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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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    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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    Determination of subclinical atherosclerosis in plaque type psoriasis patients without traditional risk factors for atherosclerosis
    (Turkish Anaesthesiology and Intensive Care Society, 2012) Altekin E.R.; Koç S.; Karakaş M.S.; Yanikoglu A.; Başarici I.; Demir I.; Alpsoy E.
    Objectives: Systemic inflammation plays an important role in the pathogenesis of atherosclerosis in psoriasis patients. Therefore, persistent skin inflammation in psoriasis patients may contribute to the development of premature atherosclerosis, as it occurs in rheumatoid arthritis and systemic lupus erythematosus. We aimed to evaluate the relationship between subclinical atherosclerosis and psoriasis by using pulse wave velocity (PWV) and the measurement of carotid intima media thickness (CIMT) in psoriatic patients. Study design: Fifty-seven plaque-type psoriasis patients (31 males, 26 females; mean age 41±10.8 years) and 60 healthy individuals (32 males, 28 females; mean age 40±9.4 years) were included. Atherosclerotic risk factors were excluded in both of the groups. Demographic, bio-chemical data, psoriasis area and severity index (PASI) score of the psoriasis group, and disease duration were recorded. Carotid-femoral artery PWV and CIMT values were compared. Results: PWV, and the maximum and average CIMT values of psoriasis patients were higher than those of the healthy group (PWV: 7.04±1.1 m/sn vs. 6.03±0.61 m/sn, p<0.001; maximum CIMT: 0.86±0.09 mm vs. 0.77±0.06 mm, p<0.001; mean CIMT: 0.73±0.09 mm vs. 0.66±0.06 mm p<0.001, respectively). Although there was no difference in the lipid levels of the groups, total/HDL cholesterol (4.40±1.26 vs. 3.88±1.18, p=0.02, respectively), and LDL/HDL cholesterol ratios (2.78±0.98 vs. 2.32±0.92, p=0.01, respectively) of the psoriasis group were higher than those of the healthy group. A positive correlation was observed between PASI and the PWV (r=0.417, p=0.001). Conclusion: Despite the nonexistence of atherosclerotic risk factors, the risk of development of atherosclerosis is higher in psoriasis patients compared to healthy individuals. In addition to damage of the artery wall caused by systemic inflammation, lipid metabolism disorders may contribute to the development of atherosclerosis in these patients. © 2012 Turkish Society of Cardiology.
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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 in patients with obstructive sleep apnea by automated function imaging method; an observational study [Obstrüktif uyku apneli hastalarda subklinik sol ventrikül sistolik disfonksiyonunun otomatik fonksiyonel görüntüleme yöntemiyle degerlendirilmesi: Gözlemsel bir çali{dotless}şma]
    (2012) Altekin Dr. R.E.; Yanikoglu A.; Karakaş M.S.; Öze D.; Yildirim A.B.; Kabukçu M.
    Objective: We aimed to evaluate the subclinical left ventricular (LV) systolic dysfunction with the automated function imaging method (AFI) based on speckle tracking echocardiography (STE) in obstructive sleep apnea patients (OSA) with normal left ventricular ejection fraction (LVEF) and without any confounding disease that can cause myocardial dysfunction. Methods: Twenty-one healthy individuals and 58 OSA patients were included in this observational cross-sectional study. According to the severity of disease, OSA patients were examined in three groups; mild, moderate and severe OSA. Apical 2-, 3- and 4- chamber images were obtained for AFI evaluation. The global systolic longitudinal strain (GL S) values were determined for each view, and averages of these were used in comparison of the patient groups. One-way ANOVA, Kruskal-Wallis, Pearson correlation tests and linear regression analysis were used for statistical analysis. Results: The GL S values of the OSA patients were lower than of the healthy individuals and these values were decreased along with the OSA severity (Healthy:-25.58±-2.16%, Mild:-23.93±-3.96%, Moderate:-21.27±-2.60%, Severe:-16.94±-2.66%, respectively). The difference was significant between moderate OSA patients and healthy individuals, and significant between severe OSA patients and all other groups (p<0.03). The apnea-hypopnea index was found to be correlated with the GL S (ß=-0.659, 95% CI: 0.09-0.17, p<0.001). Conclusion: Longitudinal LV mechanics in OSA patients with normal LVEF are deteriorated in the subclinical stage being associated with the severity of disease. AFI can be used as an effective and safe method in the determination of subclinical myocardial dysfunction in OSA patients, because it is semi-automated and easy to use with a short analysis time. © Copyright 2012 by AVES Yayi{dotless}nci{dotless}li{dotless}k Ltd.
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    Relation of neutrophil-to-lymphocyte ratio with GRACE risk score to in-hospital cardiac events in patients with ST-segment elevated myocardial infarction
    (SAGE Publications Inc., 2015) Oncel R.C.; Ucar M.; Karakas M.S.; Akdemir B.; Yanikoglu A.; Gulcan A.R.; Demir I.
    In this study, we aimed to investigate the association of the neutrophil-to-lymphocyte ratio (NLR) with Global Registry of Acute Coronary Events (GRACE) risk score in patients with ST-segment elevated myocardial infarction (STEMI). We analyzed 101 consecutive patients with STEMI. Patients were divided into 3 groups by use of GRACE risk score. The association between NLR and GRACE risk score was assessed. The NLR showed a proportional increase correlated with GRACE risk score (P <.001). The occurrence of in-hospital cardiac death, reinfarction, or new-onset heart failure was significantly related to NLR at admission (P <.001). Likewise, NLR and GRACE risk score showed a significant positive correlation (r =.803, P <.001). In multivariate analysis, NLR resulted as a predictor of worse in-hospital outcomes independent of GRACE risk score. Our study suggests that the NLR is significantly associated with adverse in-hospital outcomes, independent of GRACE risk score in patients with STEMI. © 2014 The Author(s).
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    The significance of the left atrial volume index in cardioversion success and its relationship with recurrence in patients with non-valvular atrial fibrillation subjected to electrical cardioversion: A study on diagnostic accuracy [Elektriksel kardiyoversiyon planlanan valvüler olmayan atriyal fibrilasyonlu hastalarda sol atriyum volüm indeksinin kardiyoversiyon başari{dotless}si{dotless} ve erken dönem atriyal fibrilasyon tekrari{dotless} ile ilişkisi; bir tani{dotless}sal dogruluk çali{dotless}şmasi{dotless}]
    (AVES Ibrahim Kara, 2013) Akdemir B.; Emre Altekin R.; Küçük M.; Yanikoglu A.; Serkan Karakaş M.; Aktaş A.; Ermiş C.
    Objective: The aim of this study was to assess the predictive value of the left atrial volume index (LAVI) in electrical cardioversion (ECV) and observe the recurrence rate of atrial fibrillation (AF) after a successful ECV in patients with non-valvular atrial fibrillation. Method: This study was designed as a diagnostic accuracy and prospective cohort study. Eighty patients (mean age 62±12 years; 52.5% female) were enrolled in study. LAVI was measured using the area-length method and the indexed body surface area. Patients in whom the sinus rhythm (SR) was established following the ECV were assessed according to the clinical and electrocardiography (ECG) findings at the first month and grouped as those with continued SR or recurrent AF. The Student's t, Mann-Whitney U, Fisher's exact, Chi-square tests, ROC and logistic regression analyses were used for statistical analysis. Results: Subsequent to the ECV, SR was achieved in 62.5% (n=50) of the patients. In those where SR was established, the AP-Lad (4.32±0.62 vs. 4.77±0.4 cm/p=0.002) and LAVI (35.3±11.5 vs. 53.1±10.1 mL/m2/p<0.001) values were observed to be lower. ECV success was found to be associated only with the LAVI (OR:1.122, 95%CI: 1.058-1.191, p<0.001). The AUC was found as 0.892±0.041 for the LAVI (95% CI:0.075-0.285, p<0.001). During the controls at the end of the 1st month, SR was maintained in 72% (n=36) of the successful ECV group. Among the patients with maintained SR, the antero-posterior left atrial dimension (4.17±0.62 vs. 4.72±0.5 cm/p=0.004) and LAVI (30.8±6.2 vs. 46.8±13.9 mL/m2/p<0.001) values were also observed to be lower. Only the LAVI was found to be associated with the recurrence of the AF (OR:1.355, 95% CI: 1.154-1.591, p<0.001). The AUC was found as 0.950±0.029 for the LAVI (95% CI:0.063-0.313, p=0.003) Conclusion: Lower LAVI values before the ECV are strong and independent predictors of the success of the ECV and the maintenance of SR after a successful ECV. © 2013 by AVES Yayi{dotless}nc{dotless}l{dotless}k Ltd.