Researcher:
Tefik, Nihal

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Doctor

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Nihal

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Tefik

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Tefik, Nihal

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20222

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    Evaluation of pulmonary arterial stiffness and comparison with right ventricular functions in patients with cirrhosis preparing for liver transplantation
    (Wiley, 2022) Elçioğlu, Betül Cengiz; Baydar, Onur; Helvacı, Füsun; Karataş, Cihan; Aslan, Gamze; Kılıç, Alparslan; Tefik, Nihal; Demir, Barış; Gürsoy, Erol; Demirci, Yasemin; Ural, Dilek; Kanmaz, Turan; Aytekin, Vedat; Aytekin, Saide; Doctor; Doctor; Doctor; Doctor; Doctor; Doctor; Doctor; Doctor; Doctor; Doctor; Faculty Member; Faculty Member; Faculty Member; Doctor; School of Medicine; Koç University Hospital; N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; NA; N/A; N/A; 1057; 275799; 140946; N/A
    Objective Pulmonary complications are common in patients with liver cirrhosis. Devolopment of pulmonary hypertension (PH) is associated with a poor prognosis in these patients. Pulmonary arterial stiffness (PAS) is considered an early sign of pulmonary vascular remodeling. The aim of this study is to investigate PAS and compare it with right ventricular (RV) functions in patients with cirrhosis who are scheduled for liver transplantation. Methods The study included 52 cirrhosis patients (mean age 51.01 +/- 12.18 years, male gender 76.9%) who were prepared for liver transplantation and 59 age and sex matched (mean age 51.28 +/- 13.63 years, male gender 62.7%) healthy individuals. Patients with left ventricular ejection fraction (LVEF) less than 55%, ischemic heart disease, more than mild valvular heart disease, chronic pulmonary disease, congenital heart disease, rheumatic disease, moderate to high echocardiographic PH probability, rhythm or conduction disorders on electrocardiography were excluded from the study. In addition to conventional echocardiographic parameters, PAS value, pulmonary vascular resistance (PVR) and RV ejection efficiency was calculated by the related formulas with transthoracic echocardiography (TTE). Results Demographic characteristics and cardiovascular risk factors of the groups were similar. PAS, PVR, and sPAP values were found to be significantly higher in the patient group (20.52 +/- 6.52 and 13.73 +/- 2.05; 1.43 +/- 0.15 and 1.27 +/- 0.14; 27.69 +/- 3.91 and 23.37 +/- 3.81 p < 0.001, respectively). RV FAC and RV Ee were significantly lower and RV MPI was significantly higher in the patient group (45.31 +/- 3.85 and 49.66 +/- 3.62, p < 0.001; 1.69 +/- 0.35 and 1.85 +/- 0.23, p = 0.005; 0.39 +/- 0.07 and 0.33 +/- 0.09, p = 0.001, respectively). PAS was significantly correlated with RV FAC and MPI (r = -0.423, p < 0.001; r = 0.301, p = 0.001, respectively). Conclusions Increased PAS in cirrhosis patients may be associated with early pulmonary vascular involvement. Evaluation of RV functions is important to determine the prognosis in these patients. FAC, MPI, and RV Ee measurements instead of TAPSE or RV S ' may be more useful in demonstrating subclinical dysfunction. The correlation of PAS with RV FAC and MPI may indicate that RV subclinical dysfunction is associated with early pulmonary vascular remodeling in patients with liver cirrhosis.
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    Effects of iron deficiency on left ventricular functions in young women regardless of anemia: a speckle tracking echocardiography study
    (TÜBİTAK, 2022) Elçioğlu, Betül Cengiz; Baydar, Onur; Kılıç, Alparslan; Tefik, Nihal; Helvacı, Füsun; Gürsoy, Erol; Demirci, Yasemin; Ural, Dilek; Aytekin, Vedat; Aytekin, Saide; Doctor; Doctor; Doctor; Faculty Member; Faculty Member; Doctor; School of Medicine; Koç University Hospital; N/A; N/A; N/A; N/A; N/A; N/A; N/A; 1057; N/A; N/A
    Background/aim: iron deficiency is one of the most common metabolic disorders worldwide and affects multiple organs and systems including the cardiovascular (CV) system. Iron deficiency can cause structural and functional changes in the myocardium. The aim of the study is to evaluate left ventricular (LV) functions in patients with low ferritin levels without anemia by two-dimensional ???speckle tracking??? echocardiography (2D STE). Materials and methods: we studied 90 participants (all female) that were divided into two groups according to ferritin levels (49 patients with ferritin levels 30 ng/mL, 41 age-matched controls with 55%), active infection, high ferritin levels ( 200 ng/mL) were excluded. All patients were evaluated by transthoracic echocardiography. In addition to conventional echocardiographic parameters and Doppler measurements, LV global longitudinal strain (GLS) and strain rate (GLSR) were obtained by 2D STE. Results: mean ferritin level was 18.96 ?? 7.29 ng/mL in low ferritin group, and was 61.22 ?? 26.14 ng/mL in control group. There were no significant differences according to conventional and Doppler echocardiographic parameters between the groups. LV GLS and GLSR values were significantly lower in low ferritin group comparing with control group (17.31% ?? 1.56 and 18.96% ?? 1.53, p < 0.001; 0.64 ?? 0.13 1/s and 0.81 ?? 0.13 1/s, p < 0.001, respectively). There was a significant positive correlation between ferritin levels and LV GLS and GLSR values in study group (r = 0.482, p < 0.001; r = 0.387, p < 0.001, respectively). Ferritin level was also detected as an independent risk factor for GLS value < ???18% in logistic regression analysis. In ROC curve analysis, the area under the curve for predicting GLS < ???18% was 0.801 (p < 0.001, 95% CI 0.70???0.89) and the threshold of ferritin value was 28.5 ng/mL (sensitivity 76.1%, specificity 77.3%). Conclusion: low ferritin levels can cause subclinical LV systolic dysfunction in patients without anemia. STE provides detailed information about LV functions. With larger studies, these patients should be followed more closely and considered for iron replacement treatment before developing anemia.