report and review of literature
(Lippincott Williams & Wilkins, 2014) Tosun, Aliye; Inal, Elem; Keles, Isik; Tulmac, Murat; Tosun, Ozgur; Aydin, Gulumser; Orkun, Sevim
Anticoagulant drugs are used to reduce the incidence thromboembolic events in patients at risk. However, minor and major bleeding complications may occur during anticoagulation therapy. Femoral neuropathy secondary to retroperitoneal hematoma is a well known complication of anticoagulant drugs. However, treatment of these patients is still controversial, both conservative and surgical treatments have been advocated. Herein, we report a male patient receiving warfarin for 7 years who developed femoral neuropathy due to retroperitoneal hematoma and was successfully treated with conservative methods. We suggest that conservative treatment and appropriate rehabilitation program should be given to the patients who do not demonstrate any signs of a continued bleeding and any progressive neurological deficits. Blood Coagul Fibrinolysis 25:769-772 2014 (C) Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.
Copeptin Level and Copeptin Response to Percutaneous Balloon Mitral Valvuloplasty in Mitral Stenosis
(Karger, 2011) Gunebakmaz, Ozgur; Celik, Ahmet; Inanc, M. Tugrul; Duran, Mustafa; Karakaya, Ekrem; Tulmac, Murat; Topsakal, Ramazan
We aimed to investigate copeptin levels in mitral stenosis (MS) patients and the behavior of copeptin after hemodynamic improvement achieved by percutaneous balloon mitral valvuloplasty (PBMV). The study involved 29 consecutive symptomatic patients with moderate to severe rheumatic MS who underwent PBMV. Twenty-eight age- and gender-matched healthy volunteers composed the control group. Blood samples for copeptin were obtained immediately before and 24 h after PBMV, centrifuged, then stored at -70 degrees C until assayed. The copeptin level of the patient group was statistically different from that of the control group (61.8 +/- 34.4 and 36.8 +/- 15.2 pg/ml, respectively; p = 0.001). PBMV resulted in a significant increase in mitral valve area and a significant decrease in transmitral gradient as well as systolic pulmonary artery pressure. While hemodynamic relief was obtained, we detected a statistically significant decline in copeptin levels 24 h after PBMV compared to the baseline levels (from 61.8 +/- 34.4 to 44.1 +/- 18.2 pg/ml; p = 0.004). Copyright (C) 2012 S Karger AG, Basel
Effect of delivery mode and anaesthesia methods on cardiac troponin T
(ELSEVIER MASSON, CORP OFF, 2020) Bakirci, Sukru; Tulmac, Murat; Dag, Zeynep Ozcan; Sayan, Cemile Dayangan; Isik, Yuksel; Gencay, Isin; Boyunaga, Hakan
[Özet Yok]
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
…
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 Savas
Objective: 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)
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, Haksun
Background: 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.
Homocysteine thiolactonase activity in coronary atherosclerosis
(BAYRAKOL MEDICAL PUBLISHER, 2020) Altinay, Aylin; Kisa, Ucler; Tulmac, Murat; Ozkan, Yesim
Aim: Discovery of paraoxonase natural substrate, homocysteine thiolactone, shed more light on the protective role of paraoxonase and toxicity of homocysteine. Since homocysteine thiolactone and paraoxon were hydrolyzed at different sites in the PON protein, the aim of this study was to investigate the Hcy-thiolactonase (HTase). This study was undertaken to ascertain whether low the Hcy-thiolactonase acitivity is associated with paraoxonase activity and to clarify its relation with ox-LDL and total plasma homocysteine levels in coronary artery diseasase. Material and Methods: Forty-six subjects undergoing coronary angiography for suspected coronary artery disease were included. Depending on angiography results, 14 subjects with normal coronary arteries according to Gensini scoring were selected as a control group. Serum homocysteine thiolactonase and paraoxonase activities were measured spectrophotometrically. Homocysteine, ox-LDL levels were measured with ELISA methods. Results: A significant decrease in HTase activity and a significant increase in ox-LDL levels were observed in patients compared with controls (p=0.040, p=0.037, respectively). Homocysteine levels and paraoxonase activity did not show any statistically significant difference between groups. Positive correlations between HTase and paraoxonase activities were observed in study groups (rs=0.742, p=0.004 for control, rs=0.494, p=0.01 for patient). Discussion: HTase activity decreased in coronary artery disease in spite of unchanged paraoxonase activity and is associated with a higher level of ox-LDL. N-homocysteinylation of HDL changes the properties of apolipoprotein, which could affect the enzymatic activities. When considering a relationship between HTase activity and HDL levels, correlation observed in our study confirms a possible consequence of low PONs homocysteine thiolactonase activity.
Impact of adiponectin on left ventricular mass index in non-complicated obese subjects
(Japan Endocrine Soc, 2008) Ebinc, Haksun; Ebninc, Fatma Ayerden; Oezkurt, Zuebeyde Nur; Dogru, Mehmet Tolga; Tulmac, Murat; Yilmaz, Murat; Caglayan, Osman
To evaluate the relationship between the adiponectin levels and left ventricular mass index (LVMI) in uncomplicated obese subjects. Fifty-nine subjects were assigned to the obese (BMI >= 30 kg/ml) and 58 to the lean (BMI<30 kg/m(2)) group. Plasma glucose, insulin, serum total cholesterol and high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, triglycerides and adiponectin were measured. Insulin resistance was determined by the Homeostasis Assessment Model (HOMA-IR). The left ventricular functions of all subjects were determined by 2D and pulse wave Doppler echocardiography. LVMI was calculated as left ventricular mass (LVM) normalized for height in M-2.7. The obese group displayed significantly higher LVMI and late mitral inflow velocity. Thirty-three obese subjects met the criteria for left ventricular hypertrophy (LVH) and had lower serum adiponectin levels compared with obese subjects without LVH and lean subjects (p<0.05). Adiponectin was negatively correlated with LVMI (R: -0.277, p: 0.002). Furthermore, during the partial correlation analysis where HOMA-IR was controlled, the negative correlation between adiponectin and LVMI progressed (r: -0.283, p: 0.002). The linear regression analysis showed an independent relationship between LVMI and adiponectin. (beta: -0.214, p: 0.01) Obesity is associated with LVH. This study showed direct influence of adiponectin on LVMI.
Markers of Endothelial Dysfunction and Evaluation of Vascular Reactivity Tests in Behcet Disease
(Sage Publications Inc, 2014) Ozuguz, Pinar; Karabulut, Ayse Anil; Tulmac, Murat; Kisa, Ucler; Kocak, Mukadder; Gunduz, Ozgur
We assessed endothelial dysfunction (ED) in patients with Behcet disease (BD; n = 40) and healthy controls (n= 20). Serum lipid, homocysteine, asymmetric dimethylarginine (ADMA) and high-sensitivity C-reactive protein (hsCRP) levels, erythrocyte sedimentation rates (ESRs), and ultrasonographic flow-mediated dilatation (FMD) were measured. Mean hsCRP, ESR, homocysteine, and ADMA were significantly higher in the BD group (P <.001 for all). Patients with active BD had higher serum levels of hsCRP, homocysteine, and ESR compared with those in remission (P <.001, P <.001, and P =.005, respectively). Flow-mediated dilatation was significantly lower in patients with BD than in controls (P =.001). Flow-mediated dilatation correlated negatively with BD duration and serum ADMA levels (P <.001, r =-.745 and P <.001, r = -.682); a positive correlation was seen between serum ADMA levels and BD duration (P <.001, r =.552). Only stepwise multivariate regression analysis revealed BD duration to have a significant effect on FMD. Flow-mediated dilatation, in conjunction with markers of inflammation, may evaluate ED in patients with BD.
Preoperative exercise heart rate recovery predicts intraoperative hypotension in patients undergoing noncardiac surgery
(Elsevier Science Inc, 2012) Kose, Emine Arzu; Kabul, Hasan Kutsi; Yildirim, Vedat; Tulmac, Murat
Study Objective: To assess the predictive role of heart rate (HR) recovery in the detection of intraoperative hypotension in patients undergoing noncardiac surgery. Design: Prospective, observational study. Setting: Department of cardiology and operating rooms of university hospitals. Patients: 160 ASA physical status 1 and 2 patients scheduled for elective noncardiac surgery. Measurements: All patients underwent exercise stress testing. Maximum HRs and metabolic equivalent levels were recorded. Heart rate recovery at the first, second, and third minutes were calculated by subtracting HRs one, two, and three minutes into the recovery period from the maximal HR at peak exercise. A decrease in mean arterial pressure (MAP) of greater than 30% was defined as intraoperative hypotension and recorded. Patients were classified to two groups according to whether they had intraoperative hypotension. Main Results: Hypotensive episode was observed in 31 patients (19.7%) during the operation. The presence of diabetes mellitus was higher in patients with intraoperative hypotension (22.6% vs 7.1%, P = 0.019). Mean HR recovery at the first, second, and third minutes was significantly lower in the intraoperative hypotension group (P = 0.001, P = 0.004, and P = 0.031, respectively). Heart rate recovery at the first, second, and third minutes was a good predictor of intraoperative hypotension, but only HR recovery at the first minute (OR 0.82, 95% CI 0.73 to 0.92, P = 0.001) and HR recovery at the second minute (OR, 0.90; 95% CI, 0.82 to 0.98; P = 0.019) were independent predictors of intraoperative hypotension. A higher negative correlation was noted between the degree of MAP reduction and HR recovery at the first minute (r = -0.797, P = 0.001). Conclusions: Abnormal preoperative exercise HR recovery predicts intraoperative hypotension in patients undergoing noncardiac surgery. Given the importance of intraoperative hypotension, preoperative use of exercise testing might be considered. (c) 2012 Elsevier Inc. All rights reserved.
Relation of Kynurenine/Tryptophan with Immune and Inflammatory Markers in Coronary Artery Disease
(Clin Lab Publ, 2014) Ozkan, Yesim; Sukuroglu, Murat Kadir; Tulmac, Murat; Kisa, Ucler; Simsek, Bolkan
Background: Inflammation and immune activation have a crucial role in the pathogenesis of cardiovascular diseases. Indolamine 2,3-dioxygenase, a tryptophan catabolising enzyme, is up-regulated with various inflammatory stimuli. The aim of this study was to evaluate the relationship of tryptophan degradation with immune and inflammatory markers in coronary artery disease. Methods: 57 subjects undergoing coronary angiography were recruited. 18 subjects with normal coronary arteries according to Gensini scoring were selected as a control group and the rest of subjects were included in patient group. Serum tryptophan and kynurenine levels were determined with HPLC-UV method, and kynurenine/tryptophan ratio was evaluated as IDO activity. Serum neopterin and myeloperoxidase activity were measured by ELISA method. Results: While the kynurenine/tryptophan ratio and neopterin levels were similar in both groups, the patient group had higher myeloperoxidase and hs-CRP levels than controls (p = 0.02, p = 0.002, respectively). The kynurenine/tryptophan ratio was correlated with neopterin in both groups (r = 0.389, p = 0.025; r = 0.683, p = 0.002, respectively) and with hs-CRP in patients (r = 0.637, p = 0.001). Also, neopterin levels were correlated with hs-CRP in patients (r = 0.755, p = 0.0001). Conclusions: Our results are in line with a role of inflammation in coronary artery disease. The study provides evidence that IDO activity is related with immune and inflammatory states. Also, the study was performed in a limited hospital-based population. Further studies are warranted in the larger groups.
The Role of Matrix Metalloproteinase-2 Promoter Polymorphisms in Coronary Artery Disease and Myocardial Infarction
(Mary Ann Liebert, Inc, 2011) Alp, Ebru; Menevse, Sevda; Tulmac, Murat; Yilmaz, Akin; Yalcin, Ridvan; Cengel, Atiye
The matrix metalloproteinase (MMP) family are key enzymes involved in the breakdown of the extracellular matrix in normal physiological processes, including tissue remodeling, and disease processes, such as arthritis and metastasis. The promoter polymorphism in the MMP2 gene may be responsible for multiple diseases related to extracellular matrix degradation. Therefore, we aimed to investigate the relationship between genotypes or haplotypes of -1575 G/A, -1306 C/T, -790 T/G, and -735 C/T promoter polymorphisms and coronary artery disease (CAD) with or without myocardial infarction (MI) history. This study included 298 patients with angiographically confirmed CAD and 299 age matched controls. Genomic DNA was isolated from whole blood and genotyping was performed by the polymerase chain reaction-restriction fragment length polymorphism method. No significant associations were found between -1575 G/A, -1306 C/T, and -790 T/G polymorphisms and CAD with or without MI history. However, the frequency of the -735 TT genotype was significantly lower in the controls than in the patients with MI alone when compared with the CC genotype (p = 0.021). Only the distribution of the ACGC haplotype in CAD patients exhibited a significant difference than that in controls (p < 0.05). The distribution of other haplotypes did not differ between CAD patients and controls. The present investigation is the first report to detect an association between MMP2 promoter polymorphisms and CAD with or without MI history in the Turkish population. Further case-control studies in CAD development might be contributed to clarify the role of these polymorphisms.
Serum paraoxonase 1 activity, asymmetric dimethylarginine levels, and brachial artery flow-mediated dilatation in women with polycystic ovary syndrome
(Elsevier Science Inc, 2011) Soyman, Zeynep; Noyan, Volkan; Tulmac, Murat; Yucel, Aykan; Sagsoz, Nevin; Bayrak, Tulin; Cakir, Erdinc
Objective: To evaluate endothelial function via serum asymmetric dimethylarginine (ADMA) levels, paraoxonase 1 (PON1) activity, and brachial artery flow-mediated dilatation (FMD) in women with polycystic ovary syndrome (PCOS). Design: Prospective case-control study. Setting: University hospital. Patient(s): Thirty patients with PCOS with a mean age of 24.33 +/- 4.50 years and 30 healthy controls matched for body mass index (BMI) and age. Intervention(s): Endothelial function was assessed biochemically with serum ADMA levels and serum PON1 activity and functionally with brachial artery FMD by ultrasonography. Main Outcome Measure(s): Serum ADMA levels, serum PON1 activity, brachial artery FMD, hormonal and biochemical parameters. Result(s): Patients with PCOS had higher levels of free testosterone and insulin, and higher waist-hip ratio and Ferriman Gallwey scores when compared with the controls. Fasting glucose and homeostasis model assessment of insulin resistance were not different between the groups. There was no statistically significant difference in ADMA levels between two groups. Serum PON1 activity and brachial artery FMD were statistically significantly lower in women with PCOS. There was negative correlation between ADMA and PON1 in patients with PCOS. Conclusion(s): Serum PON1 activity and brachial artery FMD, as markers of endothelial dysfunction and cardiovascular risk, were statistically significantly lower in women with PCOS compared with healthy controls matched for age and BMI. Endothelial dysfunction may be seen at earlier ages in patients with PCOS. (Fertil Steril (R) 2011;95:1067-72. (C) 2011 by American Society for Reproductive Medicine.)
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. Tolga
We 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.

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