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    Öğe
    Investigation of heart rate variability and heart rate turbulence in chronic hypotensive hemodialysis patients
    (SPRINGER, 2020) Yalim, Zafer; Demir, Mehmet Emin; Yalim, Sumeyra Alan; Alp, Caglar
    Background Sudden cardiac death is the leading cause of cardiac-related death in hemodialysis patients. Hypotensive episodes in pre-, intra-, and post-dialytic periods can present serious clinical challenges that affect a patient's quality of life and prognosis. The aim of the present study was to evaluate cardiac autonomic control and arrhythmogenic risk by analyzing 24-h heart rate variability (HRV) and heart rate turbulence (HRT) in hypotensive hemodialysis patients. Methods A total of 79 patients on maintenance hemodialysis treatment, 39 normotensive and 40 with frequent hypotension episodes during non-dialysis periods, were included in the study. Dialysis-free periods were recorded with a 24-h Holter rhythm and ambulatory blood pressure monitor device. The time-domain parameters of HRV and HRT, including turbulence onset (TO) and turbulence slope (TS), were calculated. Results Values for SDNN (105.5 +/- 7.02, 127.6 +/- 6.2 p < 0.001), SDANN (95.1 +/- 5.9, 111.8 +/- 5.01 p < 0.001), and SDNN index (50.04 +/- 2.7, 55.6 +/- 3.7 p = 0.03), in the hypotensive group were significantly lower than in the normotensive group, respectively. Values for RMSSD (26.5 +/- 2.5, 27.3 +/- 2.7 p = 0.178), pNN50 (17 +/- 1.7, 55.6 +/- 3.7 p = 0.03), and TI (35.1 +/- 3.1, 34.7 +/- 2.6 p = 0.542) in both groups were not significantly different; however, there was a significant difference between HRT parameters, TO (- 1.8 +/- 0.37, - 2.4 +/- 0.39 p < 0.001) and TS (6.9 +/- 0.71, 8.2 +/- 0.97 p < 0.001), respectively, hypotensive and normotensive group. Conclusion Dialysis patients that experience frequent hypotensive episodes may also undergo significant changes in HRT and HRV which may be indicative of serious cardiac sequela. Thus, in such cases, a complete cardiologic evaluation is warranted.
  • [ X ]
    Öğe
    Mortality Trends from Ischemic Heart Disease in Turkey: 2009-2019
    (Kare Publ, 2022) Yalim, Zafer; Dogan, Nurhan; Yalim, Sumeyra Alan
    Objective: Cardiovascular diseases still play an important role in public health and epidemiology as the leading cause of death worldwide. Ischemic heart disease is the most common reason in this group. This study aims to analyze the latest trends in ischemic heart disease mortality rates in Turkey by age, gender, and region using the Turkish Statistical Institute mortality data and evaluate the results. Methods: We have obtained ischemic heart disease mortality data (2009-2019, in 12 regions) for Turkey from the mortality database of the Turkish Statistical Institute. Joinpoint analysis was used to estimate the annual percentage change and average annual percentage change to identify significant changes in trends. Results: The mean mortality rate for ischemic heart disease in Turkey was in an increasing trend from 2009 to 2019 (annual percentage change=1.7 (-0.8; 4.3), P = .166). This increase was more pronounced in women (annual percentage change = 2.2 (-0.7; 5.2), P=.121) compared to men (annual percentage change = 1.4 (-1.1; 3.9), P = .235). When the period between 2015 and 2019 was evaluated, it was determined that ischemic heart disease mortality was in a decreasing trend in the groups over 65 years of age. The death rate due to ischemic heart disease is almost 2 times higher in men than in women in Turkey, and this rate ratio is highest in the Istanbul region. Conclusion: Although ischemic heart disease mortality trends have decreased globally, our country's average is still on an increasing trend. However, significant decreases have been observed in ischemic heart disease mortality rates, especially in the group over 65 years of age, in the last 5 years.