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Öğe The association between NT-proBNP levels, functional capacity and stage in patients with heart failure(Taylor & Francis Ltd, 2005) Karabulut, A; Kaplan, A; Aslan, C; Iltumur, K; Toprak, G; Toprak, NObjective - Amino-terminal probrain natriuretic peptide (NT-proBNP), a biologically inactive derivative of BNP, is clinically more useful owing to its longer half-life, higher plasma concentrations, lesser variation among individuals, and higher in vitro stability. In this regard, NT-proBNP may be a better indicator of the severity of ventricular dysfunction. In this study, the association of NT-proBNP levels with functional capacity and stage of heart failure was explored in patients with CHF Also, we particularly focused on the presence and significance of neurohormonal activation in the group of patients classified as stage-A according to ACC/AHA guidelines. Methods and results - 64 patients with CHF (31 men, 33 women; mean age 58.26 +/- 10.59 y) and 36 healthy controls (24 men, 12 women; mean age 57.47 +/- 10.83) were included in this study. The New York Heart Association (NYHA) classification system (I, II, III, IV) was used to define the functional capacity; and the stage of the heart failure was based on the ACC/AHA guidelines (A, B, C, D). Healthy female participants had higher NT-proBNP levels compared to their male counterparts (p < 0.001). Left ventricular ejection fraction (LVEF) did not correlate significantly with functional capacity and stage of the disease. CHF patients had higher NT-proBNP compared to controls (p < 0.001). There was a positive correlation between NT-proBNP and functional capacity in patients, and NT-proBNP increased significantly with each increasing class of the disease. Similarly, a positive correlation existed between the stage of heart failure and NT-proBNP levels, which increased significantly with increasing stages of the disease. Patients with NYHA I and stage A disease had higher NT-proBNP levels compared to controls (p = 0.04). Conclusions - The severity of CHF can be objectively assessed by measuring the circulating levels of NT-proBNP. Even in NYHA I and stage A disease, NT-proBNP levels are higher compared to controls (p = 0.04). NT-proBNP can provide objective information regarding the severity of the disease and also aid in treatment decisions in patients with CHF.Öğe Complement activation in acute coronary syndromes(Wiley, 2005) Iltumur, K; Karabulut, A; Toprak, G; Toprak, NThe complement system is part of the host defence response. However, considerable evidence suggests that complement plays an important role in the pathophysiology of ischemic heart disease. The aim of this study was to evaluate complement activation in patients with all forms of acute coronary syndromes (ACS) and to examine the relationship between the degree of complement activation and myocardial injury The study population included 152 subjects (26 females): 82 with ACS (35 acute myocardial infarction (AMI), 22 non-Q wave MI (NQMI), 25 unstable angina (UAP)) (Group A), 35 stable angina (SA) (Group B), and 35 healty control subjects (Group Q. Complement 3 (C3), Complement 4 (C4), C-reactive protein (CRP), troponin I (TnI) as well as creatine kinase MB (CK-MB) were evaluated. Patients' blood samples were taken on admission (day 1) and after 2, 3 and 7 days in group A. However, only one measurement was performed in the groups B and C. Plasma C3 and C4 peak levels were significantly higher in patients with AMI (141 +/- 29 and 35 +/- 11 mg/dl) and NQMI (136 +/- 13 and 35 +/- 7 mg/dl) than in patients with SA (128 +/- 14 and 27 +/- 10 mg/dl) and the control subjects (114 +/- 22 and 22 +/- 7 mg/dl) (p < 0.03). Also, C3 and C4 serum levels in patients with SA and UAP (126 +/- 16 and 31 +/- 7 mg/dl) were significantly higher than those in control subjects (p < 0.01, p < 0.03, respectively). At 1-week follow-up, there were no significant differences between the plasma levels of C3 and C4 in patients with UAP (p > 0.05). However, plasma levels of C3 and C4 were significantly different between days in patients with AMI and NQMI (p < 0.0001). Plasma C3 and C4 levels in ACS showed a relationship with peak CK-MB and Tn I levels (p < 0.01). Plasma CRP level in ACS showed positive correlation with C3 (p < 0.01) and C4 (p < 0.001). In this study, we determined that plasma C3 and C4 levels were elevated in ACS and SA. Although C3 and C4 were higher in ACS and SA, the systemic levels of inflammatory markers in patients with SA and UAP were lower than those found in the AMI and NQMI groups. The relationship between C3, C4 levels and ACS further suggests that the complement activation is related to necrosis within the myocardium.Öğe Contribution of the peak exercise QT dispersion to the accuracy of an exercise test during the evaluation of coronary artery disease(Acta Cardiologica, 2000) Ülgen, MS; Karadede, A; Alan, S; Temamogulari, AV; Karabulut, A; Toprak, NObjective - Regional defects in ventricle repolarization are extremely sensitive to ischaemia which can be measured as QT dispersion (QTd). We investigated the role of QTd calculated at the time of peak exercise during treadmill studies. Methods and results - Thirty-three women and eighty men, whose treadmill test results and coronary angiography studies had been examined, were divided into four groups according to the test results: 1)subjects with a negative treadmill test and without significant stenosis results in the angiography, were considered normal (N; n = 35); 2) subjects with both a positive exercise test and a significant presence of stenotic coronary arteries, were considered true positive (TP; n = 52); 3) subjects with a positive exercise test, but without significant stenosis results in the angiography, were considered false positive (FP; n = 14); 4) subjects with a negative treadmill study, despite significantly stenotic arteries, were considered false negative (FN; n = 12), All subjects were evaluated on the basis of age, significant ST-segment depression, peak heart rate, rest and peak exercise QT, and QpT (measured from the beginning of the QRS complex to the highest point of the T wave) dispersion, and corrected (QTcd, QpTcd) values for heart rate. The most significant differences were observed between the N and the TP groups in terms of QTd and QTcd (p < 0.01), with a higher correlation (r = 0.48). A significant relationship was also observed in terms of QpT and QpTcd values during peak exercise (p < 0.01). The sensitivity of the peak exercise QTcd and QTcd greater than or equal to 70 ms in determining coronary artery disease was found to be 74%. In cases of QTcd greater than or equal to 70 ms, in addition to ST-segment depression, the test was found to be less sensitive, but more specific at 96%. Conclusion - It suggests that when peak exercise QTd and QpTd values are taken into account, with the exception of the ST-segment depression, the accuracy of the exercise test will increase and false positive results will decrease.Öğe Electrocardiologic and echocardiographic features of patients exposed to scorpion bite(Sage Publications Inc, 2004) Alan, S; Ulgen, MS; Soker, M; Geyik, F; Karabulut, A; Toprak, NThe purpose of this study is to examine clinical progress and hemodynamic and electrocardiologic features (QT depression and heart rate variability [HRV]) of patients exposed to a scorpion bite. Seventeen patients bitten by scorpions, and, as a control group, 15 healthy subjects were included in the study. Standard electrocardiograph (ECG) records, 24-hour Holter-ECG, and Doppler echocardiographic examinations were performed. Holter ECG indicated sinus tachycardia, sinus bradycardia, paroxysmal supraventricular tachycardia, atrial fibrillation, first-degree and second-degree atrioventricular block not requiring treatment, early atrial beats, and early ventricular beats in the patients at frequencies of 82%, 12%, 35%, 12%, 8%, 70%, and 47%, respectively. HRV parameters that reflected parasympathetic activity (SD 35 +/-13-43 +/-16, RMS-SD: 20 +/-9-30 +/-12, high frequency: 7.8 +/-2-4.3 +/-3, p<0.05) were significantly lower (p<0.05). Low frequency, which especially showed sympathetic activity (LF: 11 +/-13 - 11 +/-23, p > 0.05), was similar in both groups. In addition, the LF/HF ratio, which reflected sympathovagal balance, was significantly increased in the patient group (1.5 +/-1-3.0 +/-2, p = 0.005). Corrected QT and QT dispersion values were not significantly different with respect to the control (p > 0.05). In the patient group compared to the control, a significant decrease was determined in the proportion of mitral E velocity to mitral A velocity (mEv/mAv), diastolic filling period (DFP), and left ventricular ejection fraction (LVEF), while a significant increase was noticed in pulmonary artery pressure (PAP) (mEv/mAv: 0.9 +/-0.4-1.7 +/-0.6, DFP: 362 +/-8.5-425 +/-89, LVEF: 53.1 +/-6.7-68.6 +/-5.8, PAP: 38.1 +/-13-27.2 +/-6, p<0.05). Scorpion bite leads to serious cardiovascular disorders, associated with decreased HRV, decreased systolic and diastolic functions, increased arrhythmic events, and hemodynamic disturbance with sympathetic and parasympathetic balance disturbance.Öğe Hepatopulmonary syndrome and right ventricular diastolic functions: An echocardiographic examination(Blackwell Publishing, 2006) Karabulut, A; Iltumur, K; Yalcin, K; Toprak, NAim: Liver functions are affected in the course of cardiac diseases, and similarly, liver diseases affect cardiac functions. Many studies in the literature have shown that left ventricular systolic and/or diastolic dysfunction may develop during chronic liver disease. However, there are limited studies investigating right ventricular functions during chronic liver diseases. Methods: A total of 84 patients who had no systolic and/or diastolic dysfunction in the left ventricle (LV) were evaluated; 46 patients with liver cirrhosis; 10 (21.74%) cirrhotic patients with hepatopulmonary syndrome (HPS) (group 1), 36 (78.26) cirrhotic patients without HPS (group 2), and 38 healthy individuals were treated as control. Results: Right ventricular diastolic dysfunction was determined in all patients of group 1 (100%), 26 of group 2 (72.22 %), and 4 of the controls (10.52%) (P < 0.05). Tricuspid deceleration time (dt) was significantly different between the groups (P < 0.05). In addition, right atrium (RA) diameters, right ventricle (RV) diameters, and RV wall thickness were significantly different between the groups (P < 0.05). Pulmonary artery pressure (P < 0.05) and pulmonary vascular resistance (P < 0.05) were also seen to be higher in group 1 than those in group 2 and control group. Conclusions: Right ventricular diastolic dysfunction rate is high in chronic liver diseases. In the presence of HPS, right ventricular diastolic dysfunction is more remarkable in patients than those without HPS. Right ventricular diastolic dysfunction may result in dilatation and hypertrophy in the right heart.Öğe Iatrogenic left atrioventricular fistula after aortic valve re-replacement(I C R Publishers, 2005) Iltumur, K; Karabulut, A; Karadede, A; Toprak, NLeft ventriculoatrial fistula is a very rare cardiac disorder. The case is reported of a male patient who was admitted to the authors' clinic with dyspnea and fatigue. The patient had an atrioventricular fistula between the left atrium and left ventricle, and had undergone aortic valve re-replacement for prosthesis malfunction about one year previously. The fistula was considered to be the result of iatrogenic injury related to valve re-replacement surgery.Öğe Insulin response to oral glucose loading and coronary artery disease in nondiabetics(Int Heart Journal Assoc, 2005) Karabulut, A; Iltumur, K; Toprak, N; Tuzcu, AK; Kara, IH; Kaplan, A; Aksu, YHyperinsulinemia is related to coronary artery disease (CAD), as an indication of decreased insulin sensitivity. Although there are man), Studies showing the relation between fasting insulin levels and insulin resistance. there are fewer studies on postprandial insulin levels. The aim of the present Study was to investigate the relationship between postprandial insulin levels and CAD and its extent in our patients. For this purpose, oral glucose tolerance testing was performed in 222 patients with no known diabetes and who were scheduled to undergo diagnostic coronary angiography. The patients were first separated into two groups, one group (group I) having an insulin response within reference values to oral glucose loading, and the other group (group II) with a higher than normal insulin response. The presence and extent of CAD in the two groups were compared. While 65% of the patients in group I had CAD, this rate increased to 79% in group 2 patients (P = 0.02). The mean vessel scores were 0.92 +/- 0.78 in group I and 1.67 +/- 0.99 (P < 0.0001) in group 2 patients. The stenosis scores were 2.192 +/- 2.077 in group I and 5.588 +/- 3.519 (P < 0.001) in group 2, while the extent scores were 1.230 +/- 1.292 in group I and 2.729 +/- 1.847 in group 2 (P < 0.0001). The differences between the two groups were significant. Postprandial insulin values were positively correlated with CAD (P = 0.001, r = 0.214), vessel scores (P < 0.0001, r = 0.326), stenosis scores (P < 0.0001. r = 0.261), and extent scores (P < 0.0001, r = 0.419). Logistic regression analysis revealed hyperinsulinemia increased CAD independent from the other risk factors (OR = 5.742 CI 95%: 1.809-18.227, P = 0.003).Öğe N-terminal proBNP plasma levels correlate with severity of mitral stenosis(I C R Publishers, 2005) Iltumur, K; Karabulut, A; Yokus, B; Yavuzkir, M; Taskesen, T; Toprak, NBackground and aim of the study: Brain natriuretic peptide (BNP), a neurohormone, is secreted predominantly from the ventricular myocardium. Studies investigating BNP secretion in diseases affecting the right side of the heart are scarce. The relationship between N-terminal proBNP (NT-proBNP) and echocardiographic and clinical findings was studied in cases with isolated moderate to severe rheumatic mitral stenosis (MS), and in patients with previous mitral valve replacement (MVR). Methods: Thirty-two patients with MS (mean age 41.2 +/- 5.7 years), 20 with MVR (mean age 46.0 +/- 4.6 years) and 30 healthy individuals (mean age 40.3 +/- 4.9 years) were included in the study. In addition to NT-proBNP measurements, detailed transthoracic echocardiography was performed in all patients and healthy subjects. Results: Plasma levels of NT-proBNP were significantly higher in patients with MS than in those with MVR or in controls (99.8 +/- 12.7 versus 74.7 +/- 6.9 and 48.5 +/- 10.5 pg/ml, respectively; p < 0.0001 all groups). NT-proBNP levels showed a significantly greater increase in severe MS than in moderate MS (109.8 +/- 5.6 versus 88.3 +/- 7.6 pg/ml, p < 0.0001). NT-proBNP levels also were higher in MVR patients than in controls (74.7 +/- 6.9 versus 48.5 +/- 10.5 pg/ml; p < 0.0001). Although NT-proBNP levels did not correlate with left ventricular ejection fraction (LVEF) in patients with MS (r = -0.33; p > 0.05), there was a positive correlation with pulmonary artery pressure (r = 0.87; p < 0.001) and a negative correlation with mitral valve area (MVA) (r = -0.89; p < 0.0001). However, multivariate analysis identified only MVA as an independent correlate of NT-proBNP (P = -0.47; p = 0.02). Conclusion: In patients with rheumatic MS, NT-proBNP levels correlated positively with MS severity. Moreover, NT-proBNP levels increased significantly in patients with MS, but were significantly lower in those who underwent MVR.Öğe A severe (type II) hepatopulmonary syndrome in a patient with idiopathic portal hypertension and treatment with paroxetine(Van Zuiden Communications, 2005) Yilmaz, S; Dursum, M; Canoruc, F; Bayan, K; Karabulut, A; Akay, HThe hepatopulmonary syndrome has been defined as chronic liver disease accompanied by abnormal pulmonary gas exchange, which might result in arterial deoxygenation, and widespread intrapulmonary vasodilation. Although it has been pointed out that hepatopulmonary syndrome occurs in liver cirrhosis, there are a few studies in the literature reporting noncirrhotic portal hypertension as a cause of hepatopulmonary syndrome. Currently, liver transplantation is the only effective therapy for such patients. On the other hand, there is also a proposal about considering paroxetine, a potent nitric oxide synthase inhibitor, for use in the hepatopulmonary syndrome. We present a patient with severe (type II) hepatopulmonary syndrome caused by idiopathic portal hypertension and discuss the consequences of paroxetine therapy.
