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Öğe Deterioration of heart rate recovery index in patients with erectile dysfunction(2016) Ulucan, Şeref; Kaya, Zeynettin; Keser, Ahmet; Katlandur, Hüseyin; Karanfil, Mustafa; Ateş, İsmailObjective: Heart rate recovery (HHR) after exercise is a function of vagal reactivation. This study aimed to evaluate HHR index in patients with erectile dysfunction.Methods: Men over the age of 18 years who were diagnosed with erectile dysfunction were included in the study. Ninety patients with erectile dysfunction (mean age56.1±8.3 years) and 50 healthy subjects as controls (mean age53.1±10.4 years) were compared. The erectile status of patients was evaluated using the sexual health inventory for men questionnaire. Basal electrocardiography, echocardiography, and treadmill exercise testing were performed in all patients and controls. The HHR index was defined as the reduction in heart rate from the rate at peak exercise to the rate at the first minute (HRR), second minute (HRR), third minute (HRR), and fifth minute (HRR) after terminating exercise stress testing. An independent sample t-test, Pearson correlation coefficient test, linear multivariate regression analysis, and receiver operating characteristic curve analysis were used for statistical assessment.Results: All HHR indices were found to be significantly decreased in patients with erectile dysfunction (p>0.001). Effort capacity was markedly lower (9.1±2.3 vs. 10.4±2.3 METs, p0.002) among patients with erectile dysfunction. HRR and HRR were found to be an independent risk factor for erectile dysfunction (Beta0.462, p>0.001; Beta0.403, p>0.001; respectively) in linear regression analysis.Conclusion: Decreased HHR index may be considered as one of the independent predictors of impaired autonomic function in patients with erectile dysfunction.Öğe Effect of serum uric acid on the positive predictive value of dobutamine stress echocardiography(Springer, 2016) Aribas, Alpay; Akilli, Hakan; Kayrak, Mehmet; Alibasic, Hayrudin; Yildirim, Oguzhan; Sertdemir, Ahmet Lutfi; Karanfil, MustafaThere is controversial data regarding the relationship between uric acid (UA) and coronary artery disease and cardiovascular events. Despite the deleterious effects of hyperuricemia on endothelial function, the effect of UA on myocardial ischemia has not been previously studied. We aimed to investigate the relationship between UA and myocardial ischemia that was identified using dobutamine stress echocardiography (DSE). In this retrospective study, the laboratory and DSE reports of 548 patients were reviewed. The patients were divided into two groups based on the presence of ischemia and further subdivided into three groups according to the extent of ischemia (none, ischemia in 1-3 segments, ischemia in > 3 segments). Serum UA levels were compared. Determinants of ischemia were assessed using a regression model. UA was increased in patients with ischemia and was correlated with the number of ischemic segments (p < 0.001). A cutoff value of UA > 5 mg/dl had 63.9 % sensitivity, 62.0 % specificity, 42.5 % positive predictive value (PPV), and 79.6 % negative predictive value for ischemia. When the positive DSE exams were further sorted according to the UA cutoff, the PPV of DSE increased from 80.2 to 94.0 %. Uric acid (odds ratio 1.51; 95 % CI 1.14-1.99), diabetes mellitus, HDL and glomerular filtration rate were found to be independent determinants of myocardial ischemia in DSE. Increased UA is associated with both the presence and extent of DSE-identified myocardial ischemia. A UA cutoff may be a good method to improve the PPV of DSE.Öğe A Rare Varieties of Diabetic Autonomic Neuropathy: Carotid Sinus Hypersensitivity, Case Report(2016) Kaya, Ahmet; Turan, Elif; Turan, Yaşar; Karanfil, Mustafa; Kulaksızoğlu, Mustafa; Güney, FigenCarotid sinus hypersensitivity is a common cause of fainting and falls in older adults and can be diagnosed by carotid sinus massage. We have presented a 67-year-old diabetic male patient who was admitted to our clinic because of hyperglycemia. In thyroid examination, clouding of consciousness occurred with unilateral palpation. Documented 4,8 seconds and undocumented 7 seconds of asystole were detected during the carotid sinus massage. An implantable cardioverter defibrillator was implanted in our patient. Carotid sinus hypersensitivity should be kept in mind in the examination of diabetic patients.Öğe The Relationship Between Neutrophil / Lymphocyte Ratio and Myocardial Ischemia Detected in Dobutamine Stress Echocardiography(Elsevier Science Inc, 2013) Akilli, Hakan; Kayrak, Mehmet; Alibasic, Hajrudin; Aribas, Alpay; Yildirim, Oguzhan; Karanfil, Mustafa; Sertdemir, Ahmet Lutfi[Abstract Not Availabe]Öğe The relationship between white coat hypertension and sleep quality(Springer Japan Kk, 2014) Kaya, Zeynettin; Kayrak, Mehmet; Demir, Kenan; Gunduz, Mehmet; Alibasic, Hayruddin; Karanfil, Mustafa; Akilli, HakanImpaired sleep quality is frequently associated with hypertension. The present study aims to examine self-reported sleep quality of patients with white coat hypertension. A total of 74 subjects who were evaluated in a cardiology outpatient clinic, including 39 normotensive subjects and 35 patients with white coat hypertension between the ages of 20 and 65 were included in this study. Patients with elevated office blood pressure (>= 140/90 mm Hg) and normal 24-h and daytime ambulatory blood pressure (<125/80 mm Hg and <130/85 mm Hg, respectively) were defined as white coat hypertension. Patient's sleep quality was evaluated using the Pittsburgh sleep quality index. Global Pittsburgh sleep quality index score was significantly higher in patients with white coat hypertension than normotensive subjects (7.2 +/- 3.7 vs. 5.1 +/- 3.8, P = 0.01). Poor sleep quality was present in 65% of patients with white coat hypertension, and in 30% of the normotensive group (P = 0.003). A multiple logistic regression analysis showed that white coat hypertension (odds: 6.7 (95% confidence interval [CI] 1.22-36.64), P = 0.03) and female gender (odds: 10.1(95% CI 1.35-76.32), P = 0.02) were independent predictors of poor sleep quality. In conclusion, white coat hypertension seems to be associated with impaired sleep quality.Öğe Sol Ventrikül Diyastol Sonu Basıncı Tahmininde Mitral A Dalga Yükselme Zamanının Değeri(2015) Akıllı, Hakan; Arıbaş, Alpay; Erer, Murat; Kayrak, Mehmet; Karanfil, Mustafa; Erdoğan, Halil İbrahim; Özdemir, Kurtuluş; Gök, HasanAmaç: Bu çalışmada sol ventrikül ejeksiyon fraksiyonunun korunduğu hastalarda (ejeksiyon fraksiyonu >%50), mitral A dalga yükselme zamanının, sol ventrikül diyastol sonu basıncını öngörmedeki yerinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Mayıs 2012 ile Ekim 2013 tarihleri arasında koroner anjiyografi yapılmasına karar verilen 121 hasta çalışmaya dahil edildi. Ekokardiyografi kayıtları alındıktan sonra, ölçümlerden habersiz başka bir araştırmacı tarafından sol kalp kateterizasyonu ile sol ventrikül diyastol sonu basıncı ölçüldü. Basınç değerlerine göre hastalar üç gruba ayrıldı. Sol ventrikül diyastol sonu basıncı 0 ile 10 mmHg arası olanlar grup 1, 11 ile 15 mmHg arasında olanlar grup 2, 16 mmHg ve üzeri olanlar ise grup 3'e dahil edildi. Demografi k özellikler, vital bulgular ve ekokardiyografi k parametreler gruplar arasında karşılaştırıldı. Bulgular: Çalışmamıza dahil edilen 121 hastadan 60 (%49,5) tanesi grup 1'e, 30 (%24,7) tanesi grup 2 ye, 31 (%25,6) tanesi grup 3 içerisine alındı. Gruplar arası yapılan analizde yaş, cinsiyet, vücut kitle indeksi, komorbit durumlar ve vital bulgular arasında anlamlı bir fark izlenmedi. Gruplar arasında mitral A dalga yükselme zamanında anlamlı bir fark izlenmedi. (Sırasıyla, 79,3±19,6 cm/sn, 83,9±12,5 cm/sn, 80,2±20,1 cm/sn p=0,51). Sonuç: Tüm bu bulgulara rağmen net veriler için daha fazla hasta katılımının olduğu çalışmalara ihtiyaç olduğu açıktır.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 White Coat Hypertension and Poor Sleep Quality(Elsevier Science Inc, 2013) Kaya, Zeynettin; Kayrak, Mehmet; Demir, Kenan; Gunduz, Mehmet; Alibasic, Hayruddin; Karanfil, Mustafa; Akilli, Hakan[Abstract Not Availabe]