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Öğe Corelation Between the 24-Hour Urine Aldosterone Levels and Atrial Electromechanical Conduction Time(Elsevier Science Inc, 2013) Soylu, Ahmet; Alibasic, Hayrudin; Yildirim, Elif; Toker, Aysun; Erdogan, Halil Ibrahim; Duzenli, Mehmet Akif; Tokac, Mehmet[Abstract Not Availabe]Öğe Dysphagia due compression of right pulmonary artery aneurysm to the esophagus(Turkish Soc Cardiology, 2013) Kayrak, Mehmet; Erdogan, Halil Ibrahim; Yildirim, Oguzhan[Abstract Not Availabe]Öğe Gender-Related Changes of the Epicardial Fat Thickness and Leptin in Obstructive Sleep Apnea(Wiley, 2014) Akilli, Hakan; Kayrak, Mehmet; Bekci, Taha Tahir; Erdogan, Halil Ibrahim; Aribas, Alpay; Yildirim, Oguzhan; Taner, AlpaslanBackgroundEpicardial fat thickness (EFT), an indicator of visceral obesity, and leptin are 2 novel markers for studying the obstructive sleep apnea (OSA) population. This study aimed to investigate the effects of gender on leptin levels and EFT, and the relation with OSA severity. MethodsA total of 149 patients with OSA (female/male 55/94 and mean age 50.89.2 years) and 50 control patients (female/male 24/26 and mean age 48.98.8 years) were included in the study. The study population was divided into 4 groups according to apnea/hypopnea index (AHI) as control (AHI <5), the mild OSA (AHI 5-14), the moderate OSA (AHI 15-29), and the severe OSA (AHI 30). EFT was obtained from parasternal long-axis and parasternal short-axis echocardiographic images. ResultsLeptin levels among females were significantly higher than among males (10.5 [7.8] vs. 5.4 [4.5] ng/mL, P=0.001, respectively). Among women, leptin levels were significantly higher in the severe OSA group compared to the control group (9.8 [9.0] vs. 15.5 [10.1] ng/mL, P=0.05, respectively). Conversely, no relation was observed between OSA severity and the leptin levels among men. EFT was not significantly different between the 2 genders (P>0.05). EFT was thicker in the severe OSA group than in the control and mild OSA groups among women, whereas EFT was not changed according to OSA severity among males (P>0.05). ConclusionLeptin and EFT may be a valuable parameter in the evaluation of OSA severity in women than in men.Öğe Management of right heart thrombi associated with acute pulmonary embolism: a retrospective, single-center experience(Aves Yayincilik, 2013) Akilli, Hakan; Gul, Enes Elvin; Aribas, Alpay; Ozdemir, Kurtulus; Kayrak, Mehmet; Erdogan, Halil IbrahimObjective: The mortality of right heart thrombi (RHT) associated with pulmonary embolism (PE) is increased about three to four times. The most devastating scenario is fragmentation of RHT and occurrence of recurrent PE. The reports regarding the management of RHT complicated with PE are very scarce in the current literature. Therefore, we report a single-center experience in this paper. Methods: From January 2006 to December 2011, data of all patients diagnosed with acute PE were analyzed retrospectively. Of the 312 acute PE cases confirmed with computed tomography, total 35 patients who were diagnosed with concomitant RHT (prevalence of 11%) by echocardiography were recruited. After excluding of six patients with metastatic malignancy a total 29 patients were accepted eligible for the analysis. In addition, catheter -induced thrombus (type B) were not included to the study. The difference between categorical variables was analyzed with Chi-square test and continuous variables were analyzed with Mann-Whitney U test. A p value of <0.05 was considered statistically significant. Results: Overall mortality was high (34%) in study population: among undergoing surgery-100%, therapy with thrombolytics -18%, and heparin -27%. Troponin levels were found significantly higher in died patients than that in survived patients (p=0.03). There was no significant difference regarding to clinical and echocardiographic characteristics of patients received heparin versus thrombolytic except for shock index (p=0.02). In addition, patients treated with heparin had increased duration of hospitalization compared to subjects treated with thrombolytic (median: 8 vs 3 days p<0.01). Conclusion: Despite of the low incidence of RHT, a mortal course is still an important problem during PE. The decision on treatment modality should be performed based on the hemodynamic parameters, laboratory findings, and bleeding risk of the patients.Öğe Prognostic Value of Neutrophil to Lymphocyte Ratio in Patients with Acute Pulmonary Embolism: A Restrospective Study(Elsevier Science Inc, 2014) Kayrak, Mehmet; Erdogan, Halil Ibrahim; Solak, Yalcin; Akll, Hakan; Gul, Enes Elvin; Yldrm, Oguzhan; Erer, MuratBackground Acute pulmonary embolism (PE) is a serious clinical condition characterised by a high mortality rate. Previous studies showed that leukocytosis was associated with recurrences of venous thromboemboli, major bleeding and increased mortality. The aim of the present study was to investigate the prognostic value of neutrophil to lymphocyte ratio (NLR) in patients with acute PE during short term follow-up. Method A total of 640 patients were screened by 126 code of ICD-9 and 359 patients were included as cases of confirmed acute PE. Admission blood counts and clinical data were obtained from medical charts. The predictors of 30-day mortality were examined. Results Fifty-one out of 359 patients (14.2%) included in the study died during 30 days follow-up. In multivariate Cox regression analysis systolic blood pressure (HR:0.97 (0.94-0.99 CI95%), p = 0.019), diabetes mellitus (HR:3.3 (1.30-8.39 CI95%), p = 0.012), CK-MB(HR:1.03 (1.01-1.06 CI95%), p = 0.024) and NLR (HR:1.03 (1.01-1.06 CI95%), p = 0.008) were predictors of 30-day mortality. An optimal cut-off value of NLR was determined as 9.2 by using ROC curve. Hazards ratio of NLR > 9.2 was found to be 3.60 (1.44-9.18 CI95%, p = 0.006). NLR > 9.2 had a sensitivity, specificity, negative predictive value, and positive predictive value of 68.6%, 80.5%, 93.9% and 36.5%, respectively. Conclusion NLR on hospital admission may be a predictor of 30-day mortality in acute PE. Since complete blood count is a part of the routine laboratory investigation in the most hospitalised patients use and preliminary promising results of this study, NLR should be investigated in future prospective randomised trials regarding prognostic value in acute PE.Öğe Relation of 24-Hour Urinary Aldosterone Levels with Nondipper Blood Pressure Pattern in Normotensive Individuals(Elsevier Science Inc, 2013) Soylu, Ahmet; Alibasic, Hayrudin; Yildirim, Elif; Toker, Aysun; Erdogan, Halil Ibrahim; Duzenli, Mehmet Akif; Tokac, Mehmet[Abstract Not Availabe]Öğe Relationship Between Myocardial Bridges and Arrhythmic Complications(H M P Communications, 2012) Erdogan, Halil Ibrahim; Gul, Enes Elvin; Gok, HasanMyocardial bridge (MB) is defined as compression of coronary artery during systole while it is normal in diastole. In angiographic series, the prevalence of this anomaly was reported between 0.5% and 2.5%. It is occasionally seen in the middle segment of the left anterior descending coronary artery. Although MB is considered to be a benign anomaly, the association of MB with ischemia, systolic dysfunction, conduction abnormality, arrhythmias, and sudden cardiac death were reported. Herein, we report 3 cases of MB that were diagnosed with coronary angiography and were associated with arrhythmic complications. In 2 patients, complete atrioventricular block was present, and another patient was diagnosed with sick sinus syndrome with the help of an electrophysiological study. All patients underwent permanent cardiac pacemaker implantation.Öğe Sturge-Weber syndrome and dilated cardiomyopathy: coincidence or associated disease?(Aves Yayincilik, 2012) Erdogan, Halil Ibrahim; Gul, Enes Elvin; Yildirim, Oguzhan; Duzenli, Mehmet Akif[Abstract Not Availabe]Öğe Swallowing-induced atrioventricular block and syncope in a patient with achalasia(Aves, 2015) Erdogan, Halil Ibrahim; Gok, Hasan; Karanfil, Mustafa[Abstract Not Availabe]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.Öğe Transesophageal echocardiography in the evaluation of penetrating intrapericardial injuries(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2013) Erdogan, Halil Ibrahim; Gul, Enes Elvin; Gok, Hasan[Abstract Not Availabe]Öğe The use of axial diameters and CT obstruction scores for determining echocardiographic right ventricular dysfunction in patients with acute pulmonary embolism(Springer, 2014) Aribas, Alpay; Keskin, Suat; Akilli, Hakan; Kayrak, Mehmet; Erdogan, Halil Ibrahim; Guler, Ibrahim; Yildirim, OguzhanTo evaluate the accuracy of cardiac computed tomography (CT) parameters and pulmonary artery (PA) obstruction (OS) scores in determining the echocardiographic right ventricular dysfunction (RVD) in hemodynamically stable patients with acute pulmonary embolism (PE). A total of 120 patients with acute PE were included in the study. Right ventricle/left ventricle ratio (RV/LV); PA axial diameter; superior vena cava (SVC) axial diameter; and Ghanima, Miller, Qanadli, and Mastora obstruction scores were obtained using CT. RVD was assessed by echocardiography. The patients were divided into two groups based on the presence or absence of RVD. RV/LV ratio, SVC axial diameter, PA axial diameter, and Miller, Qanadli, and Mastora scores were significantly increased in the RVD group. Multivariate logistic regression analysis showed that RV/LV ratio [OR 6.36 (2.02-279.46 95 % CI), p = 0.01] and PA axial diameter [OR 5.02 (1.02-1.26 95 % CI), p = 0.03] were independent predictors of echocardiographic RVD. Predictive values of these parameters were improved when combined with other intragroup cutoff values. A cutoff value for the RV/LV ratio of > 1.08 had 81.43 % sensitivity, 52.08 % specificity, 71.3 PPV, and 65.8 NPV for prediction of RVD. Tomographic axial diameters enable more accurate predictions of RVD than OS scores do.Öğe The Value of Axial Diameters and Obstruction Scores for Determining the Echocardiographic Right Ventricular Dysfunction in Acute Pulmonary Embolism(Elsevier Science Inc, 2013) Aribas, Alpay; Keskin, Suat; Akilli, Hakan; Kayrak, Mehmet; Erdogan, Halil Ibrahim; Guler, Ibrahim; Yildirim, Oguzhan[Abstract Not Availabe]