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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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    Pulmonary artery and right ventricle function in patients with bicuspid aortic valve
    (2017) Geçmen, Çetin; Güler, Gamze Babür; Hatipoğlu, Suzan; Kahyaoğlu, Muzaffer; Çap, Murat; İzci, Servet; Önal, Çağatay; Erdoğan, Emrah; Hakgör, Aykun; Candan, Özkan; Kalaycı, Arzu; Unkun, Tuba; İzgi, İbrahim Akın
    Objective: Bicuspid aortic valve (BAV) is a complex developmental anomaly caused by abnormal aortic leaflet formation during valvulogenesis. The present study is an assessment of the effects of BAV disease on the ascending aorta and pulmonary artery (PA), and an evaluation of the consequences for systolic and diastolic functioning of the left and right ventricles.?Methods: Total of 66 patients were eligible for inclusion. Pulmonary artery maximum diameter (PAD) was obtained 1 cm distal to the pulmonary annulus. Using pulsed-wave tissue Doppler imaging, left ventricular (LV) early diastolic velocity (E?) measurement was obtained at the annulus with placement of sample volume. Right ventricle (RV) peak global strain rate during systole (RV-SRS), early diastole (RV-SRE), and late diastole (RV-SRA) were calculated.?Results: In this study, 40.9% (n=27) of patients were female and average age was 35±11years. RV-SRS values (?=-.781, t=-2.723; p=0.010) and log-LV tissue Doppler imaging E’ (?=2.996, t=-5.405; p=<0.001) were negatively correlated, and log-PAD (?=4.861, t=3.052; p=0.005) was positively and independently correlated with ascending aortic diameter.?Conclusion: Ascending aorta diameter is positively correlated with PA diameter in BAV patients, and RV strain rate and LV diastolic parameters are affected before development of the valve disease.
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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