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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 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 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 Fibulins: a new biomarker for pulmonary thromboembolism?(Taylor & Francis Ltd, 2020) Acat, Murat; Dikis, Ozlem Sengoren; Dulger, Seyhan Us; Akbay, Ertan; Karakaya, Ekrem; Haskul, Ismail; Chousein, Efsun GoncaObjectives Fibulin-1, -2, -4, and -5 have important role in several vascular diseases. We aimed to investigate if fibulin-4 and -5 can be used as a biomarker for pulmonary thromboembolism (PTE). Methods This is a prospective case control study. Thirthy patients diagnosed with PTE and 31 in the control group. Data on demographic characteristics, length of hospital stay, blood cell counts, troponin and BNP levels, arterial blood gases, radiological reports, indication for thromboembolitic treatment, intensive care unit (ICU) requirement, and loss of life were recorded for the patients group. Serum Fibulin-4 and Fibulin-5 levels were measured. Results Fibulin 4 levels correlated positively with female gender (p < .01, r = 0.433). Positive results were found in 14 (46.7%) patients for PESI.0.1; in 7 (23.3%) patients for D-dimer; in 7 (23.3%) patients for troponin-I; in 7(23.3%) patients for BNP. Median values for Fibulin 4 level were significantly higher in patients positive for BNP. Fibulin-5 level was found to be correlated with the presence of embolism (p = .041, r = 0.263). Conclusions Fibulin-4 and -5 have been shown to be relevant to cardiovascular biology and diseases. Experimental studies and observations in humans show that they may play a role in several cardiovascular diseases particularly pulmonary embolism.Öğe Increased para-aortic adipose tissue on echocardiography may closely be related with fragmented QRS(Facultad de Salud de la Universidad del Valle, 2024-10-28) Çakan, Fahri; Akıncı, Sinan; Adar, Adem; Köktürk, Uğur; Akbay, Ertan; Önalan, OrhanBackground: The association of fragmented QRS (fQRS) with many cardiac pathologies such as cardiac fibrosis has been described previously. Paraaortic adipose tissue (PAT) is thought to be associated with many cardiac diseases and there is only one publication on its echocardiographic evaluation. Aims: To describe the possible relationship between fQRS and PAT. Methods: Patients presenting to the cardiology outpatient clinic were evaluated for inclusion in the study. Presence of additional R' wave or notching/splitting of S wave in two contiguous ECG leads was defined as fragmented QRS (fQRS) and patients were divided into two groups according to fQRS status on ECG. The hypoechoic space in front of the ascending aorta was considered as PAT in the parasternal long-axis view. The medical history and routine laboratory parameters of the participants were recorded. Univariate and multivariate binary regression analysis was used to determine the relationship between PAT and fQRS. Results: A total of 221 patients were enrolled and divided into two groups according to fQRS status. PAT was significantly higher in the fQRS group: 9.2 mm (7.1/12.3) vs 6.8 mm (1.2/10.9), p=0.001. Univariate analysis showed significant association between fragmented QRS and PAT size (OR 1.122, p= 0.001). Binary regression analysis revealed an independent and strong association between aortic size (OR 1.4, CI95% 1.012-1.938, p=0.042), paraaortic adipose tissue (OR 1.483, CI95% 1.084-2.029, p=0.014) and fragmented QRS. Conclusions: The presence of fQRS is associated with PAT, a newly defined parameter in echocardiography.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 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 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.
