Person: SÜNBÜL, MURAT
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SÜNBÜL
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MURAT
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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 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 Open Access The impact of cystic fibrosis- and noncystic fibrosis-bronchiectasis on pulmonary artery wall thickness and right heart functions assessed by speckle-tracking echocardiography(2023-06-01) GÜREL, YUSUF EMRE; VEZİR, DUYGU; KOCAKAYA, DERYA; SÜNBÜL, MURAT; ÇİNÇİN, AHMET ALTUĞ; ÖZBEN SADIÇ, BESTE; SAYAR, NURTEN; CEYHAN, BERRİN; Gürel E., VEZİR D., Güçtekin T., Doğan Z., KOCAKAYA D., Olgun S., SÜNBÜL M., Çinçin A., Özben B., SAYAR N., et al.BACKGROUND: Right heart functions are affected in patients with bronchiectasis as a result of pulmonary hypertension induced by chronic hypoxemia. Pulmonary artery wall thickness has recently been introduced as a sign of intensive and prolonged inflammation. The aim of this study was to analyze right ventricular and right atrial functions and to mea-sure pulmonary artery wall thickness in patients with cystic fibrosis-bronch iecta sis in comparison to those with noncystic fibrosis-bronchiectasis and healthy individuals. METHODS: We studied 36 patients with cystic fibrosis-bronchiectasis, 34 patients with noncystic fibrosis-bronchiectasis, and 32 age- and sex-matched control subjects. Lung function tests were performed. All subjects underwent comprehensive echocardiographic evaluation including conventional, tissue Doppler, speckle-tracking, and pulmonary artery wall thickness measurements. RESULTS: Right ventricular global longitudinal strain and global longitudinal right atrial strain during ventricular systole decreased in cystic fibrosis-bronchiectasis group compared with noncystic fibrosis-bronchiectasis and control groups (P <.001, both). Conversely, pulmonary artery wall thickness was increased in cystic fibrosis-bronchiectasis group in comparison to other groups (P <.001). Moreover, right ventricular global longitudinal strain was lower and pulmonary artery wall thickness was higher in patients with airflow obstruction (P <.001 and P =.025, respectively) than in those without. Only right ventricular global longitudinal strain was significantly correlated with pulmonary function test parameters. The negative effect of cystic fibrosis on right ventricular and right atrial functions was independent of age, gender, and disease duration. CONCLUSION: Our study showed that right ventricular and right atrial functions were deteriorated and pulmonary artery wall was thickened in cystic fibrosis-bronchiectasis patients more than noncystic fibrosis-bronchiectasis patients. Right ventricular global longitudinal strain detected subclinical right ventricular dysfunction and was associated with the severity of pulmonary disease.Publication Metadata only Predictors of Concomitant Coronary Artery Disease and Major Cardiovascular Events in Patients with Acute Ischemic Stroke(Wolters Kluwer Medknow Publications, 2021) ÖZBEN SADIÇ, BESTE; Ileri C., Ozben B., Dogan Z., Sunbul M., Bulut1 B., Tigen K., Sayar N., Midi1 I., Basaran Y.Background: Coronary artery disease (CAD) and ischemic stroke share the same risk factors. Objective: The aim of the study was to explore the prevalence and predictors of concomitant CAD in acute ischemic stroke patients. Methods: One hundred and five patients (64.3 ± 15.0 years, 61 male) presenting with acute ischemic stroke documented by neuroimaging were consecutively included. All patients were carefully evaluated to determine their cardiovascular disease risk scores. The patients who had been previously shown to have ≥50% stenosis in at least one of the major coronary arteries by coronary angiography were grouped as CAD patients. Results: Of the 105 stroke patients, 27 patients had documented concomitant CAD. The stroke patients with CAD had higher cardiovascular risk scores and troponin I levels and carotid plaques were more prevalent. ROC analysis determined cut-off values as ≥22% for Framingham Heart Study Risk Score, ≥0.05 ng/mL for Troponin I, and ≥0.80 mm for carotid artery intima-media thickness to predict concomitant CAD. During 6 months of follow-up, among the 78 stroke patients without documented CAD, 16 patients had experienced major cardiovascular events including myocardial infarction, recurrent stroke, or cardiovascular death. These patients had higher Framingham Heart Study Risk Score and high-sensitive C reactive protein levels. Conclusion: Our study suggests stroke patients with higher Framingham Heart Study Risk Score and troponin I levels and carotid plaques be further investigated for the presence of concomitant CAD. © 2021 Wolters Kluwer Medknow Publications. All rights reserved.Publication Metadata only Regional myocardial dysfunction assessed by two-dimensional speckle tracking echocardiography in systemic sclerosis patients with fragmented QRS complexes(CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS, 2014) ÇİNÇİN, AHMET ALTUĞ; Tigen, Kursat; Sunbul, Murat; Ozen, Gulsen; Durmus, Erdal; Kivrak, Tarik; Cincin, Altug; Ozben, Beste; Atas, Halil; Direskeneli, Haner; Basaran, YeldaBackground: The aim of the study was to explore the relation between regional myocardial dysfunction and fragmented QRS (fQRS) complexes in systemic sclerosis (SSc). Methods: Fifty-three SSc patients and 26 controls were included. All subjects underwent speckle tracking echocardiography for evaluation of left ventricular (LV) function and ECG to check for fQRS complexes. Results: SSc patients had significantly lower LV global longitudinal, radial and circumferential strain and twist compared to controls. Thirteen SSc patients had fQRS (DII, DIII, aVF leads in eleven patients and V1 to V5 leads in two patients) and they had significantly lower global longitudinal and circumferencial strain compared to SSc patients with normal QRS. The SSc patients with fQRS in DII, DIII, and aVF leads had impaired longitudinal strain and delay in time to peak longitudinal strain in inferior LV segments compared to those with normal QRS. Conclusion: fQRS is associated with lower strain measures in SSc patients indicating impairment in LV function. (C) 2014 Elsevier Inc. All rights reserved.Publication Metadata only The evaluation of ventricular functions by speckle tracking echocardiography in preeclamptic patients(SPRINGER, 2020) YOLDEMİR, AHMET TEVFİK; Paudel, Ashok; Tigen, Kursat; Yoldemir, Tevfik; Guclu, Mehmet; Yildiz, Ipek; Cincin, Altug; Sunbul, Murat; Gurel, Emre; Sayar, Nurten; Ozben, BestePreeclampsia is a maternal disorder of pregnancy characterized by concomitant increase in preload and afterload with end organ dysfunction. The aim of our study is to evaluate left ventricular (LV) and right ventricular (RV) functions with speckle tracking echocardiography in preeclamptic patients. Fifty-five preeclamptic (mean age: 30.7 +/- 5.9 years) and 35 healthy pregnant women (mean age: 28.8 +/- 5.7 years) of the same race, similar age and gestational week were consecutively included. The diagnosis of preeclampsia was based on the criteria proposed by the American College of Obstetricians and Gynecologists. LV and RV functions were assessed by both conventional and speckle tracking echocardiography after the 30th gestational week and at the postpartum 6th months. The preeclamptic patients had significantly larger left atrium, thicker interventricular septum, higher systolic pulmonary artery pressure and mitral E/e ' ratio compared to controls during pregnancy while LV ejection fraction was similar. Preeclamptic patients had significantly lower LV and RV global longitudinal strain (GLS) during pregnancy compared to controls (- 18.0 +/- 2.6% vs. - 19.8 +/- 2.1% p = 0.001 and - 26.7 +/- 3.3% vs. 28.9 +/- 3.3% p = 0.002, respectively). In the postpartum period, while LVGLS values of preeclamptic patients increased significantly (- 18.0 +/- 2.6% vs. - 20.4 +/- 2.4% p < 0.001) and became similar to those of controls at the sixth month, the RVGLS decreased significantly (- 26.7 +/- 3.3% vs. - 25.8 +/- 2.7% p = 0.003) making the difference in RVGLS between the preeclamptic patients and controls more prominent. Preeclampsia may impair LV and RV function. Long-term follow up with larger sample is needed to determine the clinical relevance of the observed changes in strain.Publication Metadata only Left Ventricular and Atrial Functions in Hypertrophic Cardiomyopathy Patients with Very High LVOT Gradient: A Speckle Tracking Echocardiographic Study(WILEY-BLACKWELL, 2014) ÇİNÇİN, AHMET ALTUĞ; Tigen, Kursat; Sunbul, Murat; Karaahmet, Tansu; Dundar, Cihan; Ozben, Beste; Guler, Ahmet; Cincin, Altug; Bulut, Mustafa; Sari, Ibrahim; Basaran, YeldaBackgroundDetermination of myocardial deformation (strain) by two-dimensional (2D) speckle tracking echocardiography (STE) is a new method for evaluating left ventricular (LV) regional function in patients with hypertrophic cardiomyopathy (HCM). The aim of this study was to assess LV and left atrial (LA) functions with 2DSTE in HCM patients and to investigate relation between strain analysis and LV outflow tract (LVOT) gradient. MethodsForty consecutive HCM patients (26 male, mean age: 47.715.2years), and 40 healthy volunteers (22 male, mean age: 46.611.2years) were included in the study. All subjects underwent a transthoracic echocardiography for evaluation of LV and LA functions with 2DSTE. The HCM patients were divided into 2 groups according to the presence of resting LVOT gradient >100mmHg. ResultsLeft ventricular global longitudinal strain (GLS), global radial strain (GRS), and global circumferential strain (GCS) were significantly lower in patients with HCM compared with controls (-20.3 +/- 3.6% vs. -24.1 +/- 3.4% P<0.001, 38.1 +/- 12.8% vs. 44.8 +/- 10.2% P=0.012, and -22.0 +/- 4.4% vs. -23.9 +/- 4.0% P=0.045, respectively). Although basal and apical rotation were similar between the groups, mid-rotation was significantly clockwise in HCM patients (-1.53 +/- 2.06 degrees vs. 0.05 +/- 1.7 degrees P<0.001). Both LA reservoir functions and LA conduit functions were significantly lower in HCM patients (21.6 +/- 9.1% vs. 39.4 +/- 10.6% P<0.001, and 10.5 +/- 4.3% vs. 15.7 +/- 5.3%, P<0.001). Fifteen patients had a resting LVOT gradient of >100mmHg and they had significantly decreased GLS, twist and untwist compared to the HCM patients with lower resting LVOT gradient (-18.7 +/- 2.3% vs. -21.2 +/- 3.9% P=0.016, 19.4 +/- 4.3 degrees vs. 23.5 +/- 7.4 degrees P=0.038 and -94.0 +/- 29.1 degrees/sec vs. -134.9 +/- 55.8 degrees/sec, 0.005, respectively). Although basal and apical rotation were similar between the 2 groups, mid-rotation was significantly clockwise in HCM patients with higher LVOT gradient (-2.52 +/- 1.76 degrees vs. -0.96 +/- 2.03 degrees, P=0.018). Correlation analysis revealed that LVOT peak velocity was associated with GLS (r=-0.358, P=0.023), LV mid-rotation (r=-0.366, P=0.024), and LV untwist (r=-0.401, P=0.013). ConclusionsLeft ventricular and LA functions are impaired in patients with HCM. 2DSTE is useful in determining patients with impaired myocardial mechanics. High LVOT gradient may be one of the responsible factors that trigger deterioration of LV longitudinal strain and twist mechanics in patients with HCM. Further studies are required to clarify the preliminary results of this study.Publication Open Access The impact of right ventricular function assessed by 2-dimensional speckle tracking echocardiography on early mortality in patients with inferior myocardial infarction(WILEY, 2018-03) ÇİNÇİN, AHMET ALTUĞ; Kanar, Batur G.; Tigen, Mustafa K.; Sunbul, Murat; Cincin, Altug; Atas, Halil; Kepez, Alper; Ozben, BesteBackgroundRight ventricular (RV) involvement in inferior myocardial infarction (MI) increases in-hospital morbidity and mortality. HypothesisRV systolic dysfunction assessed by 2-dimensional speckle tracking echocardiography (STE) might be a predictor of early mortality in patients with acute inferior MI. MethodsEighty-one consecutive patients with acute inferior MI (mean age, 60.812.7years; 18 females) were included. RV myocardial involvement was defined as an elevation >1mm in V-1 or V4R within 12hours of symptom onset. RV function was assessed by STE. Patients were followed for 30days for all-cause mortality. ResultsThirty-eight patients had RV myocardial involvement, and they had significantly lower tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (RVS), and left ventricular (LV) and RV global longitudinal strain (GLS). Nine patients (11%) died within 30days. The mean age of mortality group was higher with more female frequency. They had significantly higher pro-BNP, hs-troponin T, and creatinine levels, but lower hemoglobin levels. TIMI 3 flow was significantly less achieved in mortality group. RV myocardial involvement was more frequent in the mortality group, and they had significantly lower TAPSE, RVS, and LV and RV GLS. Multivariate analysis revealed that age and RV GLS were independent predictors of early mortality. RV GLS -14% predicted early mortality in patients with acute inferior MI with a sensitivity of 88.9% and a specificity of 62.5% (AUC: 0.817, P =0.002). ConclusionsRV GLS may be useful in predicting early mortality in patients with acute inferior MI.Publication Open Access Subclinical Regional Myocardial Dysfunction Assessed by Two-Dimensional Speckle Tracking Echocardiography in Systemic Sclerosis Patients with Fragmented QRS Complexes(ELSEVIER SCIENCE INC, 2013-10) ÇİNÇİN, AHMET ALTUĞ; Sunbul, Murat; Tigen, Kursat; Ozen, Gulsen; Durmus, Erdal; Kivrak, Tarik; Cincin, Altug; Ozben, Beste; Atas, Halil; Direskeneli, Haner; Basaran, YeldaPublication Metadata only Circulating endothelial cell number and markers of endothelial dysfunction in previously preeclamptic women(MOSBY-ELSEVIER, 2015) ÖZBEN SADIÇ, BESTE; Tuzcu, Zeyneb Baspehlivan; Asicioglu, Ebru; Sunbul, Murat; Ozben, Beste; Arikan, Hakki; Koc, MehmetOBJECTIVE: Patients with preeclampsia (PE) have endothelial dysfunction and an increased future risk of cardiovascular (CV) mortality. The number of circulating endothelial cells (CECs) is markedly increased in conditions associated with a high degree of endothelial cell activation/injury including PE. We hypothesized that the number of CECs continues to be increased in women with a history of PE, reflecting ongoing endothelial cell activation/injury. STUDY DESIGN: CECs, flow-mediated vasodilation, levels of adhesion molecules and soluble vascular endothelial growth factor receptor-1 (sVEGFR1), and urine albumin/creatinine ratio were determined in 21 healthy women with ongoing normal pregnancy, 24 healthy currently nonpregnant women with a history of normal pregnancy, a total of 17 women with currently active mild (n = 11) or severe (n = 6) PE without hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome, and 16 currently nonpregnant women with a history of mild (n = 10) or severe (n = 6) PE. RESULTS: Blood samples from women with active preeclampsia had higher CECs (9.9 +/- 7.9 cells/mL) than healthy pregnant women (3.0 +/- 4.1 cells/mL; P <.001), healthy nonpregnant women with a history of normal pregnancy (3.4 +/- 4.0 cells/mL; P<. 001), or women with a history of preeclampsia (2.4 +/- 2.0 cells/mL; P <.001). The number of CECs were similar between women with a history of preeclampsia and healthy nonpregnant women with a history of normal pregnancy. Patients with active preeclampsia had significantly higher soluble vascular cell adhesion molecule-1, soluble E-selectin, sVEGFR1, and urinary albumin/creatinine ratio than healthy pregnant women. However, soluble vascular cell adhesion molecule-1, soluble E-selectin, urinary albumin/creatinine ratio were similar in women with a history of preeclampsia and healthy nonpregnant women with a history of normal pregnancy. However, women with a history of preeclampsia had higher sVEGFR1 levels than women with a history of normal pregnancy (P <.05). CONCLUSION: Markers of endothelial activation, dysfunction, and damage were increased in patients with PE. After the delivery, this activation status is similar to the age-matched nonpregnant women with a history of normal pregnancy. However, sVEGFR-1 levels remain higher in women with a history of preeclampsia compared with women without a history of preeclampsia.
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