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    Comparison of left and right ventricular pulsed and tissue Doppler myocardial performance index values using Z-score in newborns with hypoxic-ischemic encephalopathy
    (Turkish Soc Cardiology, 2011) Alp, Hayrullah; Karaaslan, Sevim; Baysal, Tamer; Oran, Bulent; Ors, Rahmi
    Objective: The aim of the study is determination of myocardial performance index (MPI/Tei index) using pulsed (PD) and tissue Doppler (TD) techniques to show cardiac response in newborns with hypoxic-ischemic encephalopathy (HIE) and healthy newborns and eventually evaluation of the differences between these two techniques. Methods: The study is a prospective observational study. Twenty term newborns diagnosed as perinatal asphyxia during postnatal 24 hours due to the defined criteria and fifty healthy term neonates as control group were included the study. Hypoxic group was divided into two groups with Sarnat stages, Sarnat Stage 1 and 2-3. MP's (Tei indexes) were calculated with PD and TO echocardiographic techniques in all groups after the 24 hours of birth and one year later. The statistical differences between same techniques were calculated with Kruskal-Wallis test and Z score was used to compare the superiority of two techniques. Results: The MPI values calculated by PD (0.41 +/- 0.04, 0.51 +/- 0.02) and TD (0.59 +/- 0.04, 0.51 +/- 0.02) during the first day of life in Sarnat Stage 2-3 in both ventricles were significantly higher than the control group (p<0.01, p<0.02, p<0.03). While the Z score, calculated for MPI measured by PD and TD methods, were found similar in both ventricles in Sarnat Stage 1 and control groups, it was significantly different in other groups of Sarnat stages. Conclusion: The degree of cardiac response in neonates with HIE is associated with the severity of hypoxia. MPI values are not different from the controls in newborns received mild hypoxia while they are higher in the patients who were received moderate or severe hypoxia. Any advantage could not be found between two techniques according to the measurement values, but higher variability in the value of MPI, measured by TO method, calculated from moderate and severe hypoxia group was detected. (Anadolu Kardiyol Derg 2011; 11: 719-25)
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    Dispersion Durations of P-wave and QT Interval in Children With Congenital Heart Disease and Pulmonary Arterial Hypertension
    (Springer, 2013) Sap, Fatih; Karatas, Zehra; Altin, Hakan; Alp, Hayrullah; Oran, Bulent; Baysal, Tamer; Karaarslan, Sevim
    This study aimed to investigate homogeneity disorders of ventricular repolarization and atrial conduction via QT dispersion and P-wave dispersion in children with congenital heart disease (CHD) and pulmonary arterial hypertension (PAH). Three groups of 20 each were generated and involved in this study. The first group included 20 children with both CHD and PAH. The second group consisted of 20 children with CHD but no PAH, and the third group was composed of 20 age- and sex-matched healthy children. Electrocardiographic records were used to determine P-wave, QT, and corrected QT (QTc) dispersions. The pulmonary hypertension group compared with the group having no pulmonary hypertension and the control group showed a significantly longer P-wave dispersion duration (39.10 +/- A 9.54 vs. 26.30 +/- A 4.99 ms, p < 0.001; and 24.80 +/- A 6.94 ms, p < 0.001, respectively) and QT dispersion duration (52.80 +/- A 15.11 vs. 37.60 +/- A 6.00 ms, p < 0.001; and 35.00 +/- A 7.77 ms, p < 0.001, respectively). In addition, the durations of maximum QTc and QTc dispersion were significantly longer in pulmonary hypertension group than in the other two groups. The risk of atrial and ventricular arrhythmia was found to be increased in the patients with both CHD and PAH. Physicians should pay close attention to possible atrial and ventricular arrhythmias during the treatment and follow-up evaluation of these patients.
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    Is myocardial performance index useful in differential diagnosis of moderate and severe hypoxic-ischaemic encephalopathy? A serial Doppler echocardiographic evaluation
    (Cambridge Univ Press, 2012) Karaarslan, Sevim; Alp, Hayrullah; Baysal, Tamer; Cimen, Derya; Ors, Rahmi; Oran, Bulent
    Introduction: The aim of this study was to investigate the importance of myocardial performance index as an additive criterion to Sarnat criteria in differential diagnosis of newborn babies with moderate and severe hypoxic-ischaemic encephalopathy. Methods: Our study group included 50 healthy term newborn babies and 20 newborn babies with hypoxic ischaemic encephalopathy. The 20 newborn babies with hypoxic-ischaemic encephalopathy were scored using Sarnat grades. Left and right ventricular functions were determined on the first day and thereafter in the 1, 3-4, 6-7, and 11-12 months of life by M-Mode and pulsed Doppler. Results: Myocardial performance indexes of the left ventricle were significantly higher in the severe hypoxic ischaemic encephalopathy group than in the control group during the first, second, and third analyses (p = 0.01, p = 0.02, p = 0.02, respectively) and only during the first analysis (p = 0.01) in the moderate hypoxic-ischaemic encephalopathy group. In addition, the myocardial performance indexes of the right ventricle were significantly higher during the first, second, and third analyses in both severe and moderate hypoxic-ischaemic encephalopathy groups than in the control group (p = 0.01, all). Hypoxia-induced alterations last longer in the right ventricle than in the left ventricle in the moderate group, as during the second and third analyses myocardial performance index continues to be higher than the control group. Conclusion: Myocardial performance indexes for the left and right ventricles were significantly higher in both severe and moderate hypoxic-ischaemic encephalopathy groups than in the control group during the first analysis, and myocardial performance index greater than or equal to 0.5 can be used in order to distinguish moderate and severe hypoxic-ischaemic encephalopathy babies according to Sarnat grades as a discriminative additive criterion.
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    Is myocardial performance index useful in differential diagnosis of moderate and severe hypoxic-ischaemic encephalopathy? A serial Doppler echocardiographic evaluation (vol 22, pg 335, 2012)
    (Cambridge Univ Press, 2012) Karaarslan, Sevim; Alp, Hayrullah; Baysal, Tamer; Cimen, Derya; Ors, Rahmi; Oran, Bulent
    [Abstract Not Availabe]
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    Normal values of left and right ventricular function measured by M-mode, pulsed doppler and Doppler tissue imaging in healthy term neonates during a 1-year period
    (Elsevier Ireland Ltd, 2012) Alp, Hayrullah; Karaarslan, Sevim; Baysal, Tamer; Cimen, Derya; Ors, Rahmi; Oran, Bulent
    Background: The measurements of left and right ventricular functions change after birth due to the influence of several hemodynamic changes upon the immature myocardium. Aim: The aim of this study was to investigate the changes in left (LV) and right ventricular (RV) functions of healthy term newborns using conventional and Doppler echocardiography during a 1-year period. Subjects and methods: Fifty healthy term newborns were examined prospectively on the first day, 3-4, 6-7, 9-10 and 11-12 months of their lives by M-mode, pulsed Doppler (PD) and Doppler tissue imaging techniques (DTI). PD velocities were obtained from mitral and tricuspid valves while DTI velocities were obtained from the lateral annuluses of atrioventricular valves. Results: EF and FS did not change significantly by time. Early (E) flow velocity and early myocardial (Em) velocity were higher than late (A) flow velocity and atrial systolic (Am) velocity for LV, while A and Am velocities were higher than E and Em velocities for RV, respectively during the study period. E. A, Em, Am, Sm velocities and Em/Am ratios increased while E/Em ratios decreased significantly by time (P<0.05) for both ventricle. However, E/A ratios of LV and RV did not change significantly by time. Myocardial performance index (MPI), obtained by PD for RV and by DTI for LV, decreased significantly by time (P<0.05) and these DTI values were higher than PD values during the study period. Conclusions: Due to hemodynamic and maturation change of myocardium PD and DTI velocity changes took place during the first year of life which reflects differences in ventricular adaptation. (C) 2012 Elsevier Ireland Ltd. All rights reserved.
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    Plasma leptin, neuropeptide Y, ghrelin, and adiponectin levels and carotid artery intima media thickness in epileptic children treated with valproate
    (Springer, 2012) Tokgoz, Huseyin; Aydin, Kursad; Oran, Bulent; Kiyici, Aysel
    Weight gain is a common side effect of valproate (VPA) treatment, although the mechanism is not clear. Abnormal weight gain and obesity are associated with dyslipidemia, hypertension, and atherosclerosis. Measurement of the common carotid artery intima media thickness (CAIMT) gives a picture of early arterial wall alterations and, currently, is considered a noninvasive marker of premature atherosclerosis. The aim of the present study was to evaluate plasma insulin, leptin, neuropeptide Y (NPY), ghrelin, and adiponectin levels in children with epilepsy treated with VPA and to evaluate these parameters for early atherosclerosis. Twenty prepubertal children with idiopathic epilepsy treated with VPA were enrolled in this study. Body mass index (BMI) and fasting insulin glucose ratio (FIGR) were calculated, and the plasma insulin, leptin, NPY, ghrelin, and adiponectin levels; the lipid profiles; and CAIMT were measured for all subjects before the treatment and after a follow-up period of 6 and 12 months. When pretreatment values were compared with those at the end of 6 and 12 months, the mean BMI values, plasma insulin, leptin, NPY levels, and FIGR were increased, whereas the plasma ghrelin and adiponectin levels, lipid profiles, and CAIMT did not change significantly at the end of 6 and 12 months. These results suggest that weight gain during VPA treatment may be related to increases in insulin, leptin, and NPY levels. Additionally, in this study, no increase in the risk for early atherosclerosis was determined by CAIMT in children with epilepsy treated with VPA.
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