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    Impact of empagliflozin on left atrial mechanical and conduction functions in patients with type 2 diabetes mellitus
    (Wiley, 2023) Aslan, Muzaffer; Oksen, Dogac; Kaynak, Cagdas; Ozudogru, Osman
    Objective Empagliflozin, an oral anti-diabetic drug that inhibits the sodium-dependent glucose co-transporter 2 (SGLT2), has pleiotropic effects on the myocardium. The aim of the study is to investigate the effect of empagliflozin on atrial electromechanical delay (AEMD) and the left atrial (LA) mechanical functions in patients with type 2 diabetes mellitus (DM). Method In total 62 patients (40.3% female, mean age 50.5 +/- 8.6 years old) with type 2 DM were enrolled to the study. Participants were used a SGLT2 inhibitor (empagliflozin 10-25 mg/daily) for 6 months. Patients were examined initially and after 6 months with echocardiography. LA volume was recorded, atrial conduction times were measured using tissue Doppler imaging (TDI). Results No significant change was observed in LA volumes (maximal, minimal, and presystolic), total emptying and passive emptying volume at the end of 6 months; however, there was a significant decrease in active emptying volume (8.3 +/- 2.9 ml/m(2) vs. 7.9 +/- 2.9 ml/m(2), p = 0.04). The posteroanterior lateral, septal, and tricuspid conduction times significantly decreased after the empagliflozin treatment. The decrease in right inter-AEMD was statistically significant (13.25 +/- 10.21 ms vs. 10.85 +/- 9.14 ms, p = 0.011). The changes in inter-AEMD were found to be correlated with the changes in LA active emptying volume (r = 0.408). Conclusion Empagliflozin may enhance the structure and electrical conductions of the atrium and may prevent DM patients from DM-2-related functional disorder and arrhythmia.
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    Impact of oxidative stress on myocardial performance in patients with diabetes: a focus on subclinical left ventricular dysfunction
    (Bmj Publishing Group, 2024) Oksen, Dogac; Aslan, Muzaffer
    Introduction Oxidative stress is known to affect left ventricular functions negatively. There is a strong bidirectional connection between diabetes mellitus (DM) and oxidative stress. In parallel, left ventricular dysfunction is observed more frequently, even in patients with DM without other risk factors. In this context, the objective of this study is to comparatively investigate the potential relationship between oxidative stress and subclinical left ventricular dysfunction (SCLVD) assessed by Myocardial Performance Index (MPI) in patients with and without DM. Research design and methods The sample of this observational cross-sectional single-center study consisted of 151 patients who were evaluated for oxidative stress and SCLVD by tissue Doppler echocardiography. Patients' total oxidant status (TOS), total antioxidant status (TAS), and Oxidative Stress Index (OSI) values were calculated. The effects of oxidative stress and DM on MPI were analyzed. Results There were 81 patients with DM (mean age: 46.17 +/- 10.33 years) and 70 healthy individuals (mean age: 45.72 +/- 9.04 years). Mean TOS and OSI values of the DM group were higher than healthy individuals (5.72 +/- 0.55 vs 5.31 +/- 0.50, p = <0.001; and 4.92 +/- 1.93 vs 1.79 +/- 0.39, p = <0.001; respectively). The mean TAS value of the DM group was significantly lower than the healthy group (1.21 +/- 0.40 vs 3.23 +/- 0.51, p = <0.001). There was a significant correlation between OSI and MPI mitral in the DM group (R 0.554, p = <0.001) but not in the healthy group (R -0.069, p=0.249). Conclusions Both oxidative stress and myocardial dysfunction were found to be more common in patients with DM. The study's findings indicated the negative effect of oxidative stress on myocardial functions. Accordingly, increased oxidative stress caused more significant deterioration in MPI in patients with DM compared with healthy individuals.
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    Ranolazine improved left ventricular diastolic functions and ventricular repolarization indexes in patients with coronary slow flow
    (Frontiers Media Sa, 2023) Oksen, Dogac; Aslan, Muzaffer; Ozmen, Emre; Yavuz, Yunus Emre
    IntroductionCoronary slow flow (CSF) is a condition commonly encountered during angiography. Recent studies have shown the adverse effects of CSF on left ventricular diastolic functions. CSF reportedly increases the novel ventricular repolarization parameters. Ranolazine is a preparation with a prominent anti-anginal activity that has positive effects on anti-arrhythmic and diastolic parameters. In this context, this study was carried out to investigate the effects of ranolazine on left ventricular diastolic functions and repolarization in patients with CSF.Material and methodsForty-six patients with CSF and 29 control subjects were included in the patient and control groups, respectively. Both groups received ranolazine for one month and were evaluated using 12-lead electrocardiography, conventional echocardiography, and tissue Doppler imaging at the baseline and after one month of ranolazine treatment.ResultsCorrected P, QT dispersion, and Tp-e interval values were significantly higher in the patient group than in the control group. There was a significant decrease in isovolumic relaxation time (IVRT) and deceleration time (DT) values after the ranolazine treatment compared to the baseline values in the patient group but not the control group. A significant increase was observed in the mean E and A velocities and the mean E/A ratio after the ranolazine treatment compared to the baseline values in the patient group. Additionally, there was a significant difference between the Tp-e interval and corrected P dispersion values measured after the ranolazine treatment compared to the baseline values in the patient group but not in the control group.ConclusionThis study's findings demonstrated that ranolazine positively affected impaired diastolic functions and repolarization parameters, particularly in patients with CSF.