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Öğe Association of pulmonary artery obstruction index with elevated heart-type fatty acid binding protein and short-term mortality in patients with pulmonary embolism at intermediate risk(Turkish Soc Radiology, 2012) Gul, Enes Elvin; Can, Ilknur; Guler, Ibrahim; Yesildag, Ahmet; Abdulhalikov, Turyan; Kayrak, Mehmet; Ozdemir, KurtulusPURPOSE Heart-type fatty acid binding protein (H-FABP) is a sensitive marker of myocardial injury and predictor of worse prognosis in patients with pulmonary embolism (PE). Assessment of right ventricular dysfunction and pulmonary artery obstruction index (PAOI) with computed tomography (CT) has been reported as a predictor of mortality in PE. Therefore, we aimed to assess the correlation between H-FABP and CT angiographic PAOI in PE patients at intermediate risk. MATERIALS AND METHODS Sixty-one patients (28 males; mean age, 62 +/- 17 years) with diagnosis of PE were included in this study. CT was performed in all patients, and the following parameters were evaluated: right ventricle/left ventricle ratio (RV/LV), pulmonary artery axial diameter, superior vena cava axial diameter, and PAOI determined with Qanadli score. Blood samples were assessed for H-FABP and troponin levels. Patients were followed for 30 days after discharge. RESULTS Mean PAOI was 57 +/- 18%. Eleven patients died during the follow-up period due to PE (18% mortality rate). H-FABP was positive in 21 patients (35%). There was no difference in CT parameters between patients with positive H-FABP and negative H-FABP. In addition, CT parameters were similar between patients who survived and those who did not. RV/LV ratio correlated with PAOI score. Among the biomarkers, troponin levels correlated with both RV/LV ratio and PAOI. H-FABP was an independent predictor of mortality. PAOI and RV/LV ratio did not predict 30-day mortality. CONCLUSION Although H-FABP positivity confers a bad prognosis on PE patients at intermediate risk, PAOI did not predict mortality in this group.Öğe Atrial Functions in Prediabetic Patients(Elsevier Science Inc, 2013) Abdulhalikov, Turyan; Gul, Enes Elvin; Akilli, Hakan; Kayrak, Mehmet; Alibasic, Hajrudin; Yazici, Mehmet; Gok, Hasan[Abstract Not Availabe]Öğe Oxidant and antioxidant parameters in prediabetes and diabetes(Springer India, 2015) Erdem, Said Sami; Toker, Aysun; Kayrak, Mehmet; Cicekler, Humeyra; Gonulalan, Gulsum; Abdulhalikov, Turyan; Yerlikaya, Fatma HumeyraThe aim of our study was to evaluate serum paraoxonase (PON1), total antioxidant status (TAS), total oxidant status (TOS), and ischemia-modified albumin (IMA) levels in patients with prediabetes, diabetes, and in healthy control subjects. The subjects were aged between 20 and 60 years. Forty diabetic subjects (mean age 46.6 +/- 9.7 years), 39 prediabetic subjects (mean age 44.0 +/- 9.3 years) and 24 healthy control subjects (mean age 43.7 +/- 9.7 years). Lipid profile, PON1, TAS, TOS and IMA levels were measured. The serum TOS and IMA levels in diabetes were significantly higher than those of the control subjects (P=0.024 and P=0.012, respectively), while the serum PON1 levels of the diabetes patients were significantly lower than those of the control subjects (P=0.039). The serum TOS levels of the diabetes patients were significantly higher than those of the subjects with prediabetes (P=0.013). There were no significant differences between the serum IMA and PON1 levels of the prediabetes and diabetes groups (P=0.075 and P=0.110, respectively). The serum TAS levels of the three groups were similar. The present study demonstrated that in diabetes there is greater oxidative stress. Patients with type 2 diabetes had higher TOS and IMA levels, but lower PON1 values, than controls. There were no differences in oxidative stress markers between prediabetic patients and healthy subjects.Öğe Right ventricular involvement in anterior myocardial infarction: a tissue Doppler-derived strain and strain rate study(Elsevier Espana, 2013) Sonmez, Osman; Kayrak, Mehmet; Altunbas, Gokhan; Abdulhalikov, Turyan; Alihanoglu, Yusuf; Bacaksiz, Ahmet; Ozdemir, KurtulusOBJECTIVE: Strain and strain rate imaging is currently the most popular echocardiographic technique that reveals subclinical myocardial damage. There are currently no available data on this imaging method with regard to assessing right ventricular involvement in anterior myocardial infarction. Therefore, we aimed to evaluate right ventricular regional functions using a derived strain and strain rate imaging tissue Doppler method in patients who were successfully treated for their first anterior myocardial infarction. METHODS: The patient group was composed of 44 patients who had experienced their first anterior myocardial infarction and had undergone successful percutaneous coronary intervention. Twenty patients were selected for the control group. The right ventricular myocardial samplings were performed in three regions: the basal, mid, and apical segments of the lateral wall. The individual myocardial velocity, strain, and strain rate values of each basal, mid, and apical segment were obtained. RESULTS: The right ventricular myocardial velocities of the patient group were significantly decreased with respect to all three velocities in the control group. The strain and strain rate values of the right mid and apical ventricular segments in the patient group were significantly lower than those of the control group (excluding the right ventricular basal strain and strain rate). In addition, changes in the right ventricular mean strain and strain rate values were significant. CONCLUSION: Right ventricular involvement following anterior myocardial infarction can be assessed using tissue Doppler based strain and strain rateÖğe Self-Reported Sleep Quality of Patients with Atrial Fibrillation and the Effects of Cardioversion on Sleep Quality(Wiley, 2013) Kayrak, Mehmet; Gul, Enes Elvin; Aribas, Alpay; Akilli, Hakan; Alibasic, Hajrudin; Abdulhalikov, Turyan; Yildirim, OguzhanBackground Atrial fibrillation (AF) is the most common sustained cardiac rhythm disturbance encountered in clinical practice and is associated with impaired quality of life. Data from the previous studies have shown that sleep quality (SQ), as a component of life quality, may also deteriorate in patients with AF. However, it remains unclear; we do not know whether SQ improves after sinus rhythm is maintained. Therefore, we aimed to examine the relationship between SQ and AF, as well as the effects of sinus rhythm restoration with direct current cardioversion (DCC) on SQ among patients with persistent AF. Methods One hundred fifty-three patients with a diagnosis of nonvalvular AF and 150 age-matched control subjects with sinus rhythm were recruited. SQ was assessed using the Pittsburgh Sleep Quality Index (PSQI). The study was designed with two stages. First, the difference in SQ between AF patients and age-matched controls was examined. Patients with global PSQI scores greater than 5 were defined as poor sleepers. Thus, a higher global PSQI score indicated worsened SQ. Predictors of poor SQ were also analyzed using a regression model. Second, the effect of rhythm control on SQ was studied in patients with AF who were eligible for DCC. Of the 65 patients with persistent AF, 54 patients with successful cardioversion were followed for 6 months. The remaining 11 patients, whose cardioversion was unsuccessful, were not followed. After 6 months of follow-up, the PSQI scores of patients with sinus rhythm maintenance (n = 39) and patients with AF recurrence (n = 15) were reassessed. Changes in global PSQI scores (baseline vs after 6 months) were analyzed. Results The PSQI scores were significantly higher in the AF group compared to the control group (9.4 +/- 4.6 vs 5.8 +/- 4.1, P = 0.001, respectively). The prevalence of poor sleepers was significantly higher in the AF group (76%) than in the control group (45%) (P < 0.001 by the (2) test). Multivariate logistic regression analysis showed that AF (odds ratio [OR]: 3.36, 95% confidence interval [CI]: 2.00-5.55), age (OR: 1.02, 95% CI: 1.00-1.04), and diabetes mellitus (OR:1.79, 95% CI: 1.03-3.14) were independent predictors of poor SQ. In the second stage, the effect of rhythm control on the SQ of the 54 patients with successful DCC was analyzed. PSQI scores improved significantly between baseline and the 6 months in sinus rhythm maintenance group (8.7 +/- 4.1 vs 7.2 +/- 3.8, P < 0.001, respectively). However, in the AF recurrence group, the change in global PSQI scores between baseline and the sixth month was not statistically significant (9.8 +/- 4.5 vs 9.2 +/- 4.2, P = 0.56, respectively). Conclusion Patients with AF have shorter sleep duration and poor SQ. Maintenance of sinus rhythm after DCC may have a favorable effect on the SQ of patients with AF. Nevertheless, AF is an independent predictor of poor SQ.Öğe Thrombolysis in patients with pulmonary embolism and elevated heart-type fatty acid-binding protein levels(Springer, 2014) Gul, Enes Elvin; Can, Ilknur; Kayrak, Mehmet; Abdulhalikov, Turyan; Erdogan, Halil Ibrahim; Altunbas, Gokhan; Ozdemir, KurtulusRecent studies have reported that a novel cardiac biomarker, heart-type fatty acid-binding protein (h-FABP), significantly predicts mortality inpatients with pulmonary embolism (PE) at intermediate risk. The aim of this study was to evaluate the effect of thrombolytic therapy on prognosis of the intermediate risk acute PE patients with elevated levels of h-FABP. This is non-interventional, prospective, and single-center cohort study where 80 patients (mean age 62 +/- A 17 years, 32 men) with confirmed acute PE were included. Only patients with PE at intermediate risk (echocardiographic signs of right ventricular overload but without evidence for hypotension or shock) were included in the study. h-FABP and other biomarkers were measured upon admission to the emergency department. Thrombolytic (Thrl) therapy was administered at the physician's discretion. Of the included 80 patients, 24 were h-FABP positive (30 %). 14 patients (58 %) with positive h-FABP had clinical deterioration during the hospital course and required inotropic support and 12 of these patients died. However, of 56 patients with negative test, only 7 patients worsened or needed inotropic support and five patients died during the hospital stay. Mortality of patients with PE at intermediate risk was 21 %. The 30-day mortality rate was significantly higher in h-FABP(+) patients compared to h-FABP(-) patients (9 vs. 50 %, p < 0.001). Multivariate analysis revealed h-FABP as the only 30 day mortality predictor (HR 7.81, CI 1.59-38.34, p = 0.01). However, thrl therapy did dot affect the survival of these high-risk patients. Despite, h-FABP was successful to predict 30-days mortality in patients with PE at intermediate risk; it is suggested to be failed in determining the patients who will benefit from thrl therapy.
