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    Evaluation of Cardiac Autonomic Dysfunction in Patients With Duchenne-type Muscular Dystrophy
    (Journal Neurological Sciences, 2010) Yilmazer, Murat Muhtar; Omeroglu, Rukiye Eker; Bornaun, Helen; Oner, Naci; Nisli, Kemal
    Objective: The aim of this study was to investigate the presence of cardiac autonomic dysfunction by time-domain heart rate variability analysis in patients with Duchenne Muscular Dystrophy (DMD). Methods: We evaluated cardiac autonomic function by time-domain heart rate variability analysis on 24-hour Holter ECG recordings in 43 patients with DMD and 34 healthy male controls. The variability of the heart rate and its circadian rhythm were assessed. The results of time-domain analyses were compared between study and control group. In addition left ventricular end-diastolic diameter, left ventricular ejection fraction and fractional shortening were measured by 2-dimensional echocardiography. Results: The mean age of study group was 8.79 +/- 3.0 years (range, 3 to 17 years), and control group was 9.52 +/- 3.1 years (range, 4 to 16 years). All of the time-domain parameters (NN, SDNN, SDANN, SDNN-i, RMSSD, pNN50) of the study group were significantly lower than control group. However no significant difference was found in left ventricular end-diastolic diameter on echocardiographic examination between study and control groups. Conclusion: The time-domain parameters were found to be decreased significantly in DMD patients. Our data showed a marked impairment of cardiac autonomic function in patinets with DMD, which reflect to mainly involve the parasympathetic activity. We concluded that autonomic dysfunction has developed in the earlier period in DMD before the development of mechanical cardiac dysfunction
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    Repolarization abnormalities in Duchenne-type muscular dystrophy
    (Turkish Soc Cardiology, 2009) Yilmazer, Murat Muhtar; Omeroglu, Rukiye Eker; Bornaun, Helen; Oner, Naci; Nisli, Kemal; Ertugrul, Turkan
    Objectives: Duchenne-type muscular dystrophy (DMD) is an X-linked recessive inherited disease affecting mainly the skeletal and cardiac muscles. We aimed to seek associations between the incidence of ventricular arrhythmias and corrected QT (QTc) dispersion and its component, corrected JT (JTc) dispersion in patients with DMD. Study design: The study included 43 consecutive male patients (mean age 8.8 +/- 3.0 years; range 3 to 17 years) with DMD. On standard 12-lead electrocardiograms (ECG) the QT and JT intervals and the corrected QT (QTc) and JTc dispersions were calculated. Ventricular extrasysto-les were assessed on 24-hour Holter ECG recordings. Ventricular dysrhythmic patterns were evaluated according to the Lown-Wolf classification. The results were compared with those of a control group of 34 healthy children (mean age 9.5 +/- 3.1 years). Results: The mean QTc and JTc dispersion values were significantly higher in DMD patients compared to controls (QTc: 78.0 +/- 20.6 msec vs. 50.9 +/- 16.5 msec; JTc: 77.6 +/- 20.5 msec vs. 50.8 +/- 17.7 msec; p<0.05). The results of Holter monitoring were evaluated in 36 patients and in 33 controls. Ventricular extrasystoles were found in six patients (16.7%) and in one (grade I) control subject (3%). The incidence of pathological findings was significantly higher in the study group (p<0.05), including grade I pathology in four patients, grade II pathology in one patient, and grade IV in one patient. QTc and JTc dispersion values of the patients with and without ventricular extrasystoles showed no statistically significant difference (p>0.05). Conclusion: Similar QTc and JTc dispersion values detected in patients with and without ventricular extrasystoles may suggest that ventricular repolarization abnormalities occur in early life and may predispose to the development of ventricular arrhythmias in the long-term.
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    Risk factors for persistence of coronary artery abnormalities in Turkish children with Kawasaki disease
    (Turkish J Pediatrics, 2015) Yilmazer, Murat Muhtar; Oner, Taliha; Gokalp, Selman; Doksoz, Onder; Guven, Baris; Vupa-Cilengiroglu, Ozgur; Mese, Timur
    The aim of this study was to identify the risk factors for persistence of coronary artery abnormalities (CAAs) in Kawasaki disease and to compare the differences between complete (n=25) and incomplete (n=18) forms of the disease in relation to CAAs. The patients' demographic (age and sex), clinical (season of admission, duration of fever, form of Kawasaki disease), laboratory (complete blood count, eosinophil count, serum biochemistry, C-reactive protein level, erythrocyte sedimentation rate [ESR], urinary analysis), echocardiographic and therapeutic data were evaluated retrospectively from the medical records. The incidence of sterile pyuria was nearly twofold greater in patients with initial CAAs than in patients in which CAAs were not present (25% and 13%, respectively; p=0.33). In multivariate logistic regression analysis, ESR and pyuria were found to be associated with persistence of CAAs (p=0.035 and p=0.046, respectively). In addition, we found that duration of fever was significantly associated with persistence of CAAs (p=0.045). However, gender, age at presentation, peripheral blood eosinophilia, low albumin level, CRP, leukocytosis and anemia were not predictive for persistence of CAAs. There was no difference between the complete and incomplete form of the disease in regard to persistence of CAAs. As a result, we have determined that duration of fever, high levels of ESR and presence of sterile pyuria can be used to predict the persistence of CAAs in Kawasaki disease.