Researcher:
Aslanger, Emre

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Doctor

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Emre

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Aslanger

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Aslanger, Emre

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    Publication
    Effects of exercise on postexercise ventricular-arterial coupling and pulsatile efficiency in patients with systolic dysfunction
    (Wiley, 2015) Assous, Benjamin; Bihry, Nicolas; Beauvais, Florence; Logeart, Damien; Cohen-Solal, Alain; N/A; Aslanger, Emre; Doctor; N/A; Koç University Hospital
    Background A suboptimal ventricular-arterial (VA) interaction may have a prolonged depressing effect on the failing heart after functional reserves forced to their limits under stress conditions such as exercise. The continuation of excessive load in the postexercise period may be more important than the load during exercise, because the sum of postexercise periods generally exceeds exercise time itself. We sought that exercise-induced changes in postexercise VA coupling and pulsatile efficiency in patients with heart failure (HF). Methods Thirty consecutive HF with reduced ejection fraction (EF) and thirty age-, sex- and peak VO2-matched subjects with preserved EF were enrolled. Pre- and postexercise echocardiographic and tonometric measurements were taken to calculate left ventricular and arterial elastances, arterial compliance and wave reflections, and steady and pulsatile power. Results VA coupling significantly deteriorated in HF group (from 1.50 +/- 0.47 to 2.00 +/- 0.75 mmHg/mL, P < 0.01), but control group maintained basal favourable coupling status after exercise (from 1.04 +/- 0.29 to 1.03 +/- 0.24 mmHg/mL, P = 0.77). Pulsatile percentage of total power significantly increased with exercise in HF group, whereas it showed a significant decrease in control group. The change in pulsatile power fraction was correlated with the change in augmentation pressure (r = 0.41, ss = 3.00, P < 0.01) and inversely correlated with the change in total arterial compliance (r =.0.29, ss =.8.52, P = 0.02). Conclusion Our data indicate that exercise-induced VA decoupling and pulsatile inefficiency extend into postexercise phase in patients with systolic dysfunction. The exact duration of these derangements requires further studies.
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    Potential contribution of virtual histology plaque composition to hemodynamic–morphologic dissociation in patients with non-ST elevation acute coronary syndrome 
    (Elsevier Ireland Ltd, 2015) Cakir, Ozan; Atici, Adem; Panc, Cafer; Demirkiran, Ahmet; Surmen, Semih; Sarikaya, Remzi; Erdogan, Onur; Umman, Sabahattin; N/A; N/A; N/A; Aslanger, Emre; Gölcük, Şükriye Ebru; Sezer, Murat; Doctor; Doctor; Doctor; N/A; N/A; N/A; Koç University Hospital; Koc University Hospital; N/A; N/A; N/A
    Objective: Histologic plaque characteristics may influence the hemodynamic effect generated by physiologically significant unstable coronary lesions where plaque content and surface related factors are expected to contribute to the maximum translesional pressure drop. In this study, we aimed to identify local lesion specific virtual histological characteristics that may potentially affect hemodynamic outcome measures. Methods: Forty-eight consecutive patients with non-ST-elevation acute coronary syndrome (NSTEACS) having paired hemodynamic and morphological data were enrolled. A dual sensor guide-wire was used for the assessment of fractional flow reserve (FFR) and stenosis resistance (HSR) in the culprit vessel. Virtual histology intravascular ultrasound imaging was performed after obtaining hemodynamic data. Results: In a hemodynamically significant lesion subset (FFR < 0.75 [n = 34]), after controlling for lesion length, MLA and coronary artery compliance, FFR correlated with necrotic core (NC) area (r = -0.423, p = 0.028) at MLA and NC volume (r = -0.497, p = 0.008) and dense calcium (DC) volume (r = -0.332, p = 0.03) across the entire lesion segment. Likewise, NC (r = -0.544, p = 0.005) and DC (r = 0.376, p = 0.03) areas at MLA and NC (r = 0.545, p = 0.005) and DC (r = 0.576, p = 0.003) volumes across the entire lesion segment were associated with HSR in the hemodynamically significant lesion group (HSR > 0.80 [n = 33]). However, no correlation has been observed between intracoronary hemodynamic end-points and plaque components in hemodynamically insignificant lesions. Conclusions: This study demonstrated that for a given coronary stenosis geometry and arterial compliance, plaque composition may influence hemodynamic outcome measures in functionally significant stenoses in patients with NSTEACS. (C) 2015 Elsevier Ireland Ltd. All rights reserved.