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Öğe A Little-Known Subject: Lead and Cardiac Toxicity(Elsevier Science Inc, 2013) Demircelik, Muhammed Bora; Yilmaz, Omer Caglar; Yilmaz, Hinc; Tutkun, Engin; Gurel, Ozgul Malcok; Atar, Inci Asli; Cetin, Zehra Guven[Abstract Not Available]Öğe Association between Red Blood Cell Distribution Width and Coronary Artery Calcification in Patients Undergoing 64-Multidetector Computed Tomography(Korean Soc Cardiology, 2015) Gurel, Ozgul Malcok; Demircelik, Muhammed Bora; Bilgic, Mukadder Ayse; Yilmaz, Hakki; Yilmaz, Omer Caglar; Cakmak, Muzaffer; Eryonucu, BeyhanBackground and Objectives: The red blood cell distribution width (RDW) has been found to be associated with cardiovascular morbidity and mortality. The objective of this study was to determine whether the RDW measures are associated with the coronary artery calcification score (CACS) in patients who did not present with obvious coronary heart disease (CHD). Subjects and Methods: A total of 527 consecutive patients with a low to intermediate risk for CHD but without obvious disease were enrolled in this study. The study subjects underwent coronary computerized tomography angiography and CACS was calculated. The patients were divided into two groups based on CACS: Group I (CACS <= 100) and Group II (CACS>100). The two groups were compared in terms of classic CHD risk factors and haematological parameters, particularly the RDW. Results: Group I patients were younger than Group II patients. The Framingham risk score (FRS) in patients of Group II was significantly higher than that in patients of Group I. Group II patients had significantly elevated levels of haemoglobin, RDW, neutrophil count, and neutrophil/lymphocyte ratio compared with Group I patients. CACS was correlated with age, RDW, and ejection fraction. In the multivariate analysis, age, RDW, and FRS were independent predictors of CACS. Using the receiver-operating characteristic curve analysis, a RDW value of 13.05% was identified as the best cut-off for predicting the severity of CACS (>100) (area under the curve=0.706). Conclusion: We found that the RDW is an independent predictor of the CACS, suggesting that it might be a useful marker for predicting CAD.Öğe Association of ambulatory arterial stiffness index with sEPCR in newly diagnosed hypertensive patients(Taylor & Francis Ltd, 2015) Yilmaz, Hakki; Cakmak, Muzaffer; Inan, Osman; Darcin, Tahir; Aktas, Aynur; Gurel, Ozgul Malcok; Bilgic, Mukadder AyseAim: Increased arterial stiffness is strongly associated with cardiovascular diseases, while thrombotic events are more common than hemorrhagic events in hypertensive patients. Markers of a hypercoagulable state may also predict future cardiovascular events in hypertensive patients. Here, we speculated that increased arterial stiffness might lead to the development of a hypercoagulable state that can play a role in the thrombotic complications of hypertension. Soluble endothelial protein C receptor (sEPCR) is one such marker of hypercoagulation. The ambulatory arterial stiffness index (AASI) could be accepted as a non-invasive measure of arterial stiffness. The aim of this study was to investigate association of AASI with levels of sEPCR in newly diagnosed hypertensive patients. Materials and methods: The study included 263 newly diagnosed essential hypertensive patients and 55 healthy normotensive controls. All subjects underwent 24 h ambulatory blood pressure monitoring (ABPM); the AASI was derived from ABPM tracings. Plasma sEPCR was measured by ELISA. Results: Hypertensive patients (n=263) had higher AASI, C-reactive protein (CRP) and sEPCR versus the normotensive healthy group (n=55). Univariate analysis showed that AASI was positively associated with age (r=0.212, p< 0.001) body mass index (r=0.412, p<0.001), pulse pressure (r=0.350, p<0.001), plasma sEPCR (r=0.894, p<0.001), 24-h heart rate (r=0.176, p=0.001) and inversely related to high-density lipoprotein (HDL) (r=-0.293, p<0.001). Multivariate analyses revealed that sEPCR and HDL are independently correlated to AASI. Conclusion: We suggest that increased AASI is associated with elevated sEPCR. It might be responsible for subsequent thrombotic events in newly diagnosed hypertensive patients.Öğe Association of Red Blood Cell Distribution Width with Coronary Artery Calcification(Elsevier Science Inc, 2013) Gurel, Ozgul Malcok; Bilgic, Ayse; Demircelik, Bora; Gunes, Mahmut; Yilmaz, Omer Caglar; Bozduman, Fadime; Kahyalar, Kemal[Abstract Not Available]Öğe CA 125 levels and left ventricular function in patients with end-stage renal disease on maintenance hemodialysis(Taylor & Francis Ltd, 2014) Yilmaz, Hakki; Gurel, Ozgul Malcok; Celik, Huseyin Tugrul; Sahiner, Enes; Yildirim, Mehmet Erol; Bilgic, Mukadder Ayse; Bavbek, NuketPurpose: The aim of this study was to analyze associations between serum cancer antigen 125 (CA 125) levels and left ventricular (LV) function in patients with end-stage renal disease on maintenance hemodialysis (HD). Methods: CA 125 levels, pro-brain natriuretic peptide (pro-BNP) and biochemical parameters were measured, and echocardiography was performed for 110 patients and 47 healthy controls. Results: The mean CA 125 level in patients, 38.78 +/- 35.48 U/mL, was significantly higher than that found in healthy controls (9.20 +/- 4.55 U/mL; p = 0.003). Patients with elevated CA 125 levels (n = 40) had significantly lower levels of albumin and reduced relative wall thickness, LV ejection fraction (EF) and fractional shortening but significantly higher levels of pro-BNP and a greater left ventricular end-diastolic diameter (LVEDd) and -systolic diameter (LVESd). CA 125 levels were positively correlated with pro-BNP (r = 0.596, p<0.05) and C-reactive protein (CRP) levels (r = 0.439, p<0.05), as well as LVEDd (r = 0.599, p<0.001), LVESd (r = 0.750, p<0.001) and LV mass index (r = 0.378, p<0.05). In contrast, serum CA 125 levels were negatively correlated with albumin (r = -0.513, p<0.05) and hemoglobin (r = -0.475, p<0.05) as well as the EF (r = -0.878, p<0.0001). A depressed EF (beta = -1.121, p<0.0001) and increased CRP levels (beta = 0.247, p = 0.035) were independent predictors of high CA 125 levels in the whole group in the multivariate-model. Conclusions: Our study is the first to demonstrate an association between serum CA 125 levels and LV systolic dysfunction via inflammation in patients on maintenance HD.Öğe Epicardial adipose tissue and pericoronary fat thickness measured with 64-multidetector computed tomography: potential predictors of the severity of coronary artery disease(Hospital Clinicas, Univ Sao Paulo, 2014) Demircelik, Muhammed Bora; Yilmaz, Omer Caglar; Gurel, Ozgul Malcok; Selcoki, Yusuf; Atar, Inci Asli; Bozkurt, Alper; Akin, KayihanOBJECTIVE: The aim of the present study was to investigate the relationship between pericoronary fat and the severity and extent of atherosclerosis, quantified using 64-multidetector computed tomography, in patients with suspected coronary artery disease. METHODS: The study population consisted of 131 patients who were clinically referred for noninvasive multislice computed tomography coronary angiography for the evaluation of coronary artery disease. Patients were classified as follows: no atherosclerosis, Group 1; nonobstructive atherosclerosis (luminal narrowing <50% in diameter), Group 2; and obstructive atherosclerosis (luminal narrowing >= 50%) in a single vessel or obstructive atherosclerosis in the left main coronary artery and/or multiple vessels, Group 3. Epicardial adipose tissue was defined as the adipose tissue between the surface of the heart and the visceral layer of the pericardium (visceral epicardium). Epicardial adipose tissue thickness (mm) was determined in the right ventricular anterior free wall. The mean thickness of the pericoronary fat surrounding the three coronary arteries was used for the analyses. RESULTS: The average thickness over all three regions was 13.2 +/- 2.1 mm. The pericoronary fat thickness was significantly increased in Group 3 compared with Groups 2 and 1. The epicardial adipose tissue thickness was significantly increased in Group 3 compared with Groups 2 and 1. A receiver operating characteristic curve for obstructive coronary artery disease was assessed to verify the optimum cut-off point for pericoronary fat thickness, which was 13.8 mm. A receiver operating characteristic curve for obstructive coronary artery disease was also assessed to verify the optimum cut-off point for epicardial adipose tissue, which was 6.8 cm. CONCLUSION: We showed that the epicardial adipose tissue and pericoronary fat thickness scores were higher in patients with obstructive coronary artery diseases.Öğe Galectin-3 as a new biomarker of diastolic dysfunction in hemodialysis patients(Urban & Vogel, 2015) Gurel, Ozgul Malcok; Yilmaz, Hakki; Celik, Tugrul H.; Cakmak, Muzaffer; Namuslu, Mehmet; Bilgic, Ayse M.; Bavbek, NuketGalectin-3 (gal-3) is an emerging prognostic biomarker in heart failure (HF). Clinical and experimental studies suggest that gal-3 is an important mediator of HF. Here we aimed to examine the relationship between gal-3 and diastolic dysfunction in patients undergoing maintenance hemodialysis (HD). We examined the relationship between plasma gal-3 levels and left ventricular diastolic function. Plasma gal-3 was measured in 87 subjects with chronic HD and in 45 healthy controls using biochemical evaluations. Conventional echocardiography and pulsed tissue Doppler assessment were performed in all patients. Left ventricular diastolic dysfunction (LVDD) was defined as E' < 8 cm/s. The E/E' ratio was used as the main determinant of LVDD grade. The mean gal-3 concentrations were: 16.05 ng/ml (13.89-19.75) in healthy controls; 14.54 ng/ml (10.85-17.65) in HD patients with normal diastolic function; and 23.30 ng/ml (20.12-26.87) in HD patients with LVDD (p < 0.01). Plasma gal-3 levels correlated with E/E' (r = 0.933, p < 0.01), left atrial volume index (r = 0.713, p < 0.01), and E' (r = -0.685, p < 0.01). ROC analysis showed that the best gal-3 cut-off point for the diagnosis of LVDD was 20.12 ng/ml with a sensitivity of 67.6 % and specificity of 84.6 % (AUC = 0.803). We suggest that gal-3 may be a promising biomarker for the detection of LVDD in HD patients.Öğe Is Radiological Hand Osteoarthritis Associated with Atherosclerosis?: A Cross-Sectional Study in Turkish Women(Elsevier Science Inc, 2013) Demircelik, Muhammed Bora; Aydin, Halil Ibrahim; Cemeroglu, Ozlem; Yasar, Zeynep Sila; Gurel, Ozgul Malcok; Bozduman, Fadime; Selcoki, Yusuf[Abstract Not Available]Öğe Recurrent Acute Coronary Syndromes With Normal Homocystein Level: A Mutation of MTHFR Gene(Gazi Univ, Fac Med, 2014) Gurel, Ozgul Malcok; Demircelik, Muhammed Bora; Gunes, Mahmut; Eryonucu, BeyhanA 29-year-old female patient, complaining of squeezing retrosternal chest pain, was admitted to our emergency department. Her angina pectoris had started fifteen days ago and accentuated during the last two days. In her medical history, it was determined that during the last four years she had been admitted to hospitals with the same complaint twice, troponins were found to be elevated, she was hospitalized and coronary angiography (CAG) was totally normal. The young woman with recurrent acute coronary syndrome had a mutation in the MTHFR gene. On the determination of normal coronary arteries, we have demonstrated the localization of myocardial infarction via magnetic resonance imaging. In our case we have found no other risk factors except MTHFR 1298 gene mutation for coronary artery disease. MTHFR 1298 gene mutation may cause this state of hypercoagulopathy.Öğe Red Cell Distribution Width and Coronary Artery Calcification Reply(Korean Soc Cardiology, 2016) Gurel, Ozgul Malcok; Demircelik, Muhammed Bora; Eryonucu, Beyhan[Abstract Not Available]Öğe Relationship of late arteriovenous fistula stenosis with soluble E-selectin and soluble EPCR in chronic hemodialysis patients with arteriovenous fistula(Springer, 2015) Bilgic, Mukadder Ayse; Yilmaz, Hakki; Bozkurt, Alper; Celik, Huseyin Tugrul; Bilgic, Ismail Celal; Gurel, Ozgul Malcok; Kirbas, IsmailVascular access dysfunction caused by stenosis is a major complication for hemodialysis (HD) patients. However, physiopathology of late arteriovenous fistula (AVF) stenosis is still under investigation. The aim of the present study was to evaluate the association between plasma soluble EPCR (sEPCR) with serum soluble E-selectin (sE-selectin) concentration and late AVF stenosis in HD patients. Plasma sEPCR and serum sE-selectin concentrations were measured in 94 HD patients. Using these data, we studied the association of sEPCR and sE-selectin with the presence and degree of AVF stenosis using ultrasonography and fistulogram. Fifty-one patients have AVF stenosis, and the others (n = 43) have patent AVF. The degree of AVF stenosis was correlated with serum sE-selectin levels (r = 0.351, p = 0.01), but not sEPCR (r = 0.075, p = 0.702). The median level of sE-selectin was statistically higher in the group of AVF stenosis than in the group of patent AVF [463.2 pg/ml (275.4-671.4) vs. 162.5 pg/ml (96.7-285.3), p = 0.001]. Increased sE-selectin levels [OR (OR) = 6.356, p = 0.015] and high levels of LDL (OR = 4.321, p = 0.044) were independent predictors of late AVF stenosis in the multivariate model. sE-selectin and the LDL were the most important predictors of late AVF stenosis. In addition, sE-selectin correlated with the degree of AVF stenosis. We suggested that atherosclerosis might be contributing factor for development of late AVF stenosis.Öğe The Investigation of a Disintegrin and Metalloproteinase with ThromboSpondin Motifs (ADAMTS) 1, 5 and 16 in Thoracic Aortic Aneurysms and Dissections(Clin Lab Publ, 2016) Gunes, Mahmut Fatih; Akpinar, Mehmet Besir; Comertoglu, Ismail; Akyol, Sumeyya; Demircelik, Bora; Gurel, Ozgul Malcok; Aynekin, BusraBackground: Disintegrin-like and Metalloproteinase with Thrombospondin Motifs (ADAMTS) proteins that are fundamentally located in the extracellular matrix (ECM) have critical roles on different cellular processes by altering the ECM architecture. It has been known that expression of some members of these proteinases increases in aneurismal and dissectional aortic tissue. The purpose of this study is to investigate ADAMTS1, 5, 16 and tissue inhibitors of metalloproteinases-1,-2 (TIMP-1,-2) levels in aortic tissue obtained from patients with thoracic aortic aneurysms and dissections and to achieve new insights about the function of ADAMTS family members. Methods: We investigated ADAMTS1, 5, and 16 expression in human thoracic aortic aneurysms (TAA) (n = 22), thoracic aortic dissections (TAD) (n = 12), and thoracic aortas from age-matched control organ donors (n = 6) (a total number of 34 cases and 6 controls). The expression levels of ADAMTS proteins were determined by Western blot technique using anti-ADAMTS1, ADAMTS5, ADAMTS16, TIMP-1 and TIMP-2 antibodies. Results: ADAMTS1, 5, and 16 protein expressions were significantly higher in thoracic aortic aneurysm and dissection tissues compared to control aortic tissues. Furthermore, TIMP-1 protein levels decreased in TAA and TAD tissues, TIMP-2 did not change. Conclusions: Under the light of our findings, increased expression of ADAMTS1, 5, and 16 proteins may promote deceleration in thoracic aortic aneurysm progression. This is the first study that demonstrates ADAMTS5 and ADAMTS16 proteolytic activity in aneurysm and dissection.Öğe Usefulness of Preprocedural Serum Uric Acid Level to Predict Restenosis of Bare Metal Stents(Excerpta Medica Inc-Elsevier Science Inc, 2014) Turak, Osman; Canpolat, Ugur; Ozcan, Firat; Mendi, Mehmet Ali; Oksuz, Fatih; Isleyen, Ahmet; Gurel, Ozgul MalcokSerum uric acid (SUA) level is known as a significant predictor for cardiovascular diseases, partly through increased inflammatory response and smooth muscle cell proliferation. Inflammation and smooth muscle cells play a crucial role in the pathogenesis of in-stent restenosis (ISR). However, the relation between SUA and ISR has not been studied. The aim of the present study was to investigate the predictive value of preprocedural SUA on the development of ISR in patients who undergo coronary bare-metal stent implantation. Clinical, biochemical, and angiographic data from 708 consecutive patients (mean age 60.3 +/- 9.3 years, 71% men) who had undergone bare-metal stent implantation and additional control coronary angiography for stable or unstable angina pectoris were analyzed. Patients were divided into tertiles on the basis of preprocedural SUA levels. Stent restenosis was observed in 54 patients (23%) in the lowest tertile, in 79 (34%) in the middle tertile, and in 109 (46%) in the highest tertile (p < 0.001). Using multiple logistic regression analysis, diabetes mellitus, smoking, high-density lipoprotein cholesterol, stent length, C-reactive protein level, and preprocedural SUA level emerged as independent predictors of ISR. On receiver-operating characteristics curve analysis, SUA level >5.5 mg/dl had 75% sensitivity and 71% specificity (area under the curve 0.784, p < 0.001) in predicting ISR. In conclusion, higher preprocedural SUA is a powerful and independent predictor of bare-metal stent restenosis in patients with stable and unstable angina pectoris. (C) 2014 Elsevier Inc. All rights reserved.
