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Öğe Assessment of the relationship between coronary flow rates and myocardial perfusion abnormality in patients with nonobstructive coronary artery disease: an observational study in cardiac syndrome X and coronary slow flow(Lippincott Williams & Wilkins, 2019) Özde, Cem; Aktüre, Gülşah; Aytekin, Seda; Sayın, Ahmet Egemen; Ay, Esra Koç; Coşkun, Gökhan; Kayapınar, OsmanObjectives In this study, we evaluated and compared the level of myocardial ischaemia caused by cardiac syndrome X (CSX) and coronary slow flow (CSF) with single photon emission computed tomography myocardial perfusion imaging (SPECT-MPI), and determined if changes in the level of myocardial ischaemia exist in CSF and CSX cases according to thrombolysis in myocardial infarction frame count (TFC). Materials and methods The study population consisted of 66 patients with CSF and 78 angiographically normal patients (36 of them with CSX and 42 of them healthy controls). The coronary flow rates of all patients were documented using TFC. Subsequently, all patients were evaluated with SPECT-MPI and categorized into the following groups according to their results: patients with CSF, patients with CSX, and patients with normal coronary arteries. Finally, we investigated whether a relationship existed between the SPECT-MPI and TFC results from these three groups. Results All ischaemia scores for MPI were significantly higher in the CSF group than in the CSX and control groups (P < 0.05). TFC was significantly associated with the severity of ischaemia in the CSF patients. There was a significant positive correlation between the summon difference score (SDS) and mean TFC value (P < 0.05) as well as between the SDS and each individual coronary TFC value in the CSF patients (P < 0.05). The number of vessels involved in CSF was positively correlated with the SDS. Conclusion CSF is associated with more severe myocardial ischaemia than CSX. The level of myocardial ischaemia on SPECT-MPI was correlated with the TFC and the number of affected coronary vessels in patients with CSF. These results suggest that CSF is a more serious clinical entity than CSX, and that the clinical severity of CSF appears to increase as the coronary flow rate decreases.Öğe Evaluating the effect of nasal septoplasty on atrial electromechanical features(W B Saunders Co-Elsevier Inc, 2019) Kayapınar, Osman; Kaya, Adnan; Özde, Cem; Cebeci, Derya; Ünlü, İlhanBackground: Recent studies have demonstrated that right ventricular (RV) dysfunction and increased pulmonary artery pressure may be frequent in patients with upper airway obstruction. In this study, we evaluated atrial conduction delays in patients with upper airway obstruction secondary to nasal septum deviation (NSD). Methods: A total of 32 patients with upper airway obstruction secondary to NSD undergoing a septoplasty procedure were enrolled in this study. Preoperative electrocardiography and transthoracic echocardiography were performed in all patients who underwent surgery. The mean pulmonary artery pressure (mPAP) and atrial conduction time (ACT) were recorded before and 6 months after the surgical procedures. Results: The PAP was significantly lower postoperatively than preoperatively (20.75 +/- 4.83 vs. 24.68 +/- 5.26; P < 0.001). The postoperative Electromechanical Delay of Mitral septal wall (EMD-MS) value was significantly lower than that preoperatively (46.20 +/- 8.5 vs. 40.5 +/- 9.9; P < 0.001). The postoperative Electromechanical Delay of Mitral lateral wall (EMD-ML) value decreased significantly compared to the preoperative period (46.3 +/- 7.4 vs. 40.6 +/- 9.3; P < 0.001). The postoperative Electromechanical Delay of Tricuspit lateral wall (EMD-TL) value was significantly lower than that preoperatively (43.8 +/- 7.0 vs. 38.1 +/- 9.1; P < 0.001). There was no significant change in pre- or postoperative measurements of inter- and intra-atrial conduction delays. Conclusions: We demonstrated that upper airway obstruction secondary to NSD causes a significant increase in mPAP and a significant delay in ACT, which improved after nasal septoplasty. According to these results, we conclude that upper airway obstruction may be an important risk factor for pulmonary arterial hypertension, RV dysfunction, and atrial arrhythmias, especially in unoperated cases.Öğe Hipertansiyon Hastalarında Obezite ve Depresyonun Değerlendirilmesi(2024) Aktüre, Gülşah; Kayapınar, Osman; Özde, Cem; Sayın, Ahmet Egemen; Coşkun, Gökhan; Ekşi, EnsarAmaç: Hipertansiyon, dünyada önlenebilir ölüm nedenlerinin arasında en sık karşılaşılanların başında gelir. Anksiyete ve depresyon semptomlarının da hipertansiyon gelişimine önemli katkısı olduğu daha önce birçok çalışmada araştırılmıştır. Ancak, çalışmaların sonucunda farklılıklar gözlenmiştir. Hipertansiyona neden olan en önemli risk faktörlerinden birisi obezitedir. Biz bu çalışmamızda Düzce Üniversitesi Aile Hekimliği polikliniğine başvuran hastalarda, vücut kitle indeksi (VKİ) ve Hamilton depresyon skorunun kan basıncı üzerine olan etkisinin araştırılması amaçlandı. Gereç ve Yöntemler: Bu kesitsel çalışmaya, Düzce Üniversitesi Aile Hekimliği polikliniğine başvuran ve obezite tanısı konan 228 hasta çalışmaya dahil edildi. Hastaların VKİ ve Hamilton depresyon skorları hesaplanarak, sistolik ve diastolik kan basınçları ile olan ilişkileri incelendi. Bulgular: Çalışmaya dahil edilen hastaların 28‘i erkek (%12), 200‘ü kadın (%88) idi. Çalışmamızda cinsiyet, meslek durumu, öğrenim durumu ve sigara içiciliğinin HAMD depresyon puanı üzerine anlamlı etkisi olmadığı saptandı. Çalışmaya dahil edilen 228 hastanın Hamilton depresyon puanı incelendi. 182 (%79,8) hastada depresyon saptanmadı. 35 hastada (%15,3) minör depresyon saptandı. 11 hastada (%4,8) majör depresyon saptandı. Hamilton depresyon skoru artışının sistolik kan basıncında artışı üzerine istatistiksel olarak anlamlı etkisi olduğu saptandı (p=0,017). Sonuç: Elde edilen bulgulara göre, VKİ ve Hamilton depresyon skoru artışının kan basıncı artışı ile ilişkili olabileceği saptandı. Hipertansiyon hastalarına bütünsel yaklaşımlar önemlidir. Hastaların yaşam tarzı, alışkanlıkları, mevcut kilo durumu ve psikolojik stres durumları ayrıntılı olarak incelenmelidir. Bu da bize gösteriyor ki, aile hekimliğinin hastalara biyopsikososyal olarak bütünsel yaklaşımı hipertansiyon korunması ve tedavisinde önemli bir rol oynamaktadır.Öğe Perkütan Koroner İşlem Yapılan Hastalarda Klopidogrel Direncinin Klinik Belirteçleri(2019) Kayapınar, Osman; Özde, CemAmaç: Antiplatelet tedavi güncel koroner arter hastalığının vazgeçilmez parçası olup, ADP inhibitörlerine karşı gelişen direnç hastaların istenmeyen kardiyovasküler olay yaşamalarına sebep olmaktadır. Bu çalışmada perkütan koroner işlem yapılan hastalarda klopidogrel direnci belirteçlerinin saptanması amaçlandı. Gereç ve Yöntem: Koroner arter hastalığı nedeniyle peruktan girişim yapılan ve birinci hafta sonunda bakılan testte klopidogrel direnci saptanan ardışık 80 hasta (38 klopidogrel direnci, 42 kontrol) çalışmaya alındı. VerifyNow testinde >208 platelet reaktivite ünitesi klopidogrel direnci ve >550 aspirin reaksiyon ünitesi aspirin direnci olarak kabul edildi. 28 hasta ST elevasyonlu MI, 18 hasta ST elevasyonsuz MI ve diğer hastalara stabil koroner hastalığı nedeniyle tedavi edilmişti. Hastaların demografik bulguları, özgeçmiş ve soy geçmişlerine ait değişkenler, vücut kitle indeksi, enjeksiyon fraksiyonu, aspirin direnci ve biyokimyasal parametreleri karşılaştırıldı. Bulgular: Hastaların ortalama yaşı 59±12 idi ve 15’i kadındı. Klopidogrel direnci saptanan olgular anlamlı olarak Hemoglobin değerleri daha düşüktü. Direnç gözlenenlerde hipertansiyon öyküsü daha sık iken kadın cinsiyet ve sigara içenler daha fazlaydı. Lojistik regresyon analizi sonucunda hemoglobin (ters yönde; Odds oranı = 0.8; % 95 güvenlik aralığı (0.678-0.945), p=0.008]) anlamlı olarak klopidogrel direncini öngördürdü. Sonuç: Düşük hemoglobin değeri diğer klinik değişkenlerden bağımsız olarak klopidogrel direncini öngördürmektedir.Öğe Prevalence and characteristics of CAAs in the black sea region(Derman Medical Publ, 2018) Kayapınar, Osman; Sayın, Ahmet Egemen; Kaya, Adnan; Özde, Cem; Keskin, MuhammedAim: To date there has been no data about the prevalence of coronary artery anomaly (CAA) in the Turkish population of the Black Sea Region who underwent trans-radial coronary angiography. We aimed to determine the frequency and characteristics of CAA in our patients. Material and Method: All the coronary angiographies performed from September 2015 to September 2016 in our hospital were reviewed. Demographic characteristics and laboratory parameters of patients were reviewed retrospectively from the patients' data set. A total of 1617 patient were included in our study. Results: CAAs were found in 73 patients (4.51%), of whom 41 (56.16%) had intrinsic coronary artery anatomy. Twenty-two (30.13%) patients had anomaly of origination and course and 10 (13.69%) patients had anomaly of coronary artery termination. The mean age was 59.35 +/- 11.86 in the study group and 60.11 +/- 6.61 in the control group. Myocardial bridge was the most common anomaly in our study with a prevalence of 2.16%. Absent LMCA was the second most common anomaly in our study with a prevalence of 0.80% and coronary artery fistula was third with a prevalence of 0.61%. Discussion: We found the prevalence of CAAs among the Turkish population of the Black Sea Region to be similar to previously published studies from our country. To avoid misunderstandings one must know the normal anatomy of coronary vasculature, variations, and the anomalies. When coronary angioplasty or cardiac surgery is planned in patients with CAA, special attention must be paid not to harm coronary arteries in unexpected locations.Öğe Relationship Between the Reciprocal Change in Inflammation-Related Biomarkers (Fibrinogen-to-Albumin and hsCRP-to-Albumin Ratios) and the Presence and Severity of Coronary Slow Flow(Sage Publications Inc, 2019) Kayapınar, Osman; Özde, Cem; Kaya, AdnanInflammation has been implicated in the pathogenesis of endothelial dysfunction, atherosclerosis, and microvascular coronary dysfunction. In this context, it is thought that fibrinogen, high-sensitive C-reactive protein (hsCRP), and albumin may be associated with the pathogenesis of coronary slow flow (CSF). We aimed to evaluate the ratios of fibrinogen-to-albumin and hsCRP-to-albumin in patients with CSF compared to patients with angiographically normal coronary arteries and stable coronary artery disease (CAD). In all, 65 patients with CSF, 65 patients with newly diagnosed stable CAD, and 65 control participants with angiographically normal coronary arteries were included. The coronary flow rates of all patients were determined by the Thrombolysis in Myocardial Infarction frame count method. Fibrinogen, hsCRP, and albumin levels were analyzed in all patients, and the fibrinogen-to-albumin and hsCRP-to-albumin ratios were calculated. The baseline characteristics of the 3 groups were similar. The plasma albumin level was significantly lower, whereas the fibrinogen and the hsCRP levels were significantly higher, in the CSF and CAD groups compared to the controls. The fibrinogen-to-albumin and hsCRP-to-albumin ratios were significantly higher in both the CSF and the CAD groups compared to the control group. The hsCRP-to-albumin ratio was positively correlated with the mean Thrombolysis in Myocardial Infarction frame count in the whole study population. According to the receiver-operating characteristic analysis, the efficacies of the fibrinogen-to-albumin and hsCRP-to-albumin ratios in predicting CSF were significant. The fibrinogen-to-albumin and hsCRP-to-albumin ratios, which were increased by a reciprocal change, suggest that inflammation may play a role in the pathogenesis of CSF.Öğe Serum Sistatin-C düzeyleri Diyastolik Kalp Yetmezliğinde Öngördürücü Olabilir(Duzce Univ, 2018) Kayapınar, Osman; Özde, Cem; Kaya, AdnanAmaç: Diyastolik kalp yetmezliği; sistolik kalp yetmezliği gibi değerlendirilirken aslında bunların birbirinden ayrı patofizyolojik mekanizmalarla ilerlediği bilinmektedir. Çalışmamızda serum Sistatin C düzeyi ve diyastolik fonksiyon bozukluğu arasındaki ilişkiyi incelemeyi hedefledik. Gereç ve Yöntem: Mayıs 2010 ve Eylül 2010 tarihleri arasında Düzce Üniversitesi Tıp Fakültesi Hastanesi Kardiyoloji polikliniğine başvuranlar kabul edildi. Hastaların diyastolik parametreleri değerlendirildi ve serum Sistatin C düzeyleri çalışıldı. Hastalar diyastolik fonksiyonlarına göre normal, grade 1, grade 2 olarak üç gruba ayrıldı ve serum Sistain C düzeyi ile bu gruplar arasında ilişki araştırıldı. Bulgular: Grade 1 ve grade 2 diyastolik disfonksiyonu olan hastalar ile diyastolik fonksiyon bozukluğu olmayanlar serum Sistatin C seviyelerine göre karşılaştırıldı. Diyastolik disfonksiyon olan gruplarda Sistatin C düzeyinde anlamlı düzeyde artış olduğu gösterildi (grade 1:p<0,0001, grade 2: P<0,004). Serum sistatin C seviyeleri için Reciever operating eğrisi (ROC) , serum sistatin C > 0,997 ng / ml seviyesinde, diyastolik disfonksiyonu % 80 özgüllük ve% 78.95 duyarlılık ile tanımlayabildi. Sonuç: Serum sistain C düzeyi diyastolik disfonksiyonun erken tespitinde ve takibinde faydalı olabilir.Öğe Subclinical right ventricular dysfunction in intermittent and persistent mildly asthmatic children on tissue Doppler echocardiography and serum NT-proBNP: Observational study(Wiley, 2018) Özde, Cem; Doğru, Mahmut; Özde, Şükriye; Kayapınar, Osman; Kaya, Adnan; Korkmaz, AhmetBackground Bronchial asthma may lead to pulmonary hypertension, right ventricular (RV) dysfunction, and cor pulmonale due to elevated afterload on the RV later in life. The aim of this study was to determine whether serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) might serve as a biomarker for detecting subclinical RV dysfunction using echocardiography during the early stages of bronchial asthma. Methods Sixty-eight pediatric patients with asthma (asthma group) and 69 age- and sex-matched healthy children (control group) were enrolled. The study was conducted in a tertiary woman and child diseases education and research hospital from January 2013 to December 2013. RV function (2-D and tissue-Doppler echocardiography), pulmonary function (spirometry) and serum NT-proBNP concentration were evaluated. Results Mean age was 10.5 +/- 2.8 years in the asthma group and 10.2 +/- 2.7 years in the control group (P = 0.522). RV diastolic function was significantly decreased in the asthma group (ratio of tricuspid lateral annular early diastolic peak velocity to tricuspid lateral annular late diastolic peak velocity [E '/A '], 1.29 +/- 0.68 vs 1.74 +/- 0.89, P = 0.001). RV myocardial performance index was significantly higher in the asthma group than in the control group (0.28 +/- 0.06 vs 0.24 +/- 0.07, respectively; P = 0.003). Finally, serum NT-proBNP concentration was significantly higher in the asthma group than in the control group (292.3 +/- 142.2 pg/mL vs 208.2 +/- 70.1 pg/mL, respectively; P = 0.003). Conclusion Increased serum NT-proBNP is associated with subclinical RV dysfunction in asthmatic children. RV function is significantly affected in children with bronchial asthma.
