Person: SÜNBÜL, MURAT
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SÜNBÜL
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Publication Metadata only Right ventricular metastasis of lung cancer Persistent ST-segment elevation and constrictive physiology(URBAN & VOGEL, 2014) ÇİNÇİN, AHMET ALTUĞ; Cincin, A.; Samedov, F.; Sari, I.; Sunbul, M.; Tigen, K.; Mutlu, B.Publication Metadata only Right ventricular longitudinal deformation parameters and exercise capacity Prognosis of patients with chronic thromboembolic pulmonary hypertension(URBAN & VOGEL, 2014) KEPEZ, ALPER; Sunbul, M.; Kepez, A.; Kivrak, T.; Eroglu, E.; Ozben, B.; Yildizeli, B.; Mutlu, B.Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive disease characterized by increased pulmonary vascular resistance resulting in pulmonary hypertension and right heart failure. The six-minute walk test (6MWT) distance is associated with the prognosis of CTEPH patients. Speckle tracking echocardiography (STE) is a reliable method for determining ventricular function. The aim of this study was to assess and compare the right ventricular (RV) function of CTEPH patients according to their 6MWT distances. Forty-nine consecutive CTEPH patients (mean age, 50 +/- 16 years; 22 male) who were referred to our center for pulmonary thromboendarterectomy (PTE) were included in the study. All patients underwent the 6MWT and right heart catheterization (RHC). Standard echocardiography and STE were performed on all patients before PTE. Patients were divided into two groups based on their 6MWT distance being less or more than 300 m. Patients with a shorter 6MWT distance had a significantly larger RV, while they had a significantly lower RV fractional area change and higher myocardial performance index suggesting impaired RV function. Both RV basal-lateral strain and strain rate measures were significantly lower in patients with shorter 6MWT distances than those with longer 6MWT distances. Similarly, they had lower RV basal-septal, mid-lateral, and global strain measures. 6MWT distances were correlated with RV basal-lateral and mid-lateral strain measures (r = 0.349, p = 0.025 and r = 0.415, p = 0.008, respectively). Our data suggest that RV myocardial deformation parameters are associated with 6MWT distances. Determination of RV dysfunction by STE may be helpful in identifying patients with a poor prognosis.Publication Open Access Asymptomatic ST segment elevation in the recovery phase of the exercise stress test due to slow coronary flow(TERMEDIA PUBLISHING HOUSE LTD, 2014) SARI, İBRAHİM; Sunbul, Murat; Erdogan, Okan; Sari, IbrahimExercise-induced ST segment elevation without Q wave formation is rarely observed. Frequent causes are significant coronary stenosis, myocardial bridge and coronary vasospasm. Both exercise-induced ST segment elevation due to stow coronary flow and ST segment elevation in the recovery phase of the exercise stress test are very rare. We present a 49-year-old man with asymptomatic inferolateral ST segment elevation in the recovery phase of the exercise stress test due to slow coronary flow, which has not been reported previously. The learning points of the present paper are as follows: a) although significant coronary stenosis, myocardial bridge and coronary vasospasm are frequent causes of exercise-induced ST segment elevation, slow coronary flow might also cause it; b) one should keep in mind that ST segment elevation might also occur in the recovery phase; and c) ST segment elevation might be asymptomatic, as in the present case.Publication Open Access Subclinical Atherosclerosis in Systemic Sclerosis: Not Less Frequent Than Rheumatoid Arthritis and Not Detected With Cardiovascular Risk Indices(WILEY, 2016-10) SÜNBÜL, MURAT; Ozen, Gulsen; Inanc, Nevsun; Unal, Ali U.; Korkmaz, Fatmanur; Sunbul, Murat; Ozmen, Mustafa; Akar, Servet; Deniz, Rabia; Donmez, Salim; Pamuk, Omer N.; Atagunduz, Pamir; Tigen, Kursat; Direskeneli, HanerObjective. To determine the frequency of subclinical atherosclerosis in patients with systemic sclerosis (SSc; scleroderma) compared to healthy subjects (HS) and rheumatoid arthritis (RA) patients and to determine the ability of cardiovascular (CV) risk indices in detecting SSc patients with subclinical atherosclerosis. Methods. A total of 110 SSc patients (102 females and 8 males, mean +/- SD age 50.5 +/- 11.9 years), 110 age-and sex-matched RA patients, and 51 HS without CV disease were examined with ultrasonography (US). Carotid intima-media thickness (cIMT) >0.90 mm and/or carotid plaques were used as the gold standard for subclinical atherosclerosis (US+). Systematic Coronary Risk Evaluation (SCORE), QRisk II, and 2013 American College of Cardiology (ACC)/American Heart Association (AHA) CV risk indices were calculated. Results. Twenty-one (19.1%) SSc patients, 24 (21.8%) RA patients, and 3 (5.9%) HS had subclinical atherosclerosis (SSc versus RA: P=0.62, SSc versus HS: P=0.029). cIMT in SSc was higher compared to HS (0.68 +/- 0.15 mm versus 0.61 +/- 0.10 mm; P=0.008) but similar to RA patients (0.66 +/- 0.14 mm; P=0.82). Subclinical atherosclerosis in SSc was associated with age (odds ratio [OR] 1.07, P=0.013), elevated erythrocyte sedimentation rate (OR 3.4, P=0.045), and pulmonary arterial hypertension (OR 4.27, P=0.012). Concerning CV risk indices, of the 21 US+ SSc patients only 0, 3 (14.2%), and 6 (28.6%) were classified as high CV risk according to SCORE, QRisk II, and ACC/AHA risk indices, respectively. Conclusion. Subclinical atherosclerosis in SSc patients is more frequent than in HS, but is as frequent as in RA patients in which accelerated atherosclerosis is clearly defined. CV risk indices for the general population are considerably insufficient to detect SSc patients with atherosclerosis.Publication Metadata only The effect of cardiac rehabilitation on blood pressure, and on left atrial and ventricular functions in hypertensive patients(WILEY, 2021) ÇİNÇİN, AHMET ALTUĞ; Sahin, Ahmet Anil; Ozben, Beste; Sunbul, Murat; Yagci, Ilker; Sayar, Nurten; Cincin, Altug; Gurel, Emre; Tigen, Kursat; Basaran, YeldaPurpose Hypertension is associated with left ventricular (LV) hypertrophy, impaired LV relaxation, and left atrial (LA) enlargement. Cardiac rehabilitation (CR) improves clinical outcomes in a broad spectrum of cardiac disease. The aim of our study was to determine the effect of CR on blood pressure (BP), and on LA and LV functions in hypertensive patients. Methods Thirty consecutive hypertensive patients who would undergo CR program, and 38 hypertensive patients who refused to undergo CR program were included. All patients underwent ambulatory BP monitoring and transthoracic echocardiography, which were repeated after completion of the CR program, or 12 weeks later in the control group. LA and LV functions were assessed by both speckle tracking and 3-dimensional echocardiography. N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were assessed before and after CR. Results Although initial ambulatory BP values and NT-proBNP levels were similar between the groups, daily, day-time, and night-time BP and NT-proBNP were significantly lower in the CR group after rehabilitation. LA reservoir strain and LV global longitudinal strain of the CR group significantly increased after CR while no significant increase was observed in controls. Conclusion CR improves LA and LV strain while lowering BP and should be encouraged in routine management of hypertensive patients.Publication Metadata only Nonalcoholic Steatohepatitis Score is an Independent Predictor of Right Ventricular Dysfunction in Patients with Nonalcoholic Fatty Liver Disease(WILEY-HINDAWI, 2015) SÜNBÜL, MURAT; Sunbul, Murat; Kivrak, Tarik; Durmus, Erdal; Akin, Hakan; Aydin, Yucel; Ergelen, Rabia; Yilmaz, Yusuf; Agirbasli, MehmetObjectiveNonalcoholic fatty liver disease (NAFLD) is associated with increased risk of cardiovascular disease and impaired left ventricular (LV) function, yet the impact of NAFLD on right ventricular (RV) function remains unclear. We investigate the RV functional properties in patients with NAFLD. MethodsNinety consecutive patients with the diagnosis of biopsy-proven NAFLD and 45 age- and sex-matched controls were included. All patients underwent an echocardiographic examination. RV function was evaluated by two-dimensional (2D) speckle-tracking echocardiography (STE). ResultsMean fibrosis stage and nonalcoholic steatohepatitis (NASH) scores were 1.31.1 and 5.2 +/- 1.6, respectively. NAFLD patients displayed decreased RV function compared to controls. NAFLD patients with liver fibrosis (67 patients) had significantly lower RV function assessed by GLS (global longitudinal strain) compared to patients without liver fibrosis (18.9 +/- 3.4% vs. 21.6 +/- 2.3%, P<0.001). NASH score 5 was associated with lower RV-GLS (18.9 +/- 3.1% vs. 21.0 +/- 3.4%, P=0.006). NASH score inversely correlated with RV-GLS (r=-0.370, P<0.001) such as patients with impaired RV-GLS (<19%) showed significantly higher NASH score compared to normal RV-GLS group (5.8 +/- 1.4 vs. 4.8 +/- 1.7, P=0.009). Logistic regression analysis revealed that NASH score was an independent predictor of impaired RV function in patients with NAFLD. ConclusionsPatients with NAFLD have impaired RV function. NASH score inversely correlates with RV-GLS and independently predicts impaired RV function in patients with NAFLD.Publication Open Access Evaluation of Association Between Fluoro-D-Glucose Positron Emission Tomography Uptake with Right Ventricular Functions in Patients with Chronic Thromboembolic Pulmonary Hypertension(ELSEVIER SCIENCE INC, 2013-10) YILDIZELİ, BEDRETTİN; Sunbul, Murat; Kivrak, Tarik; Oguz, Mustafa; Ozguven, Salih; Gungor, Serkan; Dede, Fuat; Turoglu, Halil Turgut; Yildizeli, Bedrettin; Mutlu, BulentPublication Metadata only Right ventricular and atrial functions in systemic sclerosis patients without pulmonary hypertension Speckle-tracking echocardiographic study(URBAN & VOGEL, 2015) SÜNBÜL, MURAT; Durmus, E.; Sunbul, M.; Tigen, K.; Kivrak, T.; Ozen, G.; Sari, I.; Direskeneli, H.; Basaran, Y.Background. Systemic sclerosis (SSc) is a systemic connective tissue disease and cardiac involvement is one of the most important causes of death. Right ventricular (RV) systolic dysfunction is a poor prognostic finding in SSc patients. Assessment of RV function has some difficulties because of its crescent shape and extensive trabeculations. Two-dimensional (2D) speckle-tracking echocardiography (STE) is an angle-independent quantitative technique to evaluate myocardial function. The aim of this study was to assess the RV and right atrial (RA) functions of SSc patients without pulmonary hypertension by using 2D STE. Patients and methods. A total of 40 patients with SSc (mean age 48.5 +/- 11.4 years, 28 female) and 40 healthy volunteers (mean age 45.9 +/- 7.6 years, 21 female) were included in the study. All subjects underwent transthoracic echocardiography for evaluation of RV and RA functions with 2D STE. Results. Although left ventricular systolic and diastolic functions, systolic pulmonary artery pressure (PAP), and RA measurements were similar in both groups, tricuspid annular plane systolic excursion (TAPSE) and maximum systolic myocardial velocity (S') were decreased in SSc patients. The RV free wall global longitudinal strain (GLS) of SSc patients was lower than the controls (-18.5 +/- 4.9% vs. -21.8 +/- 2.4%, p< 0.001) and the RA reservoir and conduit functions were also decreased in SSc patients compared with controls (34.4 +/- 9.9% vs. 39.7 +/- 11.2%, p= 0.027 and 15.0 +/- 5.7% vs. 18.7 +/- 6.4%, p= 0.009, respectively). Disease duration was inversely correlated with RVGLS and TAPSE (r: -0.416, p= 0.018 and r: -0.383, p= 0.031, respectively). Conclusion. The use of 2D STE can be helpful in the detection of impairment in RV and RA functions in SSc patients with normal PAP.Publication Open Access Evaluation of Alexithymia, Somatosensory Sensitivity, and Health Anxiety Levels in Patients with Noncardiac Chest Pain(HINDAWI LTD, 2014) SÜNBÜL, MURAT; Zincir, Selma Bozkurt; Sunbul, Murat; Sunbul, Esra Aydin; Dalkilic, Bahar; Cengiz, Fatma; Kivrak, Tarik; Durmus, ErdalObjective. Noncardiac chest pain (NCCP) is seen more frequently in young population and in these patients loss of function is evolving in social and professional areas. The aim of the study is to evaluate the levels of anxiety and somatic perception in patients with chest pain presenting to cardiology clinic. Methods. Fifty-one patients with noncardiac chest pain and 51 healthy controls were included in the study. All participants performed self-report based health anxiety inventory (HAI), somatosensory amplification scale (SAS), and Toronto alexithymia scale (TAS). Results. The patient group had significantly higher scores on the SAS, HAI-1, and HAI-T scales compared to controls (P < 0.001, P = 0.006, and P = 0.038, resp.). SAS, HAI-1, and HAI-T scores were significantly higher in female patients than male (P = 0.002, 0.036, and 0.039, resp.). There were significant differences in all TAS subscale scores between two groups. Patients, who had total TAS score more than 50, also presented higher levels of health anxiety (P = 0.045). Conclusions. Anxiety, somatic symptoms, and the exaggerated sense of bodily sensations are common in patients with NCCP. These patients unnecessarily occupy the cardiology outpatient clinics. These negative results can be eliminated when consultation-liaison psychiatry evaluates these patients in collaboration with cardiology departments.Publication Metadata only Evaluation of right and left heart mechanics in patients with chronic thromboembolic pulmonary hypertension before and after pulmonary thromboendarterectomy(SPRINGER, 2015) YILDIZELİ, BEDRETTİN; Sunbul, Murat; Kivrak, Tarik; Durmus, Erdal; Yildizeli, Bedrettin; Mutlu, BulentThe aim of the present study was to evaluate of the right and left heart mechanics by two-dimensional (2D) speckle tracking echocardiography (STE) in chronic thromboembolic pulmonary hypertension (CTEPH) patients before and after pulmonary thromboendarterectomy (PTE). A total of 40 consecutive CTEPH patients (mean age 49.3 +/- A 13.5 years, 27 female) were included. 2D STE was performed in all patients before, and 3 months, after PTE. 12 months of prognostic data were also recorded via the use of telephone calls. Postoperative 6-minute walk test (6MWT) distances were significantly longer than preoperative values (410.5 +/- A 61.5 vs. 216.6 +/- A 131.4 m, p < 0.001). Postoperative left ventricular (LV) and right ventricular (RV) systolic functions (LV EF, TAPSE, RVS) were similar compared to preoperative values. While postoperative RV, right atrial (RA) and systolic pulmonary artery pressure measurements were significantly lower, LV and left atrial (LA) measurements were higher than preoperative values. Postoperative LV and RV global longitudinal strain (GLS) measurements were significantly higher than preoperative values. Postoperative LV global radial and circumferential strain measurements were similar to preoperative values. While postoperative RA reservoir and conduit functions were significantly higher, postoperative LA reservoir and conduit functions were similar to preoperative values. Correlation analysis revealed that baseline 6MWT distances were correlated with LV GLS, RV GLS, and RA reservoir and conduit functions in the preoperative and postoperative periods. 2D STE indices may help the clinician in assessing the effect of PTE on cardiac functions and may also be used for follow-up data in CTEPH patients.