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 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 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 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.Publication Metadata only Percutaneous closure of the coronary artery-pulmonary artery fistula in a patient with apical hypertrophic cardiomyopathy [Apikal hipertrofik kardiyomiyopatili bir hastada koroner arter ile pulmoner arter arasindaki fistülün perkütan yolla kapatilmasi](Turkish Anaesthesiology and Intensive Care Society, 2013) MUTLU, BÜLENT; Sünbül M., Topal N.P., Kivrak T., Mutlu B.A fifty-four-year-old female patient was admitted to our unit with exertional chest pain of six months duration. Transthoracic echocardiography showed apical hypertrophy. Upon further investigation, cardiac magnetic resonance imaging revealed apical hypertrophic cardiomyopathy. The patient underwent myocardial perfusion scintigraphy which showed anterior ischemia. Coronary angiography revealed an arteriovenous fistula (AVF) from the left anterior descending artery to the pulmonary artery. The patient's chest pain was attributed to a coronary steal syndrome secondary to the coronary AVF. The AVF fistula was closed with a coil and the patient's chest pain improved. In conclusion, coronary steal syndrome may lead to myocardial ischemia in patients with a coronary AVF. © 2013 Türk Kardiyoloji Derneǧi.Publication Metadata only Neutrophil to lymphocyte and platelet to lymphocyte ratio in patients with dipper versus non-dipper hypertension(TAYLOR & FRANCIS INC, 2014) ÇİNÇİN, AHMET ALTUĞ; Sunbul, Murat; Gerin, Fethullah; Durmus, Erdal; Kivrak, Tarik; Sari, Ibrahim; Tigen, Kursat; Cincin, AltugBackground: Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are associated with worse outcome in various diseases. Non-dipping blood pressure pattern is associated with higher cardiovascular mortality. The aim of this study was to explore the association between NLR and PLR in patients with dipper versus non-dipper hypertension. Methods: The study included 166 patients with hypertension. Eighty-three patients (40 male, mean age: 49.1 +/- 10.5 years) had dipper hypertension, while 83 patients (41 male, mean age: 52.3 +/- 12.7 years) had non-dipper hypertension. Results: Baseline demographic characteristics were similar in both groups. Patients with non-dipper hypertension had significantly higher NLR compared to dipper hypertension (2.3 +/- 0.9 versus 1.8 +/- 0.5, p < 0.001). Patients with non-dipper hypertension had significantly higher PLR compared to dipper hypertension (117.7 +/- 35.2 versus 100.9 +/- 30.5, p = 0.001). In univariate analysis, hyperlipidemia, smoking, presence of diabetes, PLR more than 107 and NLR more than 1.89 were among predictors of dipper and non-dipper status. In logistic regression analyses, only hyperlipidemia (odds ratio: 2.96, CI: 1.22-7.13) and PLR more than 107 (odds ratio: 2.62, Cl: 1.13-6.06) were independent predictors of dipper and non-dipper status. A PLR of 107 or higher predicted non-dipper status with a sensitivity of 66.3% and specificity of 68.7%. Conclusion: We demonstrated that patients with non-dipper hypertension had significantly higher NLR and PLR compared to dipper hypertension, which has not been reported previously. Moreover PLR more than 107 but not NLR was independent predictor of non-dipper status.Publication Metadata only Left Ventricular Strain and Strain Rate by Two-Dimensional Speckle Tracking Echocardiography in Patients with Subclinical Hypothyroidism(2012-11-01) SÜNBÜL, MURAT; MUTLU, BÜLENT; SÜNBÜL M., Kivrak T., Yildiz H., Durmus E., Kanar B., Ozben B., MUTLU B.Publication Metadata only Evaluation of arterial stiffness and hemodynamics by oscillometric method in patients with systemic sclerosis(SPRINGER WIEN, 2013) ÇİNÇİN, AHMET ALTUĞ; Sunbul, Murat; Tigen, Kursat; Ozen, Gulsen; Durmus, Erdal; Kivrak, Tarik; Cincin, Altug; Kepez, Alper; Atas, Halil; Direskeneli, Haner; Basaran, YeldaArterial stiffness and its hemodynamic consequences are associated with adverse cardiovascular events. Pulse wave velocity (PWV) and augmentation index (AIx) are noninvasive markers of arterial stiffness. Systemic sclerosis (SSc) is a systemic, autoimmune disease affecting mainly the small vessels. The aim of this study was to evaluate the arterial stiffness parameters and hemodynamics by oscillometric method in patients with SSc. Thirty-five consecutive patients with diagnosed SSc and 35 age- and sex-matched healthy controls were included in the study. Measurements of arterial stiffness were carried out by using a Mobil-O-Graph arteriograph system that detected signals from the brachial artery. While hemodynamic parameters were not statistically significant between SSc and control groups, heart rate was significantly higher in SSc group (84 +/- 12 and 72 +/- 7 bpm, p = 0.001). SSc patients had significantly higher AIx and PWV values compared with controls (27.9 +/- 12.4 versus 21.0 +/- 11.4 %, p = 0.019 and 6.56 +/- 1.5 versus 5.04 +/- 0.17 m/s, p < 0.001, respectively). PWV was significantly associated with SSc when adjusted by heart rate (p = 0.001, Odds ratio (OR): 17.304, 95 % confidence interval (CI): 3.225-92.832). PWV and AIx were significantly higher in patients with SSc. Measurement of arterial stiffness parameters using oscillometric method was reliable, reproducible and easy in patients with SSc.