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    Assessment of left atrial dysfunction in obstructive sleep apnea patients with the two dimensional speckle-tracking echocardiography
    (2012) Altekin R.E.; Yanikoglu A.; Karakas M.S.; Ozel D.; Kucuk M.; Yilmaz H.; Demir I.
    Background The aim of this study was to compare left atrial (LA) longutidinal myocardial function in obstructive sleep apnea (OSA) patients with healthy individuals using two-dimensional speckle-tracking echocardiography method (2D-STE). Method Twenty one healthy individuals and 58 OSA patients were included. According to the AHI (apnea hypopnea index) patients were examined in mild, moderate and severe OSA groups. Images of the LA were acquired from the apical two- and four-chamber views. LA strain (LAS) and strain rate(LASR) parameters [systolic (S), early diastolic (E), late diastolic (A) during atrial contraction] were assessed. Results LA S-S, LASR-S, LAS-E and LASR-E values decreased with severity of OSA. Severe OSA patients have lower LAS-S and LASR-S values (p < 0.03).While a difference in the LA SR-E value between groups was significant beginning with the moderate OSA group (p < 0.03), no LAS-E value differences were observed between moderate and mild OSA groups (p > 0.03). LAS-A and LA SR-A values were increasing with the disease severity up to moderate OSA. LAS-A and LASR-A values of moderate OSA were greater than the mild OSA patients and healthy individuals (p < 0.03). Thesewere lower in severe OSA than the moderate OSA (p < 0.03), however, theywere greater than the healthy individuals (p < 0.03). The AHI was found to be negatively correlated with the LAS-S, LASR-S LA S-E, LASR-E, whereas AHI was not correlated with the LAS-A, LASR-A values. Conclusion LA remodeling and dysfunction that accompany OSA can be detected in the subclinical stage with a detailed evaluation of active and passive functions of the LA using the 2D-STE method. © Springer-Verlag 2012.
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    Association between mean platelet volume and severity of disease in patients with obstructive sleep apnea syndrome without risk factors for cardiovascular disease
    (2013) Karakaş M.S.; Altekin R.E.; Baktir A.O.; Küçük M.; Çilli A.; Yalçinkaya S.
    Objectives: Obstructive sleep apnea syndrome (OSAS) is associated with increased cardiovascular morbidity and mortality. Platelet activation and aggregation are central processes in the pathophysiology of atherothrombosis. Mean platelet volume (MPV), a determinant of platelet activation, is a newly-emerging risk factor for atherothrombosis. Therefore, we have investigated the possible association between OSAS and MPV. Study design: We selected 30 mild, 32 moderate, and 31 severe OSAS patients and 31 healthy control subjects matched for age, sex, and body mass index. MPV was measured using an automated blood cell counter. Results: The MPV levels were significantly higher in the severe OSA group than in the control group (8.6±1.1 vs. 7.8±0.7 fl, p=0.03). There were no significant differences in respect to MPV between controls and patients with mild and moderate OSA (7.8±0.7 vs. 8.3±1.2 fl, p=0.2; 7.8±0.7 vs. 8.4±1.3 fl, p=0.08) and between patients with mild, moderate, and severe OSA (8.3±1.2 vs. 8.4±1.3 vs. 8.6±1.1 fl, p=0.9). Significant correlations were seen between MPV and apnea-hypopnea index (r=0.347, p?0.001), minimal oxygen saturation (r=-0.224, p=0.03), and the percentage of recording time spent at a oxygen saturation less than 90% (r=0.240, p=0.02). Conclusion: Our results suggest that OSAS patients tend to have relatively increased platelet activation andatherothrombotic risk. © 2013 Turkish Society of Cardiology.
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    Determination of subclinical atherosclerosis in obstructive sleep apnea syndrome patients without traditional risk factors for atherosclerosis [Ateroskleroti·k ri·sk faktörleri· olmayan obstrükti·f uyku apne sendromlu hastalarda subkli·ni·k aterosklerozun saptanmasi]
    (2013) Karakaş M.S.; Altekin R.E.; Özbek S.C.; Yanikoglu A.; Akdemir B.; Er A.; Yalçinkaya A.S.
    Objective: Obstructive sleep apnea-hypopnea syndrome (OSAS) is associated with high cardiovascular morbidity and mortality. Recent studies have suggested a pathophysiological link between OSAS and atherosclerosis; for which carotid intima-media thickness (CIMT) and pulse wave velocity (PWV) has been considered as an early marker. The aim of this study was to assess the presence of early signs of atherosclerosis and cardiovascular effects of OSAS depending on its severity, in patients without clinically diagnosed cardiovascular disease and any coincident risk factors for atherosclerosis. Material and Method: Thirty one healthy subjects without any systemic disease and OSAS, and patients with OSAS without known atherosclerosis and also without any risk factors for atherosclerosis were examined in the study. According to the severity, 30 patients were in mild OSAS, 32 were in moderate OSAS and 31 patients were in severe OSAS group. Bilateral CIMT assesment and PWV analysis were performed in patients and controls. Results: Significant differences existed between control subjects and patients with mild, moderate and severe OSAS in PWV (5.70±0.48, 6.76±0.61, 7.72±0.82, 8.94±1.72 m/sec respecitively; p<0.0001) and CIMT (0.712±0.040, 0.812±0.037, 0.900±0.056, 0.971±0.74 mm respectively; p<0.0001). AHI and TST% were positively correlated with the following; the PWV (p<0.001- r=0.67 / p<0.001- r=0,70 respectively), the maximal CIMT (p<0.001- r=0.79 / p<0.001- r=0.74 respectively), The minimal SaO2 values were negatively correlated with the following; the PWV (p<0.001, r=-0.66), the maximal CIMT (p<0.001, r=-0.68). Conclusion: OSAS patients have tendency to atherosclerosis development, and this process increases proportionally with the severity of the disease.
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    Evaluation of left atrial function using two-dimensional speckle tracking echocardiography in end-stage renal disease patients with preserved left ventricular ejection fraction
    (Via Medica, 2013) Altekin R.E.; Yanikoglu A.; Karakas M.S.; Ozel D.; Yilmaz H.; Demir I.
    Background: Left atrial (LA) deformation analysis by two-dimensional speckle tracking echocardiography (2D-STE) has recently been proposed as an alternative approach for estimating left ventricular (LV) filling pressure and dysfunction. Aim: To assess the LA myocardial function using 2D-STE in end-stage renal disease (ESRD) patients with preserved LV ejection fraction (PLVEF) and to evaluate the relationship of the obtained results with echocardiographically estimated pulmonary capillary wedge pressure (ePCWP). Methods: Eighty-five ESRD patients and 60 healthy individuals were enrolled in the study. Images of the LA were acquired from apical two- and four-chamber views. The LA volumes (LAV) were calculated using the biplane area-length method. The LA volume indices (LAVI) were calculated by dividing the LA volumes by the body surface area. The LA strain (%) (LAS) parameters (systolic [LAS-S], early diastolic [LAS-E], late diastolic [LAS-A] during atrial contraction) were assessed, and the ePCWP was calculated according to the following formula: ePCWP = 1.25(E/E') + 1.9. LA stiffness was calculated non-invasively and based on the ratio of E/E' to LAS-S. Results: In patients with ESRD, the LAS-S (32.22 ± 7.64% vs. 57.93 ± 8.71%; p < 0.001), LAS-E (-15.86 ± 5.7% vs. -33.37 ± 7.71%; p < 0.001), and the LAS-A (-15.41 ± 4.16% vs. -24.57 ± 4.68%; p < 0.001) values were observed to be lower than the healthy group; while the LA stiffness (0.4 ± 0.19 vs. 0.17 ± 0.05; p < 0.001) value was higher. When the patients with ESRD were divided into two groups as those with a maximum LAVI value over 31.34 mL/m2 and those with a maximum LAVI below this value, the LAS-S (30.36 ± 8.32% vs. 34.11 ± 6.43%; p = 0.023) and the LAS-E (-14.97 ± 5.88% vs. -16.76 ± 5.42%; p = 0.039) values were lower in the group with a LAVI value over 31.34 mL/m2; while the LA S-A (-16.06 ± 4.44% vs. -14.75 ± 3.8%; p < 0.001) and LA stiffness (0.4 ± 0.19 vs. 0.17 ± 0.05; p < 0.001) values were higher. An association was observed between the ePCWP and LAS-S (p < 0.001), LAS-E (p = 0.01), LAS-A (p < 0.001), and LA stiffness (p < 0.001) values. Conclusions: The results of our study have demonstrated that LA myocardial function assessed using the 2D-STE method is associated with the ePCWP, which is an echocardiographically calculated marker of LV dysfunction. The LA deformation parameters may be used as echocardiographic findings to predict the LV dysfunction in ESRD patients with PLVEF. Further studies are needed to determine the independent prognostic power of the atrial strain measurement as a predictor of future cardiovascular events in ESRD patients. Copyright © Polskie Towarzystwo Kardiologiczne.
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    Evaluation of renal function in non-hypertensive patients with obstructive sleep apnea [Obstrüktif uyku apne sendromu olan normotansif hastalarda böbrek fonksiyonlari{dotless}ni{dotless}n degerlendirilmesi]
    (2012) Karakaş M.S.; Özbek S.C.; Akdemir B.; Er A.; Yanikoglu A.; Altekin R.E.; Çilli A.
    Objective: Obstructive sleep apnea syndrome (OSAS) is one of the most common sleep disorders in society. The presence of hypertension is shown in 30-60% of OSAS patients. Creatinine clearance (CC) in hypertensive OSAS patients was found to be lower than non-hypertensive OSAS patients. In our study, we aimed to determine CC in non- hypertensive OSAS patients comparing with the control group and determine that CC is affected by the severity of OSAS. Material and Methods: Ninety-three patients with complaints of snoring who were diagnosed as obstructive sleep apnea syndrome with polysomnography were examined in the study between March 2009-November 2010. Renal function tests were performed in these patients and creatinine clearance was calculated. Results: According to the OSAS severity, 30 patients were in the mild, 32 in moderate and 31 in severe OSAS group.There were no statistically significant differences in the demograpic data, systolic and diastolic blood pressure and CC between OSAS and control groups There was no corelation between severity of disease and CC. Conclusion: Due to the pathophysiologic features of OSAS, chronic kidney disease can develop in these patients, although hypertension has not yet developed. Therefore it must be considered that, hypertension may develop in patients with OSAS; blood pressure monitoring, evaluation and monitoring of renal function should not be neglected. © 2012 by Erciyes University School of Medicine.
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    Evaluation of subclinical left ventricular systolic dysfunction using two-dimensional speckle- tracking echocardiography in patients with non- alcoholic cirrhosis
    (Hellenic Cardiological Society, 2014) Altekin R.E.; Caglar B.; Karakas M.S.; Ozel D.; Deger N.; Demir I.
    Introduction: Cirrhosis is associated with certain abnormalities in left ventricular (LV) structure and function. Two-dimensional speckle-tracking echocardiography (2D-STE) enables a rapid and accurate analysis of regional LV systolic mechanics in the longitudinal, radial and circumferential directions. The aim of this study was to precisely assess the differences among the 3 directions in the early impairment of LV myocardial contraction in non-alcoholic cirrhotic patients with preserved LV pump function.Method: A total of 75 subjects, including 38 cirrhotic patients and 37 healthy individuals, were enrolled. Using 2D-STE, the strain (S) and systolic strain rate (SRS) values belonging to the radial (R), circumferential (C), and longitudinal (L) functions of the LV were measured.Results: In the cirrhotic group, the LS(20.57 ± 2.1 vs. 28.7 ± 43.1, p<0.001) and LSR-S(1.1 ± 0.24 vs. 1.6 ± 0.3) values were found to be lower, whereas the CS(24.82 ± 2.57 vs. 19.16 ± 4.58, p<0.001) and C SRS(1.41 ± 0.3 vs. 1.2 ± 0.4, p±0.004) values were found to be higher than in the healthy control group. The RSand RSR-Svalues did not differ among the groups. A relationship was observed between the MELD score, which shows the severity of the disease, and the CS value (â: 0.211, p<0.01, 95%CI: 0.086-0.503).Conclusion: LV myocardial contraction was impaired in the longitudinal direction. However, LV pump function was augmented by the circumferential shortening during the ventricular systole. Using the 2D-STE method for the regional evaluation of the LV, the LV damage can be detected in the subclinical phase in cirrhotic patients. © 2014, Hellenic Cardiological Society. All rights reserved.
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    Relation between mean platelet volume and subclinical atherosclerosis in patients with metabolic syndrome [Metabolik sendromlu hastalarda ortalama trombosit hacminin subklinik ateroskleroz ile ilişkisi]
    (Turkish Anaesthesiology and Intensive Care Society, 2014) Gülcan A.R.; Karakaş M.S.; Akdemir B.; Uçar M.; Altekin R.E.; Yilmaz H.
    Objectives: Metabolic syndrome (MetS) is associated with increased cardiovascular morbidity and mortality. There is evidence of platelet activation in MetS. Mean platelet volume (MPV), a determinant of platelet activation, is a newly emerging risk factor for atherothrombosis. Therefore, we investigated the possible association between subclinical atherosclerosis, as evaluated by carotid intima-media thickness (CIMT) measurement and MPV, in MetS patients. Study design: Seventy-four patients with MetS were enrolled in the study. Patients were divided into two groups according to CIMT measurement: 35 patients with CIMT ?1.0 mm were in Group 1 and 39 patients with CIMT <1.0 mm were in Group 2. MPV was measured using an automated blood cell counter. Results: The MPV level was significantly higher in patients with CIMT ?1.0 mm than in patients with CIMT <1.0 mm (8.2±0.7 vs. 7.8±0.6 fl; p=0.01). In our study, we observed that platelet count was lower in KIMK ?1.0 mm group and this finding was also found to be statistically significant. Conclusion: The risk of atherosclerosis could be shown by following the MPV values in MetS patients. Therefore, our results suggest that MPV is an important marker for early detection of atherosclerotic risk in patients with MetS. © 2014 Türk Kardiyoloji Dernegi.