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    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, N
    Objective - 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.
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    Cardiac hydatid cysts located in both the left ventricular apex and the intraventricular septum: Case report
    (Springer, 2000) Ulgen, MS; Alan, S; Karadede, A; Aydinalp, O; Toprak, N
    Cardiac hydatid cyst is rarely encountered and constitutes 0.5%-2% of all hydatid cases. Although left ventricular (LV) location for hydatid cysts has been frequently reported, the involvement of both the left ventricle and the interventricular septum (IVS) has not been previously reported in the literature. We present a case of cardiac hydatid cyst with fatal recurrent cerebral embolism and the unusual involvement of both LV and IVS demonstrated by transthoracic echocardiography.
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    Clinical investigation: Thyroid function test abnormalities in cardiac arrest associated with acute coronary syndrome
    (Bmc, 2005) Iltumur, K; Olmez, G; Ariturk, Z; Taskesen, T; Toprak, N
    Introduction It is known that thyroid homeostasis is altered during the acute phase of cardiac arrest. However, it is not clear under what conditions, how and for how long these alterations occur. In the present study we examined thyroid function tests (TFTs) in the acute phase of cardiac arrest caused by acute coronary syndrome (ACS) and at the end of the first 2 months after the event. Method Fifty patients with cardiac arrest induced by ACS and 31 patients with acute myocardial infarction ( AMI) who did not require cardioversion or cardiopulmonary resuscitation were enrolled in the study, as were 40 healthy volunteers. The patients were divided into three groups based on duration of cardiac arrest (< 5 min, 5 - 10 min and > 10 min). Blood samples were collected for thyroid-stimulating hormone (TSH), triiodothyronine (T-3), free T-3, thyroxine (T-4), free T-4, troponin-I and creatine kinase-MB measurements. The blood samples for TFTs were taken at 72 hours and at 2 months after the acute event in the cardiac arrest and AMI groups, but only once in the control group. Results The T-3 and free T-3 levels at 72 hours in the cardiac arrest group were significantly lower than in both the AMI and control groups ( P < 0.0001). On the other hand, there were no significant differences between T-4, free T-4 and TSH levels between the three groups ( P > 0.05). At the 2-month evaluation, a dramatic improvement was observed in T-3 and free T-3 levels in the cardiac arrest group ( P < 0.0001). In those patients whose cardiac arrest duration was in excess of 10 min, levels of T-3, free T-3, T-4 and TSH were significantly lower than those in patients whose cardiac arrest duration was under 5 min ( P << 0.001, P < 0.001, P < 0.005 and P < 0.05, respectively). Conclusion TFTs are significantly altered in cardiac arrest induced by ACS. Changes in TFTs are even more pronounced in patients with longer periods of resuscitation. The changes in the surviving patients were characterized by euthyroid sick syndrome, and this improved by 2 months in those patients who did not progress into a vegetative state.
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    Complement activation in acute coronary syndromes
    (Wiley, 2005) Iltumur, K; Karabulut, A; Toprak, G; Toprak, N
    The 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.
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    A complicated case of pericardial hydatid cyst manifesting as constrictive pericarditis
    (Pulsus Group Inc, 2000) Karadede, A; Ülgen, MS; Temamogullari, AV; Toprak, N
    Although cardiac involvement with hydatid cyst is quite rare as a major complication, constrictive pericarditis is even less common. A 55-year-old man is presented in whom a hydatid cyst located in the right cardiophrenic angle anterior to the right ventricle ruptured into the pericardial sac, resulting in constrictive pericarditis.
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    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, N
    Objective - 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.
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    The effect of glucose-insulin-potassium solution on ventricular late potentials and heart rate variability in acute myocardial infarction
    (Lippincott Williams & Wilkins, 2001) Ulgen, MS; Alan, S; Akdemir, O; Toprak, N
    Background Blunted heart rate variability (HRV) and presence of ventricular late potentials (VLPs) are known to correlate with an increased risk of ventricular tachycardia and sudden cardiac death in acute myocardial infarction (AMI), In the present study, we investigated the effect of glucose-insulin-potassium (GIK) solution on the VLPs and HRV in AMI. Methods Seventy-two consecutive patients with first Q wave AMI were randomized to GIK solution and placebo. HRV analysis and ambulatory electrocardiographic recordings were taken in all patients between 24 and 48 h. Sub-maximal exercise testing and echocardiography were performed and signal-averaged electrocardiography (SAECG) was recorded before discharge. Results Total filtered QRS duration (FORS: 102 +/- 7 versus 108 +/- 11 ms; P < 0.05), low-amplitude signal (LAS: 25 +/- 8 versus 32 +/- 11 ms; P < 0.01) and frequency of VLPs (21 versus 45%; P < 0.05) were found to be significantly lower while root-mean-square voltage of the terminal 40 ms. of QRS (RMS-40: 45 +/- 18 versus 36 +/- 20 V; P < 0.05), and left ventricular ejection fraction (EF: 55 +/- 6 versus 48 +/- 7; P < 0.05) were significantly higher in the GIK group when compared to placebo. During the hospital period, the presence and frequency of post-myocardial infarction angina were significantly lower in the GIK group (15 versus 29%, P < 0.05), whereas an insignificant decrease in frequency of ventricular arrhythmias was observed in these patients. On HRV analysis, there was no significant difference between two groups in either time domain (SID, SDNN, RMS-SD) or frequency domain (HF, LF, LF/HF ratio) parameters. Conclusion GIK solution may be beneficial to VLPs, ischaemic events, and left ventricular systolic performance in the early period of AMI. This therapy has no significant effect on HRV in AM] patients. Coron Artery Dis 12:507-512 (C) 2001 Lippincott Williams &Lippincott Wilkins.
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    The effects of glucose-insulin-potassium therapy on signal-averaged electro-cardiography and heart rate variability in acute myocardial infarction
    (W B Saunders Co Ltd, 2000) Ulgen, MS; Alan, S; Karadede, A; Iltimür, K; Toprak, N
    [Abstract Not Available]
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    The effects of right ventricular involvement on heart rate variability and ventricular late potentials in acute inferior myocardial infarction
    (Sage Publications Inc, 2001) Ülgen, MS; Toprak, N
    Depressed heart rate variability and presence of ventricular late potentials in acute myocardial infarction are associated with a poor prognosis. Although it is known that the abnormalities vary according to anterior or inferior location of acute myocardial infarction, the relationship with right ventricular acute myocardial infarction is not clear. The effects of right ventricular myocardial infarction on heart rate variability and ventricular late potentials are studied. The study was performed with a total of 46 patients (38 males; aged 56 +/- 13 yr, range, 33 to 70 yr). Twenty-six patients had isolated inferior myocardial infarction while 20 patients had accompanying right ventricular involvement. For all patients, ambulatory Holter recordings between 24 and 48 hours following myocardial infarction, echocardiography in first 48 hours, and signal-averaged electrocardiography with submaximal exercise at average day 6 (range, 5 to 8 days) were performed. Heart rate variability and signal-averaged electrocardiography recordings were repeated after discharge (average, 39 days). During the first 24 to 48 hr, time domain parameters (SDNN1 and SD1) were significantly lower (SDNN1: 62 +/- 17 vs 100 +/- 20 ms, p = 0.001; SD: 37 +/- 10 vs 50 +/- 16 ms, p = 0.03) in patients with isolated inferior MI than in those with right ventricular involvement, whereas root-mean-square voltage (RMS-SD1) showed no significant difference in both groups (28 +/- 7 vs 35 +/- 8 ms). In post-discharge heart rate variability recordings, there were no significant differences (SDNN2: 86 +/- 13 vs 95 +/- 15 ms; SD2: 48 +/- 11 vs 57 +/- 13 ms; RMS-SD2: 32 +/- 14 vs 35 +/- 9 ms). In pre-discharge tests, the mean value of low-amplitude signals (LAS(1)) was higher (26 +/- 9 vs 33 +/- 11 ms, p = 0.03) in patients with isolated inferior myocardial infarction than in those with right ventricular involvement, while other signal-averaged electrocardiography parameters were not significantly different (filtered QRS(1) 102 +/- 5 vs 105 +/- 10 ms, RMS-40(1): 44 +/- 13 vs 26 +/- 10 muV; incidence of ventricular late potentials: 23% vs 30%, p = NS, respectively). In post-discharge tests, all of signal-averaged electrocardiography parameters were similar in both groups (filtered QRS(2): 112 +/- 12 vs 114 +/- 8 ms, LAS(2): 28 +/- 9 vs 32 +/- 13 ms, RMS-40(2): 36 +/- 10 vs 34 +/- 11 muV, and frequency of ventricular late potentials(2): 23% vs 30%, p = NS). These data suggest that right ventricular involvement in an acute inferior myocardial infarction is associated with improved heart rate variability parameters but not ventricular late potentials in pre-discharge period. However, the influence of right ventricular involvement on heart rate variability parameters fades away in the post-discharge period.
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    The effects of trimetazidine on heart rate variability and signal-averaged electrocardiography in early period of acute myocardial infarction
    (Elsevier Ireland Ltd, 2001) Ulgen, MS; Akdemir, O; Toprak, N
    Background: Acute myocardial infarction (AMI) is accompanied by electrophysiological changes in cardiovascular system as well as those in autonomic cardiac control. Heart rate variability (HRV) is depressed due to increased sympathetic activity and/or decreased parasympathetic activity following AMI. Moreover, the frequency of ventricular late potentials (VLP) is increased due to the electrophysiological changes. Based on the hypothesis that the treatments increasing HRV and decreasing the frequency of VLP can improve the prognosis of AMI, we investigated the short-term effects of trimetazidine (TMZ) on HRV and VLP in patients with AMI. Methods: The study group consisted of 64 patients (men 49, mean age 55 +/- 12 years, range 26-70) suffering from first Q-wave AMI. Thirty-one of them were treated with conventional therapy (thrombolytic therapy, aspirin, beta-blocker, heparin and intravenous nitroglycerin) plus TMZ 20 mg tid. The remaining 33 patients served as controls. Holter monitorization between 24 and 48 h, echocardiography at average day 6 (range 4-7 days) and SAECG and sub-maximal exercise at average day 7 (range 6-9 days) were performed to all patients. Results: While HRV parameters reflecting parasympathetic activity (SDSD: 43 +/- 16 ms-35 +/- 13 ms, RMSSD: 34 +/- 14 ms-27 +/- 8 ms, HF: 7.8 +/- 5 ms(2) -4.3 +/- 4 ms(2), P < 0.05) were of significantly higher levels in TMZ group, the low frequency component mainly reflecting sympathetic activity (LF: 10 6 ms(2)-10 +/- 5 ms(2), P > 0.05) was similar in both groups. In addition, LF/HF ratio showing sympatho-vagal balance was significantly decreased in TMZ group (1.5-3.0, P = 0.005). About VLP, the mean FQRS (105 +/- 8 ms-107 +/- 10 ms), LAS (28 +/- 10 ms-30 +/- 11 ms:) and RMS-40 (34 +/- 15 muV-41 +/- 12 muV) were not different in both two groups (P > 0.05). Conclusion: Our results suggest that TMZ treatment causes changes in sympatho-vagal balance in favor of vagal activity by increasing parasympathetic activity in AMI at early period; however, no effect on VLP was observed. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.
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    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, N
    The 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.
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    Hepatopulmonary syndrome and right ventricular diastolic functions: An echocardiographic examination
    (Blackwell Publishing, 2006) Karabulut, A; Iltumur, K; Yalcin, K; Toprak, N
    Aim: 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.
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    Iatrogenic left atrioventricular fistula after aortic valve re-replacement
    (I C R Publishers, 2005) Iltumur, K; Karabulut, A; Karadede, A; Toprak, N
    Left 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.
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    Influence of angiotensin-converting enzyme I/D gene polymorphism on the right ventricular myocardial performance index in patients with a first acute anterior myocardial infarction
    (Japanese Circulation Soc, 2005) Ozturk, O; Ulgen, MS; Tekes, S; Ozturk, U; Toprak, N
    Background The genetic influence on the myocardial performance index is uncertain, so the aim of the present study was to determine the effects of polymorphism of the angiotensin-converting enzyme (ACE) gene on the right ventricular myocardial performance index (RVMPI) after a first acute anterior myocardial infarction (MI). Methods and Results The subjects were 116 patients with a first acute anterior MI. Based on the polymorphism of the ACE gene, they were classified into 3 groups: deletion/deletion (DD) genotype (group 1, n=45), insertion/deletion (ID) genotype (group 2, n=58), insertion/insertion (II) genotype (group 3, n=13). Echocardiograms were used to determine the RVMPI, left ventricular myocardial performance index (LVMPI), tricuspid E/A, tricuspid deceleration time and the left ventricular diameter diastolic and diameter systolic (LVDd and LVDs). RVMPl and LVMPI were significantly higher in the ACE DD group. Tricuspid E/A, DT, LVDd and LVDs showed no differences among the 3 groups. Conclusion The ID polymorphism of the ACE gene may affect RVMPI and LVMPI after a first acute anterior MI.
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    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, Y
    Hyperinsulinemia 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).
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    Intima-media thickness and arterial distensibility in Behcet's disease
    (Sage Publications Inc, 2004) Alan, S; Ulgen, MS; Akdeniz, S; Alan, B; Toprak, N
    The etiology of Behcet's disease, a systemic vasculitis, is unknown. Vascular involvement may be seen in 25% of patients with Behcet's disease. Vasculitis make the prognosis of Behcet's disease severe. The aim of this study is to examine the structural and functional changes and relations of these changes with progression and prognosis of Behcet's disease. For this purpose, 40 patients with Behcet's disease and 40 healthy volunteer control subjects were analyzed, additionally patients with Behcet's disease were divided into 2 subgroups as those with vascular complications and those without vascular complications. Intima-media thickness and arterial distensibility were measured in all subjects with carotid artery ultra sonography, Carotid artery distensibility was significantly lower in the patient group compared to the control group (0.67 +/- 0.2, 0.93 +/- 0.4, p < 0.05), and carotid artery IMT was significantly higher (0.59 +/- 12, 0.80 +/- 0.11, p < 0.05). A statistically significant increase in IMT has been detected (0.77 +/- 11, 0.86 +/- 11, p < 0.05) in patients with Behcet's disease with vascular involvement compared to patients with Behcet's disease without vascular involvement, arterial distensibility in patients with vascular disease was similar with those who has no vascular disease (0.69 +/- 0.25, 0.63 +/- 0.25, p > 0,05). There was a significant negative linear regression between arterial distensibility and systolic blood pressure (SBP) (B= -1 X 10(-2), p < 0.05), and a significant positive linear regression has also been found between IMT and SBP and diastolic blood pressure (DBP) and pulse pressure (PP) (B = 6.8 X 10(-3) for SBP, p < 0.05, B = 6.9 X 10(-3) for DBP, p < 0.05, B = 6 X 10(-3) for PP, p < 0.05). As a result, IMT increases and AD decreases in patients with Behcet's disease compared to results in the control group. Although more studies are required for this subject, use of noninvasive parameters such as IMT and AD, which reflect the structural and functional characteristics of vasculature, may be useful to define disease progression and subjects at high risk.
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    Long-term glucose insulin potassium infusion improves systolic and diastolic function in patients with chronic ischaemic cardiomyopathy
    (E M H Swiss Medical Publishers Ltd, 2003) Alan, S; Ulgen, MS; Dedeoglu, I; Kaya, H; Toprak, N
    We assessed the effects of glucose-insulin-potassium (GIK) using echocardiography, right ventricular catheterisation and myocardial scintigraphy with 99mTc sestamibi in stable patients with ischaemic cardiac dysfunction. Methods: Thirty male patients with stable coronary disease (SCD) and an ejection fraction (EF) <40% were studied for systolic and diastolic function. Glucose 30%, 300 insulin units and KCl 6 g/l were infused at 1 ml/kg per hour for 24 hours. Haemodynamic, echocardiographic and myocardial scintigraphy measurements were recorded at rest on completion of the GIK infusion. Results: A significant increase in EF was observed (32.1 +/- 7.8% and 43.3 +/- 11.6%, p <0.01). A significant prolongation was seen in the diastolic filling periods (365 +/- 52 msec and 428 +/- 70 msec, p <0.05). A significant decrease in pulmonary capillary wedge pressure was measured (22.2 +/- 5.3 and 17.1 +/- 4.3, p <0.01) and a significant decrease in stress score (S S) was observed (13 +/- 7 and 11 +/- 5, p >0.05). Conclusion: Our present work suggests that GIK infusion improves systolic and diastolic function in patients with SCD and an ejection fraction <40%. Further studies are needed to determine whether long-term GIK infusion could be useful for therapeutic strategies in patients with chronic ischaemic coronary diseases.
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    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, N
    Background 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.
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    Relation between coronary artery disease, risk factors and intima-media thickness of carotid artery, arterial distensibility, and stiffness index
    (Westminster Publ Inc, 2003) Alan, S; Ulgen, MS; Ozturk, O; Alan, B; Ozdemir, L; Toprak, N
    Atherosclerosis is a diffuse process that involves vessel structures. In recent years, the relation of noninvasive parameters such as intima-media thickening (IMT), arterial distensibility (AD), and stiffness index (SI) to cardiovascular diseases has been researched. However, we have not found any study that has included all these parameters. The aim of this study is to examine the relation between the presence of coronary artery disease (CAD) and its risk factors to AD, SI, and IMT, which are the noninvasive predictors of atherosclerotic process in the carotid artery. Included in the study were 180 patients who were diagnosed as having CAD by coronary angiography (those with at least; greater than or equal to 30% stenosis in the coronary arteries) and, as a control group, 53 persons who had normal appearing coronary angiographies. IMT, AD, and SI values of all the patients in the study were measured by echo-Doppler imaging (AD formula = 2 x (AoS-AoD)/PP x AoD, SI formula = (SBP/DBP)/([AoS - AoD]/AoD). Significantly increased IMT (0.82 +/-0.1, 0.57 +/-0.1, p<0.05), decreased AD (0.25 +/-0.9, 0.37 +/-0.1, p<0.05), and increased SI (13 +/-4, 8 +/-3, p<0.05) values were detected in the CAD group compared to the control group. A significant correlation was found between IMT and presence of diabetes mellitus (DM), systolic blood pressure, total cholesterol, and presence of plaque in carotids, and age. In the coronary artery disease group there was a significant correlation between AD and age, systolic blood pressure, and HDL cholesterol levels, while there was no significant correlation with plaque development. A significant correlation was also found between stiffness index and systolic blood pressure and age; however, there was no relation between number of involved vessels and IMT, AD, and SI. We found sensitivity, specificity, and positive predictive and negative predictive values for CAD diagnosis to be 70%, 75%, 77%, and 66%, respectively. In CAD cases, according to data in this study, IMT and SI increased while AD decreased, and this was detected by carotid artery Doppler ultrasonography. Therefore, it was concluded that these cheaper, noninvasive, and easily available parameters could be used in early diagnosis of CAD.