Metabolik sendromlu hastalarda subklinik aterosklerozu öngörmede güncel bir ekokardiyografik parametre: Aortik yayılım hızı

Buyuklu, Mutlu; DEMİRTAŞ, LEVENT; Hamur, Hikmet; BAKIRCI, EFTAL MURAT; TOPAL, Ergün; Değirmenci, Hüsnü; CEYHUN, Gökhan; ONK, ORUÇ ALPER; AKBAS, EMIN MURAT

Metabolik sendromlu hastalarda subklinik aterosklerozu öngörmede güncel bir ekokardiyografik parametre: Aortik yayılım hızı

Eftal Murat BAKIRCI, (Erzincan Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Erzincan, Türkiye)

Hüsnü DEĞİRMENCİ, (Erzincan Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Erzincan, Türkiye)

Oruç Alper ONK, (Erzincan Üniversitesi, Tıp Fakültesi, Kalp ve Damar Cerrahisi Anabilim Dalı, Erzincan, Türkiye)

Levent DEMİRTAŞ, (Erzincan Üniversitesi, Tıp Fakültesi, İç Hastalıkları Anabilim Dalı, Erzincan, Türkiye)

Emin Murat AKBAŞ, (Erzincan Üniversitesi, Tıp Fakültesi, İç Hastalıkları Anabilim Dalı, Erzincan, Türkiye)

Hikmet HAMUR, (Erzincan Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Erzincan, Türkiye)

Mutlu BÜYÜKLÜ, (Erzincan Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Erzincan, Türkiye)

Gökhan CEYHUN, (Erzincan Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Erzincan, Türkiye)

Ergün TOPAL (Erzincan Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Erzincan, Türkiye)

MN Kardiyoloji

4 2

Yıl: 2014 Cilt: 21 Sayı: 4 Sayfa Aralığı: 213 - 221 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Metabolik sendromlu hastalarda subklinik aterosklerozu öngörmede güncel bir ekokardiyografik parametre: Aortik yayılım hızı

Öz:

Amaç: Çalışmamızın amacı, metabolik sendrom (MS)lu hastalarda aortik yayılımhızı (AYH) ve karotis intima medya kalınlığı (KİMK) ile değerlendirilen subklinik ateroskleroz arasındaki ilişkiyi araştırmaktı. Gereç ve Yöntem: MSlu 122 hasta ve yaş ve cinsiyet açısından eşleştirilmiş 80 sağlıklı kontrol çalışmaya dahil edildi. AYH ve KİMK ölçüldü. MSlu hastalar KİMK ölçümüne göre, KİMK <0,9 mm olan 66 hasta grup 1, KİMK ≥0,9 mm olan 56 hasta ise grup 2 olmak üzere ikiye ayrıldı. Bulgular: MSlu hastalar önemli ölçüde artmış KİMK ve daha yüksek nötrofil lenfosit (N/L) oranı ve hs-CRP düzeylerine sahipti. AYH kontrole göre MSlu hastalarda önemli ölçüde daha düşük idi (49,5±13,8 ve 54,4±8,2, p=0,005). Yine, AYH grup 1e göre grup 2de önemli ölçüde daha düşük idi (40,2±12,0 ve 57,5±9,7, <0,001). KİMKnın AYH ile negatif (r=-0,494, p<0,001), N/L oranı (r=0,334, p<0,001) ve hsCRP (r=0,167, p=0,018) ile pozitif korele olduğu bulundu. Çok değişkenli lojistik regresyon analizi AYH (p<0,001), N/L oranı (p<0,001) ve sistolik kan basıncının (p=0,034) subklinik aterosklerozun (KİMK ≥0,9 mm) bağımsız prediktörleri olduğunu gösterdi. Sonuç: AYH ölçümü, günlük ekokardiyografik muayenede kullanılabilen, kolay ve pratik bir yöntemdir. AYH MSlu hastalarda subklinik aterosklerozun varlığının değerlendirilmesinde kullanılabilir.

Anahtar Kelime:

Konular: Endokrinoloji ve Metabolizma Hematoloji

A novel echocardiographic parameter for predicting subclinical atherosclerosis in the patients with metabolic syndrome: Aortic propagation velocity

Öz:

Aim: The aim of our study was to investigate the relationship between aortic propagation velocity (APV) and subclinical atherosclerosis, as evaluated by carotid intima-media thickness (CIMT) measurement in the patients with metabolic syndrome (MS). Material and Method: A total of 122 patients with MS and 80 age- and gendematched controls were included into the study. APV and CIMT were measured. Patients were divided into two groups according to CIMT measurement: 66 patients with CIMT<0.9 mm were in Group 1 and 56 patients with CIMT ≥0.9 mm were in Group 2. Results: The patients with MS had significantly increased CIMT and higher neutrophil to lymphocyte ratio (NLR) and hs-CRP levels than those of controls. APV was significantly lower in the patients with MS than the control group (49.5±13.8 vs 54.4±8.2, p=0.005). Also, APV was significantly lower in Grup 2 than in Grup 1 (40.2±12.0 vs 57.5±9.7, <0.001). CIMT was found to be correlated negati- vely with APV (r=-0.494, p<0.001) and correlated positively with NLR (r=0.334, p<0.001), and hs-CRP (r=0.167, p=0.018). Multivariate logistic regression analysis revealed that APV (p<0.001), NLR (p<0.001), and systolic blood pressure (p=0.034) were independent predictors of subclinical atherosclerosis (CIMT≥0.9 mm). Conclusion: The measurement of APV is an easy and practical method which could be used in daily echocardiographic examination. APV can be used in the evaluation of the presence of subclinical atherosclerosis in the patients with MS.

Anahtar Kelime:

Konular: Endokrinoloji ve Metabolizma Hematoloji

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

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11. Simsek H, Sahin M, Gunes Y, Dogan A, Gumrukcuoglu HA, Tuncer M. A Novel Echocardiographic Method for the Detection of Subclinical Atherosclerosis in Newly Diag- nosed, Untreated Type 2 Diabetes. Echocardiography 2013;30:644-48.
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17. Carey DG, Jenkins AB, Campbell LV, Freund J, Chisholm DJ. Abdominal fat and insulin resistance in normal and overweight women: Direct measurements reveal a strong relationship in subjects at both low and high risk of NIDDM. Diabetes 1996;45:633-8.
18. Okada M, Miida T, Hama H, et al. Possible risk factors of carotid artery atherosclerosis in the Japanese popula- tion: a primary prevention study in non-diabetic sub- jects. Intern Med 2000;39:362-8
19. Hassinen M, Komulainen P, Lakka TA, et al. Metabolic Syndrome and the Progression of Carotid Intima-Media Thickness in Elderly Women. Arch Intern Med 2006 Feb 27;166:444-9.
20. Scuteri A, Najjar SS, Muller DC, et al. Metabolic syn- drome amplifies the age-associated increases in vascular thickness and stiffness. J Am Coll Cardiol 2004;43:1388- 95.
21. Davis PH, Dawson JD, Mahoney LT, Lauer RM. Increased carotid intimal-medial thickness and coronary calcifica- tion are related in young and middle-aged adults. The Muscatine study. Circulation 1999;100:838-42.
22. Tzou WS, Douglas PS, Srinivasan SR, et al. Increased sub- clinical atherosclerosis in young adults with metabolic syndrome: the Bogalusa Heart Study. J Am Coll Cardiol 2005;46:457-63.
23. Thenappan T, Ali Raza J, Movahed A. Aortic atheromas: Current concepts and controversies-a review of the liter- ature. Echocardiography 2008;25:198-207.
24. Tribouilloy C, Shen WF, Peltier M, Lesbre JP. Noninvasive prediction of coronary artery disease by transesophageal echocardiographic detection of thoracic aortic plaque in valvular heart disease. Am J Cardiol 1994;74:258-60.
25. Kim HY, Kim CJ, Rho TH, et al. Transesophageal echocar- diographic detection of thoracic aortic plaque could non- invasively predict significant obstructive coronary artery disease. Korean J Intern Med 1999;14:20-6.
26. Gunes Y, Tuncer M, Guntekin U, et al. The relation be- tween the color M-mode propagation velocity of the de- scending aorta and coronary and carotid atherosclerosis and flow-mediated dilatation. Echocardiography 2010; 27:300-5.
27. Sen T, Tufekcioglu O, Ozdemir M, et al. A new echocar- diographic parameter of aortic stiffness and atheroscle- rosis in patients with coronary artery disease: Aortic propagation velocity. J Cardiol 2013;62:236-40.
28. Guldiken S, Demir M, Arikan E, et al. The levels of circu- lating markers of atherosclerosis and inflammation in subjects with different degrees of body mass index: solu- ble CD40 ligand and high-sensitivity C-reactive protein. Thromb Res 2007;119:79-84.
29. Kressel G, Trunz B, Bub A, et al. Systemic and vascular markers of inflammation in relation to metabolic syn- drome and insülin resistance in adults with elevated ath- erosclerosis risk. Atherosclerosis 2009;202:263-71.
30. Buyukkaya E, Karakas MF, Karakas E, et al. Correlation of neutrophil to lymphocyte ratio with the presence and severity of metabolic syndrome. Clin Appl Thromb Hemost 2014;20:159-63. t 2008;14:42-6.
10. Simsek H, Sahin M, Gunes Y, et al.A novel echocardio- graphic method as an indicator of endothelial dysfunc- tion in patients with coronary slow flow. Eur Rev Med Pharmacol Sci 2013;17:689-93.
11. Simsek H, Sahin M, Gunes Y, Dogan A, Gumrukcuoglu HA, Tuncer M. A Novel Echocardiographic Method for the Detection of Subclinical Atherosclerosis in Newly Diag- nosed, Untreated Type 2 Diabetes. Echocardiography 2013;30:644-48.
12. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treand cardiovascular events. N Eng J Med 2011;21:213-221
8. Kablak-Ziembicka A, Tracz W, Przewlocki T, Pieniazek P, Sokolowski A, Konieczynska M. As-sociation of increased carotid intima-media thickness with the extent of coro- nary artery disease. Heart 2004; 90:1286-90.
9. Gunes Y, Tuncer M, Yildirim M, et al. A novel echocardio- graphic method for the prediction of coronary artery dis- ease. Med Sci Monit 2008;14:42-6.
10. Simsek H, Sahin M, Gunes Y, et al.A novel echocardio- graphic method as an indicator of endothelial dysfunc- tion in patients with coronary slow flow. Eur Rev Med Pharmacol Sci 2013;17:689-93.
11. Simsek H, Sahin M, Gunes Y, Dogan A, Gumrukcuoglu HA, Tuncer M. A Novel Echocardiographic Method for the Detection of Subclinical Atherosclerosis in Newly Diag- nosed, Untreated Type 2 Diabetes. Echocardiography 2013;30:644-48.
12. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001;285:2486-97.
13. Schiller NB, Shah PM, Crawford M, et al. American Society of Echocardiography Committee on Standards, Subcommittee on Quantification of Two-Dimensional Echocardiograms. Recommendations for quantification of the left ventricle by two-dimensional echocardiogra- phy. J Am Soc Echocardiogr 1989;2:58-67.
14. Stein JH, Korcarz CE, Hurst RT, et al. Use of carotid ultra- sound to identify subclinical vascular disease and evalu- ate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr 2008;21:93-111;189-90.
15. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hyperten- sion of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013;31:1281-357.
16. Onat A, Karabulut A, Yazıcı M, Can G, Sansoy V. Türk yetişkinlerde hiperkolesterolemi ve hipertansiyon birlik- teliği: Sıklığına ve kardiyovasküler riski öngördürmesine ilişkin TEKHARF çalışması verileri. T Kardiyol Dern Arş 2004;32:533-41.
17. Carey DG, Jenkins AB, Campbell LV, Freund J, Chisholm DJ. Abdominal fat and insulin resistance in normal and overweight women: Direct measurements reveal a strong relationship in subjects at both low and high risk of NIDDM. Diabetes 1996;45:633-8.
18. Okada M, Miida T, Hama H, et al. Possible risk factors of carotid artery atherosclerosis in the Japanese popula- tion: a primary prevention study in non-diabetic sub- jects. Intern Med 2000;39:362-8
19. Hassinen M, Komulainen P, Lakka TA, et al. Metabolic Syndrome and the Progression of Carotid Intima-Media Thickness in Elderly Women. Arch Intern Med 2006 Feb 27;166:444-9.
20. Scuteri A, Najjar SS, Muller DC, et al. Metabolic syn- drome amplifies the age-associated increases in vascular thickness and stiffness. J Am Coll Cardiol 2004;43:1388- 95.
21. Davis PH, Dawson JD, Mahoney LT, Lauer RM. Increased carotid intimal-medial thickness and coronary calcifica- tion are related in young and middle-aged adults. The Muscatine study. Circulation 1999;100:838-42.
22. Tzou WS, Douglas PS, Srinivasan SR, et al. Increased sub- clinical atherosclerosis in young adults with metabolic syndrome: the Bogalusa Heart Study. J Am Coll Cardiol 2005;46:457-63.
23. Thenappan T, Ali Raza J, Movahed A. Aortic atheromas: Current concepts and controversies-a review of the liter- ature. Echocardiography 2008;25:198-207.
24. Tribouilloy C, Shen WF, Peltier M, Lesbre JP. Noninvasive prediction of coronary artery disease by transesophageal echocardiographic detection of thoracic aortic plaque in valvular heart disease. Am J Cardiol 1994;74:258-60.
25. Kim HY, Kim CJ, Rho TH, et al. Transesophageal echocar- diographic detection of thoracic aortic plaque could non- invasively predict significant obstructive coronary artery disease. Korean J Intern Med 1999;14:20-6.
26. Gunes Y, Tuncer M, Guntekin U, et al. The relation be- tween the color M-mode propagation velocity of the de- scending aorta and coronary and carotid atherosclerosis and flow-mediated dilatation. Echocardiography 2010; 27:300-5.
27. Sen T, Tufekcioglu O, Ozdemir M, et al. A new echocar- diographic parameter of aortic stiffness and atheroscle- rosis in patients with coronary artery disease: Aortic propagation velocity. J Cardiol 2013;62:236-40.
28. Guldiken S, Demir M, Arikan E, et al. The levels of circu- lating markers of atherosclerosis and inflammation in subjects with different degrees of body mass index: solu- ble CD40 ligand and high-sensitivity C-reactive protein. Thromb Res 2007;119:79-84.
29. Kressel G, Trunz B, Bub A, et al. Systemic and vascular markers of inflammation in relation to metabolic syn- drome and insülin resistance in adults with elevated ath- erosclerosis risk. Atherosclerosis 2009;202:263-71.
30. Buyukkaya E, Karakas MF, Karakas E, et al. Correlation of neutrophil to lymphocyte ratio with the presence and severity of metabolic syndrome. Clin Appl Thromb Hemost 2014;20:159-63. atment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001;285:2486-97.
13. Schiller NB, Shah PM, Crawford M, et al. American Society of Echocardiography Committee on Standards, Subcommittee on Quantification of Two-Dimensional Echocardiograms. Recommendations for quantification of the left ventricle by two-dimensional echocardiogra- phy. J Am Soc Echocardiogr 1989;2:58-67.
14. Stein JH, Korcarz CE, Hurst RT, et al. Use of carotid ultra- sound to identify subclinical vascular disease and evalu- ate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr 2008;21:93-111;189-90.
15. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hyperten- sion of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013;31:1281-357.
16. Onat A, Karabulut A, Yazıcı M, Can G, Sansoy V. Türk yetişkinlerde hiperkolesterolemi ve hipertansiyon birlik- teliği: Sıklığına ve kardiyovasküler riski öngördürmesine ilişkin TEKHARF çalışması verileri. T Kardiyol Dern Arş 2004;32:533-41.
17. Carey DG, Jenkins AB, Campbell LV, Freund J, Chisholm DJ. Abdominal fat and insulin resistance in normal and overweight women: Direct measurements reveal a strong relationship in subjects at both low and high risk of NIDDM. Diabetes 1996;45:633-8.
18. Okada M, Miida T, Hama H, et al. Possible risk factors of carotid artery atherosclerosis in the Japanese popula- tion: a primary prevention study in non-diabetic sub- jects. Intern Med 2000;39:362-8
19. Hassinen M, Komulainen P, Lakka TA, et al. Metabolic Syndrome and the Progression of Carotid Intima-Media Thickness in Elderly Women. Arch Intern Med 2006 Feb 27;166:444-9.
20. Scuteri A, Najjar SS, Muller DC, et al. Metabolic syn- drome amplifies the age-associated increases in vascular thickness and stiffness. J Am Coll Cardiol 2004;43:1388- 95.
21. Davis PH, Dawson JD, Mahoney LT, Lauer RM. Increased carotid intimal-medial thickness and coronary calcifica- tion are related in young and middle-aged adults. Theand cardiovascular events. N Eng J Med 2011;21:213-221
8. Kablak-Ziembicka A, Tracz W, Przewlocki T, Pieniazek P, Sokolowski A, Konieczynska M. As-sociation of increased carotid intima-media thickness with the extent of coro- nary artery disease. Heart 2004; 90:1286-90.
9. Gunes Y, Tuncer M, Yildirim M, et al. A novel echocardio- graphic method for the prediction of coronary artery dis- ease. Med Sci Monit 2008;14:42-6.
10. Simsek H, Sahin M, Gunes Y, et al.A novel echocardio- graphic method as an indicator of endothelial dysfunc- tion in patients with coronary slow flow. Eur Rev Med Pharmacol Sci 2013;17:689-93.
11. Simsek H, Sahin M, Gunes Y, Dogan A, Gumrukcuoglu HA, Tuncer M. A Novel Echocardiographic Method for the Detection of Subclinical Atherosclerosis in Newly Diag- nosed, Untreated Type 2 Diabetes. Echocardiography 2013;30:644-48.
12. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001;285:2486-97.
13. Schiller NB, Shah PM, Crawford M, et al. American Society of Echocardiography Committee on Standards, Subcommittee on Quantification of Two-Dimensional Echocardiograms. Recommendations for quantification of the left ventricle by two-dimensional echocardiogra- phy. J Am Soc Echocardiogr 1989;2:58-67.
14. Stein JH, Korcarz CE, Hurst RT, et al. Use of carotid ultra- sound to identify subclinical vascular disease and evalu- ate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr 2008;21:93-111;189-90.
15. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hyperten- sion of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013;31:1281-357.
16. Onat A, Karabulut A, Yazıcı M, Can G, Sansoy V. Türk yetişkinlerde hiperkolesterolemi ve hipertansiyon birlik- teliği: Sıklığına ve kardiyovasküler riski öngördürmesine ilişkin TEKHARF çalışması verileri. T Kardiyol Dern Arş 2004;32:533-41.
17. Carey DG, Jenkins AB, Campbell LV, Freund J, Chisholm DJ. Abdominal fat and insulin resistance in normal and overweight women: Direct measurements reveal a strong relationship in subjects at both low and high risk of NIDDM. Diabetes 1996;45:633-8.
18. Okada M, Miida T, Hama H, et al. Possible risk factors of carotid artery atherosclerosis in the Japanese popula- tion: a primary prevention study in non-diabetic sub- jects. Intern Med 2000;39:362-8
19. Hassinen M, Komulainen P, Lakka TA, et al. Metabolic Syndrome and the Progression of Carotid Intima-Media Thickness in Elderly Women. Arch Intern Med 2006 Feb 27;166:444-9.
20. Scuteri A, Najjar SS, Muller DC, et al. Metabolic syn- drome amplifies the age-associated increases in vascular thickness and stiffness. J Am Coll Cardiol 2004;43:1388- 95.
21. Davis PH, Dawson JD, Mahoney LT, Lauer RM. Increased carotid intimal-medial thickness and coronary calcifica- tion are related in young and middle-aged adults. The Muscatine study. Circulation 1999;100:838-42.
22. Tzou WS, Douglas PS, Srinivasan SR, et al. Increased sub- clinical atherosclerosis in young adults with metabolic syndrome: the Bogalusa Heart Study. J Am Coll Cardiol 2005;46:457-63.
23. Thenappan T, Ali Raza J, Movahed A. Aortic atheromas: Current concepts and controversies-a review of the liter- ature. Echocardiography 2008;25:198-207.
24. Tribouilloy C, Shen WF, Peltier M, Lesbre JP. Noninvasive prediction of coronary artery disease by transesophageal echocardiographic detection of thoracic aortic plaque in valvular heart disease. Am J Cardiol 1994;74:258-60.
25. Kim HY, Kim CJ, Rho TH, et al. Transesophageal echocar- diographic detection of thoracic aortic plaque could non- invasively predict significant obstructive coronary artery disease. Korean J Intern Med 1999;14:20-6.
26. Gunes Y, Tuncer M, Guntekin U, et al. The relation be- tween the color M-mode propagation velocity of the de- scending aorta and coronary and carotid atherosclerosis and flow-mediated dilatation. Echocardiography 2010; 27:300-5.
27. Sen T, Tufekcioglu O, Ozdemir M, et al. A new echocar- diographic parameter of aortic stiffness and atheroscle- rosis in patients with coronary artery disease: Aortic propagation velocity. J Cardiol 2013;62:236-40.
28. Guldiken S, Demir M, Arikan E, et al. The levels of circu- lating markers of atherosclerosis and inflammation in subjects with different degrees of body mass index: solu- ble CD40 ligand and high-sensitivity C-reactive protein. Thromb Res 2007;119:79-84.
29. Kressel G, Trunz B, Bub A, et al. Systemic and vascular markers of inflammation in relation to metabolic syn- drome and insülin resistance in adults with elevated ath- erosclerosis risk. Atherosclerosis 2009;202:263-71.
30. Buyukkaya E, Karakas MF, Karakas E, et al. Correlation of neutrophil to lymphocyte ratio with the presence and severity of metabolic syndrome. Clin Appl Thromb Hemost 2014;20:159-63.
Muscatine study. Circulation 1999;100:838-42.
22. Tzou WS, Douglas PS, Srinivasan SR, et al. Increased sub- clinical atherosclerosis in young adults with metabolic syndrome: the Bogalusa Heart Study. J Am Coll Cardiol 2005;46:457-63.
23. Thenappan T, Ali Raza J, Movahed A. Aortic atheromas: Current concepts and controversies-a review of the liter- ature. Echocardiography 2008;25:198-207.
24. Tribouilloy C, Shen WF, Peltier M, Lesbre JP. Noninvasive prediction of coronary artery disease by transesophageal echocardiographic detection of thoracic aortic plaque in valvular heart disease. Am J Cardiol 1994;74:258-60.
25. Kim HY, Kim CJ, Rho TH, et al. Transesophageal echocar- diographic detection of thoracic aortic plaque could non- invasively predict significant obstructive coronary artery disease. Korean J Intern Med 1999;14:20-6.
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APA	BAKIRCI E, Değirmenci H, ONK O, DEMİRTAŞ L, AKBAS E, Hamur H, Buyuklu M, CEYHUN G, TOPAL E (2014). Metabolik sendromlu hastalarda subklinik aterosklerozu öngörmede güncel bir ekokardiyografik parametre: Aortik yayılım hızı. , 213 - 221.
Chicago	BAKIRCI EFTAL MURAT,Değirmenci Hüsnü,ONK ORUÇ ALPER,DEMİRTAŞ LEVENT,AKBAS EMIN MURAT,Hamur Hikmet,Buyuklu Mutlu,CEYHUN Gökhan,TOPAL Ergün Metabolik sendromlu hastalarda subklinik aterosklerozu öngörmede güncel bir ekokardiyografik parametre: Aortik yayılım hızı. (2014): 213 - 221.
MLA	BAKIRCI EFTAL MURAT,Değirmenci Hüsnü,ONK ORUÇ ALPER,DEMİRTAŞ LEVENT,AKBAS EMIN MURAT,Hamur Hikmet,Buyuklu Mutlu,CEYHUN Gökhan,TOPAL Ergün Metabolik sendromlu hastalarda subklinik aterosklerozu öngörmede güncel bir ekokardiyografik parametre: Aortik yayılım hızı. , 2014, ss.213 - 221.
AMA	BAKIRCI E,Değirmenci H,ONK O,DEMİRTAŞ L,AKBAS E,Hamur H,Buyuklu M,CEYHUN G,TOPAL E Metabolik sendromlu hastalarda subklinik aterosklerozu öngörmede güncel bir ekokardiyografik parametre: Aortik yayılım hızı. . 2014; 213 - 221.
Vancouver	BAKIRCI E,Değirmenci H,ONK O,DEMİRTAŞ L,AKBAS E,Hamur H,Buyuklu M,CEYHUN G,TOPAL E Metabolik sendromlu hastalarda subklinik aterosklerozu öngörmede güncel bir ekokardiyografik parametre: Aortik yayılım hızı. . 2014; 213 - 221.
IEEE	BAKIRCI E,Değirmenci H,ONK O,DEMİRTAŞ L,AKBAS E,Hamur H,Buyuklu M,CEYHUN G,TOPAL E "Metabolik sendromlu hastalarda subklinik aterosklerozu öngörmede güncel bir ekokardiyografik parametre: Aortik yayılım hızı." , ss.213 - 221, 2014.
ISNAD	BAKIRCI, EFTAL MURAT vd. "Metabolik sendromlu hastalarda subklinik aterosklerozu öngörmede güncel bir ekokardiyografik parametre: Aortik yayılım hızı". (2014), 213-221.

APA	BAKIRCI E, Değirmenci H, ONK O, DEMİRTAŞ L, AKBAS E, Hamur H, Buyuklu M, CEYHUN G, TOPAL E (2014). Metabolik sendromlu hastalarda subklinik aterosklerozu öngörmede güncel bir ekokardiyografik parametre: Aortik yayılım hızı. MN Kardiyoloji, 21(4), 213 - 221.
Chicago	BAKIRCI EFTAL MURAT,Değirmenci Hüsnü,ONK ORUÇ ALPER,DEMİRTAŞ LEVENT,AKBAS EMIN MURAT,Hamur Hikmet,Buyuklu Mutlu,CEYHUN Gökhan,TOPAL Ergün Metabolik sendromlu hastalarda subklinik aterosklerozu öngörmede güncel bir ekokardiyografik parametre: Aortik yayılım hızı. MN Kardiyoloji 21, no.4 (2014): 213 - 221.
MLA	BAKIRCI EFTAL MURAT,Değirmenci Hüsnü,ONK ORUÇ ALPER,DEMİRTAŞ LEVENT,AKBAS EMIN MURAT,Hamur Hikmet,Buyuklu Mutlu,CEYHUN Gökhan,TOPAL Ergün Metabolik sendromlu hastalarda subklinik aterosklerozu öngörmede güncel bir ekokardiyografik parametre: Aortik yayılım hızı. MN Kardiyoloji, vol.21, no.4, 2014, ss.213 - 221.
AMA	BAKIRCI E,Değirmenci H,ONK O,DEMİRTAŞ L,AKBAS E,Hamur H,Buyuklu M,CEYHUN G,TOPAL E Metabolik sendromlu hastalarda subklinik aterosklerozu öngörmede güncel bir ekokardiyografik parametre: Aortik yayılım hızı. MN Kardiyoloji. 2014; 21(4): 213 - 221.
Vancouver	BAKIRCI E,Değirmenci H,ONK O,DEMİRTAŞ L,AKBAS E,Hamur H,Buyuklu M,CEYHUN G,TOPAL E Metabolik sendromlu hastalarda subklinik aterosklerozu öngörmede güncel bir ekokardiyografik parametre: Aortik yayılım hızı. MN Kardiyoloji. 2014; 21(4): 213 - 221.
IEEE	BAKIRCI E,Değirmenci H,ONK O,DEMİRTAŞ L,AKBAS E,Hamur H,Buyuklu M,CEYHUN G,TOPAL E "Metabolik sendromlu hastalarda subklinik aterosklerozu öngörmede güncel bir ekokardiyografik parametre: Aortik yayılım hızı." MN Kardiyoloji, 21, ss.213 - 221, 2014.
ISNAD	BAKIRCI, EFTAL MURAT vd. "Metabolik sendromlu hastalarda subklinik aterosklerozu öngörmede güncel bir ekokardiyografik parametre: Aortik yayılım hızı". MN Kardiyoloji 21/4 (2014), 213-221.