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    Impedance cardiography for demonstrating procedural efficacy of percutaneous mitral balloon valvuloplasty
    (Türkiye Klinikleri, 2015) Omaygenç, Mehmet Onur; Do?an, Cem; Bakal, Ruken Bengi; Candan, Özkan; Hatipoğlu Akpınar, Suzan; Babür Güler, Gamze; Kaymaz, Cihangir; Özdemir, Nihal
    Objective: Impedance Cardiography (ICG) method, facilitates measuring hemodynamic parameters indirectly by recording thoracic impedance variations induced by cyclic changes in blood flow. The aim of this study is to evaluate alterations in hemodynamic parameters obtained by impedance cardiography (ICG) in addition to conventional echocardiographic and catheterization data after percutaneous mitral balloon valvuloplasty (PMBV). Material and Methods: 18 patients with severe rheumatic mitral stenosis to whom PMBV had been performed were included in this study. Impedance cardiographic measurements were performed in addition to routine echocardiographic examination and invasive left atrial and pulmonary arterial pressure recordings before and after the procedure. Cardiac output was calculated with direct Fick method before PMBV. Average values of several measurements were used to obtain the most accurate results for atrial fibrillation patients in the study group. Results: Following successful PMBV, in impedance cardiographic evaluation an increase in cardiac output (4.69±1.46 and 5.68±1.3 l/min, before and after PMBV, respectively, p<0.001) and cardiac index (2.72±0.81 and 3.29±0.73 l/min/m2, before and after PMBV, respectively, p<0.001) an evident prolongation in ejection period (246.8±40.3 and 275.2±32.1 msec, before and after PMBV, respectively, p<0.001); and a statistically significant reduction in pre-ejection period (103.7±41.8 and 82.7±16.8 msec, before and after PMBV, respectively, p=0.033), and thoracic fluid content (34.3±11.2 and 27.7±5.31/k?, before and after PMBV, respectively, p=0.037) was observed. There was a strong correlation between preprocedural cardiac output calculations of ICG and direct Fick method (r:0.89, p<0.001). onclusion: In addition to the conventional methods, serial recordings of impedance cardiographic outputs may yield beneficial information for the assessment of PMBV efficacy.As a non-invasive and easily applicable method, it might be utilized during in-hospital follow-up.
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    Left atrial expansion index is an independent predictor of diastolic dysfunction in patients with preserved left ventricular systolic function: A three dimensional echocardiography study
    (Springer, 2014) Hatipoğlu, Suzan; Özdemir, Nihal; Babür Güler, Gamze; Omaygenç, Mehmet Onur; Bakal, Ruken Bengi; Kahveci, Gökhan; Unkun, Tuba; Şahin, Gülsüm; Kaymaz, Cihangir
    In the absence of mitral valve disease left atrial (LA) volume is a marker of diastolic dysfunction and its severity. This study investigated the relationship between left ventricular (LV) end diastolic pressure (LVEDP) and LA volumes and phasic atrial functions detected by real-time full volume three-dimensional echocardiography (RT3DE), in a patient population with preserved LV systolic function. Seventy-two (39 female and 33 male; mean age 56.1 +/- A 9.0 years) stable patients with normal LV ejection fraction (EF) undergoing cardiac catheterization were studied. All patients underwent comprehensive echocardiographic examination just before catheterization and LVEDP was obtained. In addition to conventional echocardiographic measurements and Doppler indices; by using RT3DE LA maximum, minimum and pre-a-wave volumes were measured; LA total, passive and active emptying volumes and fractions were calculated. LV systolic function was assessed by EF and global longitudinal strain by speckle tracking. RT3DE minimum LA volume index, RT3DE active LAEF and LA expansion index (EI) were statistically significant univariate predictors of LVEDP a parts per thousand yen 16 mmHg. When age and hypertension adjusted multivariate analysis was performed EI [beta = -1.741, p = 0.015; OR 0.175; 95 % CI (0.043-0.717)] was an independent predictor of elevated LVEDP. RT3DE evaluation of LA function during entire cardiac cycle has incremental value for the diagnosis of diastolic dysfunction in patients with preserved EF. We suggest that RT3DE evaluation of LA may find clinical application in this field.
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    Prediction of elevated left ventricular filling pressures in patients with preserved ejection fraction using longitudinal deformation indices of the left ventricle
    (Oxford University Press, 2015) Hatipoğlu, Suzan; Özdemir, Nihal; Babür Güler, Gamze; Bakal, Ruken Bengi; Geçmen, Çetin; Candan, Özkan; Doğan, Cem; Unkun, Tuba
    Aims Estimation of left ventricular (LV) filling pressures is a clinical challenge in patients with preserved ejection fraction (EF). In the present study, we investigated whether LV and atrial longitudinal strain and strain rate (SR) parameters derived by speckle tracking echocardiography (STE) could be used to predict invasively measured LV end-diastolic pressure (LVEDP) in this patient population. Methods and results LVEDP was measured before coronary angiography was performed in 65 patients with preserved EF (>= 50%) referred to elective cardiac catheterization; besides, patients enrolled underwent comprehensive echocardiographic examination before the procedure. In addition to conventional echocardiographic parameters used to evaluate diastolic function LV longitudinal strain and SR, as well as peak atrial longitudinal strain during LV systole, measurements were performed using STE. Only log-diastolic blood pressure, systolic SR, early diastolic SR, SR during isovolumetric relaxation (SRIVR), and mitral early diastolic flow velocity/SRIVR significantly correlated with LVEDP. When age-adjusted stepwise linear regression analysis was performed, SRIVRT values (beta = -20.682, t = -3.292; P = 0.002) and log-diastolic blood pressure levels (beta = 21.118, t = 3.784; P < 0.001) were independently correlated with LVEDP. Conclusion When compared with conventional echocardiographic parameters, other longitudinal strain, and SR indices, SRIVRT independently predicted LVEDP in conjunction with log diastolic blood pressure. We suggest that SRIVRT is a valuable parameter to evaluate diastolic function in patients with preserved EF.
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    Relationship between histopathological features of aspirated thrombi and long-term left ventricular function in patients with ST-segment elevation myocardial infarction
    (Turkish Society of Cardiology, 2020) Omaygenç, Mehmet Onur; Doğan, Cem; Somay, Adnan; Karaca, Oğuz; Bakal, Ruken Bengi; Teber, Mehmet Kamil; Hatipoğlu, Suzan; Bayram, Zübeyde; Kaymaz, Cihangir; Özdemir, Nihal
    Objective: This study was an investigation of the severity ofinflammation (SOI) in aspirated material and thrombus age toexamine any association with pre-discharge and long-term leftventricular (LV) function after ST-elevation myocardial infarction (STEMI).Methods: The study group comprised 25 patients with STEMIfrom whom an occlusive thrombus was aspirated from the infarct-related artery with a 7-F catheter. The SOI in the aspirate was determined according to the mean leukocyte countin 5 high-power magnification fields and graded as mild in thepresence of ?100 leukocytes per field or significant if therewere >100 leukocytes per field. The thrombi were categorizedas fresh or lytic/organized (L/O) using predefined criteria.Echocardiographic assessment was performed prior to discharge and at 1 year. Adverse left ventricular remodeling (LVR)was defined as a 20% increase in LV end-diastolic volume incomparison with baseline values.Results: LVR was observed in 8 patients. The mean leukocytecount of the aspirate (127.5±86.0 vs 227.2±120.7; p=0.026)and frequency of significant inflammation (35% vs 75%;p=0.046) were significantly higher in the group with LVR. Theserum high-sensitivity C-reactive protein (hsCRP) level wassignificantly correlated with the leukocyte count of the aspirate (r=0.532; p=0.006). An L/O thrombus was related to betterpre-discharge and long-term LV volumes and ejection fractionvalues compared with a fresh thrombus.Conclusion: A significant increase in the leukocyte count inthe aspirate and a fresh thrombus might predict long-term LVfunctional deterioration irrespective of the clinical and procedure-related characteristics. In addition, serum markers of inflammation, like hsCRP, might also reflect the intensity of thelocal inflammatory response at the site of occlusion.
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    SYNTAX score predicts postoperative atrial fibrillation in patients undergoing on-pump isolated coronary artery bypass grafting surgery
    (Turkish Soc Cardiology, 2016) Geçmen, Çetin; Babür Güler, Gamze; Erdoğan, Emrah; Hatipoğlu, Suzan; Güler, Ekrem; Yılmaz, Fatih; Unkun, Tuba; Cap, Murat; Bakal, Ruken Bengi; Bayram, Tülay; Deniz Acar, Rezzan; Candan, Özkan; Özdemir, Nihal
    Objective: Atrial fibrillation (AF) is the most common arrhythmia following coronary artery by-pass graft surgery (CABG). The value of SYNTAX score to predict postoperative atrial fibrillation (PoAF) has not been clearly addressed. We aimed to evaluate this relationship in patients undergoing isolated CABG.Methods: This study was designed as a single-center, non-randomized, observational, prospective study. Ninety-four patients undergoing isolated on-pump CABG, who had sinus rhythm and were older than 18 years, were enrolled. Demographic characteristics of the patients were recorded; SYNTAX score was calculated preoperatively for each patient. The univariate and multivariate logistic regression analysis were used to determine for predictors of PoAF.Results: The median SYNTAX score of the enrolled patients was 21, (56-5). PoAF was observed in 31 (33.3%) patients. Univariate logistic regression showed that age, chronic obstructive pulmonary disease (COPD), red blood cell distribution width (RDW), urea, initial troponin I, peak postoperative troponin I, interventricular septum, left atrial diameter, and SYNTAX score were significantly associated with the frequency of PoAF following CABG. An independent association was identified with age [?: 0.088, p:0.023, OR: 1.092, 95% CI (1.012-1.179)], COPD [(?: 2.222, p:0.003, OR: 9.228, 95% CI (2.150-39.602)], and SYNTAX score [(?: 0.130, p:0.002, OR: 1.139, 95% CI (1.050-1.235)].Conclusion: This study showed that a higher SYNTAX score was related to more frequent PoAF in patients undergoing isolated on-pump CABG