Betul Erer - Academia.edu (original) (raw)
Papers by Betul Erer
Acta Cardiologica Sinica, 2012
A twenty-year old female with a history of allergic asthma and Raynaud's phenomenon was admit... more A twenty-year old female with a history of allergic asthma and Raynaud's phenomenon was admitted to our emergency department with retrosternal chest pain of one hour duration accompanied by generalized erythema, urticarial rashes, moderate dyspnea, nausea and vomiting. Her symptoms developed after taking a dose of naproxen sodium for dysmenorrhea. ECG showed ST segment elevation in leads I and aVL and ST segment depression in leads III and aVF. The patient's chest pain relieved and ST elevations resolved during her transport to the catheterization laboratory, Immediate angiography revealed normal coronary arteries.This coronary syndrome was thought to be secondary to allergy-induced coronary vasospasm known as ”Kounis syndrome”. The main pathophysiological mechanism of coronary spasm in Kounis syndrome is the inflammatory mediators released during a hypersensitivity reaction triggered by food, insect bites or drugs. Here, we report a case of coronary spasm secondary to allcr...
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2008
We investigated factors associated with prolonged prehospital delay in patients with acute myocar... more We investigated factors associated with prolonged prehospital delay in patients with acute myocardial infarction (AMI). A total of 439 patients (351 males, 88 females; mean age 57+/-12 years) with ST-elevation AMI were interviewed within 48 hours of hospitalization. Patients were pain-free and hemodynamically stable at the time of interview. Data were collected on the time from the onset of chest pain to hospital admission and on sociodemographic and clinical characteristics. The patients were evaluated in two groups according to the place to which the first presentation was made, i.e., a local clinic/small hospital (clinic group: n=209, 47.6%) or our tertiary fully equipped cardiovascular center (hospital group: n=230, 52.4%). The median and mean delay times were 70 min and 185.2+/-334.8 min, respectively. Of the study group, 136 patients (31%) arrived within 60 minutes after the onset of symptoms. The median delay time was significantly longer in the clinic group (120 min vs 60 mi...
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2008
We investigated mean platelet volume (MPV) in patients with slow coronary flow (SCF) and its poss... more We investigated mean platelet volume (MPV) in patients with slow coronary flow (SCF) and its possible relationship with clinical presentation. The study included 50 patients with SCF and otherwise normal coronary arteries and 22 patients (control group) with normal coronary arteries. In the SCF group, there were 26 patients with stable angina pectoris (SAP), and 24 patients with unstable angina pectoris (USAP). Coronary blood flow was measured using the TIMI frame count. To determine MPV, blood samples with K3 EDTA were processed after one hour of venipuncture. The relationship between MPV and SCF was sought. The mean TIMI frame count was markedly increased in patients with SCF compared to controls (p<0.0001). No significant differences existed between the groups with regard to white blood cell and platelet counts. Patients with SCF had significantly higher MPV values compared to controls (9.4+/-2.3 fl vs 8.1+/-2.0 fl, p=0.014). In subgroup analysis, MPV was significantly increas...
Medical Principles and Practice, 2015
Objective: In this study, we aimed to investigate the left atrial (LA) electrical and mechanical ... more Objective: In this study, we aimed to investigate the left atrial (LA) electrical and mechanical functions in patients with metabolic syndrome (MetS). Subjects and Methods: The study population consisted of 87 patients with MetS and 67 controls. Intra-atrial and interatrial electromechanical delays (EDs) were measured with tissue Doppler imaging. P-wave dispersion (Pd) was calculated from the 12-lead electrocardiograms. LA volumes were measured echocardiographically by the biplane area-length method. Results: Intra-atrial and interatrial EDs and Pd were significantly higher in patients with MetS (10.3 ± 6.3, 21.0 ± 11.5 and 41.7 ± 10.8) than in controls (7.4 ± 5.5, 12.3 ± 10.4 and 29.2 ± 7.4; p = 0.003, p < 0.001 and p < 0.001, respectively). The LA preatrial contraction volume and active emptying volumes were higher in this population, but the LA passive emptying fraction was lower. In the multivariate linear regression analysis, the presence of MetS, LA active emptying volum...
Journal of the American College of Cardiology, 2013
ABSTRACT The Zwolle score (Zs) is a validated risk score that has been used to identify low-risk ... more ABSTRACT The Zwolle score (Zs) is a validated risk score that has been used to identify low-risk patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). The Syntax score (Ss) is an angiographic score that evaluates the complexity of coronary artery disease (CAD). We aimed to create a simple risk score by combining these two scores for risk stratification in patients with STEMI undergoing primary PCI. 299 consecutive STEMI patients (mean age 57.4±11.7, 240 men) who underwent primary PCI were prospectively enrolled in to the present study. The study population was divided into tertiles based on admission Zs and Ss. A high Zs (>3) and high Ss (>24) were defined as values in the third tertiles. A low Zs and low Ss were defined as values in the lower two tertiles. Patients were then classified into four groups: High Zs and high Ss (HZsHSs, n=26); high Zs and low Ss (HZsLSs, n=29);low Zs and high Ss (LZsHSs, n=48);low Zs and low Ss (LZsLSs, n=196). In-hospital cardiac outcomes were then recorded. In-hospital cardiovascular mortality was higher in HZsHSs (50%) compared to HZsLSs (27.5%), LZsHSs (0%), and LZsLSs(0.5%) groups. After adjustment for potentially confounding factors, HZsHSs (odds ratio [OR] 77.6, 95% confidence interval [CI], 6.69-113.1; p=0.001), and HZsLSs (OR 28.9, 95% CI, 2.77-56.2; p=0.005) status, but not LZsHSs and LZsLSs status, remained independent predictors of in-hospital cardiovascular mortality. STEMI patients with HZsHSs represent the highest risk population for in-hospital cardiovascular mortality.
Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology, 2010
Increased resistance to pulmonary venous drainage is the main mechanism in pulmonary hypertension... more Increased resistance to pulmonary venous drainage is the main mechanism in pulmonary hypertension (PH) developing due to left heart disease. This condition may occur as a result of various diseases affecting left ventricle, left atrium, mitral or aortic valves. Pulmonary hypertension is the common and well-recognized complication of left ventricular systolic dysfunction and pulmonary arterial hypertension accompanying chronic heart failure is related to increased mortality. Treatment should be tailored according to the underlying disease.
Echocardiography, 2010
To determine the subclinical effects of isolated obesity and its duration on cardiac function by ... more To determine the subclinical effects of isolated obesity and its duration on cardiac function by using routine echocardiography and tissue Doppler myocardial strain rate. Forty-nine subjects were enrolled in this study; 29 with isolated obesity defined as a body mass index &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 30 kg/m(2) with no other cardiovascular comorbidities, and 20 nonobese controls. All subjects underwent two-dimensional and Doppler echocardiography including tissue Doppler imaging and myocardial strain rate. The average duration of obesity was 12.1 years (4-18 years). Abnormalities of left ventricular (LV) wall thickness, mass, diastolic function, and left atrial size were detected in obese individuals, despite having preserved ejection fractions. The LV global longitudinal peak strain rate was significantly lower in obese subjects compared to nonobese control subjects (1.07 +/- 0.14 vs. 1.38 +/- 0.12, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Using multivariate analysis, the duration of obesity (ss=-0.76, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), body mass index (ss=-0.35, P = 0.023), and age (ss=-0.29, P = 0.009) were independent predictors of the decreased LV global longitudinal peak strain rate, while the duration of obesity (ss=-0.66, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and body mass index (ss=-0.28, P = 0.037) were independent predictors of the decreased right ventricular (RV) peak strain rate. The presence and the duration of obesity were associated with impairment of subclinical biventricular systolic and diastolic function. These findings have the potential to increase awareness of subclinical cardiac manifestations in patients with isolated obesity and influence their early management.
Modern Rheumatology, 2013
Objective The aim of this study was to investigate the frequency of familial Mediterranean fever ... more Objective The aim of this study was to investigate the frequency of familial Mediterranean fever (FMF)-associated MEFV gene variations in patients with systemic lupus erythematosus (SLE). Methods The study group comprised 190 SLE patients and 101 healthy controls of Turkish origin with no clinical features of FMF. All individuals were genotyped for the four most common MEFV gene variations (M694V, M680I, V726A and E148Q) by PCR-restriction fragment length polymorphism analysis. Results The frequency of carrying any of the four MEFV gene variations under study was 15 % in patients with SLE and 10 % in the healthy controls (p = 0.23). After the exclusion of the less penetrant E148Q variation, re-analysis for the three penetrant mutations revealed a significant association between exon 10 variations and pericarditis [p = 0.038, odds ratio (OR) 3.5, 95 % confidence interval (CI) 1.0-12.1], and pleural effusion (p = 0.043, OR 5.2, 95 % CI 0.8-30.9). No significant association was detected between the MEFV gene variations and a higher acute phase response. Conclusions The MEFV gene variations analyzed in our study do not seem to increase the overall susceptibility to SLE and do not have any strong association with its clinical manifestations. The possibility of a modest effect of penetrant exon 10 MEFV variants on the development of serosal effusions needs to be explored in a larger series of patients.
Acta Cardiologica Sinica, 2012
A twenty-year old female with a history of allergic asthma and Raynaud's phenomenon was admit... more A twenty-year old female with a history of allergic asthma and Raynaud's phenomenon was admitted to our emergency department with retrosternal chest pain of one hour duration accompanied by generalized erythema, urticarial rashes, moderate dyspnea, nausea and vomiting. Her symptoms developed after taking a dose of naproxen sodium for dysmenorrhea. ECG showed ST segment elevation in leads I and aVL and ST segment depression in leads III and aVF. The patient's chest pain relieved and ST elevations resolved during her transport to the catheterization laboratory, Immediate angiography revealed normal coronary arteries.This coronary syndrome was thought to be secondary to allergy-induced coronary vasospasm known as ”Kounis syndrome”. The main pathophysiological mechanism of coronary spasm in Kounis syndrome is the inflammatory mediators released during a hypersensitivity reaction triggered by food, insect bites or drugs. Here, we report a case of coronary spasm secondary to allcr...
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2008
We investigated factors associated with prolonged prehospital delay in patients with acute myocar... more We investigated factors associated with prolonged prehospital delay in patients with acute myocardial infarction (AMI). A total of 439 patients (351 males, 88 females; mean age 57+/-12 years) with ST-elevation AMI were interviewed within 48 hours of hospitalization. Patients were pain-free and hemodynamically stable at the time of interview. Data were collected on the time from the onset of chest pain to hospital admission and on sociodemographic and clinical characteristics. The patients were evaluated in two groups according to the place to which the first presentation was made, i.e., a local clinic/small hospital (clinic group: n=209, 47.6%) or our tertiary fully equipped cardiovascular center (hospital group: n=230, 52.4%). The median and mean delay times were 70 min and 185.2+/-334.8 min, respectively. Of the study group, 136 patients (31%) arrived within 60 minutes after the onset of symptoms. The median delay time was significantly longer in the clinic group (120 min vs 60 mi...
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2008
We investigated mean platelet volume (MPV) in patients with slow coronary flow (SCF) and its poss... more We investigated mean platelet volume (MPV) in patients with slow coronary flow (SCF) and its possible relationship with clinical presentation. The study included 50 patients with SCF and otherwise normal coronary arteries and 22 patients (control group) with normal coronary arteries. In the SCF group, there were 26 patients with stable angina pectoris (SAP), and 24 patients with unstable angina pectoris (USAP). Coronary blood flow was measured using the TIMI frame count. To determine MPV, blood samples with K3 EDTA were processed after one hour of venipuncture. The relationship between MPV and SCF was sought. The mean TIMI frame count was markedly increased in patients with SCF compared to controls (p<0.0001). No significant differences existed between the groups with regard to white blood cell and platelet counts. Patients with SCF had significantly higher MPV values compared to controls (9.4+/-2.3 fl vs 8.1+/-2.0 fl, p=0.014). In subgroup analysis, MPV was significantly increas...
Medical Principles and Practice, 2015
Objective: In this study, we aimed to investigate the left atrial (LA) electrical and mechanical ... more Objective: In this study, we aimed to investigate the left atrial (LA) electrical and mechanical functions in patients with metabolic syndrome (MetS). Subjects and Methods: The study population consisted of 87 patients with MetS and 67 controls. Intra-atrial and interatrial electromechanical delays (EDs) were measured with tissue Doppler imaging. P-wave dispersion (Pd) was calculated from the 12-lead electrocardiograms. LA volumes were measured echocardiographically by the biplane area-length method. Results: Intra-atrial and interatrial EDs and Pd were significantly higher in patients with MetS (10.3 ± 6.3, 21.0 ± 11.5 and 41.7 ± 10.8) than in controls (7.4 ± 5.5, 12.3 ± 10.4 and 29.2 ± 7.4; p = 0.003, p < 0.001 and p < 0.001, respectively). The LA preatrial contraction volume and active emptying volumes were higher in this population, but the LA passive emptying fraction was lower. In the multivariate linear regression analysis, the presence of MetS, LA active emptying volum...
Journal of the American College of Cardiology, 2013
ABSTRACT The Zwolle score (Zs) is a validated risk score that has been used to identify low-risk ... more ABSTRACT The Zwolle score (Zs) is a validated risk score that has been used to identify low-risk patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). The Syntax score (Ss) is an angiographic score that evaluates the complexity of coronary artery disease (CAD). We aimed to create a simple risk score by combining these two scores for risk stratification in patients with STEMI undergoing primary PCI. 299 consecutive STEMI patients (mean age 57.4±11.7, 240 men) who underwent primary PCI were prospectively enrolled in to the present study. The study population was divided into tertiles based on admission Zs and Ss. A high Zs (>3) and high Ss (>24) were defined as values in the third tertiles. A low Zs and low Ss were defined as values in the lower two tertiles. Patients were then classified into four groups: High Zs and high Ss (HZsHSs, n=26); high Zs and low Ss (HZsLSs, n=29);low Zs and high Ss (LZsHSs, n=48);low Zs and low Ss (LZsLSs, n=196). In-hospital cardiac outcomes were then recorded. In-hospital cardiovascular mortality was higher in HZsHSs (50%) compared to HZsLSs (27.5%), LZsHSs (0%), and LZsLSs(0.5%) groups. After adjustment for potentially confounding factors, HZsHSs (odds ratio [OR] 77.6, 95% confidence interval [CI], 6.69-113.1; p=0.001), and HZsLSs (OR 28.9, 95% CI, 2.77-56.2; p=0.005) status, but not LZsHSs and LZsLSs status, remained independent predictors of in-hospital cardiovascular mortality. STEMI patients with HZsHSs represent the highest risk population for in-hospital cardiovascular mortality.
Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology, 2010
Increased resistance to pulmonary venous drainage is the main mechanism in pulmonary hypertension... more Increased resistance to pulmonary venous drainage is the main mechanism in pulmonary hypertension (PH) developing due to left heart disease. This condition may occur as a result of various diseases affecting left ventricle, left atrium, mitral or aortic valves. Pulmonary hypertension is the common and well-recognized complication of left ventricular systolic dysfunction and pulmonary arterial hypertension accompanying chronic heart failure is related to increased mortality. Treatment should be tailored according to the underlying disease.
Echocardiography, 2010
To determine the subclinical effects of isolated obesity and its duration on cardiac function by ... more To determine the subclinical effects of isolated obesity and its duration on cardiac function by using routine echocardiography and tissue Doppler myocardial strain rate. Forty-nine subjects were enrolled in this study; 29 with isolated obesity defined as a body mass index &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 30 kg/m(2) with no other cardiovascular comorbidities, and 20 nonobese controls. All subjects underwent two-dimensional and Doppler echocardiography including tissue Doppler imaging and myocardial strain rate. The average duration of obesity was 12.1 years (4-18 years). Abnormalities of left ventricular (LV) wall thickness, mass, diastolic function, and left atrial size were detected in obese individuals, despite having preserved ejection fractions. The LV global longitudinal peak strain rate was significantly lower in obese subjects compared to nonobese control subjects (1.07 +/- 0.14 vs. 1.38 +/- 0.12, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Using multivariate analysis, the duration of obesity (ss=-0.76, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), body mass index (ss=-0.35, P = 0.023), and age (ss=-0.29, P = 0.009) were independent predictors of the decreased LV global longitudinal peak strain rate, while the duration of obesity (ss=-0.66, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and body mass index (ss=-0.28, P = 0.037) were independent predictors of the decreased right ventricular (RV) peak strain rate. The presence and the duration of obesity were associated with impairment of subclinical biventricular systolic and diastolic function. These findings have the potential to increase awareness of subclinical cardiac manifestations in patients with isolated obesity and influence their early management.
Modern Rheumatology, 2013
Objective The aim of this study was to investigate the frequency of familial Mediterranean fever ... more Objective The aim of this study was to investigate the frequency of familial Mediterranean fever (FMF)-associated MEFV gene variations in patients with systemic lupus erythematosus (SLE). Methods The study group comprised 190 SLE patients and 101 healthy controls of Turkish origin with no clinical features of FMF. All individuals were genotyped for the four most common MEFV gene variations (M694V, M680I, V726A and E148Q) by PCR-restriction fragment length polymorphism analysis. Results The frequency of carrying any of the four MEFV gene variations under study was 15 % in patients with SLE and 10 % in the healthy controls (p = 0.23). After the exclusion of the less penetrant E148Q variation, re-analysis for the three penetrant mutations revealed a significant association between exon 10 variations and pericarditis [p = 0.038, odds ratio (OR) 3.5, 95 % confidence interval (CI) 1.0-12.1], and pleural effusion (p = 0.043, OR 5.2, 95 % CI 0.8-30.9). No significant association was detected between the MEFV gene variations and a higher acute phase response. Conclusions The MEFV gene variations analyzed in our study do not seem to increase the overall susceptibility to SLE and do not have any strong association with its clinical manifestations. The possibility of a modest effect of penetrant exon 10 MEFV variants on the development of serosal effusions needs to be explored in a larger series of patients.