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Tuncel DA, Pekoz BC, Koc AS, Sumbul HE. Point Shear Wave Elastography Detected Liver Stiffness Increased in Pediatric Patient With Thalassemia Major. Ultrasound Q 2024; 40:82-86. [PMID: 38436375 DOI: 10.1097/ruq.0000000000000675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
ABSTRACT Transient elastography (TE) and point shear wave elastography (pSWE) are 2 elastographic ultrasound examinations used in liver stiffness (LS) measurement. It was shown that the LS value detected by TE in pediatric β-thalassemia major patients has increased, and there was no LS evaluation obtained with pSWE in literature. Thus, in this study, it was aimed to evaluate LS with pSWE examination in children with thalassemia major and to determine LS-related parameters in these patients. Sixty-three schoolchildren with a diagnosis of β-thalassemia major and 21 healthy controls between the ages of 7 and 18 years were included. In addition to routine anamnesis, physical examination, and laboratory examinations, renal and liver ultrasounds were performed. Liver stiffness values were measured by pSWE examination. Serum levels of urea, aspartate-aminotransferase, alanine-aminotransferase, iron, and ferritin were significantly higher in patients, and serum creatinine, iron binding capacity, and hemoglobin levels were found to be significantly lower (P < 0.05 for each). Liver stiffness values were significantly higher in patients compared with healthy controls. In linear regression analysis, serum iron and iron binding capacity values were found to be closely related with LS (P < 0.001 vs. β = 0.482 and P = 0.047 vs. β = 0.237, respectively). Liver stiffness values obtained by pSWE examination increase significantly in patients. According to the results of our study, in addition to the previously known TE method, we think that the LS evaluation obtained by pSWE, a new method that can make more accurate measurements, can be used in the possible early detection of target organ damage in children with thalassemia major.
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Affiliation(s)
| | | | | | - Hilmi Erdem Sumbul
- Department of Internal Medicine, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
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Tumer C, Saler T, Aslan MZ, Koc AS, Koc M, Erel O, Neselioglu S, Gulumsek E, Avci BS, Avci A, Sumbul HE. Aumento da Espessura Médio-intimal Aórtica e sua Relação com Estresse Oxidativo Elevado em Pacientes com Talassemia Menor. Arq Bras Cardiol 2022; 119:426-435. [PMID: 35703665 PMCID: PMC9438530 DOI: 10.36660/abc.20210666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 01/26/2022] [Indexed: 11/23/2022] Open
Abstract
Fundamento A espessura médio-intimal (EMI) da artéria aorta abdominal (EMI-A) pode ser um marcador precoce de aterosclerose subclínica e um indicador objetivo de estresse oxidativo em pacientes com talassemia menor. Objetivo Avaliar se as EMIs da artéria aorta e da artéria carótida (EMI-C) se alteram com estresse oxidativo, e examinar a relação entre esses parâmetros em pacientes com talassemia menor. Métodos O estudo incluiu 80 pacientes diagnosticados com talassemia menor, e 50 indivíduos sadios com idade e sexo similares. Após procedimentos de rotina, as amostras de sangue foram coletadas dos grupos de estudo para a medida da homeostase tiol/dissulfeto e da albumina modificada pela isquemia (AMI). As medidas da EMI-C foram realizadas a partir de quatro regiões diferentes (artéria carótida externa direita e esquerda e artéria carótida interna direita e esquerda) por ultrassonografia, e a medida da EMI-A foi realizada por ultrassonografia abdominal. Um valor de p<0,05 foi definido como estatisticamente significativo. Resultados Nos pacientes com talassemia menor, os níveis de tiol nativo e tiol total, e a razão tiol nativo/tiol total foram mais baixos, e os valores de AMI, razão dissulfeto/tiol nativo, e razão dissulfeto/tiol total foram mais altos que no grupo controle. A EMI-A foi significativamente maior no grupo de pacientes com talassemia menor que nos controles (1,46±0,37 vs 1,23±0,22 e p<0,001). Quando os parâmetros associados com EMI-A na análise univariada foram avaliados por regressão linear multivariada, EMI-A apresentou uma relação positiva, e os níveis de tiol nativo e tiol total apresentaram uma forte relação negativa com AMI (p<0,01). Conclusão Nós demonstramos, pela primeira vez, um aumento no estresse oxidativo com a elevação da EMI-A, e valores inalterados da EMI-C em pacientes com talassemia menor.
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Sumbul HE, Koc AS. Correction: The Abdominal Aortic Intima-Media Thickness Increases in Patients with Primary Hyperparathyroidism. Exp Clin Endocrinol Diabetes 2022; 130:e6. [PMID: 30134476 DOI: 10.1055/a-0697-6549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Hilmi Erdem Sumbul
- Department of Internal Medicine, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - Ayse Selcan Koc
- Department of Radiology, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
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Pekoz BC, Koc M, Kucukosmanoglu M, Koc AS, Koca H, Dönmez Y, Sumbul HE. Evaluation of Liver Stiffness After Atrial Septal Defect Closure. Ultrasound Q 2022; 38:165-169. [PMID: 35420064 DOI: 10.1097/ruq.0000000000000611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT In this study, we aimed to evaluate the liver stiffness (LS) values and the right ventricle (RV) functions after atrial septal defect (ASD) closure treatment. Sixty-six patients were included (38 female, 28 male) in the study. Patients were grouped into 3 subgroups (group I = 21 patients without ASD closure, group II = 38 patients who underwent ASD closure, and group III = 11 patients with ASD and Eisenmenger syndrome). After 1-year follow-up of the patients who underwent ASD closure, LS was assessed using the liver elastography technique. Echocardiographic changes and LS changes over time were compared. Absolute Δ-LS and Δ-liver size were found to be significantly decreased in group II compared with the other groups. While liver size, LS levels, RV and left ventricle (LV) dimensions, and tricuspid regurgitation pressure gradient were found to be significantly decreased; the tricuspid annular plane systolic excursion and the LV ejection fraction were significantly increased in group II. In addition, Δ-LV and Δ-RV dimensions and Δ-tricuspid regurgitation pressure gradient values were statistically significant and Δ-tricuspid annular plane systolic excursion and LV ejection fraction values were statistically higher in group II compared with the other groups. In conclusion, our study demonstrates that the LS is another parameter, which significantly decreases in patients treated with ASD occluder devices and can be used as an objective follow-up parameter in addition to classic echocardiographic measurements.
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Affiliation(s)
| | | | - Mehmet Kucukosmanoglu
- Internal Medicine, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | | | | | | | - Hilmi Erdem Sumbul
- Internal Medicine, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
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Gulumsek E, Sumbul HE, Buyuksimsek M, Demir K, Koc AS, Tas A, Bulut Y, Kara B. Liver Stiffness Is Markedly Decreased After Chronic Hepatitis C Treatment. Ultrasound Q 2022; 38:142-148. [PMID: 35678480 DOI: 10.1097/ruq.0000000000000572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM The aim of the study was to demonstrate the liver stiffness (LS) change in chronic hepatitis C (CHC) patients obtained by elastography point quantification technique in before and after antiviral treatment (AVT). MATERIAL AND METHODS This prospective study included 84 patients diagnosed with CHC who had not previously received treatment for CHC and who had an indication for using direct-acting AVT. Necessary measurements were recorded with noninvasive liver fibrosis (LF) examinations. Posttreatment control of patients was carried out (ombitasvir + paritaprevir + ritonavir) + 3 months after the start of treatment for those treated with dasabuvir and 6 months after the start of treatment for patients treated with sofosbuvir + ribavirin. Liver stiffness changed after AVT is accepted as (Δ-LS), LS before AVT-LS after AVT. RESULTS Basal LS was found to decrease significantly after AVT (8.00 ± 2.56 kPa vs 6.95 ± 2.86 kPa, P < 0.05). Similar aspartate aminotransferase-to-platelet ratio index and platelet number fibrosis 4 indices were observed before and after AVT (P > 0.05). It was observed that Δ-LS value after AVT was lower in patients with Child-Pugh class A cirrhosis than patients without cirrhosis (P < 0.05). In the comparison between Δ-LS value after AVT and LF score determined by liver biopsy, it was seen that the greatest Δ-LS value was in patients with fibrosis score of 3. An independent relationship was found between Δ-LS after AVT and LF score determined by biopsy (P < 0.05). CONCLUSIONS The LS value determined by the elastography point quantification technique is more effective than other noninvasive laboratory methods in demonstrating the CHC treatment response in clinical practice.
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Affiliation(s)
| | | | | | | | - Ayse Selcan Koc
- Radiology, University of Health Sciences-Adana Health Practice and Research Center
| | | | - Yurdaer Bulut
- Department of Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey
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Sumbul HE, Avci BS, Bankir M, Pekoz BC, Gulumsek E, Koc AS. Ovarian Stiffness Is Significantly Increased in Polycystic Ovary Syndrome and Related With Anti-Mullerian Hormone: A Point Shear Wave Elastography Study. Ultrasound Q 2022; 38:83-88. [PMID: 35020692 DOI: 10.1097/ruq.0000000000000592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Parenchymal stiffness obtained by point shear-wave elastography (pSWE) in solid organs is used as a sign of damage in these organs. However, its clinical use and whether patients with polycystic ovary syndrome (PCOS) have increased ovarian tissue stiffness are still unclear. The aim of this study is to determine the parameters related to ovarian stiffness and whether there is an increase in ovarian stiffness in patients with PCOS compared with healthy controls. METHODS Forty-five women who were followed up regularly with the diagnosis of PCOS and 30 healthy controls similar to age and sex were included in this study. In addition to the routine follow-up parameters for PCOS, serum homeostatic model assessment of insulin resistance and anti-Mullerian hormone (AMH) levels were examined in all patients, and pSWE examination was performed with pelvic ultrasound (US) and ElastPQ technique. RESULTS Serum dehydroepiandrosterone sulfate, luteinizing hormone/follicle-stimulating hormone, testosterone, homeostatic model assessment of insulin resistance, and AMH were higher in PCOS compared with healthy controls (P < 0.001). Right, left, and mean ovary stiffness and volumes were significantly higher in PCOS group than healthy controls (P < 0.001). Correlation analysis was performed between mean ovary stiffness and dehydroepiandrosterone sulfate, luteinizing hormone/follicle-stimulating hormone, testosterone, homeostatic model assessment, and AMH and ovary volumes (P < 0.01 for each one). In linear regression analysis, only AMH was found to be related to mean ovary stiffness (P < 0.001 and β = 0.734). CONCLUSIONS Ovarian stiffness value obtained by ElastPQ technique and pSWE method increases in PCOS patients compared with healthy controls and is closely related to serum AMH levels. In patients with PCOS, in addition to the conventional US, ovarian stiffness measured by pSWE may be an auxiliary examination in the follow-up of the disease. However, it was concluded that the ovarian stiffness measurement obtained in our current study should be supported by studies involving more patients and the transvaginal US method.
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Affiliation(s)
| | | | | | - Burcak Cakir Pekoz
- Department of Radiology, Adana City Research and Training Hospital, Health Science University, Adana
| | | | - Ayse Selcan Koc
- Department of Radiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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Sumbul HE, Koc AS, Pınar A, Aslan MZ, Gulumsek E, Koca H, Bulut Y, Karakoc E, Turunc T, Bayrak E, Ozturk HA, Avci A, Unal I, Icen YK, Koc M, Sahin AR, Okyay RA. Modified Lung Ultrasound Score in Evaluating the Severity of Covid-19 Pneumonia. Ultrasound Med Biol 2021; 47:2080-2089. [PMID: 34088529 PMCID: PMC8086809 DOI: 10.1016/j.ultrasmedbio.2021.04.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 05/02/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 causes coronavirus disease 2019 (Covid-19), which has been declared as a pandemic by the World Health Organization. The aim of the study described here was to determine the severity of pneumonia and the clinical parameters related to a modified lung ultrasound score (mLUS) in patients with COVID-19 pneumonia. The study included 44 patients with proven COVID-19 pneumonia. Patients were divided into three groups on the basis of pneumonia severity: mild/moderate pneumonia (group I), severe pneumonia (group II) and critically ill patients (group III). It was determined that mLUS values in groups I-III were 6.51 ± 4.12, 23.5 ± 5.9 and 24.7 ± 3.9, respectively. mLUS values were significantly higher in group II and III patients than in group I patients. There was a positive relationship between mLUS and age and N-terminal pro-brain natriuretic peptide level and a negative relationship with PaO2/FiO2 (p = 0.032, β = 0.275 vs. p = 0.012, β = 0.315 vs. p = 0.001, β = -0.520, respectively). In patients with COVID-19 pneumonia, mLUS increases significantly with the severity of the disease.
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Affiliation(s)
- Hilmi Erdem Sumbul
- Department of Internal Medicine, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Ayse Selcan Koc
- Department of Radiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Arzu Pınar
- Department of Pulmonary Disease, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Muhammed Zubeyir Aslan
- Department of Internal Medicine, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Erdinc Gulumsek
- Department of Internal Medicine, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Hasan Koca
- Department of Cardiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Yurdaer Bulut
- Department of Internal Medicine, Intensive Care Unit, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Emre Karakoc
- Department of Internal Medicine, Intensive Care Unit, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Tuba Turunc
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Edip Bayrak
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Huseyin Ali Ozturk
- Department of Internal Medicine, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Akkan Avci
- Department of Emergency Medicine, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Ilker Unal
- Department of Biostatistics, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Yahya Kemal Icen
- Department of Cardiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Mevlut Koc
- Department of Cardiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Ahmet Riza Sahin
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Ramazan Azim Okyay
- Department of Public Health, Faculty of Medicine, KahramanmarasSutcu Imam University, Kahramanmaras, Turkey.
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Bankir M, Koc AS, Gorgulu FF, Sumbul HE, Koc M. Hemoptysis and massive focal alveolar hemorrhage after successful biventricular pacemaker implantation. Niger J Clin Pract 2021; 24:443-445. [PMID: 33723121 DOI: 10.4103/njcp.njcp_650_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
During and after cardiac resynchronization therapy (CRT) implantation, many adverse events may occur. We present an interesting and important patient with hemoptysis and massive focal alveolar hemorrhage in a patient after a successful CRT implantation. CRT implantation was completed without any problems. In the follow-up, complaints of cough and hemoptysis began 1 h after the procedure. On the PA chest X-ray, a ground glass image was found in the left upper zone. Thorax CT revealed focal alveolar hemorrhage in the left upper lobe anterior segmental lung parenchyma. The patient was followed up with medical treatment and discharged in good health.
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Affiliation(s)
- M Bankir
- Department of Internal Medicine, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - A S Koc
- Department of Radiology, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - F F Gorgulu
- Department of Radiology, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - H E Sumbul
- Department of Internal Medicine, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - M Koc
- Department of Cardiology, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
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Gulumsek E, Pekoz BC, Koc AS, Aslan MZ, Ali Ozturk H, Arici FN, Sumbul HE. Liver Stiffness Is Increased in Polycystic Ovary Syndrome and Related With Complement C1q/Tumor Necrosis Factor-Related Protein 3 Levels: A Point Shear Wave Elastography Study. Ultrasound Q 2020; 37:133-137. [PMID: 33337585 DOI: 10.1097/ruq.0000000000000537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Nonalcoholic fatty liver disease is very common in patients with polycystic ovary syndrome (PCOS). In patients with PCOS, the clinical use of liver stiffness (LS) and whether LS increases or decreases are still unclear. The purpose of this study was to determine the parameters related to LS and whether there is an increase in LS in patients with PCOS compared with healthy controls. Thirty-eight women diagnosed with PCOS according to Rotterdam criteria and 28 healthy age- and sex-matched controls were included in this study. In addition to routine follow-up parameters for all patients, serum homeostatic model assessment of insulin resistance (HOMA-IR) and complement C1q/tumor necrosis factor-related protein 3 (CTRP3) levels were measured, and point shear wave elastography was performed. Body mass index; waist circumference; systolic blood pressure; serum glucose, alanine aminotransferase, highly sensitive C-reactive protein, and dehydroepiandrosterone sulfate, testosterone, and HOMA-IR levels; and luteinizing hormone/follicle-stimulating hormone ratio were higher in PCOS group compared with healthy controls (P < 0.05). Serum CTRP3 levels were lower in patients with PCOS (P < 0.05). Liver stiffness value was significantly higher in PCOS group than healthy controls (P < 0.001). Positive correlation was found between LS and waist circumference as well as calcium, dehydroepiandrosterone sulfate, testosterone, and HOMA-IR levels (P < 0.05 for each one). Negative correlation was found between LS and CTRP (P < 0.01 for each one). In linear regression analysis, only CTRP3 level was found to be related to LS (P < 0.001 and β = 0.734). Liver stiffness value obtained by point shear wave elastography increases in patients with PCOS compared with healthy controls and is closely and negatively related to serum CTRP3 levels.
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Affiliation(s)
| | | | | | - Muhammed Zubeyir Aslan
- Department of Internal Medicine, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - Huseyin Ali Ozturk
- Department of Internal Medicine, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - Fatih Necip Arici
- Department of Internal Medicine, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - Hilmi Erdem Sumbul
- Department of Internal Medicine, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
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Abstract
INTRODUCTION We aimed to investigate changes in renal cortical stiffness (CS) in Type 2 diabetes mellitus (DM) and pre-DM patients compared to subjects with normal glucose metabolism (NGM), as well as the usefulness of renal CS to determine the presence of nephropathy. METHODS This study included 125 individuals with NGM, pre-DM and Type 2 DM. Routine laboratory data was obtained, and micro- and macrovascular involvement were investigated. Urinary albumin-creatinine ratio (UACR) was measured for urinary albuminuria detection. In addition to routine renal ultrasonography, CS was measured using renal elastography. RESULTS Among the included patients, 42, 40 and 43 patients had NGM, pre-DM and Type 2 DM, respectively, with prevalence of nephropathy of 5%, 15% and 33%, respectively. Carotid and aortic intima-media thickness (IMT), renal width, and CS were found to be higher in the pre-DM and Type 2 DM groups than the NGM group. Aortic IMT, renal width and UACR levels were independently associated with CS. Patients with nephropathy were found to have a higher CS value than those without nephropathy (8.72 ± 1.67 kPa vs. 10.60 ± 1.74 kPa, p = 0.001). In receiver operating characteristic curve analysis, when the cut-off value for CS was taken as 9.2 kPa, renal CS predicted the possibility of nephropathy with 78.9% sensitivity and 71.4% specificity. CONCLUSION CS values are significantly higher in patients with impaired glucose metabolism. We recommend CS measurement as part of routine screening of nephropathy in patients with pre-DM and newly diagnosed Type 2 DM.
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Affiliation(s)
- Hilmi Erdem Sumbul
- Department of Internal Medicine, University of Health Sciences, Adana Health Practice and Research Center, Adana, Turkey
| | - Ayse Selcan Koc
- Department of Radiology, University of Health Sciences, Adana Health Practice and Research Center, Adana, Turkey
| | - Erdinç Gülümsek
- Department of Internal Medicine, University of Health Sciences, Adana Health Practice and Research Center, Adana, Turkey
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Koca H, Koc AS, Sumbul HE, Koc M. Liver stiffness increases in patients with severe pericardial effusion, especially in the presence of cardiac tamponade. Med Ultrason 2020; 22:133-138. [PMID: 32190850 DOI: 10.11152/mu-2295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIMS Liver stiffness (LS) is associated with central venous pressure and pericardial effusion (PE) may be associated with these increased pressures. The aim of this study was to investigate the change in LS obtained by liver elastography (LE) in patients with severe PE and its usefulness for the diagnosis of cardiac tamponade. MATERIALS AND METHODS Forty-patients with severe-PE were included in this study. All patients underwent LE examination in addition to echocardiography. Patients were divided into 2 groups: with and without cardiac tamponade. RESULTS In patients with cardiac tamponade, LS values, inspiratory-expiratory vena cava inferior (VCI) diameters and presence of <50% inspiratory-VCI collapse was significantly higher. LS value and inspiratory-VCI diameter before pericardiocentesis independently determined the risk of cardiac tamponade. Each 1kPa increase in LS value and 1mm increase in inspiratory-VCI diameter increased the risk of cardiac tamponade by 4.9-times and 40.8%, respectively. When the cut-off value of 10kPa for LS was analyzed, it determined the presence of cardiac tamponade with ≥90% sensitivity and specificity. The higher LS before pericardiocentesis and the decrease in LS after pericardiocentesis (Δ-Liver stiffness of 5.91±1.79 kPa in first group and 2.31±1.25 kPa in the second group) was interpreted to be directly related to the pathophysiology of systemic congestion due to PE. CONCLUSION In all patients with severe PE, and especially in patients with cardiac tamponade, the LS is significantly increased and this modification can be explained by the systemic congestion. However, this being the first study to evaluate LS in patients with severe PE and cardiac tamponade, the data should be confirmed by multicenter prospective studies.
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Affiliation(s)
- Hasan Koca
- Department of Cardiology, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey.
| | - Ayse Selcan Koc
- University of Health Sciences - Adana Health Practice and Research Center.
| | - Hilmi Erdem Sumbul
- Department of Internal Medicine, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey.
| | - Mevlut Koc
- Department of Cardiology, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey.
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Demirtas AO, Koc AS, Sumbul HE, Koca H, Icen YK, Demirtas D, Pekoz BC, Ardıc LM, Koc M, Kucukosmanoglu M. Liver stiffness obtained by ElastPQ ultrasound shear wave elastography independently determines mean right atrial pressure. Abdom Radiol (NY) 2019; 44:3030-3039. [PMID: 31154483 DOI: 10.1007/s00261-019-02083-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE We aimed to investigate the relationship between right atrial pressure (RAP) and liver stiffness (LS) determined by liver elastography (LE) during cardiac resynchronization therapy (CRT) in patients with heart failure (HF) and conventional pacemaker (PM) implantation in patients without HF. METHODS 60 patients with HF who underwent CRT and 60 patients without HF who underwent PM were enrolled. Routine echocardiography and laboratory examinations were performed. Systolic, diastolic, and mean RAP measurements were performed inversely during PM implantation and LS measurement with ElastPQ technique. RESULTS Systolic, diastolic, and mean RAP, left ventricular (LV) systolic-diastolic, right ventricular (RV) diastolic and left atrial diameters, tricuspid regurgitation pressure gradient, and RV-myocardial performance index (MPI) values were significantly higher in patients with HF (p < 0.05 each-one). LV ejection fraction and tricuspid annular plane systolic excursion values were significantly lower in patients with HF group (p < 0.05 each-one). LS values and inspiratory (Ins) and expiratory inferior vena cava (IVC) diameters were significantly higher in the patients with HF (p < 0.05 each-one). Mean RAP was found to be closely related to LS value, Ins-IVC diameter, RV-MPI, and NT-proBNP levels. LS value and Ins-IVC diameter were found to determine patients with mean RAP > 5 mmHg and > 10 mmHg. When the cut-off value of LS was taken as 7 kPa, it was found that the mean RAP > 10 mmHg with 89.6% sensitivity and 87.5% specificity. CONCLUSIONS The non-invasive LS value determined by LE independently determines the mean RAP in patients with and without HF. According to our study results, > 7 kPa value for LS determined in liver US may be predictive for increased mean RAP.
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Affiliation(s)
- Abdullah Orhan Demirtas
- Department of Cardiology, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - Ayse Selcan Koc
- Department of Radiology, University of Health Sciences - Adana Health Practice and Research Center, Dr. Mithat Özsan Bulvarı Kışla Mah, 4522 Sok, No: 1 Yüreğir, Adana, Turkey.
| | - Hilmi Erdem Sumbul
- Department of Internal Medicine, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - Hasan Koca
- Department of Cardiology, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - Yahya Kemal Icen
- Department of Cardiology, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - Derya Demirtas
- Department of Internal Medicine, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - Burcak Cakır Pekoz
- Department of Radiology, University of Health Sciences - Adana Health Practice and Research Center, Dr. Mithat Özsan Bulvarı Kışla Mah, 4522 Sok, No: 1 Yüreğir, Adana, Turkey
| | - Lutfullah Mustafa Ardıc
- Department of Cardiology, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - Mevlut Koc
- Department of Cardiology, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - Mehmet Kucukosmanoglu
- Department of Cardiology, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
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Abstract
BACKGROUND We aimed to determine whether there is an increase in aortic intima-media thickness values measured from the abdominal aorta in addition to the traditional carotid intima-media thickness in patients with primary hyperparathyroidism and to determine the parameters closely related to aortic intima-media thickness. METHODS This perspective study included 65 primary hyperparathyroidism patients and 30 healthy-controls. Routine laboratory tests for the diagnosis of hyperparathyroidism and vascular ultrasound examinations were performed. Common carotid, internal carotid, and abdominal aortic intima media thickness were measured. The participants of the study was divided into 3 groups as the control (Group-I), the medical treatment (Group-II) due to primary hyperparathyroidism, and the planned surgery (group-III). RESULTS Aortic intima-media thickness, serum urea, creatinine, glucose, uric acid, hs-CRP, parathyroid hormone, calcium and urine calcium levels increased significantly from Group-I to Group-III and T-scores and serum phosphorus in levels decreased significantly. Carotid intima-media thicknesses were not significantly different between the groups. Serum and urinary calcium levels were independently associated with aortic intima-media thickness. Aortic intima-media thickness, serum phosphorus, parathyroid hormone, T-scores, serum and urinary calcium levels are independent indicators for Group-III. When the cut-off value of aortic intima-media thickness was taken as 1.5 mm, 80.6% sensitivity and 89.1% specificity were determined for patients who would go to surgery. CONCLUSION Serum and urine calcium levels were independently associated with aortic intima-media thickness. Aortic intima-media thickness is more useful than carotid intima-media thickness in showing vascular organ involvement in patients with primary hyperparathyroidism.
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Affiliation(s)
- Hilmi Erdem Sumbul
- Department of Internal Medicine, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - Ayse Selcan Koc
- Department of Radiology, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
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Koc AS. The Efficacy of 0.2 Tesla Open Magnetic Resonance Imaging Scanner in the Diagnosis of Anterior Cruciate Ligament Injury. Eur J Ther 2019. [DOI: 10.5152/eurjther.2019.18051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Koc AS, Demirtas D, Gorgulu FF, Sumbul HE. Diurnal variation of renal resistive index over 24-hour period in hypertensive patients and healthy controls. Abdom Radiol (NY) 2019; 44:1010-1018. [PMID: 30293108 DOI: 10.1007/s00261-018-1798-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE There are no data in the literature to our knowledge related to changes in renal resistive index (RRI) values over 24-h period and the importance of detecting these changes in patients who have hypertension (HT). In this study, we aimed to investigate the variation of RRI values over 24-h period and its usability in hypertensive patients. METHODS A total of 118 subjects (80 with HT and 38 healthy controls) were included in the study. Morning, midday, evening, and midnight RRI, renal pulsatility index, and accelerated time were measured by Doppler ultrasonography (US). B-mode US and elastograpic assessment were performed only in the morning. RESULTS Temporal RRI varied significantly (p < 0.001). The highest and lowest levels were found in the morning and evening, respectively. All temporal RRI levels were significantly higher in patients with HT (both p < 0.001). The absolute and relative increases in RRI (ΔRRI) levels were similar in two groups. All temporal RRI measurements positively correlated with the patient age, pulse pressure, renal cortical thickness, and cortical stiffness. However, absolute-ΔRRI and relative-ΔRRI positively correlated with the age. Absolute-ΔRRI positively correlated with the pulse pressure and cortical stiffness, and no correlation was observed between relative-ΔRRI and these variables. Of the four temporal measurements, morning RRI were found to be independently associated with cortical stiffness (p < 0.001). CONCLUSIONS RRI measurements varied over 24-h period in patients with HT and/or healthy controls. Morning RRI was significantly higher than other day time, and it is also related to renal cortical stiffness.
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Affiliation(s)
- Ayse Selcan Koc
- Department of Radiology, University of Health Sciences-Adana Health Practice and Research Center, Dr. Mithat Özsan Bulvarı Kışla Mah. 4522 Sok. No: 1 Yüreğir, Adana, Turkey.
| | - Derya Demirtas
- Department of Internal Medicine, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Feride Fatma Gorgulu
- Department of Radiology, University of Health Sciences-Adana Health Practice and Research Center, Dr. Mithat Özsan Bulvarı Kışla Mah. 4522 Sok. No: 1 Yüreğir, Adana, Turkey
| | - Hilmi Erdem Sumbul
- Department of Internal Medicine, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
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Koc AS, Pekoz BC, Donmez Y, Yasar S, Ardic M, Gorgulu FF, Icen YK, Sumbul HE, Koc M. Usability of Achilles tendon strain elastography for the diagnosis of coronary artery disease. J Med Ultrason (2001) 2019; 46:343-351. [PMID: 30783822 DOI: 10.1007/s10396-019-00931-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 01/15/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE There are close relationships between major coronary artery disease (CAD) risk factors and Achilles tendon thickness (AT-T) and AT strain ratio (AT-SR). Our aim was to evaluate the diagnostic importance of AT-T and AT-SR as obtained by ultrasonography (USG) and strain elastography (SE) for predicting CAD. MATERIALS AND METHODS One hundred and eighty-four patients scheduled to undergo coronary angiography were included in the study. Achilles tendon USG (B-mode and SE) and laboratory tests were performed on all patients. The patients were divided into two groups, i.e., patients with and without CAD. RESULTS The patients with CAD (72.8%) were more likely to be male, exhibited higher frequencies of diabetes mellitus (DM) and hyperlipidemia, exhibited higher levels of basal creatinine and glucose, and had higher AT-T and AT-SR values (p < 0.05 for all). Age, DM, AT-T, and AT-SR independently predicted the probability of CAD in a logistic regression analysis (p < 0.05 for all). Age (each year), DM (presence), AT-T (each 1 mm), and AT-SR (each 0.1) increased the CAD risk by 3.4%, 2.9 times, 47.1%, and 16.0%, respectively. ROC analysis revealed AUCs of 0.665 and 0.730 for the AT-T and AT-SR values, respectively (p < 0.05). The AT-SR cutoff value of 1.2 predicted the presence of CAD with 75.4% sensitivity and 72.7% specificity. CONCLUSIONS AT-SR is a simple, inexpensive, noninvasive, reproducible, and objective parameter for the prediction of CAD. We think that AT-SR evaluation should become a part of conventional USG assessments in patients who are at a high risk of CAD.
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Affiliation(s)
- Ayse Selcan Koc
- Department of Radiology, University of Health Sciences-Adana Health Practice and Research Center, Dr. Mithat Özsan Bulvarı Kışla Mah. 4522 Sok. No: 1 Yüreğir, Adana, Turkey.
| | - Burcak Cakir Pekoz
- Department of Radiology, University of Health Sciences-Adana Health Practice and Research Center, Dr. Mithat Özsan Bulvarı Kışla Mah. 4522 Sok. No: 1 Yüreğir, Adana, Turkey
| | - Yurdaer Donmez
- Department of Cardiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Simge Yasar
- Department of Cardiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Mustafa Ardic
- Department of Cardiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Feride Fatma Gorgulu
- Department of Radiology, University of Health Sciences-Adana Health Practice and Research Center, Dr. Mithat Özsan Bulvarı Kışla Mah. 4522 Sok. No: 1 Yüreğir, Adana, Turkey
| | - Yahya Kemal Icen
- Department of Cardiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Hilmi Erdem Sumbul
- Department of Internal Medicine, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Mevlut Koc
- Department of Cardiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
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Abstract
Elastography is a method to examine the increase in solid organs stiffness (SOS), and there is no data in the literature regarding to its use in patients with acromegaly. In this study, we aimed to investigate the change of SOS in patients with acromegaly and to determine the parameters closely related to SOS in same patient groups.We included 40 subjects with acromegaly and 40 healthy control subjects. In addition to routine renal, liver and thyroid ultrasonography (USG), SOS for 3 solid organs were measured by elastography. The participants of the study were divided into 3 groups as the control (Group-I), acromegaly patients with remission (Group-II), and acromegaly patients without remission (Group-III).Insulin growth factor-1 (IGF-1) level significantly increased from Group-I to Group-III. Glucose, creatinine, albuminuria, alkaline phosphatase, TSH, and growth factor levels were highest in Group-III and statistically significance was found only between Group-I and Group-III. Liver, kidney and thyroid size and echogenicity were increased from Group-I to Group-III. Liver and renal stiffness and thyroid gland strain ratio significantly increased from Group-I to Group-III and these parameters were statistically different between all groups. In linear regression analysis, IGF-1 levels were independent determinants of SOS.SOS values of acromegaly patients with active disease were significantly increased compared to both the control group and the acromegaly patients in remission phase. Serum IGF-1 levels were independently associated with SOS in these patients. SOS measurement should be part of a routine USG examination in patients with acromegaly, especially in patients during active disease.
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Affiliation(s)
| | | | - Ayse Selcan Koc
- Department of Radiology, University of Health Sciences—Adana Health Practice and Research Center, Adana, Turkey
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Koc AS, Sumbul HE, Gülümsek E. Increased renal cortical stiffness in patients with advanced diabetic kidney disease. Saudi J Kidney Dis Transpl 2019; 30:138-150. [PMID: 30804275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
We aimed to determine whether cortical stiffness (CS) values obtained by point shear wave elastography (pSWE) were increased in patients with diabetic kidney disease (DKD) according to increased disease stage and to determine the parameters associated with CS value in the same patient group. A total of 120 patients with Type-II diabetes mellitus who developed DKD and 22 healthy controls were included in the study. In addition to routine laboratory tests and renal ultrasonography (USG), CS levels were measured using pSWE. Carotid intima-media thickness (IMT) and aortic-IMT values were measured. Patients were grouped according to DKD stage (Stage I-II-III-IV-V), then the control group was added and, the six groups were compared within themselves. Renal CS values were found to be significantly higher in all stages of DKD than in the control group and were found to be increased in accordance with the increase in DKD stage (P <0.05). When receiver operating characteristic curve analysis was performed for determining patients with Stage IV-V DKD, it was found that AUC was >70% for parathyroid hormone (PTH), common and internal carotid-IMT, NT-proBNP, cortical thickness, and CS values. It was found that cortical thickness and PTH levels were independently associated with renal CS in DKD patients and independently determined the risk of increased CS (>9.0 kPa) in DKD patients (P <0.05). Renal CS is increased with increasing DKD stage and this is closely related to decreased cortical thickness and serum PTH levels. Renal CS measurement should be used during follow-up of a patient as part of the renal USG.
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Affiliation(s)
- Ayse Selcan Koc
- Department of Radiology, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - Hilmi Erdem Sumbul
- Department of Internal Medicine, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - Erdinç Gülümsek
- Department of Internal Medicine, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
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Koc AS, Sumbul HE. Relationship Between Renal Resistive Index and Increased Renal Cortical Stiffness in Patients with Preserved Renal Function. Eur J Ther 2018. [DOI: 10.5152/eurjther.2018.817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Icen YK, Koc AS, Sumbul HE. Reply to the Letter to the Editor Entitled "Association of SYNTAX Score With Abdominal Aortic Intima-Media Thickness in Non-ST Elevation Myocardial Infarction". Angiology 2018; 70:571. [PMID: 30394794 DOI: 10.1177/0003319718811653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Yahya Kemal Icen
- 1 Department of Cardiology, Adana Health Practices and Research Center, Health Sciences University, Adana, Turkey
| | - Ayse Selcan Koc
- 2 Department of Radiology, Adana Health Practice and Research Center, Health Sciences University, Adana, Turkey
| | - Hilmi Erdem Sumbul
- 3 Department of Internal Medicine, Adana Health Practice and Research Center, Health Sciences University, Adana, Turkey
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İçen YK, Koc AS, Sumbul HE. Reply to the Letter to the Editor Entitled ''Coronary Artery Disease Severity Is Associated With Abdominal Aortic Intima-Media Thickness in Patients With Non-ST-Segment Elevation Myocardial Infarction''. Angiology 2018; 70:568. [PMID: 30354183 DOI: 10.1177/0003319718808391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yahya Kemal İçen
- 1 Health Sciences University Adana Health Practices and Research Center Cardiology Department, Adana, Turkey
| | - Ayse Selcan Koc
- 2 Health Sciences University Adana Health Practice and Research Center Radiology Department, Adana, Turkey
| | - Hilmi Erdem Sumbul
- 3 Health Sciences University Adana Health Practice and Research Center Internal Medicine Department, Adana, Turkey
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Cilsal E, Koc AS. Renal resistive index significantly increased in hypertensive children and it is independently related to the pulse pressure and left ventricular mass index. Clin Exp Hypertens 2018; 41:607-614. [PMID: 30285504 DOI: 10.1080/10641963.2018.1523920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: To the best our knowledge there is no data in the literature related to changes in renal resistive index (RRI) values in children who have hypertension (HT). In this study, we aimed to investigate the changes of RRI values and it is usability in children with HT. Methods: A total of 75 children; 48 with newly diagnosed HT and 27 healthy controls were included in the study. Routine history, physical examination, and laboratory examinations were performed. Left ventricular (LV) dimensions and systolic-diastolic functions, septum and posterior wall thickness (IVSd and PWd) and LV mass index (LVMI) were calculated by echocardiography. In addition to routine renal ultrasonography (US), renal pulsatility indexes (RPI), accelerated time and RRI were measured. Increased RRI was accepted as >0.70. Results: Increased RRI was detected in 25 (52%) of HT patients. Systolic and diastolic blood pressure (SBP and DBP), and pulse pressure (PP), low-density lipoprotein cholesterol and triglyceride levels, RRI, RPI, kidney length, IVSd, PWd, and LVMI were significantly higher in patients with HT (both p < 0.05). SBP and PP, PWd, LV ejection fraction, LV fractional shortening, and LVMI were positively correlated with the RRI. High-density lipoprotein cholesterol was negatively correlated with the RRI. Of these measurements, RRI values were found to be independently associated with PP and LVMI (p < 0.05). Conclusions: In hypertensive children, RRI was significantly higher than healthy controls and it is also related with LVMI and PP.
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Affiliation(s)
- Erman Cilsal
- a Department of Pediatric Cardiology, University of Health Sciences - Adana Health Practice and Research Center , Adana , Turkey
| | - Ayse Selcan Koc
- b Department of Radiology, University of Health Sciences - Adana Health Practice and Research Center , Adana , Turkey
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Icen YK, Koc AS. Silent ischemic brain lesions detected by multi-slice computed tomography are associated with subclinical atrial fibrillation in patients with cardiac resynchronization therapy. Postepy Kardiol Interwencyjnej 2018; 14:285-290. [PMID: 30302105 PMCID: PMC6173091 DOI: 10.5114/aic.2018.78332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/17/2018] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION There is insufficient research on the relationship between subclinical atrial fibrillation (SCAF) and silent ischemic brain lesions (IBLs). AIM To investigate the relationship between SCAF and silent IBLs in patients with cardiac resynchronization therapy (CRT). MATERIAL AND METHODS Of 720 CRT implanted patients in our department between 2012 and 2018, 121 patients who underwent elective cranial multi-slice computed tomography (MSCT) during their follow-up were included in our study. Atrial high-rate episodes (AHRE) were detected by the CRT device. Subclinical atrial fibrillation was defined as asymptomatic AHRE longer than 6 min and shorter than 24 h. A cranial MSCT scan was performed using a 128-section scanner with contiguous 2-5 mm axial images. Patients were divided into two groups - with and without silent IBL. RESULTS Silent IBLs were detected in 21 (17.4%) of 121 patients with CRT. Ischemic brain lesion presence was found to be associated with age, CHA2DS2-VASc score, left ventricular (LV) ejection fraction (EF), hypertension and SCAF in univariate analysis (p < 0.05). In multivariate regression analysis, presence of SCAF and LVEF were found to be independent parameters predicting the risk of silent IBLs. According to this analysis, the presence of SCAF and every 1% decrease in LVEF were found to increase the risk of silent IBL by 3.5 times and 14.8%, respectively. CONCLUSIONS Subclinical atrial fibrillation is independently associated with silent IBL presence. Patients with CRT should be closely monitored for SCAF. Patients diagnosed with SCAF should be evaluated for IBL development and treated with the appropriate oral anticoagulant.
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Affiliation(s)
- Yahya Kemal Icen
- Department of Cardiology, Adana Health Practices and Research Center, Health Sciences University, Adana, Turkey
| | - Ayse Selcan Koc
- Department of Radiology, Adana Health Practices and Research Center, University of Health Sciences, Adana, Turkey
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Sumbul HE, Koc AS, Demirtas D. Increased carotid-femoral pulse wave velocity and common carotid artery intima-media thickness obtained to assess target organ damage in hypertensive patients are closely related. Clin Exp Hypertens 2018; 41:466-473. [PMID: 30141974 DOI: 10.1080/10641963.2018.1506471] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Increased carotid-femoral pulse wave velocity (CF-PWV) and increased carotid intima-media thickness (IMT) in hypertension (HT) patients are indicators of asymptomatic organ damage. The relationship between carotid IMT and CF-PWV has been shown; studies comparing CF-PWV and IMT values within different vascular regions are limited. We aimed to investigate the relationship between IMT value measured from different anatomical regions and CF-PWV, and the localization of IMT that determines increased CF-PWV best. METHODS This study included 312 patients with HT. CF-PWV measurements with Doppler ultrasonography (USG). Vascular IMTs were measurements of common-internal carotid, brachial, and femoral arteries with B-mode USG (CC-IMT, IC-IMT, B-IMT, and F-IMT, respectively). Patients were divided into two groups according to their CF-PWV value (Increased CF-PWV >10 m/s and normal CF-PWV ≤10m/s). RESULTS Increased CF-PWV was detected in 54 (17.3%) of HT patients. The patient group with increased CF-PWV was older, and their CC-IMT, IC-IMT and F-IMT values were found to be higher. The other 3 IMT increases excluding B-IMT were closely related to the CF-PWV increase. Only age and CC-IMT values were found to be most closely related to CF-PWV. CC-IMT and age were found to be independently associated with increased CF-PWV. CC-IMT (each-0.1 mm) and age (each year) were found to augment the development of increased CF-PWV by 50.3% and 14.6%, respectively. CONCLUSION There is a close relationship between CC-IMT and CF-PWV increase in HT. It was thought that it would still be more useful to look at the increase of CC-IMT compared to other vascular regions for screening asymptomatic organ damage.
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Affiliation(s)
- Hilmi Erdem Sumbul
- a Department of Internal Medicine , University of Health Sciences - Adana Health Practice and Research Center , Adana , Turkey
| | - Ayse Selcan Koc
- b Department of Radiology , University of Health Sciences - Adana Health Practice and Research Center , Adana , Turkey
| | - Derya Demirtas
- a Department of Internal Medicine , University of Health Sciences - Adana Health Practice and Research Center , Adana , Turkey
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Icen YK, Koc AS, Sumbul HE. Coronary Artery Disease Severity Is Associated With Abdominal Aortic Intima–Media Thickness in Patients With Non-ST-Segment Elevation Myocardial Infarction. Angiology 2018; 70:561-566. [DOI: 10.1177/0003319718794833] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yahya Kemal Icen
- Cardiology Department, Health Sciences University, Adana Health Practice and Research Center, Adana, Turkey
| | - Ayse Selcan Koc
- Radiology Department, Health Sciences University, Adana Health Practice and Research Center, Adana, Turkey
| | - Hilmi Erdem Sumbul
- Internal Medicine Department, Health Sciences University, Adana Health Practice and Research Center, Adana, Turkey
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Koc AS, Sumbul HE. Renal cortical stiffness obtained by shear wave elastography imaging is increased in patients with type 2 diabetes mellitus without diabetic nephropathy. J Ultrasound 2018; 21:279-285. [PMID: 30051234 DOI: 10.1007/s40477-018-0315-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/18/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE It is known that patients with type 2 diabetes mellitus (DM) who develop diabetic nephropathy have increased renal cortical stiffness (CS) determined by shear wave elastography (SWE). However, there is no data in the literature to our knowledge related to CS values determined by SWE in type 2 DM patients with normal renal function. In this study, we aimed to investigate the change of renal CS obtained by SWE examination in type 2 DM patients with normal renal function compared to non DM patients. METHODS A total of 103 patients (86 males, 17 females and mean age 63.2 ± 11.8 years) with or without type 2 DM were included in the study. The eGFR value of all patients was > 60 ml/kg/1.732. Routine history, physical examination and laboratory examinations were performed. In addition to routine renal ultrasonography (USG), renal resistive index (RRI), renal pulsatility index (RPI), accelerated time (AT), and CS were measured. RESULTS Fifty patients with type 2 DM and 53 patients without type 2 DM were included in the study. Patients with type 2 DM had higher blood glucose, blood urea nitrogen and HbA1c levels (p < 0.05 each one). Renal length and width and echogenicity were similar between two groups with conventional renal USG. Renal parenchyma thickness was higher in patients with type 2 DM. When the findings of renal Doppler USG were examined, RRI was similar between two groups. RPI and AT were higher in patients with type 2 DM. CS values obtained with renal SWE were significantly higher in patients with type 2 DM (p < 0.05). CONCLUSION Cortical stiffness value obtained by SWE is significantly higher in type 2 DM patients with normal renal function compared to patients without DM. We recommend CS measurement as part of routine screening of nephropathy in patients with type 2 DM and normal renal function to guide management and treatment plan.
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Affiliation(s)
- Ayse Selcan Koc
- Department of Radiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey.
| | - Hılmı Erdem Sumbul
- Department of Internal Medicine, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
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Koc AS, Sumbul HE. Increased aortic intima-media thickness may be used to detect macrovascular complications in adult type II diabetes mellitus patients. Cardiovasc Ultrasound 2018; 16:8. [PMID: 29891012 PMCID: PMC5996542 DOI: 10.1186/s12947-018-0127-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/06/2018] [Indexed: 12/31/2022] Open
Abstract
Background Carotid intima media thickness (C-IMT) and aortic IMT (A-IMT) increase in adult and pediatric patients with diabetes mellitus (DM), respectively. In both age groups IMT is used for early detection of macrovascular complications. In adult DM patients, A-IMT is still not a routine examination and is not used frequently. We aimed to determine whether there is an increase in A-IMT values measured from abdominal aorta besides traditional C-IMT in patients with type II DM and to determine parameters closely related to A-IMT in the same patient group. Methods We included 114 type II DM patients and 100 healthy control subjects similar in age and sex in our study. Bilateral C-IMT and A-IMT values were measured by B-mode ultrasonography (USG) in addition to anamnesis, physical examination and routine examinations of all patients. Results When the clinical, demographic and laboratory data of patients with and without DM were compared, there was a high level of glucose and HbA1c and low hemoglobin levels in the DM patient group. All other parameters were found to be similar between the two groups. When the B-mode USG findings were examined, it was found that C-IMT and A-IMT were increased in patients with DM, with the A-IMT increase being more prominent. A-IMT values were found to be strongly and positively correlated with age, systolic blood pressure, blood urea nitrogen, DM onset time and HbA1c levels, and a negatively and significantly correlated with hemoglobin levels (p < 0.05, for each). In the regression model, the parameters correlating most closely with A-IMT were DM diagnosis onset time, HbA1c and hemoglobin levels (p = 0.001 and β = 0.353, p = 0.014 and β = 0.247 and p < 0.001 and β = − 0.406). Conclusions As in pediatric DM patients also in adult DM patients A-IMT can easily be measured with new model USG devices. A-IMT must be measured during abdominal USG which is routine in adult DM patients. A-IMT is an easy, reproducible and non-invasive parameter that may be used in the diagnosis of macrovascular complications of adult type II DM.
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Affiliation(s)
- Ayse Selcan Koc
- Department of Radiology, University of Health Sciences - Adana Health Practices and Research Center, Adana, Turkey.
| | - Hilmi Erdem Sumbul
- Department of Internal Medicine, University of Health Sciences - Adana Health Practices and Research Center, Adana, Turkey
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Kaya O, Yilmaz C, Akin MA, Gulek B, Soker G, Dilek O, Koc AS. A Rare Diagnosis in a Patient With Pelvic Pain: Adnexal Schwannoma. Curr Med Imaging 2018. [DOI: 10.2174/1573405613666170504154316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Omer Kaya
- Department of Radiology, Adana Numune Teaching and Research Hospital, University of Health Sciences, Adana, Turkey
| | - Cengiz Yilmaz
- Department of Radiology, Adana Numune Teaching and Research Hospital, University of Health Sciences, Adana, Turkey
| | - Mehmet Ali Akin
- Department of Radiology, Adana Numune Teaching and Research Hospital, University of Health Sciences, Adana, Turkey
| | - Bozkurt Gulek
- Department of Radiology, Adana Numune Teaching and Research Hospital, University of Health Sciences, Adana, Turkey
| | - Gokhan Soker
- Department of Radiology, Adana Numune Teaching and Research Hospital, University of Health Sciences, Adana, Turkey
| | - Okan Dilek
- Department of Radiology, Adana Numune Teaching and Research Hospital, University of Health Sciences, Adana, Turkey
| | - Ayse Selcan Koc
- Department of Radiology, Adana Numune Teaching and Research Hospital, University of Health Sciences, Adana, Turkey
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Koc AS, Gorgulu FF, Donmez Y, Icen YK. There is a significant relationship between morning blood pressure surge and increased abdominal aortic intima-media thickness in hypertensive patients. J Med Ultrason (2001) 2018. [PMID: 29536281 DOI: 10.1007/s10396-018-0877-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE There are limited data about increased aortic intima-media thickness (A-IMT) in the presence of subclinical target organ damage in hypertensive (HT) patients. In this study, we aimed to determine the frequency of increased A-IMT, the parameters determining increased A-IMT, and the relationship between increased A-IMT and other vascular IMT measurements. MATERIALS AND METHODS We prospectively included 265 patients (mean age 54.1 ± 10.6 years, male/female 91/174) with essential HT. Physical examination of all patients was performed. Laboratory data and antihypertensive treatments were recorded. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) was performed. Bilateral carotid, brachial, and femoral artery and abdominal A-IMT values were measured by B-mode ultrasonography (USG). Patients were categorized into two main groups: patients with increased A-IMT (≥ 3 mm) or normal A-IMT (< 3 mm). RESULTS Increased A-IMT was detected in 55 patients (20.8%). There was a close relationship between increased A-IMT and advanced age, presence of coronary artery disease, high morning blood pressure surge (MBPS), and bilateral carotid and femoral IMT. Parameters associated with increased A-IMT in univariate analysis were assessed by regression analysis. Left femoral IMT and MBPS were independently associated with increased A-IMT. In the regression model, each 5-mmHg elevation in MBPS increased the risk of increased A-IMT by 34.2%. The cutoff value of MBPS obtained by the ROC curve analysis was 32 mmHg for the prediction of increased A-IMT (sensitivity 76.3%, specificity 63.5%). The area under the curve was 0.784 (95% CI 0.720-0.847, p < 0.001). CONCLUSION Abdominal A-IMT increased at a significant rate in patients with HT. An independent association was found between MBPS and A-IMT, which can both be easily detected by ABPM and B-mode USG. The high MBPS level was considered to be a simple and inexpensive method for detecting subclinical target organ damage. A-IMT measurement should also be a part of abdominal USG, which is a routine examination in HT patients.
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Affiliation(s)
- Ayse Selcan Koc
- Department of Radiology, University of Health Sciences, Adana Health Practice and Research Center, Adana, Turkey.
| | - Ferıde Fatma Gorgulu
- Department of Radiology, University of Health Sciences, Adana Health Practice and Research Center, Adana, Turkey
| | - Yurdaer Donmez
- Department of Cardiology, University of Health Sciences, Adana Health Practice and Research Center, Adana, Turkey
| | - Yahya Kemal Icen
- Department of Cardiology, University of Health Sciences, Adana Health Practice and Research Center, Adana, Turkey
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Yardim MS, Cilingiroglu N, Yaman N, Koc AS, Kaplan A, Aydın B, Umutlu MR, Tanriover MD, Turhan O. Inappropriate Utilization of Emergency Services as a Health System Provision Challenge: An Example from a University Hospital in Ankara, Turkey between 1-7 February 2014. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku165.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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