Person: KEPEZ, ALPER
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KEPEZ
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ALPER
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Publication Metadata only Recent and future innovations in the treatment of heart failure [Kalp yetersizliǧi tedavisinde yeni açılımlar: Şimdi ve gelecek](AVES, 2013) KEPEZ, ALPER; Kepez A., Mutlu B.Heart failure is still an important public health problem despite important advances regarding its treatment. Several new treatment strategies are being investigated in order to contend with this disease. Strategies proved to be safe and effective in clinical trials are being adapted to clinical practice. In this review, we will first focus on most recent treatment strategies that are recommended to be used in clinical practice and then try to mention novel strategies which are still being explored in preclinical studies. © 2013 by AVES Yayincilik Ltd.Publication Open Access Successful Treatment of Myocardial Bridge with Alcohol Septal Ablation in Hypertrophic Obstructive Cardiomyopathy(2014-02-17) KEPEZ, ALPER; Sunbul, Murat; Kepez, Alper; Tigen, Kursat; Erdogan, Okan; Mutlu, BulentPublication Metadata only THE EFFECT OF GLOBAL LONGITUDINAL STRAIN ON IMPAIRED SIX-MINUTE WALK TEST PERFORMANCE IN PATIENTS WITH SARCOIDOSIS(MATTIOLI 1885, 2020) KEPEZ, ALPER; Ozen, Deniz Kaptan; Mutlu, Bulent; Kocakaya, Derya; Turan, Burak; Sekerci, Sena Sert; Ceyhan, Berrin; Kepez, Alper; Erdogan, OkanBackground: Sarcoidosis is a multisystem and granulomatous disease associated with impaired functional capacity as a result of pulmonary and cardiac involvement. Factors adversely effecting functional capacity in patients with sarcoidosis have not been systematically assessed including myocardial strain imaging on echocardiography which enable to diagnose subclinical cardiac dysfunction. We aimed to evaluate the effect of left and right ventricular global longitudinal strain (GLS) on submaximal exercise capacity in patients with sarcoidosis who do not have clinically manifest cardiac involvement. Methods: Extracardiac biopsy proven 56 patients with sarcoidosis and 26 controls were included consecutively. Submaximal exercise capacity of the subjects was assessed with six-minute walk test (6 MWT). Pulmonary function tests and standard transthoracic and two-dimensional speckle tracking echocardiography were performed to the all subjects. Linear regression analysis was performed to find independent predictors of 6 MWT. Results: Fifty-six patients (18% male) with a mean age of 52.5 +/- 10.7 years were included. Patients with sarcoidosis had low 6 MWT performance and higher New York Heart Association classes and NT-proBNP levels. There were no significant differences between controls and patients with sarcoidosis in parameters of pulmonary function test. Biventricular GLS levels and biatrial reservoir and conduit function values were lower and systolic pulmonary artery pressure (SPAP) was significantly higher in patients with sarcoidosis as compared with controls. Older age and higher SPAP were found as independent predictors of poor 6 MWT performance. Conclusion: Although biventricular GLS levels were lower in the patients with sarcoidosis, only age and SPAP elevations were independent predictors of the submaximal exercise capacity.Publication Metadata only Prevalence of Coronary Artery to Pulmonary Artery Collaterals in Patients with Chronic Thromboembolic Pulmonary Hypertension: Retrospective Analysis from a Single Center(GEORG THIEME VERLAG KG, 2018) KEPEZ, ALPER; Kepez, Alper; Mutlu, Bulent; Paudel, Ashok; Ileri, Cigdem; Atas, Halil; Yildizeli, BedrettinBackground Our aim was to determine the prevalence of coronary artery-pulmonary artery collaterals in patients with chronic thromboembolic pulmonary hypertension (CTEPH) by retrospectively evaluating coronary angiograms of eligible consecutive patients who had undergone pulmonary endarterectomy (PEA). We also aimed to evaluate predictors and potential clinical associates of these collaterals. Methods Coronary angiograms of 83 consecutive CTEPH patients who had undergone coronary angiography before PEA operation between January 1, 2012 and June 1, 2015 were retrospectively evaluated for presence of coronary artery-pulmonary artery collaterals. Medical records of all patients were also retrospectively reviewed for demographic information, cardiovascular risk factors, preoperative right heart catheterization reports, operation reports, and follow-up data. Data of CTEPH patients with coronary artery-pulmonary artery collaterals were compared with data of CTEPH patients without such collaterals. Results There were 15 patients (18.1%) with definite and 4 patients (4.8%) with probable coronary artery-pulmonary artery collaterals among the study population. CTEPH patients with collaterals had higher preoperative pulmonary artery pressures, higher pulmonary vascular resistance (PVR) and lower cardiac index values compared with CTEPH patients without collaterals. However, CTEPH patients with collaterals displayed higher amount of reduction in PVR after PEA compared with patients without collaterals. There were no significant differences between groups regarding incidence of reperfusion injury or mortality. Conclusion Prevalence of coronary artery-pulmonary artery collaterals seems to be increased in our CTEPH patients compared with the general population. The presence of coronary artery-pulmonary artery collaterals is often combined with proximal disease with the possibility of increased reduction of PVR after PEA operation.Publication Metadata only Evaluation of left ventricular functions in patients with primary hyperparathyroidism: is there any effect of parathyroidectomy?(SPRINGER WIEN, 2017) KEPEZ, ALPER; Kepez, Alper; Yasar, Mehmet; Sunbul, Murat; Ileri, Cigdem; Deyneli, Oguzhan; Mutlu, Bulent; Yesildag, Osman; Basaran, YeldaOur aim was to evaluate left ventricular (LV) systolic and diastolic functions of primary hyperparathyroidism (pHPT) patients with detailed echocardiographic analysis and investigate the effect of parathyroidectomy on echocardiographic parameters. A total of 22 eligible consecutive patients with pHPT who underwent parathyroidectomy operation were recruited to the study. Another 22 subjects with similar age, gender and frequency of cardiovascular risk factors compared to patients were used as a control group. Echocardiographic parameters of patients scheduled for parathyroidectomy were compared to healthy matched controls. Echocardiographic parameters measured 6 months after the operation were also compared with preoperative values for each patient. Patients had higher LV mass index compared with controls. There were no significant differences between groups regarding 2D echocardiographic parameters reflecting LV systolic function and tissue Doppler velocities; however, 2D echocardiographic parameters demonstrated impairment in LV diastolic functions compared with controls. Speckle tracking echocardiography (STE) demonstrated similar LV global longitudinal systolic strain; however, left atrial conduit and reservoir functions were significantly reduced in patients with pHPT. In general, there were no significant differences between baseline and postoperative state regarding parameters reflecting LV systolic and diastolic functions; however, STE demonstrated significantly increased LV global longitudinal strain after surgery (22.3 +/- 3.3% vs 20.3 +/- 2.9%, p = 0.026). Patients with pHPT displayed higher LV mass and impairment in LV diastolic function compared with controls. Parathyroidectomy did not lead to significant improvements in LV mass or LV diastolic function; however, subtle but not apparent increases in LV systolic function were observed 6 months after surgery.Publication Metadata only The anatomical relationship between the axillary artery and vein investigated by radial coronary angiography(WILEY, 2018) KEPEZ, ALPER; Sert, Sena; Kepez, Alper; Atas, Halil; Mutlu, Bulent; Erdogan, OkanAimsTo reduce the risk of inadvertent arterial puncture and bleeding, we aimed to define a safe puncture site by demonstrating the relation of the axillary artery and vein. MethodsThe anatomical course and relation as well as crossover sites of the axillary artery and vein, the presence of small arterial bridges over the axillary vein, and validation of commonly preferred axillary venous puncture sites were determined by simultaneous ipsilateral venography in patients (n=111; 80 men, age 60 10 years) who underwent coronary angiography by radial artery access. ResultsThe axillary vein was detected at the first costa-clavicular intersection in 62% and at the second anterior and third posterior costal intersection in 60% of the patients. Small arterial bridges over the axillary vein were observed in 77% of the patients and more frequently in females and body mass index 25kg/m(2) (P=0.034 and P=0.03, respectively). The axillary artery crossed the vein in 24% of the patients and almost always within the region close to the first costa-clavicular intersection site. ConclusionOur study demonstrated a high crossover rate (24%) of axillary artery and vein and a high degree of variation in the course of axillary vein. Small arterial bridges over the axillary vein were observed in 77% of the patients.Publication Open Access Effects of balloon pulmonary angioplasty procedure on electrocardiographic parameters in patients with chronic thromboembolic pulmonary hypertension(2023-03-01) KOL, AYHAN; KEPEZ, ALPER; ATAŞ, HALİL; MUTLU, BÜLENT; KOL A., KEPEZ A., Akaslan D., Kanar B., ATAŞ H., MUTLU B.Aim: The aim of the present study was to evaluate the value of electrocardiography (ECG) in predicting post-operative hemodynamic improvement in patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing balloon pulmonary angioplasty (BPA).Material and methods: A total of 32 patients were included in the study. During ECG analysis, parameters that have been suggested to be related to right ventricular hypertrophy and/or dilatation were evaluated. The sig-nificance of the change in each parameter obtained at the pre-BPA visit and at the scheduled control visit 6 months after BPA was tested. In addition to ECG analysis, data related to right heart catheterization (RHC) and echocardiography, B-type natriuretic peptide (BNP) levels and World Health Organization (WHO) functional classifications of all patients were also recorded. The relationship between the amount of possible change in ECG parameters and the amount of possible change in hemodynamic parameters was investigated.Results: The Daniel score, which has been suggested to have prognostic value in acute pulmonary embolism, decreased from 8.22 +/- 5.68 to 6.56 +/- 5.55 after the BPA procedure (p: 0.035). Among all parameters studied, only T wave height (V2 t) in V2 derivation changed significantly from-0.77 +/- 2.39 to 1.27 +/- 2.58 mm (p: 0.036). The amount of change in V2 T was found to significantly correlate with the amount of change in systolic right ventricular pressure, mean pulmonary artery pressure, pulmonary vascular resistance, and systemic vascular resistance.Conclusion: Postprocedural T wave changes in lead V2 might serve as a marker of hemodynamic improvement in patients with CTEPH who undergo BPA.Publication Open Access Prevalence of Myocardial Bridge and Possible Associated_x000D_ Variables with Coexisting Coronary Atherosclerosis and_x000D_ Acute Coronary Syndrome(2018) KEPEZ, ALPER; Alper KEPEZ;Ashok PAUDEL;Osman YEŞİLDAĞ;Bülent MUTLUIntroduction: The present study aims to evaluate the prevalence of myocardial bridging (MB) and investigate patient andbridge-related factors that may be associated with an increased tendency for atherosclerosis and acute coronary syndrome.Methods: Consecutive coronary angiography recordings that were recorded between 01/01/2013 and 01/01/2016 wereretrospectively evaluated in this study. Data of consecutive patients with MB were obtained from patient files. Patients withMB were grouped according to the presence of significant atherosclerosis in any coronary artery and the presence of significant atherosclerosis proximal to bridge. Patients with isolated MB were also sub-grouped according to their presentationwith the acute coronary syndrome. Demographic, clinical and angiographic parameters were compared between groups.Results: There were a total of 75 patients with MB, with an overall prevalence rate of 1.07%. MB patients without coexistingsignificant atherosclerotic lesion had longer bridge length and more severe stenosis rate (21.4±9.9 mm vs. 17.2±7.6 mm,p=0.045; 73.0±12.5% vs. 65.6±13.0%, p=0.015, respectively). Diabetes mellitus was the only risk factor that was more prevalent in MB patients with significant coexisting atherosclerotic lesions. MB segment of patients with proximal significantatherosclerosis was significantly shorter compared with the length of patients without significant proximal atherosclerosis(16.0±7.4 mm vs 20.7±9.5 mm, p=0.05). The presentation as an acute coronary syndrome was more prevalent in patientswith significant atherosclerosis compared to patients with isolated MB (68.8% vs. 46.5%, p=0.045). There was no significantdiscriminative variable for presentation as acute coronary syndrome in patients with isolated MB.Discussion and Conclusion: The prevalence rate of MB in our study is in agreement with the previous angiographic studiesreported from Turkey. Coexisting atherosclerotic lesions seem to be primarily involved in the pathogenesis of acute coronarysyndrome and ischemic symptoms that had necessitated coronary angiographyPublication Metadata only Evaluation of Improvement in Exercise Capacity after Pulmonary Endarterectomy in Patients with Chronic Thromboembolic Pulmonary Hypertension: Correlation with Echocardiographic Parameters(GEORG THIEME VERLAG KG, 2014) KEPEZ, ALPER; Kepez, Alper; Sunbul, Murat; Kivrak, Tarik; Eroglu, Elif; Ozben, Beste; Yildizeli, Bedrettin; Mutlu, BulentBackgroundThe study evaluates the alterations in exercise capacity of chronic thromboembolic pulmonary hypertension (CTEPH) patients after pulmonary endarterectomy (PEA) and investigates the echocardiographic parameters associated with the degree of functional recovery. MethodsThirty consecutive patients with the diagnosis of CTEPH (17 males; mean age, 45.915.1 years) who had been referred for PEA operation were included in the study. Each patient underwent transthoracic echocardiography and 6-minute walk test (6-MWT) before and 6 months after PEA. ResultsAfter PEA, 6-MWT distances significantly increased (242.8 +/- 112.8 m vs. 423.6 +/- 89.1 m, p<0.001), whereas systolic pulmonary artery pressures and right ventricular dimensions significantly decreased (86 +/- 25.1mm Hg vs. 41.9 +/- 15.6mm Hg, p<0.001 and 42.1 +/- 10.1mm vs. 35.3 +/- 5.6mm, p<0.001, respectively). Magnitude of change in 6-MWT distance (-6-MWT) was found to be correlated with concomitant change in tricuspid annular plane systolic excursion and left ventricular myocardial performance index (r: 0.518, p: 0.004 and r: -0.385, p: 0.043, respectively). Linear regression analysis revealed preoperative 6-MWT distance as an independent negative predictor of delta-6-MWT (beta: -0.89, t: -3.97, p: 0.001). ConclusionCTEPH patients with more severely depressed exercise capacity at baseline displayed relatively greater degree of functional recovery after PEA in our study. Improvement in functional capacity was found to be correlated with improvement in parameters reflecting right ventricular functions rather than improvement in pulmonary artery pressure after PEA operation.