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Öğe Comparison of ventricular escape rates after administration of atropine, dopamine, and aminophylline in stable patients with chronic, high-grade atrioventricular block: An open-label, crossover pilot study in Turkish patients(Excerpta Medica Inc, 2002) Altun, A; Akdemir, O; Erdogan, O; Kirdar, C; Birsin, A; Tatli, E; Ozbay, GBackground: Bradyasystolic episodes are frequently observed in patients who present with presyncope, syncope, or sudden cardiac death to emergency departments. Current therapeutic modalities in treating patients with bradyasystolic episodes include pharmacotherapeutic agents (eg, atropine, epinephrine, and dopamine) and cardiac pacing. Objective: The aim of this open-label, crossover, prospective, sequential, pilot study was to compare the effects of 3 agents-atropine, dopamine, and aminophylline-on ventricular escape rate in Turkish patients. Methods: Eligible patients were stable and had chronic, symptomatic, second-degree 2:1 or third-degree atrioventricular (AV) block with a narrow complex escape rhythm. Patients who were receiving a pharmacotherapeutic regimen or who presented with a wide QRS complex escape rhythm, severely disturbed hemodynamic status, an electrolyte disturbance, previous heart surgery, myocarditis, or a reversible underlying cause (eg, acute ischemia) were excluded from the study. Study drugs were given in the same sequential order to all patients, without a washout period, until the ventricular escape rate returned to the initial level. Atropine (1 mg), dopamine (7.5 and 15 mug/kg/min), and aminophylline (240 mg, twice) were sequentially given to each patient. Results: Twelve consecutive patients (5 women, 7 men; mean age, 69 +/- 14 years) were enrolled. Compared with the baseline rate, a significantly improved ventricular escape rate was found after the beta-mimetic dose of dopamine (44 +/- 6 beats/min vs 49 +/- 10 beats/min; P = 0.005). Improvement in ventricular escape rate was also shown after the alpha-mimetic dose of dopamine, but it was not as dramatic as with the beta-mimetic dose (49 +/- 10 beats/min vs 52 +/- 13 beats/min; P = NS). Compared with the baseline rate, the ventricular escape rate was significantly increased after the second dose of aminophylline (45 +/- 10 beats/min vs 50 +/- 8 beats/min; P = 0.04). Conclusions: This study revealed that, in this patient population, significant acceleration of the ventricular escape rate was found after both the betamimetic dose of dopamine and high-dose aminophylline. This study may have been limited by its small sample size and short duration. Additional studies with larger sample sizes and of longer duration are needed to prove that dopamine and high-dose aminophylline can be used as therapy for patients with high-grade AV block and a slow escape rate.Öğe A controlled study of the effects of carvedilol on clinical events, left ventricular function and proinflammatory cytokines levels in patients with dilated cardiomyopathy(Elsevier Science Inc, 2005) Tatli, E; Kurum, TBACKGROUND: Carvedilol is known to decrease the severity of ventricular dysfunction, to increase the left ventricular ejection fraction (LVEF), and, consequently, to reduce morbidity and mortality in patients with dilated cardiomyopathy. There is accumulating evidence that inflammatory cytokines have an important role in the pathogenesis of heart failure. OBJECTIVE: To establish whether the addition of carvedilol has an additive beneficial effect on cytokines in patients with dilated cardiomyopathy who are already receiving treatment with angiotensin-converting enzyme (ACE) inhibitors, digoxin and diuretics. METHODS AND RESULTS: In this single-centre, prospective, randomized study, 60 patients with dilated cardiomyopathy with an LVEF less than 40% and already receiving digoxin, ACE inhibitors and diuretics for six months as the standard therapy were randomly assigned to receive either carvedilol (n = 30) or placebo (n = 30). Patients received an initial dosage of 3.125 mg carvedilol or placebo twice daily for two weeks, which was then increased at two-week intervals (if tolerated), first to 6.25 mg, then to 12.5 mg, and, finally, to a target dosage of 25 mg twice daily. Clinical examinations, radionuclide studies, and determinations of plasma levels of tumour necrosis factor-alpha (TNF-alpha), interleukin (IL)-2 and IL-6 were performed at baseline and repeated four months after random assignment. Primary end points were New York Heart Association functional class, LV function and plasma cytokines levels. Eight patients died (seven in the placebo group, P = 0.05). Patients treated with carvedilol had a significant improvement in functional class compared with the baseline values (P = 0.001), with a decrease in the levels of cytokines (IL-6 [P = 0.001] and TNF-alpha [P = 0.001]). LVEF increased from 22.14 7.85% to 27.85 11.80% (P = 0.002), but diastolic function did not change in the carvedilol group. CONCLUSIONS: In patients with dilated cardiomyopathy, the addition of carvedilol to treatment with digoxin, ACE inhibitors and diuretics is associated with a significant improvement in symptoms and in IV function, and suppression of inflammatory cytokines.Öğe Decreased serum osteoprotegerin levels in cardiac syndrome x(Nature Publishing Group, 2004) Altun, A; Ugur-Altun, B; Tatli, E[Abstract Not Available]Öğe Decreased serum osteoprotegerin levels in patients with cardiac syndrome X(Springer, 2004) Altun, A; Ugur-Altun, B; Tatli, EReceptor activator of nuclear factor kappaB (RANK) and osteoprotegerin (Cl represent the ligand and decoy receptor, respectively, of a pleiotropic cytokine system that regulates bone metabolism and vascular biology. Several studies supported systemic microvascular abnormalities in patients with cardiac syndrome X (CSX). This study investigates serum Cl levels in healthy obese subjects and healthy lean controls affected by cardiac syndrome X. Methods: We compared the Cl levels in 8 patients with cardiac syndrome X [2 males, 6 females; age: 46 +/- 6 yr; body mass index (BMI): 30 +/- 5 kg/m(2)] with 24 obese subjects (8 males, 16 females; age: 38 +/- 5 yr; BMI: 35 +/- 5 kg/m(2)) and 15 healthy lean controls (6 males, 9 females; age: 36 +/- 5 yr; BMI: 23 +/- 2 kg/m(2); BMI<25kg/m(2)). Results: Serum Cl levels in patients with cardiac syndrome X were lower than those in obese subjects and lean controls (11..45 +/- 8.36 pg/ml, 14.78 +/- 8.22 pg/mI, 19.24 +/- 6.96 pg/ml, respectively, cardiac syndrome X vs lean controls, P = 0.039). Conclusions: Serum OPG levels are lower in patients with CSX. Further studies on the mechanisms of OPG in microangiopathy may help to evaluate the OPG system role as a marker for disease activity, prognosis and response to therapy in cardiovascular diseases. (C) 2004, Editrice Kurtis.Öğe The effects of carvedilol on pro-inflammatory cytokines and diastolic functions in ischemic and non-ischemic dilated cardiomyopathy(Springer, 2004) Kurum, AT; Tatli, E; Yuksel, M[Abstract Not Available]Öğe Factors related to exercise capacity in asymptomatic middle-aged type 2 diabetic patients(Elsevier Ireland Ltd, 2005) Ugur-Altun, B; Altun, A; Tatli, E; Tugrul, AAim: We aimed to look at the relationship between exercise capacity and metabolic variables in unselected consecutive asymptomatic middle-aged type 2 diabetic patients as a potential marker for undiagnosed coronary heart disease. Method: Ninety patients (49 6 years) were included in the study. All patients performed a treadmill exercise test using the Bruce protocol. According to achieved EC, patients were separated into three groups; Group I (n, 24) 8 > metabolic equivalents (METs) greater than or equal to 5, Group II (n, 54) 11 > METs > 8 and Group III (n, 12) METs > 11. Results: Patients in group I are more likely to be of female gender and to have a family history of coronary heart disease (CHD) than in group III (P = 0.015, P = 0.009, respectively). When compared to group 111, patients in group I had higher fasting insulin and fibrinogen levels (P = 0.049 and P = 0.01, respectively). Homeostasis model assessment for insulin resistance (HOMA-IR) index (P = 0.03) was also higher in group I than in group III. We found a significant negative correlation between achieved exercise capacity and age (r = -0.204, P = 0.048), fasting insulin (r = -0.209, P = 0.048), HOMA-IR (r = -0.204, P = 0.048) as well as fibrinogen (r = -0.301, P = 0.007). Conclusion: Reduced exercise capacity was associated with increased insulin resistance as assessed by HOMA-IR index in asymptornatic middle-aged type 2 diabetic patients. (C) 2004 Elsevier Ireland Ltd. All rights reserved.Öğe The importance of intrapericardial drain selection in cardiac surgery(Elsevier, 2004) Ege, T; Tatli, E; Canbaz, S; Cikirikcioglu, M; Sunar, H; Ozalp, B; Duran, EIntroduction: To explore the impact of intrapericardial and infracardiac drains on pericardial effusions in cardiac surgery. Materials and methods: Patients undergoing coronary artery bypass grafting were randomized into two groups. At the end of the intervention, an intrapericardial and infracardiac Blake drain was placed in patients in group 1 (n = 97), and an intrapericardial and infracardiac semirigid drain was placed in patients in group 2 (n = 105). In addition, a semirigid drain was placed into mediastinum in all cases. The amount of drainage was calculated at six different time points postoperatively: postoperative 0 to 2 h, postoperative 2 to 4 h, postoperative 4 to 6 h, postoperative 6 to 12 h, postoperative 12 to 24 h, and postoperative 24 to 48 h. The amount of pericardial effusion was estimated by transthoracic echocardiography after the drains were removed. Results: In all measurements, the amount of drainage from intrapericardial Blake drains was higher, the total amount of drainage being equal to 330.7 +/- 29.4 mL and 193.2 +/- 19.6 mL in the Blake drain and semirigid drain groups, respectively (p = 0.000) [mean +/- SD]. When the drains were removed, the volume of pericardial effusion was 3.86 +/- 0.76 mm in Blake drain group and 7.59 +/- 1.16 mm in semirigid drain group (p = 0.000). The incidence of postoperative atrial fibrillation was 11.3% in the group with Blake drains, and 23.8% in the group with semirigid drains (p = 0.016). Conclusion: The more effective drainage obtained with infracardiac Blake drains compared to semirigid drains helps to reduce the amount of postoperative pericardial effusion and the risk of atrial fibrillation.Öğe Increased P wave dispersion: A new finding in patients with syndrome X(Pulsus Group Inc, 2002) Altun, A; Erdogan, O; Tatli, E; Ugur-Altun, B; Durmus-Altun, G; Ozbay, GThe present clinical study was undertaken in patients with syndrome X, namely angina with normal coronary arteries, to investigate the presence of increased P wave dispersion by comparing patients with coronary artery disease (CAD) and healthy control subjects. Three groups were studied - group A, 21 patients (48 6 years) with syndrome X; group B, 16 patients (56 9 years) with CAD; and group C, 16 healthy subjects (49 8 years). Patients with CAD were older than those in groups A and C (P=0.005 and P=0.035, respectively). All groups demonstrated similar PQ, QRS and RR intervals. Group B had a lower minimum P wave duration than group C (P=0.05). P wave dispersion in group A was found to be higher than that in groups B and C (P=0.018 and P=0.0001, respectively). Patients with syndrome X demonstrated increased P wave dispersion compared to patients with CAD and healthy subjects. High sympathetic tone or autonomic imbalance observed in patients with syndrome X may affect intra-atrial and interatrial conduction times, and leave them prone to develop atrial arrhythmias.Öğe Normalization of negative T waves in the chronic stage of Q wave anterior myocardial infarction as a predictor of myocardial viability(Karger, 2005) Altun, A; Durmus-Altun, G; Birsin, A; Gultekin, A; Tatli, E; Ozbay, GWe investigated whether spontaneous normalization of negative T waves ( TWN) on infarct-related ECG leads ( IRLs) in the chronic phase of Q wave anterior myocardial infarction ( MI) could be a predictor of residual viability in infarct areas. We prospectively studied 35 patients ( age 60 +/- 8.6 years) in the chronic phase of Q wave anterior MI. Spontaneous TWN ( group A, n = 23) were defined as negative T waves that became upright ( greater than or equal to0.15 mV) in 62 IRLs. The presence of negative T waves ( group B, n = 12) was defined as symmetric or biphasic negative T wave of greater than or equal to0.15 mV. All patients underwent same-day rest Tl-201-stress Tc-99m sestamibi dual-isotope myocardial perfusion SPECT and 24-hour Tl-201 reinjection imaging for ischemia and viability analysis. On scintigraphic examination, ischemic or viable myocardial segments were found in 18 patients ( 78%) with TWN and 4 patients ( 33%) of group B ( p = 0.013). The use of TWN as a parameter had a marked influence on the sensitivity ( 82%), specificity ( 62%), positive ( 78%) and negative ( 67%) predictive values and accuracy ( 74%) of the diagnosis of viable smyocardium. If we add the criterion of positive T waves in aVR with negative T waves to our criteria, we found that sensitivity ( 90%), positive ( 80%) and negative ( 80%) predictive values and accuracy ( 80%) increased. The results of our study suggest that analysis of TWN on IRLs is an accurate marker of residual viability and/or persistent peri-infarct ischemia in patients in the chronic stage of Q wave anterior MI, and therefore optimizes the diagnostic and therapeutic strategies after MI. Copyright (C) 2005 S. Karger AG, Basel.Öğe Relationship between insulin resistance assessed by HOMA-IR and exercise test variables in asymptomatic middle-aged patients with Type 2 diabetes(Springer, 2004) Ugur-Altun, B; Altun, A; Tatli, E; Arikan, E; Tugrul, AWe investigated the relationship between index of insulin resistance (IR) and exercise test variables in middle-aged asymptomatic patients with Type 2 diabetes. Methods: 90 patients (48 men, 42 women; age: 49+/-6 yr) were included in the study. We used homeostasis model assessment for IR (HOMA-IR) index as index of IR. All patients were subjected to treadmill exercise test. Four subjects were tested positive (4.4%). Study patients were separated into three groups: group I (no.=26) HOMA-IR index <2.24; group II (no.=26) index 2.24-3.59; group III (no.=38) index >3.59. Results: group I had less frequency of cardiovascular risk factors than group II and III (p=0.001). Systolic blood pressure baseline as well as peak exercise values, were higher in group III than in group I and II (p=0.048 vs p=0.01, respectively). Higher total exercise time and peak workload were found in group I than group II and III (p=0.04). The recovery of heart rate (Delta HRpr) was similar among the study groups. We found significant negative correlations between HOMA-IR and total exercise time and peak workload. In addition we found significant negative correlations between age vs chronotrophic index (CI), Delta HRpr, and peak workload. There were also similar negative correlations between duration of diabetes vs CI and Delta HRpr. Conclusions: IR is associated with a variety of cardiovascular risk factors. Some exercise test variables point out changes of autonomic tone during exercise in elevated IR group. Negative correlation between HOMA-IR and peak exercise capacity (METs) may well confirm increased mortality in hyperinsulinemia. (C) 2004, Editrice Kurtis.
