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Öğe Aortic arch calcification is strongly associated with Coronary artery calcification(Verlag Hans Huber Hogrefe Ag, 2015) Adar, Adem; Erkan, Hakan; Gokdeniz, Tayyar; Karadeniz, Aysegul; Cavusoglu, Ismail Gokhan; Onalan, OrhanBackground: We aimed to investigate the association between aortic arch and coronary artery calcification (CAC). We postulated that low- and high-risk CAC scores could be predicted with the evaluation of standard chest radiography for aortic arch calcification (AAC). Patients and methods: Consecutive patients who were referred for a multidetector computerized tomography (MDCT) examination were enrolled prospectively. All patients were scanned using a commercially available 64-slice MDCT scanner for the evaluation of CAC score. A four-point grading scale (0, 1, 2 and 3) was used to evaluate AAC on the standard posterior-anterior chest radiography images. Results: The study group consisted of 248 patients. Median age of the study group was 52 (IQR: 10) years, and 165 (67%) were male. AAC grades (r = 0.676, p < 0.0001) and age (r = 0.518, p < 0.0001) were significantly and positively correlated with CAC score. Presence of AAC was independently associated with the presence of CAC (OR: 11.20, 95% CI 4.25 to 29.52). An AAC grade of 2 was the strongest independent predictor of a high-risk CAC score (OR: 27.42, 95% CI 6.09 to 123.52). Receiver operating characteristics curve analysis yielded a strong predictive ability of AAC grades for a CAC score of >= 100 (AUC = 0.892, P < 0.0001), and 400 (AUC = 0.894, P < 0.0001). Absence of AAC had a sensitivity, specificity and accuracy of 90 %, 84% and 89 %, respectively, for a CAC score of < 100. An AAC grade of 2 predicted a CAC score of 400 with a sensitivity, specificity and accuracy of 68%, 98% and 95%, respectively. Conclusions: AAC is a strong and independent predictor of CAC. The discriminative performance of AAC is high in detecting patients with low- and high-risk CAC scores.Öğe Aortic Arch Calcification Observed on Chest X-Ray May Serve as an Independent Predictor for Recurrent Stroke(Arquivos Brasileiros Cardiologia, 2024) Cakan, Fahri; Sunal, Asli Sert; Adar, Adem; Onalan, OrhanBackground: Despite advances in diagnostic and treatment modalities, there is a need for predictive markers for recurrent strokes. Objectives: This study aimed to investigate the relationship between aortic arch calcification (AAC) and stroke recurrence in stroke patients during a one-year follow-up. Methods: All stroke patients who experienced their first event were evaluated for participation in the study. Patients who experienced recurrent strokes during the one-year follow-up were recorded. AAC was assessed by chest radiography. Based on the occurrence of recurrent strokes the patients were divided into two groups. AAC was classified into four categories according to its degree, and the presence of AAC was included in the statistical analysis. The relationship between AAC and recurrent stroke was assessed using a receiver operating characteristic curve. A significance level of <0.05 was deemed acceptable for all statistical analyses. Results: A total of 203 patients were included in the study (46.8% female, mean age 69 +/- 12.3). Recurrent stroke was detected in 49 patients. AAC, hypertension, and atrial fibrillation were more frequent in patients with recurrent stroke. Patients with recurrent stroke had a lower glomerular filtration rate and a higher red cell distribution width (RDW). In multivariate regression analysis, AAC (hazard ratio [HR], 3.544; 95% CI:1.653-7.598, p=0.001) and RDW (HR,1.214; 95% CI:1.053-1.400, p=0.008) were identified as independent predictors of recurrent stroke. Conclusion: The presence of AAC (>= grade 1) and RDW were found to be significantly associated with the development of recurrent stroke within one year. These findings may have prognostic significance in the follow-up of stroke patients.Öğe Aortic Arch Calcification on Routine Chest Radiography is Strongly and Independently Associated with Non-Dipper Blood Pressure Pattern(Arquivos Brasileiros Cardiologia, 2020) Adar, Adem; Onalan, Orhan; Cakan, Fahri; Akbay, Ertan; Karakaya, EkremBackground: Non-dipper blood pressure (NDBP) is one of the important causes of hypertension-related target organ damage and future cardiovascular events. Currently, there is no practical tool to predict NDBP pattern. Objectives: The aim of this study was to investigate the relationship between aortic arch calcification (AAC) on chest radiography and NDBP pattern. Methods: All patients referred for ambulatory BP monitoring test were approached for the study participation. NDBP was defined as the reduction of <= 10% in nighttime systolic BP as compared to the daytime values. AAC was evaluated with chest radiography and inter-observer agreement was analyzed by using kappa statistics. Univariate and multivariate logistic regression analysis was conducted to assess the association of AAC and NDBP pattern. A 2-tailed p-value < 0.05 was considered statistically significant. Results: A total of 406 patients (median age: 51.3) were included. Of these, 261(64%) had NDBP pattern. Overall, the prevalence of AAC was 230 (57%). Non-dipper group had significantly higher prevalence of AAC (70% vs. 33%, p < 0.0001) as compared to the dipper group. Presence of AAC was a strong and independent predictor of NDBP pattern (OR 3.919, 95%CI 2.39 to 6.42) in multivariate analysis. Conclusions: Presence of AAC on plain chest radiography is strongly and independently associated with the presence of NDBP pattern.Öğe Aortic arch calcification: a novel parameter for prediction of masked hypertension(Lippincott Williams & Wilkins, 2021) Akbay, Ertan; Coner, Ali; Akinci, Sinan; Adar, Adem; Cakan, Fahri; Muderrisoglu, HaldunBackground Masked hypertension is directly related to increased cardiovascular morbidity and mortality but remains underdiagnosed in clinical practice. The aim of the study was to search the role of aortic arch calcification (AAC) in the diagnosis of masked hypertension. Methods and results Among the patients who underwent ambulatory blood pressure monitoring (ABPM) in our clinic, those with office blood pressure (OBP) <140/90 mmHg were included in the study population. According to OBP, they were divided into two groups as normal (<130/85 mmHg) and high normal (130-139/85-89 mmHg) OBP groups. Subjects were also investigated for the presence of masked hypertension with ABPM and searched in masked hypertension and control groups. Masked hypertension was defined as in the latest 2017 ACC/AHA Hypertension guideline and was diagnosed as the daytime BP >= 135/85 mmHg and nighttime BP >= 120/70 mmHg. AAC was evaluated on direct X-ray telecardiography. Diagnosis of masked hypertension was searched depending on the presence of AAC and OBP measurements as well. A total of 216 volunteers were involved in the study [mean age 45.2 +/- 12.2 years; female gender 120 (55.5%)]. One hundred ten volunteers (50.9%) had masked hypertension according to the ABPM. AAC was significantly more common in the masked hypertension group (44.5% vs. 26.4%) (P = 0.005). AAC had a positive predictive value of 79% in those with high normal OBP in the diagnosis of masked hypertension, and also AAC had a negative predictive value of 74% in those with normal OBP. Conclusion AAC can be used as a reliable diagnostic tool to exclude and predict masked hypertension during office examination.Öğe Association of Fragmented QRS with Subclinical Left Ventricular Dysfunction in Patients with Obstructive Sleep Apnea(Karger, 2015) Adar, Adem; Kiris, Abdulkadir; Bulbul, Yilmaz; Bektas, Huseyin; Acat, Murat; Casim, Hasan; Onalan, OrhanObjective: We aimed to investigate whether fragmented QRS (fQRS) is associated with subclinical left ventricular (LV) dysfunction in patients with obstructive sleep apnea (OSA). Subjects and Methods: A total of 141 patients with OSA who had normal LV ejection fraction (LVEF) were included in the study. The fQRS was defined as the presence of an additional R wave, notching of R or S wave or the presence of fragmentation in 2 contiguous electrocardiography (ECG) leads. Subclinical LV dysfunction was defined as the presence of a tissue Doppler-derived Tei index of >= 0.5 in the absence of impaired LVEF (<50%) as assessed by transthoracic echocardiography. Results: Of the 141 patients, 71 (50.4%) had subclinical LV dysfunction. Overall, the prevalence of the fQRS was 61% (86/141). Patients with fQRS had significantly higher Tei indices than those without fQRS [median 0.66, interquartile range (IQR) 0.39 vs. median 0.40, IQR 0.15, p < 0.001]. The presence of fQRS on ECG predicted subclinical LV dys-function in univariate logistic regression analysis [odds ratio (OR) 6.69, 95% confidence interval (CI) 3.10-14.43]. The association remained significant after adjusting for all potential confounders (OR 4.59, 95% CI 1.94-10.87). Conclusion: fQRS on ECG was an independent predictor of subclinical LV dysfunction in patients with OSA. This simple tool might help to identify OSA patients who could be at risk for developing overt cardiac dysfunction. (C) 2015 S. Karger AG, BaselÖğe Clinical characteristics of atrial fibrillation in nonagenarian population and relationship with mortality(Edizioni Minerva Medica, 2024) Cakan, Fahri; Onalan, Orhan; Adar, Adem; Akbay, Ertan; Colluoglu, Inci T.; Kokturk, Ugur; Akin, YesimBACKGROUND: There is a considerable amount of literature available on well-known risk factors for atrial fibrillation (AF); however, available data specifically focused on the ninth decade are scarce. The main objective of this study was to assess the demographic and clinical characteristics of AF and sinus rhythm in a nonagenarian population. METHODS: All individuals aged >90 years who were admitted to the Cardiology outpatient clinic between April 2018 and January 2019 were enrolled in the study. The demographic and clinical characteristics of all patients were recorded. All deaths that occurred during the two-year follow-up period were recorded. RESULTS: In total, 112 nonagenarian individuals were included in the study. Of these patients, 50 (44.6%) had AF. The groups showed similarities in demographic and clinical characteristics. During a mean follow-up period of 596 +/- 44 days, 39 patients (78%) in the AF group and 35 patients (56.5%) in the sinus group died. Patients with AF showed a lower overall survival distribution than those with sinus rhythm (P=0.005, log-rank test chi 2=7.734). 2 =7.734). AF was associated with an increased risk of mortality (P=0.002, hazard ratio [HR] =2.104, 95% confidence interval [CI] = 1.326-3.339) in multivariate Cox regression analysis, while waist circumference and total cholesterol (P=0.003, HR=0.969, 95% CI=0.949-0.989 and P=0.046, HR=0.993, 95% CI=0.986-1.000, respectively) showed a decreased risk of mortality. CONCLUSIONS: Atrial fibrillation is very common in individuals over the age of 90 years (44.6%). Well-known risk factors do not appear to be effective in this age group, and AF is associated with a 2.1-fold increase in the risk of mortality.Öğe Could aortic arch calcification help in detection of hypertensive retinopathy?(Lippincott Williams & Wilkins, 2021) Adar, Adem; Onalan, Orhan; Sevik, Ozge; Turgut, Yeliz; Cakan, FahriObjective Hypertension-induced end-organ damage is one of the important determinants of morbidity and mortality in patients with hypertension. All types of hypertension-induced end-organ damages start with vascular damage. Vascular calcification is a marker of vascular damage and aortic arch calcification (AAC) is one of the easily identifiable types of vascular calcification. We hypothesized that AAC predicts retinopathy in hypertensive patients. Methods Consecutive hypertensive patients without diabetes mellitus were included. Chest radiography in the posterior-anterior was used to assess the presence of AAC. All patients underwent ophthalmologic examination for retinopathy. Results We included 495 hypertensive patients in this study. Of these, 306 (62%) had hypertensive retinopathy. Patients with hypertensive retinopathy had significantly higher prevalence of AAC as compared to the patients without hypertensive retinopathy (88% vs. 22%, P < 0.001). We found a strong and positive correlation between hypertensive retinopathy and AAC grades (r = 639, P < 0.001). Receiver operator characteristics curve analysis yielded a strong predictive ability of AAC for the presence of hypertensive retinopathy [area under curve = 0.814, 95% confidence interval (CI): 0.775-0.853, P < 0.0001]. In multivariate logistic regression analysis, presence of AAC [odds ratio (OR) 13.128; CI: 7.894-21.832] and serum glucose levels (OR 1.020; CI: 1.003-1.037) were strongly and independently associated with hypertensive retinopathy. Conclusion Presence of AAC on chest radiograph is strongly and independently associated with retinopathy in nondiabetic hypertensive patients. This simple, inexpensive and widely available tool may help in early detection of retinopathy in patients with hypertension.Öğe Evaluation of the relationship between para-aortic adipose tissue and ascending aortic diameter using a new method(Taylor & Francis Ltd, 2022) Adar, Adem; Onalan, Orhan; Cakan, Fahri; Keles, Hakan; Akbay, Ertan; Akinci, Sinan; Coner, AliBackground Para-aortic adipose tissue (PAT) is the local adipose tissue that externally surrounds the aorta. It contributes significantly to aortic atherosclerosis and enlargement. Studies conducted with computed tomography and magnetic resonance have shown that individuals with aortic aneurysm had more PAT than healthy individuals. In this study, we measured PAT using transthoracic echocardiography (TTE). The aim of this study is to investigate the possible relationship of TTE measured PAT with ascending aortic width. Methods PAT was defined as the hypoechoic space in front of ascending aortic 2 cm above the sinotubular junction at the end of the systole. Patients were divided into 2 groups according to the presence of dilatation in the ascending aorta using Roman's classification (aortic size index, ASI). ASI of less than 21 was considered no aortic dilation and an ASI of 21 mm/m2 or greater was considered to have aortic dilation. Results A total of 321 unselected patients were divided into the ascending aortic dilatation (AAD) group (n = 96) and the normal ascending aorta diameter group (n = 225 patients). PAT was significantly higher in the AAD group compared with the non-ADD group (0.9 (0.48) vs. 0.7 (0.91) mm, p < 0.0001). Univariate and multivariate logistic regression analysis revealed that PAT (OR: 3.005, 95%CI (1.445-6.251)) were significantly associated with AAD. Conclusions This is the first study which evaluated PAT measured by TTE. We found a significant association between PAT measured by TTE and ascending aorta width.Öğe Fragmented QRS is associated with subclinical left ventricular dysfunction in patients with chronic kidney disease(Taylor & Francis Ltd, 2014) Adar, Adem; Kiris, Abdulkadir; Ulusoy, Sukru; Ozkan, Gulsum; Bektas, Huseyin; Okutucu, Sercan; Onalan, OrhanObjective We aimed to investigate the association of fragmented QRS (fQRS) with subclinical left ventricular (LV) dysfunction in patients with chronic kidney disease (CKD). Methods and results Patients with CKD who had a normal LV ejection fraction (>= 50%) were enrolled. The tissue Doppler-derived Tei index was measured for all patients. A Tei index of >= 0.5 was considered abnormal. Subclinical LV dysfunction was defined as the presence of an abnormal Tei index in the absence of impaired LV ejection fraction (< 50%). The fQRS was defined as the presence of an additional R wave (R') or notching of R or S wave or the presence of fragmentation in two contiguous ECG leads. The study group consisted of 82 patients (45 male, mean age 54 14 years). Overall, prevalence of fQRS was 60% among CKD patients who had a preserved LV ejection fraction. Of these, 52 (63%) had an abnormal (>= 0.5) and 30 (37%) a normal Tei index (< 0.5). The prevalence of fQRS was significantly higher in patients with an abnormal Tei index than in patients with a normal Tei index (71% vs. 40%, P = 0.006). Patients with an abnormal Tei index had a lower E/A ratio as compared to patients with a normal Tei index (P = 0.03). Groups were similar with respect to all other variables. In multivariate logistic regression analysis, the presence of fQRS was independently associated (OR 3.52, 95% CI 1.28-9.64) with the presence of an abnormal Tei index after adjustment for potential confounders. Conclusion Fragmented QRS is independently associated with subclinical LV dysfunction in patients with CKD and normal ejection fraction.Öğe A Life-threatening Combination: Indomethacin and Dabigatran(Arquivos Brasileiros Cardiologia, 2020) Adar, Adem; Onalan, Orhan; Cakan, Fahri[No abstract available]Öğe A new and simple parameter for diagnosis pulmonary edema: Expiratory air humidity(Mosby-Elsevier, 2022) Adar, Adem; Can, Emine Yilmaz; Elma, Yusuf; Ferah, Meryem Akpolat; Kececi, Mete; Muderrisoglu, Haldun; Akbay, ErtanPurpose: Acute pulmonary edema is characterized by increased levels of fluid in the interstitial and alveolar space of the lung and requires emergency treatment. In acute pulmonary edema, the amount of fluid in the intra-alveolar, interstitial space, and pleural space vary considerably and this fluid will evaporate in different amounts compared to the physiological fluid. The aim of this study was to compare the humidity rates of expiratory air measured before and after pulmonary edema induced by alpha-naphthylthiourea (ANTU) in rats. Methods: The study included twenty healthy adult rats divided equally into a healthy control group and a pulmonary edema group. Pulmonary edema was induced by administering ANTU intraperitoneally in the rats in the study group. Humidity, temperature, lung weight, pleural effusion, and histopathological changes in the respiratory system due to pulmonary edema were examined in the ANTU group. Control measurments were taken before administration of ANTU and again 4 h after administration of ANTU when lung damage was considred to be at maximum levels. Results: Mean expiratory air humidity was 71.22 +/- 3.59% before ANTU and 56.28 +/- 3.94% after administration of ANTU. The mean humidity difference of -14.94 +/- 5.96% was considered statistically different (p = 0.01). Conclusion: Humidity rate in expiratory air was significantly lower in rats with acute pulmonary edema compared to healthy rats. This result supports the hypothesis that humidity in expiratory air can be considered an important parameter in patients during clinical are follow-up for pulmonary edema. (C) 2022 Elsevier Inc. All rights reserved.Öğe Newly developed left ventricular apical thrombus under dabigatran treatment(Lippincott Williams & Wilkins, 2018) Adar, Adem; Onalan, Orhan; Cakan, FahriLeft ventricular (LV) thrombi are mostly formed in the aneurysmal or akinetic segment of the LV apex. Thromboembolism to the brain is usually fatal. There is not enough information available regarding the use of these new oral anticoagulant agents in LV thrombi. In this case, we present a 56-year-old male patient who was given dabigatran (150mg, twice a day) for paroxysmal atrial fibrillation after experiencing anterior myocardial infarction. During the use of dabigatran, thrombus formation, which was not present earlier, was observed in the LV apical aneurysm. The dabigatran treatment discontinued and warfarin was initiated and, in the follow-ups, the thrombus was observed to shrink, and complete resolution was seen 6 weeks after treatment with warfarin. The patient did not experience any thromboembolic event. Our case is the first report showing that the treatment of dabigatran 150mg may not prevent LV thrombus development. Copyright (C) 2018 Wolters Kluwer Health, Inc. All rights reserved.Öğe Non-dipper kan basınç paterninin aortik ark genişliği ile ilişkisi(2017) Nıkhılraj, Cc; Adar, Adem; Önalan, Orhan; Çakan, Fahri; Karakaya, Ekrem; Akbay, ErtanAmaç: Non-dipper kan basınç paterni ile akciğer grafisinde ölçülebilen aortik ark genişliği arasındaki ilişkiyi araştırmak.Gereç ve Yöntem: Kardiyoloji polikliniğinde Haziran 2014 ile Aralık 2015 tarihleri arasında muayene olan ve 24 saatlik ambulatuar kan basınç monitörizasyonu yapılan 18 yaş üzeri hastalar ardışık olarak çalışmaya dahil edildi. Gece yeterli kan basınç düşüşünün (sistolik<%10) olmaması non-dipper kan basınç paterni olarak tanımlandı. Hastaların ön arka akciğer grafilerinde aortik ark genişliği ambulatuar kan basınç moniterizasyon sonucunu bilmeyen tecrübeli doktorlar tarafından dijital ortamda ölçüldü. Non-dipper kan basınç prediktörlerini saptamak için çok yönlü regresyon analizi uygulandı.Bulgular: Toplam 271 hasta çalışmaya dahil edildi (125 hasta non-dipper, 146 hasta dipper) Non-dipper grubu daha yaşlı, hipertansiyon ve diabetes mellitus dipper grubuna göre daha fazla, glomerüler filtrasyon hızı ise daha düşük bulundu. Aortik ark genişliği non-dipper grubunda anlamlı olarak daha geniş izlendi (38,5 ± 3,7 vs 35,1 ± 4; p <0,001). Çok yönlü regresyon analizinde, non-dipper KBP ile aortik ark genişliği (? : 1,216; p< 0,0010; CI: 1,109-1,334) ve sol ventrikül kitle indeksi (? : 0,968; p= 0,019; CI: 0,942-0,995) arasında bağımsız bir ilişki bulundu.Sonuç: Akciğer grafisi ile ölçülebilen aortik ark genişliği ile non-dipper kan basınç paterni arasında bağımsız ve güçlü bir ilişki vardır. Birinci basamak sağlık kuruluşlarında ön arka akciğer grafisindeki artmış aortik ark genişliği non-dipper kan basınç paterni varlığı açısından uyarıcı olabilir.Öğe Onychomycosis is associated with subclinical atherosclerosis in patients with diabetes(Verlag Hans Huber Hogrefe Ag, 2015) Onalan, Orhan; Adar, Adem; Keles, Hakan; Ertugrul, Goksen; Ozkan, Nurhayat; Aktas, Habibullah; Karakaya, EkremBackground: We aimed to investigate the association of toenail onychomycosis with subclinical atherosclerosis in patients with diabetes mellitus. Patients and methods: Consecutive diabetic patients who were seen at our outpatient clinic were enrolled. The carotid intima-media thickness (CIMT) was assessed and toenail onychomycosis was diagnosed with microscopic evaluation. Results: We investigated 127 patients with diabetes melltus type 2. Overall, the prevalence of toenail onychomycosis was 37.8% (48 of 127). Of the 127 patients, 60 (47.2%) had subclinical atherosclerosis (CIMT >= 1 mm). Prevalence of male gender (43.3% vs. 22.4%, p = 0.012) and onychomycosis (53.3% vs. 23.9%, p = 0.001) was significantly higher in patients with subclinical atherosclerosis. Among biochemical parameters, low-density lipoprotein (122 +/- 38 mg/dL vs. 108 +/- 36 mg/dL, p = 0.039) and glycosylated hemoglobin levels (median 8.4%, IQR: 2.1% vs. median 7.5%, IQR: 1.6%, p = 0.002) were significantly higher in patients with subclinical atherosclerosis. Study groups were similar with respect to all other demographic, clinical, and laboratory parameters. After adjustment for all potential confounders, the presence of onychomycosis was independently associated with subclinical atherosclerosis (OR 2.77, 95 % CI 1.16 to 6.30) in multivariate logistic regression analysis. Conclusions: Presence of onychomycosis in patients with diabetes is associated with subclinical atherosclerosis. Onychomycosis may be a marker of atherosclerotic arterial involvement.Öğe Pregbalin induced recurrent syncopal attacks with prolong QT interval(Wiley, 2018) Adar, Adem; Cakan, Fahri; Onalan, OrhanLong QT syndrome may lead to fatal dysrhythmia. Prolongation of QT interval due to pregabalin has been shown in rats and no data is available in humans. We report a 80-year-old female patient using pregabalin. She was presented to emergency room with syncope attacks. Her admission electrocardiography demonstrated prolonged QT interval. After excluding the possible causes of the long QT syndrome, we attributed prolonged QT interval to pregabalin therapy. After discontinuation of pregabalin QT interval returned to normal range and patient experienced no further syncope attacks. It is first time for documentation of prolonged QT due to pregabalin in humans.Öğe Radiotherapy Induces Development of Fragmented QRS in Patients with Breast Cancer(Karger, 2015) Adar, Adem; Canyilmaz, Emine; Kiris, Abdulkadir; Ilter, Abdulselam; Serdar, Lasif; Memis, Yahyahan; Bahat, ZumrutBackground: Myocardial fibrosis is a well-known side effect of radiotherapy. Fragmented QRS (fQRS) has been shown to be a marker of myocardial fibrosis. We postulated that radiotherapy induces development of fQRS in breast cancer patients. Patients and Methods: Breast cancer patients receiving locoregional radiotherapy were enrolled. Patients who had fQRS on electrocardiography (ECG) before radiotherapy were excluded. All patients were revaluated for the development of fQRS at 1-year follow-up. An age-matched healthy group served as controls. Results: A total of 52 breast cancer patients receiving locoregional radiotherapy were included (median age 49 years, interquartile range (IQR) 13). Of these, 19 (37%) had developed fQRS at 1-year follow-up. Compared with the control group, prevalence of fQRS was significantly higher in the irradiated group (37 vs. 12%; p < 0.002). Median total cardiac radiation dose was significantly higher in patients who had developed fQRS (5 Gy, IQR 5.2 vs. 1.7 Gy, IQR 4.4; p = 0.003). Cardiac radiation dose, entered either as a continuous variable (odds ratio (OR) 1.35, 95% confidence interval (CI) 104-1.74) or as a dichotomized variable (>= 2.2 Gy, OR 6.48, 95% CI 1.47-28.61), was independently associated with the development of fQRS at 1-year follow-up. Conclusion: Radiotherapy for breast cancer induces development of fQRS on ECG. Cardiac radiation dose is independently associated with the development of fQRS.Öğe Relationship between Aortic Arch Calcification, Detected by Chest X-Ray, and Renal Resistive Index in Patients with Hypertension(Karger, 2019) Adar, Adem; Onalan, Orhan; Keles, Hakan; Cakan, Fahri; Kokturk, UgurObjective: Aortic arch calcification (AAC) is a surrogate marker for arterial stiffness and hypertension-related vascular damage. Renal resistive index (RRI), a renal Doppler ultrasonography parameter, is used to assess renal hemodynamics. In this study, we aimed to evaluate the relationship between RRI and AAC in patients with hypertension. Methods: Patients with hypertension underwent a chest X-ray and renal Doppler ultrasonography. They were divided into two groups according to RRI (group 1: RRI >= 0.70; group 2: RRI <0.70). Two examiners, blinded to the findings of RRI, reviewed the AAC in these patients. The kappa value was detected to be 0.781 and a p value <0.001 was considered significant. Results: The study included 289 hypertensive patients (mean age 63.87 +/- 11.38 years). In 53.6% (n = 155) of the study subjects, RRI was observed to be >= 0.70. Patients with RRI = 70 were older and had more prevalent AAC as well as left ventricular hypertrophy. A multiple linear regression analysis was carried out to test whether presence of AAC significantly predicted RRI. The results of the regression analysis indicated that presence of AAC significantly predicted RRI (beta = 0.053; p < 0.001). Conclusions: A strong and independent relationship was found between AAC on chest X-ray and RRI in patients with hypertension. (C) 2018 The Author(s) Published by S. Karger AG, BaselÖğe Relationship between ST-Segment Shifts in Lead aVR and Coronary Complexity in Patients with Acute Coronary Syndrome(Taiwan Soc Cardiology, 2019) Adar, Adem; Onalan, Orhan; Cakan, FahriBackground: ST-segment shifts in lead aVR are associated with increased coronary atherosclerosis. However, there is insufficient data about the relationship between ST-segment shifts in lead aVR and coronary complexity. The aim of this study was to investigate this relationship. Methods: This prospective, observational study included 236 patients with acute coronary syndrome who underwent coronary angiography. Electrocardiograms on presentation were reviewed in terms of ST-segment shifts in lead aVR. Inter-observer agreement was analyzed using kappa statistics for the presence of aVR lead ST segment shifts. The patients were divided into two groups according to their Sx scores (<= 22 and > 22). Results: The mean age of the study population was 62.19 +/- 12 years. Eighty-seven patients (37%) had complex coronary artery disease as defined by intermediate-high Sx scores, and 130 patients (55%) had ST-segment shifts in lead aVR. In multivariate logistic regression analysis, ST-segment elevation or depression >= 1 mm were independently associated with intermediate-high Sx scores. Conclusions: In patients with acute coronary syndrome, the presence of ST-segment elevation or depression >= 1 mm in lead aVR may indicate coronary complexity.Öğe A strong and reliable indicator for early postoperative major cardiac events after elective orthopedic surgery: Aortic arch calcification(Mosby-Elsevier, 2019) Adar, Adem; Onalan, Orhan; Cakan, Fahri; Akbay, Ertan; Colluoglu, Tugce; Dasar, Uygar; Mutlu, TanselBackground: Cardiovascular events after orthopedic surgery may result in mortality. Therefore, predictors of early cardiovascular events after elective orthopedic surgery are required. Aim: The aim of this study is to investigate the relationship between aortic arch calcification and 30-day major adverse cardiac events following elective orthopedic surgery. Methods: Patients who had undergone orthopedic surgery were screened. Preoperative detailed anamnesis was taken. Echocardiography and standard chest x-ray were performed. Patients were followed in terms of perioperative 30-days major cardiac events and were classified into two groups according to development of perioperative major adverse cardiac events. Aortic arch calcification was evaluated by two cardiologists, blinded to study findings and was graded as 0 to 3 on chest x-ray. Results: A total of 1060 patients were approached for the study participation. Of these 714 were included in the study (mean age: 70.43, 65% female). Cardiovascular events occurred in 33 patients. As compared to the patients without cardiac events, the prevalence of aortic arch calcification, coronary artery disease, hypertension, and smoking were higher in patients with cardiac events. In addition, Lee index, left ventricular end systolic, end-diastolic and left atrial diameter were significantly higher, GFR values were significantly lower in the group with cardiac events. Multivariate regression analysis showed that smoking (OR 5.031, 95% CI 1.602 to 15.794), presence of hypertension (OR 5.133, 95% CI 1.297 to 20.308) and aortic arch calcification (OR 6.920, 95% CI 3.890 to 12.310) are independent predictors of major cardiac events within 30-day of elective orthopedic surgery. Conclusions: Presence of aortic arch calcification is associated with development of major cardiac events within 30-days after elective orthopedic surgery. (C) 2018 Elsevier Inc. All rights reserved.Öğe Subclinical Left Ventricular Dysfunction in Patients with Obstructive Sleep Apnea Reply(Karger, 2016) Onalan, Orhan; Adar, Adem; Kiris, Abdulkadir; Bulbul, Yilmaz; Bektas, Huseyin; Acat, Murat; Casim, Hasan[No abstract available]
