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Öğe Elevated mean pulmonary artery pres- sure in patients with mild-to-moderate mitral stenosis: A useful predictor of worsening renal functions? (Authors Reply)(2014) Zorkun, Cafer; Amioğlu, Güllü; Bektaşoğlu, Gökhan; Zorlu, Ali; Ekinözü, İsmail; Turgut, Okan Onur; Yılmaz, Mehmet Birhan…Öğe Elevated mean pulmonary artery pressure in patients with mild-to- moderate mitral stenosis: a useful predictor of worsening renal functions?(2013) Zorkun, Cafer; Amioğlu, Güllü; Bektaşoğlu, Gökhan; Zorlu, Ali; Ekinözü, İsmail; Turgut, Okan Onur; Yılmaz, Mehmet BirhanAmaç: Böbrek fonksiyon bozukluğu, sıklıkla kalp hastalıklarına eşlik eder ve yüksek mortalite ve morbiditeye sahiptir. Kalp yetersizliği bulunan hastalarda santral venöz basınç yüksekliği de böbrek fonksiyonlarında bozulmayla ilgilidir. Bununla birlikte; sağ kalbe ait fonksiyon bozukluğu ile kalp yetersizliği bulunan hastalarla benzer patofizyolojik özelliklere sahip mitral darlığı bulunan hastalarda böbrek fonksiyonlarında bozulmayı gösteren belirteçlerin neler olduğu bilinmemektedir. Bu çalışmada, hafif ve orta mitral darlığı bulunan hastalarda klinik ve ekokardiyografik parametrelerin bozulan böbrek fonksiyonlarını göstermedeki yerinin araştırılması hedeflenmiştir. Yöntemler: Bu çalışma prospektif kohort bir dizayna sahiptir. Hafif ve orta derecede mitral darlığı bulunan, ortalama yaşları 5013 yıl olan, 9u erkek 51i kadın 60 hastada böbrek fonksiyonları ortalama 3413 ay (1-60 ay) takip edilmiştir. Takip boyunca, glomerüler filtrasyon oranında %20den fazla azalma görülmesi böbrek fonksiyonlarında bozulma olarak kabul edilmiştir. Hastalar böbrek fonksiyonlarında bozulma gelişip gelişmemesine göre iki gruba ayrıldı. İstatistiksel analiz olarak Ki-kare, bağımsız gruplarda t/Mann-Whitney U testleri, tek ve çok değişkenli Cox orantısal risk analizleri, ROC ve Kaplan-Meier eğrisi analizleri kullanıldı. Bulgular: Çalışmaya alınan 14 hastada (%23) böbrek fonksiyonlarında bozulma tespit edilmiştir. Yapılan tek değişkenli analizlerde; erkek cinsiyet, ortalama pulmoner arter basıncı, pik triküspit regürjitasyon akımı, sistolik pulmoner arter basıncı, dijital ve antitrombositlerin kullanımı, sağatriyum boyutları ve TEİ indeksinin böbrek bozukluklarında bozulmayı gösterdiği saptanmıştır. Çok değişkenli orantısal Cox risk modeli analizleri de, takip döneminde erkek cinsiyet ve ortalama pulmoner arter basıncının böbrek fonksiyonlarında bozulma riskindeki artış ile ilişkili olduğunu göstermiştir. ROC analizinde, mPAP için kötüleşen böbrek fonksiyonunu gösteren optimal cut-off değeri % 78,6 duyarlılık ve %58,7 özgüllük ile (AUC 0,725, %95 CI 0,595-0,838) 21 mmHg olarak ölçüldü. Kaplan-Meier eğrisi ile değerlendirmelerde, mPAP 21 mmHg olanlar ve olmayanlar arasında renal fonksiyonlarda kötüleşme açısından görülen fark anlamlıydı (p0,006). Gruplar arasındaki bu fark 30 aylık takip sonrasında daha da arttı. Sonuç: Hafif ve orta derecede mitral darlığı bulunan hastalarda, ilk değerlendirmede ölçülen artmış ortalama pulmoner arter basıncı, bozulan böbrek fonksiyonlarını göstermede yararlı olabilir.Öğe Elevated mean pulmonary artery pressure in patients with mild-to-moderate mitral stenosis: a useful predictor of worsening renal functions?(Turkish Soc Cardiology, 2013) Zorkun, Cafer; Amioğlu, Güllü; Bektaşoğlu, Gökhan; Zorlu, Ali; Ekinözü, İsmail; Turgut, Okan Onur; Yılmaz, Mehmet BirhanObjective: Renal dysfunction commonly accompanies the course of cardiac disorders and strongly associates with increased morbidity and mortality. Elevated central venous pressure is related to worsening renal function in patients with heart failure. However, predictors of worsening renal function in mitral stenosis-whose pathophysiologic process is similar to heart failure with regard to right heart dysfunction-are unknown. This study aimed to evaluate whether clinical and echocardiographic parameters might predict worsening renal function in patients with mild-to-moderate mitral stenosis. Methods: The current study has a prospective cohort design. Sixty consecutive patients (9 male, 51 female, mean age 50 +/- 13 years) with mild-to- moderate mitral stenosis were followed up for 34 +/- 13 months (range 1-60) and their renal functions were monitored. Worsening renal function was defined as a decline in glomerular filtration rate of >= 20% on follow-up. In order to presence or absence of worsening renal functions, study patients divided into two groups. Statistical analysis was performed using the Chi-square, Independent samples t / Mann-Whitney U tests, univariate and multivariate Cox proportional hazards analyses, receiver operating characteristic (ROC) and Kaplan-Meier curve analyses. Results: Worsening renal function was observed in 14 patients (23%). In univariate analysis, male gender, mean pulmonary artery pressure (mPAP), peak tricuspid regurgitation velocity, systolic pulmonary artery pressure, digitalis and antiplatelet usage, right atrial size, and TEI index were determined to be predictors of worsening renal function. In a multivariate Cox proportional hazards model, mPAP (HR=1.136, 95% CI: 1.058-1.220, p<0.001) and male gender (HR= 4.110, 95% CI: 1.812-9.322, p=0.001) were associated with increased risk of worsening renal function during the follow-up period. In ROC curve analysis, the optimal cut-off value of mPAP to predict worsening renal function was measured as more than 21 mmHg, with 78.6% sensitivity and 58.7% specificity (AUC 0.725, 95% CI 0.595-0.838). According to the Kaplan-Meier curve, a significant difference was found between those who had mPAP of >21 mmHg, and those who did not have, in terms of worsening renal function (p=0.006), and the difference between the groups increased after 30 months of follow-up. Conclusion: Elevated mean pulmonary artery pressure at the time of initial evaluation, in patients with mild-to-moderate mitral stenosis, might help to predict worsening renal function.Öğe Elevated mean pulmonary artery pressure in patients with mild-to-moderate mitral stenosis: a useful predictor of worsening renal functions? Reply(Aves, 2014) Zorkun, Cafer; Amioğlu, Güllü; Bektaşoğlu, Gökhan; Zorlu, Ali; Ekinözü, İsmail; Turgut, Okan Onur; Yılmaz, Mehmet Birhan…Öğe Re: Elevated mean pulmonary artery pressure in patients with mild-to-moderate mitral stenosis: A useful predictor of worsening renal functions?(AVES Ibrahim Kara, 2014) Zorkun, Cafer; Amioğlu, Güllü; Bektaşoğlu, Gökhan; Zorlu, Ali; Ekinözü, İsmail; Turgut, Okan Onur; Yılmaz, Mehmet Birhan[No abstract available]Öğe Usefulness of admission matrix metalloproteinase 9 as a predictor of early mortality after cardiopulmonary resuscitation in cardiac arrest patients(W B Saunders Co-Elsevier Inc, 2012) Türkdoğan, Kenan Ahmet; Zorlu, Ali; Güven, Fatma Mutlu Kukul; Ekinözü, İsmail; Eryiğit, Umut; Yılmaz, Mehmet BirhanBackground: Matrix metalloproteinases (MMPs) have a central role in disease progression after ischemia-reperfusion injury. However, its prognostic significance in cardiac arrest (CA) patients having cardiopulmonary resuscitation (CPR) is unknown. The aim of this study was to investigate the relation between admission MMP-9 level and early mortality in CA patients. Methods: A total of 96 in-hospital or out-of-hospital CA patients and 40 age-and sex-matched healthy volunteers as the control group were evaluated prospectively. The patients were classified according to the CPR response into a successful group (n = 46) and a failed group (n = 50). Results: The MMP-9 levels were detected to be 56.9 +/- 4.3, 69.5 +/- 7.4, and 92.7 +/- 10.1 ng/mL in the control group, the successful CPR group (acute responders), and the failed CPR group, respectively (P < .001 for the 2 comparisons). The MMP-9 level on admission, presence of asystole, mean CA duration, out-of-hospital CPR, sodium and potassium levels, and arterial pH were found to have prognostic significance in univariate analysis. In addition, MMP-9 levels were correlated with age, troponin level, and oxygen saturation. In multivariate logistic regression analysis with forward stepwise method, only MMP-9 level on admission (odds ratio, 1.504; P < .001) and mean CA duration before CPR (odds ratio, 1.257; P = .019) remained associated with post-CPR early mortality after adjustment of other potential confounders. In addition, optimal cutoff value of MMP-9 to predict failed CPR was found as greater than 82 ng/mL, with 88% sensitivity and 97.8% specificity. Conclusions: High MMP-9 levels were associated with worse clinical and laboratory parameters, and it seems that MMP-9 helps risk stratification in CA patients. (C) 2012 Elsevier Inc. All rights reserved.
