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Öğe Echocardiographic determinants of right ventricular systolic dysfunction in non-ischemic dilated cardiomyopathy: Relation to functional status and plasma BNP levels(Elsevier, 2013) Karaca, Oğuz; Avcı, Anıl; Güler Babür, Gamze; Alizade, Elnur; Güler, Ekrem; Güneş, Hacı Murat; Göl, Gökhan; Batgerel, Ulaankhuu; Omaygenç, Mehmet Onur; Kızılırmak, Filiz; Geçmen, Çetin; Esen, Ali Metin; Türkmen, MuhsinAim: Right ventricular (RV) functions are well-known to play an important role in prognosis of patients with non-ischemic dilated cardiomyopathy (NICMP) similar to all forms of heart failure. We investigated the echocardiographic determinants of RV systolic dysfunction in patients with NICMP. Methods: Seventy-nine patients with angiographically normal coronary arteries (mean age: 50.5+12, mean EF: 31+4%) were enrolled in this study. Patients were divided into two groups according to their right ventricular (RV) systolic function determined by tissue Doppler systolic velocities (RV-Sm) as: Group A (RV-Sm >10 cm/s, n¼48) and Group B (RV-Sm <10 cm/s, n¼31)Öğe Evaluation of adiponectin and lipoprotein(a) levels in cardiac syndrome x(Urban & Vogel, 2015) Güler, Ekrem; Güler, Gamze; Kızılırmak, Filiz; Batgerel, Ulaankhuu; Demir, Gültekin Günhan; Güneş, Hacı Murat; Karaca, Oğuz; Özcan, Özgür; Barutçu, İrfan; Türkmen, Muhsin; Esen, Ali MetinAims. Low adiponectin and high lipoprotein(a) [Lp(a)] levels are associated with endothelial dysfunction, atherosclerosis, and coronary artery disease. Cardiac syndrome X (CSX) is characterized by anginal symptoms, positive stress test, and documentation of normal epicardial coronary arteries with angiography. In this study we aimed to investigate the relationship between CSX and circulating levels of adiponectin and Lp(a). Patients and methods. We enrolled 53 female patients with CSX and 33 patients as the control group. The diagnosis of CSX was made according to presence of angina, findings suggestive of ischemia during stress electrocardiography or myocardial perfusion scintigraphy, and documentation of normal coronary arteries in coronary angiography. The control group consisted of patients with atypical angina and normal stress electrocardiography test results. Both groups were matched in terms of hypertension, diabetes mellitus, and metabolic syndrome. Results. Adiponectin levels were significantly decreased in patients with CSX (4.57 mu g/ml vs. 13.18 mu g/ml; p=0.001); however, Lp(a) levels were significantly increased (36.30 mg/dl vs. 7.24 mg/dl; p<0.001). Low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) concentrations did not differ between the case group and the control group (p=0.14, p=0.62, p=0.64, respectively). There was no significant difference between groups in terms of age, body mass index, waist circumference hypertension, hyperlipidemia, diabetes mellitus, or metabolic syndrome. In multivariate analysis, Lp(a) and adiponectin were found to be independent predictors of CSX. An Lp(a) level of >21 mg/dl had 84% sensitivity and 96% specificity {area under the curve (AUC)=0.922, p<0.0001, 95% CI [0.842-0.970]} and an adiponectin level of <= 5.18 mu g/ml also had 58.7% sensitivity and 82.1% specificity (AUC=0.726, p=0.0003, 95% CI [ 0.609-0.823]) for detecting CSX. Conclusion. We detected low adiponectin and high Lp(a) levels in patients with CSX and these findings may be related to the microvascular injury in CSX.Öğe Factor XIII Val34Leu polymorphism in patients with cardiac syndrome X(Via Medica Journals, 2014) Babür Güler, Gamze; Batgerel, Ulaankhuu; Güler, Ekrem; Karaca, Oğuz; Geçmen, Çetin; Güneş, Hacı Murat; Zencirkıran Ağuş, Hicaz; Esen, Ali Metin; Türkmen, Mehmet MuhsinBackground: The aim of the study was to examine the frequency of factor XIII polymorphism among patients with cardiac syndrome X (CSX). Methods: This study was designed as a cross-sectional and observational study. Forty-eight female patients with CSX and 36 controls matched by age, gender, diabetes, and hypertension were studied. CSX was defined as typical chest pain during rest or effort, abnormal test result for exercise ECG, and presence of angiographically normal epicardial coronary arteries after ruling out inducible spasm. Factor XIII gene polymorphism was investigated by using CVD Strip Assay (ViennaLab Diagnostic GmbH) commercial kit. Results: The frequency of factor XIII (Val/Leu + Leu/Leu) mutation was significantly higher in patients with CSX (43%) than in controls (19%) (p = 0.02). Frequency of the Leu allele was significantly higher in the patient group (23.5% vs. 11.1%, p = 0.04). Factor XIII (Val//Leu + Leu/Leu) mutation (p = 0.01, OR = 3.42; 95% CI 1.22-9.58) and smoking (p = 0.04, OR = 3.33, 95% CI 1.05-10.58) were identified as independent predictors of the disease in multivariate regression analysis. Conclusions: This study indicates that there is an evidence for association between factor XIII Val34Leu polymorphism and CSX.Öğe Sirolimus-kaplı stent ile polizen-F polimerli kobalt krom stentin erken dönemde tetiklediği inflamatuvar yanıt ve uzun dönem sonuçlarının karşılaştırılması(Sağlık Araştırmaları Derneği, 2015) Yüksel, Murat; Şimşek, Zeki; Acar, Göksel; Batgerel, Ulaankhuu; Güneş, Hacı Murat; Esen, Ali Metin; Türkmen, Mehmet MuhsinAmaç: Perkütan translüminal koroner anjioplasti (PTCA) işleminin erken ve geç dönem sonuçlarında çok önemli iyileşmeler sağlayan stentler ile geç dönemde karşılaşılan en önemli sorun %25-30'lara varan restenoz oranları olmuştur. Bunun üstesinden gelmek için geliştirilen ilaç kaplı stentler (DES), restenoz oranlarını azaltmakla birlikte damar iyileşmesini ve endotelizasyonu bozduğundan stent trombozu riskini önemli ölçüde artırmıştır. Biyoinert bir molekül olan Polizen-F (PzF) polimerleriyle yüzey modifikasyonu uygulanmış yeni nesil stentler anti-inflamatuvar ve anti-trombojenik özelliklerini vurgulayarak piyasaya sürülmüştür. Bu çalışmada PzF polimeriyle kaplı stent ile sirolimus kaplı stent takılan hastaları, erken dönemdeki inflamatuvar yanıtları ve 1 yıllık takipte görülen majör istenmeyen kardiyak olay (MACE) sıklığı bakımından karşılaştırmayı amaçladık. Yöntemler: Stabil koroner arter hastalığı (KAH) tanısıyla PzF polimeri kaplı stent takılan hastalar 1.grubu (n=19), sirolimus kaplı stent takılan hastalar 2.gurubu (n=13) oluşturdu. Hastalardan perkütan koroner girişim (PKG) öncesi (pre-PKG), işlem sonrası 1. ve 10.günde (post-PKG 1. ve post-PKG 10.gün) hsCRP ve IL-6 düzeyi bakıldı. Hastalar ortalama 1 yıl süreyle gelişebilecek MACE sıklığı açısından takip edildi.Bulgular: Pre-PKG, post-PKG 1. ve 10.gündeki hsCRP ve IL-6 düzeyleri bakımından gruplar arasında anlamlı bir fark yoktu. 1.gruptaki19 hastadan 4'ünde (%21) MACE gelişirken, bu oran 2.grupta 13 hastada 1 idi (%8); fakat gruplar arasındaki bu fark istatistiksel olarak anlamlı değildi (p=0,26).Sonuç: Daha az inflamatuvar yanıtı tetiklediği ve anti-trombojenik özelliği iddiasıyla piyasaya sürülen PzF polimeriyle kaplı stent ile sirolimus-kaplı stent arasında tetikledikleri inflamatuvar yanıt belirteçleri ve 1-yıllık MACE oranları bakımından anlamlı bir fark gözlenmedi. Bu konunun aydınlatılması için prospektif, randomize, büyük ölçekli çalışmalara ihtiyaç vardır.
