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Öğe Acute coronary syndrome developed after vincristine administration(2011) Öztürk, Serkan; Baltacı, Davut; Ayhan, Selim; Yazıcı, Mehmet; Sarıtaş, AyhanVincristine and doxorubicin are among the most effective chemotherapeutic agents used in the treatment of malignancies in combination per protocols. However, these chemotherapeutic agents possess great risk for development of cardiotoxicity. The most common manifestations of cardiotoxicity due to use of those chemotherapeutic agents are arrhythmias, systolic dysfunction, cardiomyopathy, pericardial injury and myocardial ischemia. We present a case of acute coronary syndrome with complete atrio-ventricular (AV) block, developed after vincristine and doxorubicin chemotherapy in a patient with multiple myeloma and no cardiac history.Öğe Assessment of the neutrophil to lymphocyte ratio in young patients with acute coronary syndromes(2013) Öztürk, Serkan; Erdem, Alim; Özlü, Mehmet Fatih; Ayhan, Selim; Erdem, Kemalettin; Özyaşar, Mehmet; Yazıcı, MehmetAmaç: Enflamasyonun akut koroner sendrom (AKS) oluşumunda ve ilerlemesinde önemli bir rol oynadığı bilinmektedir. Beyaz kan hücresi ve alt tipleri AKS’li hastalarda enflamasyonun bir göstergesidir. Bu çalışmada, beyaz kan hücresi ve alt tiplerinin 45 yaş genç hastalarda AKS ile ilişkisinin değerlendirilmesi amaçlandı. Çalışma planı: Göğüs ağrısı şikâyetiyle acil servise başvuran ST yükselmesi olmayan AKS’li (STYz-AKS) 84 genç (45 yıl) hastanın (40 ST yükselmesiz miyokart enfarktüslü [STYzME], 44 kararsız anjina pektoris) ve 40 kişilik kontrol grubunun beyaz kan hücresi ve alt tipleri olan nötrofil ve lenfosit oranları geriye dönük olarak incelendi. Bulgular: STYz-AKS’li hastalarda hipertansiyon, diabetes mellitus, sigara kullanımı ve aile öyküsü anlamlı olarak daha yüksekti. Bu grupta ayrıca LDL seviyeleri anlamlı olarak yüksek ve HDL seviyeleri anlamlı olarak düşük bulundu (p0.041 ve p0.009). Gruplar arasında lenfosit oranları anlamlı olarak farklıydı (p0.048). Tüm gruplar arasında ve STYzME’li ile kararsız anjina pektorisli gruplar arasında N/L oranı anlamlı olarak farklı bulundu (p0.001 ve p0.041). Ayrıca, çok değişkenli doğrusal regresyon analizinde hipertansiyonun, nötrofil yüzdesinin ve N/L oranının STYz-AKS için bağımsız öngördürücüler olduğu gösterildi (sırasıyla, beta0.251, %95 GA0.002- 0.523, p0.048; beta0.561, %95 GA0.008-0.137, p0.028 ve beta0.260, %95 GA0.042-0.438, p0.018). Sonuç: N/L oranı, STYz-AKS’li genç hastalarda kontrol grubundan daha yüksek bulunmuştur. Genç STYz-AKS’li hastalarda enflamasyonun beyaz kan hücreleri ve alt tipleri ile değerlendirilmesi daha da önemli rol oynayabilir.Öğe Assessment of the neutrophil to lymphocyte ratio in young patients with acute coronary syndromes(Turkish Anaesthesiology and Intensive Care Society, 2013) Öztürk, Serkan; Erdem, Alim; Özlü, Mehmet Fatih; Ayhan, Selim; Erdem, Kemalettin; Özyaşar, Mehmet; Yazıcı, MehmetObjectives: It is well known that inflammation plays a key role in both initiation and propagation of acute coronary syndrome (ACS). White blood cell (WBC) and its subtypes are an indicator of inflammation in patients with ACS. We aimed to evaluate the WBC and its subtypes in patients aged <45 year with acute coronary syndromes. Study design: We retrospectively analyzed WBC and its subtypes (including neutrophil and lymphocyte) in 84 patients (<45 year) who were admitted to the emergency department for chest pain suggestive of ACS (44 unstable angina pectoris, 40 non-ST-segment elevation myocardial infarction [NSTEMI]), and 40 healthy controls. Results: Hypertension, diabetes mellitus, smoking, and family history were significantly higher in NSTE-ACS patients. Also, LDL levels was significantly higher and HDL levels was significantly lower in NSTE-ACS patients (p=0.041 and p=0.009). The difference in percent of lymphocytes between the groups was significant (p=0.048). N/L ratio was significantly different between all groups and between the NSTEMI and USAP (p<0.001 and p=0.041). Our results demonstrated that hypertension, percent of neutrophils, and N/L ratio was a significant independent predictor of NSTE-ACS (Beta=0.251, 95% CI=0.002-0.523, p=0.048; beta=0.561, 95% CI=0.008-0.137, p=0.028 and beta=0.260, 95% CI=0.042-0.438, p=0.018, respectively). Conclusion: N/L was found to be elevated in young patients with NSTE-ACS compared with control group. The inflammation assessed using WBC and its subtypes may be more important in young NSTE-ACS patients. © 2013 Turkish Society of Cardiology.Öğe Detection of atrial electromechanical dysfunction in obesity(Taylor & Francis Ltd, 2015) Erdem, Fatma Hızal; Öztürk, Serkan; Baltacı, Davut; Dönmez, İbrahim; Alçelik, Aytekin; Ayhan, Selim; Yazıcı, MehmetIntroduction Obesity is associated with atrial fibrillation and is known as an independent risk factor. The aim of our study was to investigate if there was any association between the body mass index and atrial electromechanical intervals in obese and non-obese patients. Methods Seventy patients were enrolled in the study. Body mass index (BMI), functional capacity, and fasting blood sugar were evaluated; then, these patients were divided into two groups, patients who had a BMI >= 30 were known as obese (35 patients) and those who had a BMI <30 were known as non-obese patients. All patients were evaluated by transthoracic echocardiography. LA volumes were measured by the discs method in the apical four-chamber view. LA active and passive emptying volumes and fraction were calculated. Using TDI, atrial electromechanical coupling (PA) was measured from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septum), and right ventricular tricuspid annulus (PA tricuspid). Results LA diameter was significantly higher in obese patients (P=0.021). LA passive emptying volume and fraction were significantly decreased in obese patients (P = 0.038 and P = 0.011). LA active emptying volume and fraction were significantly increased in obese patients (P = 0.001 and P = 0.001). Left intraatrial and interatrial electromechanical delay were significantly higher in obese patients (18.9 +/- 3.8 vs 11.9 +/- 2.0, P < 0.001 and 29.5 +/- 4.1 vs 17.9 +/- 2.5, P < 0.001). Also interatrial electromechanical delay correlated positively with BMI. Conclusion This study revealed that delayed atrial electromechanical interval and impaired LA mechanical functions were related to BMI in obese patients. These findings may be an early sign of subclinical atrial dysfunction and arrhythmias in obese patients.Öğe Detection of left ventricular asynchrony and its relationship with the Tei index in patients with coronary artery ectasia(Pulsus Group Inc, 2013) Öztürk, Serkan; Ayhan, Selim; Aslantaş, Yusuf; Erdem, Alim; Özlü, Mehmet Fatih; Ekinözü, İsmail; Yazıcı, MehmetOBJECTIVE: To evaluate left ventricular (LV) systolic asynchrony and its relationship with the Tei index using tissue Doppler imaging (TDI); and to evaluate the relationship of thrombolysis in myocardial infarction frame count (TFC) and Tei index with LV asynchrony in patients with coronary artery ectasia (CAE). METHODS: A total of 50 CAE patients and 40 control subjects were evaluated. Diagnosis of CAE was made angiographically and TFC was calculated. LV systolic and diastolic function was assessed by conventional echocardiography and TDI. Evaluation of intra-LV systolic asynchrony was performed using tissue synchronization imaging (TSI). RESULTS: In patients with CAE, the Tei index was significantly higher than in controls (0.63 +/- 0.12 versus 0.52 +/- 0.12; P<0.001). LV systolic asynchrony parameters of TSI including SD of the peak tissue velocity (Ts) of the 12 LV segments (Ts-SD-12), maximal difference in Ts between any two of the 12 LV segments (Ts-12), SD of the Ts of the six basal LV segments (Ts-SD-6), maximal difference in Ts between any of the six basal LV segments (Ts-6) were significantly lengthened in patients with subclinical hypothyroidism compared with controls (P<0.001, P<0.001, P<0.001 and P<0.001, respectively). In addition, a positive correlation was found between Ts-SD-12 and the Tei index in patients with CAE (r=0.841; P<0.001) and mean TFC was positively correlated with Ts-SD-12 and the Tei index (r=0.345; P=0.013 and r=0.291; P=0.021, respectively). CONCLUSION: Patients with CAE exhibit evidence of LV systolic asynchrony according to TSI. LV systolic asynchrony is related to the Tei index and mean TFC. Furthermore, the Tei index is an independent risk factor for LV systolic asynchrony.Öğe Detection of subclinical atrial dysfunction by two-dimensional echocardiography in patients with overt hyperthyroidism(Elsevier Masson, 2012) Ayhan, Selim; Öztürk, Serkan; Dikbaş, Oğuz; Erdem, Alim; Özlü, Mehmet Fatih; Baltacı, Davut; Yazıcı, MehmetBackground. - Hyperthyroidism is an important cardiovascular risk factor in the development of atrial fibrillation and heart failure. Increased atrial electromechanical intervals are used to predict atrial fibrillation, measured by tissue Doppler imaging (TDI). Aims. - To evaluate atrial electromechanical delay (EMD) and left atrial (LA) mechanical function in patients with overt hyperthyroidism. Methods. - Thirty-four patients with overt hyperthyroidism and 34 controls were included. A diagnosis of overt hyperthyroidism was reached with decreased serum thyroid-stimulating hormone (TSH) and increased free T4 (fT4) concentrations. Using TDI, atrial electromechanical coupling (PA) was obtained from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septum) and right ventricular tricuspid annulus (PA tricuspid). LA volumes (maximum, minimum and presystolic) were measured by the disks method in apical four-chamber view and indexed to body surface area. LA active and passive emptying volumes and fractions were calculated. Results. - LA diameter was significantly higher in hyperthyroid patients (P = 0.001). LA passive emptying volume and fraction were significantly decreased in hyperthyroid patients (P = 0.038 and P < 0.001). LA active emptying volume and fraction were significantly increased in hyperthyroid patients (P < 0.001 and P < 0.001). Left and right intra-atrial (PA lateral-PA septum and PA septum-PA tricuspid) and interatrial (PA lateral-PA tricuspid) EMDs were significantly higher in hyperthyroid patients (29.2 +/- 4.4 vs 18.1 +/- 2.6, P < 0.001; 18.7 +/- 4.3 vs 10.6 +/- 2.0, P < 0.001; and 10.5 +/- 2.9 vs 7.1 +/- 1.2, P < 0.001, respectively). Stepwise linear regression analysis demonstrated that fT4 and TSH concentrations were independent predictors of interatrial EMD (beta = 0.436, P < 0.001 and beta = -0.310, P = 0.005, respectively). Conclusion. - This study showed prolonged atrial electromechanical intervals and impaired LA mechanical function in patients with overt hyperthyroidism, which may be an early sign of subclinical cardiac involvement and dysrhythmias in overt hyperthyroidism. (c) 2012 Elsevier Masson SAS. All rights reserved.Öğe The Effects of Ivabradine on Left Ventricular Synchronization and Tei Index in Patients with Systolic Heart Failure(Taiwan Soc Cardiology, 2017) Erdem, Fatma Hizal; Öztürk, Serkan; Öztürk, Selçuk; Erdem, Alim; Ayhan, Selim; Öztürk, Mustafa; Yazıcı, MehmetBackground: The aim of our study was to evaluate in stable outpatients with systolic heart failure (HF) the 3 months effect of ivabradine on LV synchronization and Tei index in stable outpatients with systolic HF. Methods: We evaluated prospectively 40 (30 males, 10 females) patients with HF. All patients were evaluated before and after treatment by transthoracic M mode, two dimensional (2D), pulsed-wave (PW), continuous wave (CW), color flow and tissue Doppler imaging (TDI) and tissue synchronization imaging (TSI). Standard deviation of Ts of the 12 LV segments (Ts-SD-12) is the most widely used parameter of intra-LV asynchrony. Results: Thirty men and 10 women with mean +/- SD age of 64.7 +/- 9.9 years were included in this study. Most of the patients benefitted from some degree of clinical improvement, 12/16 (75.0%) from NYHA III to II and 18/24 (75.0%) from II to I, respectively. Resting heart rate was significantly reduced after ivabradine treatment (84.3 +/- 11.4 vs. 66.5 +/- 11.5 bpm, p <0.001). E/E' and Tei index were significantly changed after ivabradine treatment (17.3 +/- 9.0 vs. 14.8 +/- 7.1, p = 0.02 and 0.86 +/- 0.74 vs. 0.81 +/- 0.69, p = 0.02). Intra-LV synchrony parameters Ts-SD-12 and Ts-12 were significantly reduced after ivabradine (46.8 +/- 13.6 vs. 42.7 +/- 13.1, p = 0.01 and 142.5 +/- 44.0 vs. 128.5 +/- 45.2, p = 0.009). Conclusions: The present study demonstrated that adding ivabradine to the standard therapy reduced HR and significantly improved LV ventricular asynchrony and Tei index in systolic HF patients.Öğe Evaluation of left atrial mechanical functions and atrial conduction abnormalities in patients with clinical hypothyroid(Via Medica, 2012) Öztürk, Serkan; Dikbaş, Oğuz; Özyaşar, Mehmet; Ayhan, Selim; Özlü, Fatih; Baltacı, Davut; Yazıcı, MehmetBackground: The aim of this study was to investigate left atrial (LA) mechanical functions, atrial electromechanical delay and P wave dispersion in hypothyroid patients. Methods: Thirty-four patients with overt hypothyroid and thirty controls were included. A diagnosis of overt hypothyroid was reached with increased serum TSH and decreased free T4 (fT4) levels. LA volumes were measured using the biplane area length method and LA active and passive emptying volumes and fraction were calculated. Intra- and interatrial electromechanical delay (EMD) were measured by tissue Doppler imaging (TDI). P wave dispersion was calculated by 12 lead electrocardiograms. Results: LA diameter were significantly higher in patients with overt hypothyroid (p = 0.021). LA passive emptying volume and LA passive emptying fraction were significantly decreased with hypothyroid patients (p = 0.002 and p < 0.001). LA active emptying volume and LA active emptying fraction were significantly increased with hypothyroid patients (p < 0.001 and p < 0.001). Infra- and interatrial EMD, were measured significantly higher in hypothyroid patients (30.6 +/- 6.1 vs 18.0 +/- 2.7, p < 0.001; and 10.6 +/- 3.4 vs 6.9 +/- 1.4, p < 0.001, respectively). P wave dispersion were significantly higher in hypothyroid patients (48.8 +/- 6.2 vs 44.3 +/- 7.2, p = 0.022). In stepwise regression analysis demonstrated that, interatrial EMD and LA active emptying fraction related with TSH and fT4. Conclusions: This study showed that impaired LA mechanical and electromechanical function in hypothyroid patients. TSH and T4 were independent determinant of interatrial EMD and LA active emptying fraction. (Cardiol J 2012; 19, 3: 287-294)Öğe Evaluation of left ventricular systolic asynchrony in patients with subclinical hypothyroidism(Via Medica, 2012) Öztürk, Serkan; Alçelik, Aytekin; Özyaşar, Mehmet; Dikbaş, Oğuz; Ayhan, Selim; Özlü, Fatih; Yazıcı, MehmetBackground: The heart was very sensitive to fluctuating thyroid hormone levels. To assess intra-left ventricular (LV) systolic asynchrony in patients with subclinical thyroid dysfunction. Methods: Fifty patients with subclinical hypothyroidism and 40 controls were included. A diagnosis of subclinical hypothyroidism was reached with increased TSH and normal free T4. All subjects were evaluated by echocardiography. Evaluation of intra-LV systolic asynchrony was performed by tissue synchronization imaging (TSI), and four TSI parameters of systolic asynchrony were calculated. LV asynchrony was defined by these parameters. Results: All of the groups were similar in terms of demographic findings and conventional and Doppler echocardiograpic parameters except peak systolic velocity and early diastolic velocity. LV systolic asynchrony parameters of TSI including; standard deviation of Ts of the 12 LV segments (Ts-SD-12), maximal difference in Ts between any 2 of the 12 LV segments (Ts-12), standard deviation of TS of the 6 basal LV segments (Ts-SD-6), maximal difference in Ts between any of the 6 basal LV segments (Ts-6) were significantly lengthened in patients with subclinical hypothyroidism than controls (p < 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively). The prevalence of LV asynchrony was significantly higher in patients with subclinical hypothyroidism than control. Conclusions: Patients with subclinical hypothyroidism present evidence of LV asynchrony by TSI. LV systolic asynchrony could be a warning sign of the early stage in cardiac systolic dysfunction in subclinical hypothyroid patients. (Cardiol J 2012; 19, 4: 374-380)
