Papers by Meral Kayikcioglu
Global Heart, 2016
Introduction: Autonomic nervous dysfunctions are closely related to the occurrence, development a... more Introduction: Autonomic nervous dysfunctions are closely related to the occurrence, development and prognosis of acute myocardial infarction (AMI). Heart rate recovery after exercise (HRR)is a common clinical evaluated index of autonomic nervous function, which reflects autonomic balance under treadmill exercise. Our preliminary study showed that plasma levels of catestatin (CST) were increased gradually, and inversely associated with norepinephrine during the early phase of AMI, which indicated that CST might play an important role in regulation of autonomic nervous system after AMI. However there are few studies about the relationship between HRR and CST after AMI. Objectives: To investigate the relationship between HRR and CST in patients with acute ST segment elevation myocardial infarction (STEMI) treated with primary PCI. Methods: A total of 80 STEMI patients with blood sample were retrospectively investigated. All the patients were conducted cardiopulmonary exercise testing(CPET)within 30 days after STEMI, and heart rate recovery at 1 minute and 2 minute (HRR 1 ,HRR 2) were calculated. Levels of plasma CST in patients with blood samples before primary PCI were detected by ELISA, and the correlation between CST and HRR were investigated. Results: Mean plasma concentration of CST in those patients before PCI was 4.30AE0.61 ng/ml. The plasma levels of CST were positively associated with HRR 1 (r¼0.234,p¼0.037) and HRR 2 (r¼0.238, p¼0.033). Multiple linear regression analysis demonstrated CST was independently positively correlated to HRR 1 and HRR 2. Conclusion: Lower Catestain level is an independently predicting factor of autonomic nervous dysfunction in STEMI.
Anatolian journal of cardiology, 2018
The aim of this study was to investigate the relationships between F216L (rs28942112), R496W (rs3... more The aim of this study was to investigate the relationships between F216L (rs28942112), R496W (rs374603772), S127R (rs28942111), and D374Y (rs137852912) PCSK9 gain-of-function (GOF) mutations and primary dyslipidemia and serum lipid levels in patients with primary dyslipidemia. In this case-control study, DNA was isolated from blood samples collected from patients diagnosed with primary dyslipidemia in cardiology outpatient clinic of Ege University (n=200) and healthy individuals (n=201). F216L, R496W, S127R, and D374Y GOF mutations in the PCSK9 gene were evaluated and genotyped according to the results of melting curve analysis performed in a real-time polymerase chain reaction (PCR) 480 instrument using specific primers for each mutation. There were statistically significant differences between the patient and individuals in control groups in the R496W and D374Y mutations (x2=10.742 p=0.005; x2=6.078 p=0.048, respectively). In addition, triglyceride levels in patients with primary ...
Vnitřní lékařství, 2017
Introduction: Despite great recent progress, familial hypercholesterolemia (FH) is still underest... more Introduction: Despite great recent progress, familial hypercholesterolemia (FH) is still underestimated, under-diagnosed and thus undertreated worldwide. We have very little information on exact prevalence of patients with FH in the Central, Eastern and Southern Europe (CESE) region. The aim of the study was to describe the epidemiological situation in the CESE region from data available. Methods: All local leaders of the ScreenPro FH project were asked to provide local data on (a) expert guess of FH prevalence (b) the medical facilities focused on FH already in place (c) prof. Andrey V.
Balkan Medical Journal, 2021
The risk of a cardiovascular event increases with age. Myocardial infarction (MI) is rarely expec... more The risk of a cardiovascular event increases with age. Myocardial infarction (MI) is rarely expected at younger ages and is accepted as a disease of older ages. However, premature MI is on the rise and is a leading cause of premature death worldwide. A possible reason of this rise may be the increased prevalence of traditional atherosclerotic cardiovascular disease (ASCVD) risk factors, such as hypertension, dyslipidemia, diabetes mellitus (DM), and smoking, among younger age groups. 1,2 Additional risk factors, such as drug abuse and acquired or inherited causes of hemostatic dysfunction, should not be overlooked. Currently, the coronavirus disease-2019 (COVID-19) pandemic has accelerated the increased numbers of young individuals suffering from MI. 3
The Anatolian Journal of Cardiology, 2021
Objective: In this study, we aimed to analyze the TURKMI registry to identify the factors associa... more Objective: In this study, we aimed to analyze the TURKMI registry to identify the factors associated with delays from symptom onset to treatment that would be the focus of improvement efforts in patients with acute myocardial infarction (AMI) in Turkey. Methods: The TURKMI study is a nationwide registry that was conducted in 50 centers capable of 24/7 primary percutaneous coronary intervention (PCI). All consecutive patients (n=1930) with AMI admitted to coronary care units within 48 hours of symptom onset were prospectively enrolled during a predefined 2-week period between November 1, 2018, and November 16, 2018. All the patients were examined in detail with regard to the time elapsed at each step from symptom onset to initiation of treatment, including door-to-balloon time (D2B) and total ischemic time (TIT). Results: After excluding patients who suffered an AMI within the hospital (2.6%), the analysis was conducted for 1879 patients. Most of the patients (49.5%) arrived by self-transport, 11.8% by emergency medical service (EMS) ambulance, and 38.6% were transferred from another EMS without PCI capability. The median time delay from symptom-onset to EMS call was 52.5 (15-180) min and from EMS call to EMS arrival 15 (10-20) min. In ST-segment elevation myocardial infarction (STEMI), the median D2B time was 36.5 (25-63) min, and median TIT was 195 (115-330) min. TIT was significantly prolonged from 151 (90-285) min to 250 (165-372) min in patients transferred from non-PCI centers. The major significant factors associated with time delay were patient-related delay and the mode of hospital arrival, both in STEMI and non-STEMI. Conclusion: The baseline evaluation of the TURKMI study revealed that an important proportion of patients presenting with AMI within 48 hours of symptom onset reach the PCI treatment center later than the time proposed in the guidelines, and the use of EMS for admission to hospital is extremely low in Turkey. Patient-related factors and the mode of hospital admission were the major factors associated with the time delay to treatment.
Purpose: One of the common retinal vascular disorder is branch retinal vein occlusion (BRVO) that... more Purpose: One of the common retinal vascular disorder is branch retinal vein occlusion (BRVO) that causes visual impairment. The purpose of this study is to evaluate vascular smooth muscle cell and endothelial functions in BRVO patients. Methods: Thirty 30 BRVO patients and 30 healthy subjects were included in this study. Nitrate-mediated dilatation (NMD) which represent smooth muscle relaxation and flow-mediated dilation (FMD) which represent the endothelium-dependent relaxation of the brachial artery were measured by ultrasonography. Biochemical and laboratory tests including total cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol, apolipoprotein (Apo)-A1, Apo-B and mean systolic blood pressure (SBP), diastolic blood pressure (DBP) were also considered. Results: The median NMD value was 15.55 (12.3/25) % in the control group and 12.5 (8.3/18.7) in the BRVO group (p < 0.001). The mean FMD value was 9.71 ± 2.19% in the control group and 5.13 ± 2.72 % in the BRVO group (p...
Archives of the Turkish Society of Cardiology, 2014
Sleep Medicine, 2021
BACKGROUND/OBJECTIVE Obstructive sleep apnea (OSA) is independently associated with dyslipidemia,... more BACKGROUND/OBJECTIVE Obstructive sleep apnea (OSA) is independently associated with dyslipidemia, a surrogate marker of atherosclerosis. Low-density lipoprotein (LDL)-cholesterol is accepted as a major independent risk factor for cardiovascular disease. However, non-high-density lipoprotein (HDL)-cholesterol is a better marker of atherogenic dyslipidemia and recommended as a target of lipid lowering therapy. We aimed to assess the prevalence of atherogenic dyslipidemia, and relationship between OSA severity and serum LDL-cholesterol and non-HDL cholesterol levels in OSA patients. METHODS We retrospectively evaluated treatment naïve 2361 subjects admitted to the sleep laboratory of a university hospital for polysomnography. All subjects' lipid profile including total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, and non-HDL-cholesterol were measured. RESULTS Out of 2361 patients (mean age 49.6 ± 11.9 years; 68.9% male, apnea-hypopnea index 36.6 ± 28.4/h), 185 (7.8%) had no OSA and 2176 (92.2%) had OSA. Atherogenic dyslipidemia prevalence was high (57-66%) in OSA patients, and especially increased in severe OSA compared to other groups (p < 0.05). Though total and LDL-cholesterol did not differ between those with and without OSA, non-HDL-cholesterol (p = 0.020), and triglycerides (p = 0.001) were higher and HDL-cholesterol levels (p = 0.018) were lower in OSA patients than non-OSA. Non-HDL-cholesterol was significantly correlated with OSA severity (p < 0.001) and hypoxia parameters (p < 0.01), whereas LDL-cholesterol showed no correlation. CONCLUSIONS Atherogenic dyslipidemia is highly prevalent and non-HDL-cholesterol levels are significantly increased, predominantly in severe OSA patients. Non-HDL-cholesterol but not LDL-cholesterol, is significantly correlated with OSA severity and hypoxia parameters. Therefore, it could be better to use non-HDL-cholesterol, which is a guideline recommended target of lipid therapy, as a marker of atherosclerotic cardiovascular risk in OSA patients.
Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology, 2021
The Lancet, 2021
Background The European Atherosclerosis Society Familial Hypercholesterolaemia Studies Collaborat... more Background The European Atherosclerosis Society Familial Hypercholesterolaemia Studies Collaboration (FHSC) global registry provides a platform for the global surveillance of familial hypercholesterolaemia through harmonisation and pooling of multinational data. In this study, we aimed to characterise the adult population with heterozygous familial hypercholesterolaemia and described how it is detected and managed globally. Methods Using FHSC global registry data, we did a cross-sectional assessment of adults (aged 18 years or older) with a clinical or genetic diagnosis of probable or definite heterozygous familial hypercholesterolaemia at the time they were entered into the registries. Data were assessed overall and by WHO regions, sex, and index versus non-index cases. Findings Of the 61 612 individuals in the registry, 42 167 adults (21 999 [53•6%] women) from 56 countries were included in the study. Of these, 31 798 (75•4%) were diagnosed with the Dutch Lipid Clinic Network criteria, and 35 490 (84•2%) were from the WHO region of Europe. Median age of participants at entry in the registry was 46•2 years (IQR 34•3-58•0); median age at diagnosis of familial hypercholesterolaemia was 44•4 years (32•5-56•5), with 40•2% of participants younger than 40 years when diagnosed. Prevalence of cardiovascular risk factors increased progressively with age and varied by WHO region. Prevalence of coronary disease was 17•4% (2•1% for stroke and 5•2% for peripheral artery disease), increasing with concentrations of untreated LDL cholesterol, and was about two times lower in women than in men. Among patients receiving lipid-lowering medications, 16 803 (81•1%) were receiving statins and 3691 (21•2%) were on combination therapy, with greater use of more potent lipid-lowering medication in men than in women. Median LDL cholesterol was 5•43 mmol/L (IQR 4•32-6•72) among patients not taking lipid-lowering medications and 4•23 mmol/L (3•20-5•66) among those taking them. Among patients taking lipid-lowering medications, 2•7% had LDL cholesterol lower than 1•8 mmol/L; the use of combination therapy, particularly with three drugs and with proprotein convertase subtilisin-kexin type 9 inhibitors, was associated with a higher proportion and greater odds of having LDL cholesterol lower than 1•8 mmol/L. Compared with index cases, patients who were non-index cases were younger, with lower LDL cholesterol and lower prevalence of cardiovascular risk factors and cardiovascular diseases (all p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0•001). Interpretation Familial hypercholesterolaemia is diagnosed late. Guideline-recommended LDL cholesterol concentrations are infrequently achieved with single-drug therapy. Cardiovascular risk factors and presence of coronary disease were lower among non-index cases, who were diagnosed earlier. Earlier detection and greater use of combination therapies are required to reduce the global burden of familial hypercholesterolaemia.
Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology, 2020
Homozygous familial hypercholesterolemia (HoFH) is a rare, autosomal dominant disease that leads ... more Homozygous familial hypercholesterolemia (HoFH) is a rare, autosomal dominant disease that leads to premature cardiovascular disease (CVD). Since monozygotic twins share the intrauterine environment and have the same age and gene profile, they could represent a very special resource for the investigation of the causes and the natural course of FH. This report is a description of 36-year-old monozygotic twin brothers with almost identical early coronary artery involvement due to FH concomitant with high lipoprotein(a) (Lpa) levels and a review of the literature. Sequence analysis revealed that the twins were homozygous for the LDLR c.1060+10G>A (rs12710260) mutation and heterozygous for the LDLR c.542C>T (rs557344672) mutations. Both were also homozygous for the c.1060+7T>C (rs2738442) and c.1586+53A>G (rs1569372) mutations in the LDLR gene as well as c.4265A>T (rs568413) mutations in the APOB gene. In the literature, there are 7 twin cases with reported FH, but none with high Lpa levels. The HoFH twins in this case report had lower low-density lipoprotein (LDL) cholesterol levels than expected (before treatment 204 and 223 mg/dL), with almost identical coronary involvement. Both had an extremely high Lpa level (308 and 272 nmol/L) with a very low coronary calcium score (16 AU) and a good response to statins (>60%). There was a history of the first CVD event occurring at nearly the same age (32-34 years) in the family. This could be an important aspect of FH families as a result of the similar timing of cumulative LDL exposure exceeding the threshold of CVD events. In conclusion, this first report of monozygotic HoFH twins with elevated Lpa levels and almost identical early coronary artery involvement at the same age provides evidence to substantiate the hypothesis of lifetime cholesterol burden/exposure.
Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology, 2016
Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology, 2014
to an associated subvalvular obstruction or a high-flow state; such occurrences can be suspected ... more to an associated subvalvular obstruction or a high-flow state; such occurrences can be suspected when the DVI is normal (5). Conversely, in this case-the combination of a high valve pressure gradient and a low DVI suggested intrinsic prosthesis dysfunction or prosthesispatient mismatch (PPM); nonetheless, the persistent high transvalvular gradient and high pulmonary pressure before two percutaneous interventions were misinterpreted as PVL. Therefore the best initial treatment could be surgery rather than intervention. Distinction must be made between obstruction resulting from PPM and intrinsic prosthesis dysfunction by calculating the projected indexed EOA of the prosthesis implanted (5). Unfortunately, we could not calculate this index due to unavailable reference values for the old generated patient's prosthesis; consequently, we considered it as obstructive status. Surgery is regarded as the gold standard of dehiscence repair (6, 7). Recently-percutaneous transcatheter closures of PVLs using a wide array of devices have been reported (6, 8). Such techniques are less invasive and can be employed in most high-risk patients instead of performing repeat surgery (6, 7). The failures of percutaneous procedure in previous studies were mainly attributed either to deployment failure, to the presence of a persistent leak or both (5, 9). In our case, the pathological fibrous tissue between the sewing cuff and the annulus could conceivably have induced the weakening of the suture sites and produced the PVL. If the PVL is small and the surrounding tissue is clear, direct suture closure or device closure may be possible. If the leak is large or degenerative calcified tissue is presentspecifically in old generated prosthetic valves, the effective treatment is valve replacement. Conclusion Redo replacement of PMV is the accepted method of care in most complicated prosthesis with PVLs. The device closure of PVLs should be limited to high risk patients and be performed only in the absence of other complications like infective endocarditis, valvular degeneration, and calcification. Video 1. The transesophageal echocardiography demonstrated two side-by-side devices and confirmed significant stenosis
Nephrology Dialysis Transplantation, 2008
Background. Most haemodialysis (HD) centres use antihypertensive drugs for the management of hype... more Background. Most haemodialysis (HD) centres use antihypertensive drugs for the management of hypertension, whereas some centres apply dietary salt restriction strategy. In this retrospective cross-sectional study, we assessed the effectiveness and cardiac consequences of these two strategies. Methods. We enrolled all patients from two dialysis centres, who had been on a standard HD programme at the same centre for at least 1 year. All patients underwent echocardiographic evaluation. Clinical data were obtained from patients' charts. Centre A (n = 190) practiced 'salt restriction' strategy and Centre B (n = 204) practiced antihypertensive-based strategy. Salt restriction was defined as managing high blood pressure (BP) via lowering dry weight by strict salt restriction and insistent ultrafiltration without using anti-hypertensive drugs. Results. There was no difference regarding age, gender, diabetes, history of cardiovascular disease and efficiency of dialysis between centres. Antihypertensive drugs were used in 7% of the patients in Centre A and 42% in Centre B (P < 0.01); interdialytic weight gain was significantly lower in Centre A (2.29 ± 0.83 kgversus 3.31 ± 1.12 kg, P < 0.001). Mean systolic and diastolic blood pressures were similar in the two centres. However, Centre A had lower left ventricular (LV) mass (indexed for height 2.7 : 59 ± 16 versus 74 ± 27 g/m 2.7 , P < 0.0001). The frequency of LV hypertrophy was lower in Centre A (74% versus 88%, P < 0.001). Diastolic and systolic functions were better preserved in Centre A. Intradialytic hypotension (hypotensive episodes/100 patient sessions) was more frequent in Centre B (11 versus 27, P <0.01). Conclusions. This cross-sectional study suggests that salt restriction and reduced prescription of antihypertensive drugs may limit LV hypertrophy, better preserve LV functions and reduce intradialytic hypotension in HD patients.
Journal of the American Society of Echocardiography, 2010
The incidence of systemic thromboembolism is high in patients with hypertrophic cardiomyopathy (H... more The incidence of systemic thromboembolism is high in patients with hypertrophic cardiomyopathy (HCM). The authors hypothesized that vulnerability to such vascular events could be caused by depressed left atrial appendage (LAA) function during normal sinus rhythm (SR). The aim of this cross-sectional study was to investigate LAA contractile function during SR in patients with HCM. LAA function was assessed in 62 patients with HCM in SR and compared with that in 53 age-matched and sex-matched controls. Patients with histories of atrial fibrillation and documented episodes of paroxysmal atrial fibrillation on 24-hour Holter monitoring and depressed left ventricular ejection fractions (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;50%) were excluded. Multiplane transesophageal echocardiography was performed for determination of the morphology and function of the LAA. LAA thrombi were present in five patients (8%) with HCM. LAA emptying and filling Doppler velocities were significantly depressed in the HCM group. LAA emptying and filling velocities were negatively correlated with age in controls (r = -0.4, P = .005), but these velocities were not associated with age in the HCM group. Moreover, LAA velocities were not associated with left ventricular mass index, left ventricular outflow tract gradient, or the degree of diastolic dysfunction in the HCM group. All Doppler tissue imaging velocities obtained from LAA walls were also significantly depressed in the HCM group. LAA thrombus formation was not rare in this patient population. The significantly depressed LAA filling and emptying velocities in SR may predispose patients with HCM to thromboembolic events. The depressed Doppler tissue imaging LAA parameters in patients with HCM may indicate the presence of a possible intrinsic atrial myopathy. Thromboembolic risk should be taken into account, and the evaluation of LAA morphology and function by transesophageal echocardiography might become a component of routine workup in patients with HCM in the future.
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Papers by Meral Kayikcioglu