Person: SARI, İBRAHİM
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SARI
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İBRAHİM
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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 Severity of Depression and Anxiety Symptoms is Associated with Increased Arterial Stiffness in Depressive Disorder Patients Undergoing Psychiatric Treatment(KURE ILETISIM GRUBU A S, 2016-09) SARI, İBRAHİM; Yanartas, Omer; Sunbul, Murat; Durmus, Erdal; Kivrak, Tarik; Senkal, Zeynep; Subasi, Nilufer; Karaer, Gulhan; Ergun, Serhat; Sari, Ibrahim; Sayar, KemalObjective: Depression and anxiety are associated with both subdinical and clinical cardiovascular disease. Endothelial dysfunction, atherosclerosis, and inflammation are some of the underlying mechanisms. Pulse wave velocity (PWV) and augmentation index (Alx) are noninvasive markers for evaluation of arterial stiffness. The aim of this study was to examine the association between arterial stiffness parameters and depression/anxiety scores in depressive patients undergoing psychiatric treatment. Methods: The study population consisted of 30 patients with depression undergoing psychiatric treatment at least 4 weeks, and 25 age and gender matched healthy controls. Depression and anxiety were assessed by self-reported scales, including the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Measurements of arterial stiffness parameters were performed by using a Mobil-O-Graph arteriograph system, which detects signals from the brachial artery. Results: Baseline characteristics and clinical data were similar between the two groups. BDI and BAI scores were statistically significantly higher in patients with depression (p<0.001, p<0.01). PWV and Alx were statistically significantly higher in patients with depression compared to controls (6.40 +/- 1.31 m/s vs 5.51 +/- 0.41 m/s and 26.9 +/- 12.1 % vs 17.4 +/- 11.3 %, p=0.001, p=0.004, respectively). PWV and Alx positively, mildly and statistically significantly correlated with BDI and BAI scores. Conclusion: Arterial stiffness parameters were statistically significantly higher in depressive patients receiving antidepressant treatment. Moreover, arterial stiffness parameters statistically significantly correlated with BDI and BAI. Assessment of arterial stiffness parameters may be useful for early detection of cardiovascular deterioration in depressive patients undergoing antidepressant treatment.Publication Open Access Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio are Predictors of Heart Failure(ARQUIVOS BRASILEIROS CARDIOLOGIA, 2015) SARI, İBRAHİM; Durmus, Erdal; Kivrak, Tarik; Gerin, Fethullah; Sunbul, Murat; Sari, Ibrahim; Erdogan, OkanBackground: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are inflammatory markers used as prognostic factors in various diseases. Objectives: To compare the PLR and the NLR of heart failure (HF) patients with those of age-sex matched controls, to evaluate the predictive value of those markers in detecting HF, and to demonstrate the effect of NLR and PLR on mortality in HF patients during follow-up. Methods: This study included 56 HF patients and 40 controls without HF. All subjects underwent transthoracic echocardiography to evaluate cardiac functions. The NLR and the PLR were calculated as the ratio of neutrophil count to lymphocyte count and as the ratio of platelet count to lymphocyte count, respectively. All HF patients were followed after their discharge from the hospital to evaluate mortality, cerebrovascular events, and re-hospitalization. Results: The NLR and the PLR of HF patients were significantly higher compared to those of the controls (p < 0.01). There was an inverse correlation between the NLR and the left ventricular ejection fraction of the study population (r: -0.409, p < 0.001). The best cut-off value of NLR to predict HF was 3.0, with 86.3% sensitivity and 77.5% specificity, and the best cut-off value of PLR to predict HF was 137.3, with 70% sensitivity and 60% specificity. Only NLR was an independent predictor of mortality in HF patients. A cut-off value of 5.1 for NLR can predict death in HF patients with 75% sensitivity and 62% specificity during a 12.8-month follow-up period on average. Conclusions: NLR and PLR were higher in HF patients than in age-sex matched controls. However, NLR and PLR were not sufficient to establish a diagnosis of HF. NLR can be used to predict mortality during the follow-up of HF patients.Publication Open Access Increased Neutrophil/Lymphocyte Ratio in Patients with Depression is Correlated with the Severity of Depression and Cardiovascular Risk Factors(KOREAN NEUROPSYCHIATRIC ASSOC, 2016) SARI, İBRAHİM; Sunbul, Esra Aydin; Sunbul, Murat; Yanartas, Omer; Cengiz, Fatma; Bozbay, Mehmet; Sari, Ibrahim; Gulec, HuseyinObjective Chronic inflammation is associated with cardiovascular (CV) risk factors and psychiatric disorders. The neutrophil to lymphocyte ratio (NLR) has been investigated as a new biomarker for systemic inflammatory response. The aim of the study is to investigate the relation of NLR with severity of depression and CV risk factors. Methods The study population consisted of 256 patients with depressive disorder. Patients were evaluated with the Hamilton Rating Scale for Depression (HAM-D). Patients were classified into four groups according to their HAM-D score such as mild, moderate, severe, and very severe depression. Patients were also evaluated in terms of CV risk factors. Results Patients with higher HAM-D score had significantly higher NLR levels compared to patients with lower HAM-D score. Correlation analysis revealed that severity of depression was associated with NLR in depressive patients (r=0.333, p<0.001). Patients with one or more CV risk factors have significantly higher NLR levels. Correlation analysis revealed that CV risk factors were associated with NLR in depressive patients (r=0.132, p=0.034). In logistic regression analyses, NLR levels were an independent predictor of severe or very severe depression (odds ratio: 3.02, 95% confidence interval: 1.867-4.884, p<0.001). A NLR of 1.57 or higher predicted severe or very severe depression with a sensitivity of 61.4% and specificity of 61.2%. Conclusion Higher HAM-D scores are associated with higher NLR levels in depressive patients. NLR more than 1.57 was an independent predictor of severe or very severe depression. A simple, cheap white blood cell count may give an idea about the severity of depression.Publication Open Access Increased arterial stiffness parameters in panic disorder patients in long term treatment period(BMC, 2016-12) SARI, İBRAHİM; Yanartas, Omer; Sunbul, Murat; Senkal, Zeynep; Durmus, Erdal; Kivrak, Tarik; Subasi, Nilufer; Karaer, Gulhan; Ergun, Serhat; Sari, Ibrahim; Sayar, KemalBackground: The relationship between mental stress and cardiovascular disease has been shown in several studies. Panic disorder (PD) is also associated with cardiovascular disease due to increased risk of myocardial infarction. The aim of this study is to evaluate the association between arterial stiffness parameters and depression/anxiety scores in patients with PD. Methods: The study population consisted of 25 patients with PD and 25 age-sex-matched healthy controls. Depression and anxiety levels were evaluated by Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), respectively. Determination of arterial stiffness parameters was conducted using a Mobil-O-Graph arteriograph system that detected signals from the brachial artery. Results: While baseline characteristics were similar between two groups, BDI and BAI scores were significantly higher in patients with PD (p < 0.005). The pulse wave velocity (PWV) and Augmentation Index (AIx) were also significantly higher in patients with PD (p = 0.001, p = 0.006). There was a moderate correlation between PWV and AIx with BAI scores (r = 0.442, p = 0.001, r = 0.441, p = 0.001). AIx was also positively correlated with BDI scores (r = 0.415, p = 0.03). Conclusion: We demonstrated a significant relationship between arterial stiffness parameters and anxiety/depression scores in patients with PD who receive antidepressant treatment.Publication Open Access Burden and Depressive Symptoms Associated with Adult-Child Caregiving for Individuals with Heart Failure(2014) SARI, İBRAHİM; Bozkurt Zincir, Selma; Sunbul, Murat; Zincir, Serkan; Aydin Sunbul, Esra; Oguz, Mustafa; Feriha Cengiz, Fatma; Durmus, Erdal; Kivrak, Tarik; Sari, IbrahimBackground . The primary purpose of this study was to investigate adult-child caregiver burden in heart failure (HF) patients. Secondary purpose of the study was to identify the possible influencing factors for caregiver burden and depressive symptoms in a young adult-child caregiver group. Methods . A total of 138 adult-child caregivers and 138 patients with HF participated in this study. Caregivers’ burden, depressive symptoms, and anxiety levels were assessed by using Zarit Caregiver Burden Scale (ZCBS), Beck Depression Inventory, and State-Trait Anxiety Inventory, respectively. Results . The mean ZCBS scores of the female caregivers were significantly higher than male caregivers. Approximately one-third of the adult-child caregivers had at least mild depressive symptoms. Caregivers with higher depressive symptoms had higher levels of caregiver burden. There were positive correlations between caregiving time, severity of depressive symptoms, and perceived caregiver burden. There was a negative correlation between education level of caregivers and perceived caregiver burden. Age, socioeconomic level, and marital status of patients were affecting factors for depressive symptoms in caregivers. Among caregiver characteristics, gender, marital status, and ZCBS scores seem to influence the depression in caregivers. Conclusions . The study findings suggest significant levels of burden and depressive symptoms even in adult-child caregivers of HF patients.Publication Open Access Arterial stiffness parameters associated with vitamin D deficiency and supplementation in patients with normal cardiac functions(AVES, 2016) ÇİNÇİN, AHMET ALTUĞ; Sunbul, Murat; Cincin, Altug; Bozbay, Mehmet; Mammadov, Ceyhun; Atas, Halil; Ozsenel, Ekmel Burak; Sari, Ibrahim; Basaran, YeldaObjective: Arterial stiffness parameters including pulse wave velocity (PWV) and augmentation index (AIx) are associated with increased risk of cardiovascular disease. A close relationship has been demonstrated between vitamin D deficiency and cardiovascular disease. The aim of the present study was to investigate effects of vitamin D deficiency and supplementation on arterial stiffness parameters in patients with normal cardiac functions. Methods: Study population consisted of 45 patients with vitamin D deficiency and normal cardiac functions. Median age (interquartile range) was 45.0 (12.00) years, and 33 patients were female. Patients were treated with oral administration of vitamin D3. Arterial stiffness parameters were evaluated using Mobil-O-Graph arteriograph system, which detected signals from the brachial artery before and after treatment. Results: Vitamin D levels significantly increased after treatment (9.0 [6.00] nmol/L vs 29.0 [11.50] nmol/L, p<0.001). No significant difference was observed among conventional echocardiographic parameters before or after treatment. Post-treatment PVW and AIx were significantly lower than baseline measurements (6.8 [1.55] m/s vs 6.4 [1.30] m/s, p<0.001 and 23.0 [22.00]% vs 31.0 [14.50]%, p<0.001, respectively). Baseline vitamin D levels significantly correlated with PWV (r=-0.352, p=0.018). Post-treatment vitamin D levels also significantly correlated with post-treatment PWV (r=-0.442, p=0.002) and AIx (r=-0.419, p=0.004). Multivariate linear regression analysis revealed no independent predictor of baseline log-transformed PWV. Conclusion: Vitamin D supplementation has beneficial effects on arterial stiffness. Arterial stiffness parameters may aid in the assessment of cardiovascular risk in patients with vitamin D deficiency.