Aim: Coronary artery anomalies (CAAs) most of the time are detected at birth. The aim of this stu... more Aim: Coronary artery anomalies (CAAs) most of the time are detected at birth. The aim of this study was to report the prevalence of CAAs by investigating coronary artery angiography (CAG) images of patients admitted to the authors' hospital, a tertiary healthcare provider. Methods: Images of 16,768 patients who underwent CAG in our hospital were evaluated regarding CAAs. Results: CAAs were detected in 120 (0.7%) cases. Anomalous origin and course of arteries were observed in 86 (0.51%) cases. Seven of these cases were diagnosed with acute coronary syndrome and 5 of them were treated with angioplasty without any complication. Absence of LMCA was revealed as the most frequent anomaly in the subgroup analysis of origin and course anomalies by being spotted in 59 (49.9 %) cases of total 120. Myocardial bridge, which constituted all intrinsic coronary anomalies in our study, was determined in 18 (0.1%) patients. All of the anomalies of coronary termination were coronary artery fistulas which were seen in 16 (0.09%) of patients and 2 of them were occluded with coil. Conclusion: Absence of LMCA was the most frequently encountered anomaly. Although CAAs are rare cases, they can cause difficulties in CAG interventions and surgical operations. This study presents CAA frequencies of patients who performed CAG.
The aim of the study is to evaluate the predictive value of the model for end-stage liver disease... more The aim of the study is to evaluate the predictive value of the model for end-stage liver disease (MELD) score for mortality in stable angina pectoris patients undergoing coronary artery bypass graft (CABG) surgery. METHODS: We retrospectively analyzed 261 consecutive patients with stable angina pectoris who underwent CABG while not being on anticoagulant therapy. The patients were divided into two groups: survivors and non-survivors. The MELD score was calculated for all patients. The all-cause mortality within postoperative 12 months was the primary end point of the study. RESULTS: The follow-up period was 12 months. The non-survivors were older (72.0 ± 6.1 vs 62.4 ± 8.4 p<0.001). The MELD score was signifi cantly higher in the non-survivors group (7.5 ± 1.2 vs 6.7 ± 0.7, p<0.001). The MELD score (p = 0.001) was an independent predictor of postoperative one-year mortality. The addition of MELD score to EuroSCORE II signifi cantly improved the prognostic performance of the EuroSCORE II (EuroSCORE II vs EuroSCORE II plus MELD score: AUCs: 0.792 vs 0.842). CONCLUSION: Our research showed that the MELD score could be useful to predict mortality in patients who have stable coronary artery disease, and are undergoing CABG surgery (Tab. 3, Fig. 2, Ref. 25).
Arrhythmogenic right ventricular dysplasia (ARVD) is a rare form of cardiomyopathy. It commonly p... more Arrhythmogenic right ventricular dysplasia (ARVD) is a rare form of cardiomyopathy. It commonly presents in young adults with ventricular tachycardia or sudden death. Right ventricular (RV) dilatation and apical aneurysm are the typical findings in imaging methods. However intraventricular thrombus is rarely seen in ARVD cases. A 19 year old male was admitted to hospital with palpitation and syncope. T wave inversion was detected on anterior surface electrocardiogram. Transthoracic echocardiography revealed dilated RV and apical aneurysm in which thrombus located (Fig-1). Cardiac magnetic rezonans imaging comfirmed RV enlargement, fatty infiltration, fibrosis, wall motion abnormalities and apical aneursym with thrombus. Anticoagulation theraphy commenced to the patient. After three months later trombus resoluted and ICD was implanted. Imaging methods have a great importance in the diagnosis of ARVD besides electrocardiographic, arrhythmic, histological and familial characteristics. While right ventricular dilatation and apical aneurysm are important criteria for the diagnosis process, the presence of thrombus should be evaluated carefully.
Background: Gender-related clinical variations in patients with acute heart failure have been des... more Background: Gender-related clinical variations in patients with acute heart failure have been described in previous studies. However, there is still a lack of research on gender differences in patients hospitalized for acute heart failure in Türkiye. The aim of this study is to compare the clinical features, in-hospital approaches, and outcomes of male and female patients hospitalized for acute heart failure. Methods: Differences in clinical characteristics, medication prescription, hospital management, and outcomes between males and females with acute heart failure were investigated from the Journey Heart Failure-Turkish Population study. Results: Nine hundred eighteen patients (57.2%) were men and 688 (42.8%) were women. Women were older than men (70.48 ± 13.20 years vs. 65.87 ± 12.82 years; P <.001). The frequency of comorbidities such as hypertension (72.7% vs. 62.4%, P <.001), diabetes (46.5% vs. 38.5%, P = .001), atrial fibrillation (46.5% vs. 33.4%, P <.001), New York Heart Association class III-IV symptoms (80.6% vs. 71.2%, P =.001), and dyspnea in the rest (73.8% vs. 68.3%, P =.044) were more common in women on admission. Male patients were more frequently hospitalized with reduced left ventricular ejection fraction (51.0% vs. 72.4%, P <.001). In-hospital mortality was higher among female patients (9.3% vs. 6.4%, P =.022). Higher New York Heart Association class, lower estimated glomerular filtration rate, higher N-terminal pro-B type natriuretic peptide on admission, and mechanical ventilation usage were the independent parameters of in-hospital mortality, whereas the female gender was not. Conclusion: Our study clearly demonstrated the diversity in presentation, management, and in-hospital outcomes of acute heart failure between male and female patients. Although left ventricular systolic functions were better in female patients, in-hospital mortality was higher. Recognizing these differences in the management of heart failure in different sexes will serve better results in clinical practice.
Nutritional status and its index (Prognostic Nutritional Index, PNI) is an important prognostic f... more Nutritional status and its index (Prognostic Nutritional Index, PNI) is an important prognostic factor for ST-segment elevation myocardial infarction (STEMI). The present study investigated whether PNI it is associated with no-reflow in patients with STEMI. In this retrospective study, 404 patients with STEMI and underwent primary percutaneous coronary intervention (pPCI) were consecutively included, between January 2016 and December 2018. No-reflow phenomenon (NRP) was detected in 103 (25.4%) patients. In multivariate logistic regression analysis C-reactive protein (CRP) (odds ratio (OR): 1.693, 95% confidence interval (CI): 1.126–2.547, P = .011), left ventricle ejection fraction (LVEF) (OR: 0.777, 95% CI: 0.678–0.891, P < .001), SYNTAX score (OR: 1.114, 95% CI: 1.050–1.183, P = .001), low density lipoprotein cholesterol (LDL-C) (OR: 1.033, 95% CI: 1.013–1.055, P = .002), hemoglobin level (OR: 0.572, 95% CI: 0.395–0.827, P = .003), PNI (OR: 0.554, 95% CI: 0.448–0.686, P < .0...
European review for medical and pharmacological sciences, 2018
OBJECTIVE We aimed to determine whether the combination of a CHA2DS2-VASc score (C: Congestive He... more OBJECTIVE We aimed to determine whether the combination of a CHA2DS2-VASc score (C: Congestive Heart Failure, H: Hypertension, A2: Age ≥ 75 years, D: Diabetes mellitus, S: Stroke history, V: Vascular disease, A: Age ≥ 65 years, Sc: Sex category) and pre-percutaneous coronary intervention (PCI) thrombus load score was more sensitive at detecting the no-reflow phenomenon compared to the CHA2DS2-VASc score alone or to the thrombus load score alone in patients with acute ST-elevation myocardial infarction (STEMI) who had underwent primary PCI (PPCI). PATIENTS AND METHODS 497 patients with acute STEMIs were divided into two groups: no-reflow group (n: 194) and control group (n: 303). The Thrombolysis In Myocardial Infarction (TIMI) flow grading and Myocardial Blush Grade (MBG) were used together to define angiographic no-reflow as TIMI flow < 3 (with any MBG grade) or TIMI flow 3 with MBG 0 or 1. Successful reperfusion was defined as TIMI flow 3 with MBG 2 or 3. RESULTS CHA2DS2-VASc s...
bradyarrhythmia due to drug intoxication (109 patients, 13.9%), symptomatic sick sinus syndrome (... more bradyarrhythmia due to drug intoxication (109 patients, 13.9%), symptomatic sick sinus syndrome (83 patients, 10.7%). The route of insertion was via the internal jugular vein in 100% of the cases. The duration of transvenous pacing use was 3.8 days (range, 1 to 24 days). A total of 184 patients (23.5%) required a permanent pacemaker. No deaths were seen attributable to transvenous pacemaker implantation. Other minor complications were seen in 12 patients (1.5%). Malfunction of the temporary pacing lead occurred in 14 patients (1.8%) because of electrode displacement. Conclusions: Temporary pacemakers are used in extreme bradyarrhythmias and during acute myocardial infarction. Complications are rarely seen. In 1.8% of the patients the electrode needed to be repositioned because of failure of sensing or loss of ventricular capture.
Departmental sources Background: Epicardial adipose tissue (EAT) has been shown to be associated ... more Departmental sources Background: Epicardial adipose tissue (EAT) has been shown to be associated with diabetes mellitus (DM), hypertension (HT), coronary artery calcification, and atherosclerotic disease. Mitral annular calcification (MAC) is also associated with atherosclerosis. The purpose of this study was to assess the relationship between EAT and severe MAC. Material/Methods: The study enrolled 102 patients who had severe MAC and 107 patients who did not have MAC, as determined by echocardiographic examination. EAT was measured by transthoracic echocardiography. The parasternal long-axis view was used to measure the maximal EAT thickness. Results: Patients with severe MAC were older (p<0.001) and were more likely to be female (p<0.001). Epicardial adipose tissue (p=0.001) and urea (p=0.004) were also higher and eGFR was lower (p<0.001) in patients with severe MAC. EAT (OR: 15.96, CI %: 1.04-24.604, p<0.05), female sex, CAD, DM, eGFR, and age were independent predictors of severe MAC. The AUC for the EAT to predict severe MAC was 0.699 (95%, CI: 0.625-0.774, p<0.001). Conclusions: Our data suggest that EAT is an independent predictor for the presence of severe MAC. Routine echocardiographic assessment of EAT is a cheap and noninvasive method for evaluating patient cardiovascular risk classification.
Kounis syndrome is a condition characterized by temporary coronary spasm, reduction in coronary b... more Kounis syndrome is a condition characterized by temporary coronary spasm, reduction in coronary blood flow and myocardial ischemia by activated mast cells as a result of an abnormal immune reaction to a drug or molecule. It is also called allergic angina and allergic myocardial infarction. It was first described by Kounis and Zarvas in 1991. (1) Kounis syndrome can be observed in all age groups regardless of the history of coronary artery disease. Kounis syndrome may occur due to environmental factors such as drugs, intracoronary stent implantation, foods, insect bites, bee stings, pollen, latex exposure etc. In our case report, acute coronary syndrome occurring during anaphylaxis secondary to vitamin B and C infusion, which is frequently used in clinical practice, will be explained.
International Journal of the Cardiovascular Academy
This is an open access journal, and articles are distributed under the terms of the Creative Comm... more This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Background: We aimed to evaluate whether heart rate variability (HRV) could predict prolonged asy... more Background: We aimed to evaluate whether heart rate variability (HRV) could predict prolonged asystole before head-up tilt table test (HUTT) by comparing time domain HRV parameters of patients with type 2B vasovagal syncope (VVS) and patients with other types of VVS. Methods: Ninety-eight patients who examined with 24-hour Holter electrocardiogram monitoring before HUTT and diagnosed with VVS were enrolled. Patients were divided into two groups in accordance with their VVS type as group 1 (n = 43) consisting of patients with type 2B VVS and group 2 (n = 57) consisting of patients with other types of VVS. Time domain HRV parameters (SDNN, SDANN, SDNN index, RMSSD, pNN50) of two groups were compared. ROC curve analysis was performed to predict best cutoff values that could prognosticate occurrence of prolonged asystole during HUTT. Results: SDNN, SDANN, SDNN index values were significantly longer for group 1 compared to group 2 (P = 0.009, P = 0.006, P = 0.004; respectively). While a SDNN cutoff value of ࣙ151 ms predicted occurrence of type 2B VVS before HUTT with 69% sensitivity and 56% specificity, a SDANN value of ࣙ164 ms had 47% sensitivity and 87% specificity and a SDNN index value of ࣙ102 ms showed 40% sensitivity and 85% specificity. Conclusions: In our study, we tried to demonstrate prediction of prolonged asystole by analyzing HRV parameters before HUTT. We found out that time domain HRV parameters were longer in patients with type 2B VVS than patients with other types of VVS. Our results need to be supported by extensive studies.
Journal of Clinical and Experimental Investigations, 2013
Amac: Koroner arter hastaliginda orta dereceli lezyonlarin ciddiyetinin degerlendirilmesinde, co... more Amac: Koroner arter hastaliginda orta dereceli lezyonlarin ciddiyetinin degerlendirilmesinde, cok gozlemci ile yapilan degerlendirmenin fraksiyonel akim rezervi ile benzer sonuclar elde edip edemeyecegi belirlenmek istenmistir. Yontemler: Hastanemizin veritabani fraksiyonel akim rezervi islemleri acisindan tarandi ve hastalara ait lezyonlar uc deneyimli girisimsel kardiyolog tarafindan gorsel olarak degerlendirildi. Bulgular: 46 olgunun 8\'i (%17,4) kadin ve 38\'i (%82,6) erkekti. Yas ortalamasi 61±11 yil idi. (Erkek: 60±11 / Kadin: 70±7 yil). Tek gozlemcinin ciddi lezyonlarin ancak %66,7\'sini saptayabildigi, ciddi olmayan lezyonlarin ise en fazla %76,2\'sini saptayabildigi gozlendi. Iki gozlemcinin ortak kararina bakildiginda ise ciddi lezyonlari saptama olasiliginin maksimum %76,7, ciddi olmayan lezyonlari saptama olasiliginin ise maksimum %66,7 oldugu saptandi, yani iki gozlemcinin ortak karari ile ciddi olmayan lezyonlarin degerlendirilmesinde yanlislik olasiliginin arttigi goruldu. Uc gozlemciden biri lezyona ciddi dediginde ciddi cikma ihtimalinin %83,3 e yukseldigi (p=0,017), uc gozlemcinin de ciddi degil olarak degerlendirdigi lezyonlarin ciddi cikmama olasiliginin %90,5\'e yukseldigi (p
Sexual dysfunction after acute coronary syndrome (ACS), is a frequently encountered problem in cl... more Sexual dysfunction after acute coronary syndrome (ACS), is a frequently encountered problem in clinical practice. The aim of our study is to determine the time it takes for patients to switch to a healthy sexual life, which is one of the basic elements of a healthy social life, after a cardiovascular event in Turkish society and investigation of the effect of drugs related to ACS on sexual activity. Method: In our study, volunteer women and men who had a cardiovascular event at least 3 months before and were sexually active before the ACS between January 2017-December 2019 were evaluated using a closed questionnaire. The demographic characteristics of the patients, their comorbidities and medications, and their sexual activity levels before and after the ACS were compared. Results: After ACS, sexual dysfunction developed in 36% (n=117) of the patients. In the group with sexual dysfunction, heart failure [21% (n=25)-9% (n=18)-p=0.001], chronic renal failure [9% (n=11)-0% (n=0) p<0.001], and BPH presence [34% (n=40)-(11% (n=23) p<0.001] were higher. Similarly, beta-blocker use [95% (n=111)-84% (n=172) p=0.001] and ACE-I/ARB use [62% (n=73)-54% (n=111) p=0.05] were also higher in participants with sexual dysfunction. Conclusion: In our study, an increase in the prevalence of sexual dysfunction was observed in patients with multiple comorbidities, especially heart failure. Sexual dysfunction was found to be higher in patients using beta-blockers.
Background: Ascending aortic aneurysms are one of the primary causes of mortality. However, not m... more Background: Ascending aortic aneurysms are one of the primary causes of mortality. However, not much is known about the etiologies of aortic aneurysm. Recently, in hypertensive (HT) patients, blood pressure variability (BPV) has been recommended as a remarkable risk factor for adverse cardiovascular outcomes. This study aimed to explore the association between short-term BPV and ascending aortic dilatation (AAD). Methods: In this study, a total of 53 HT patients with AAD (aortic size index [ASI] ≥21 mm/m2) and 126 HT patients with a normal ascending aortic diameter (ASI <21 mm/m2) were included. Baseline, echocardiographic, and 24-h ambulatory blood pressure (BP) monitoring results were compared between groups. Standard deviation (SD) and coefficient of variation (CV) of BP were used to determine short-term BPV. Results: Except for daytime SBP values, daytime, nighttime, and 24-h mean systolic (SBP) and diastolic (DBP) BP levels were similar between groups. Compared with the HT p...
Carotid artery stenosis (CAS), mainly caused by carotid atherosclerosis, is related to ischemic s... more Carotid artery stenosis (CAS), mainly caused by carotid atherosclerosis, is related to ischemic stroke. We investigated whether C-reactive protein (CRP) to albumin ratio (CAR) was associated with increased severity of carotid stenosis in patients undergoing carotid angiography. A total of 269 patients who were undergoing carotid angiography were included in this study. The patients were divided into 2 groups with respect to the severe CAS: group 1 (stenosis < 70%, n = 189) or group II (stenosis ≥ 70%, n = 80). C-reactive protein to albumin ratio was higher in group II compared to group I (0.56 ± 0.25 vs 0.14 ± 0.01, P < .001). The CAR (odds ratio [OR]: 1.051, 95%CI: 1.027-1.076, P < .001), neutrophil to lymphocyte ratio (NLR), and total cholesterol levels were independent predictors of severe CAS. The area under the receiver operating characteristic curve (area under the curve) for the CAR to predict severe CAS was 0.798 (95% CI: 0.741-0.854, P < .001). C-reactive to pro...
Objective Non high density lipoprotein cholesterol (non HDL-C) covers all aterojenic lipoproteins... more Objective Non high density lipoprotein cholesterol (non HDL-C) covers all aterojenic lipoproteins and correlates with C reactive protein (CRP) which is reliable marker of inflammation. CRP is related to poor angiographic coronary collateral circulation (CCC). We aimed to show whether non HDL-C is associated with CCC.Methods Patients who underwent coronary angiography for stable coronary artery disease and at least one epicardial coronary artery occluded in the proximal or middle region were included in the study. Accrording to the Rentrop scoring system Rentrop 0 and 1 were considered to be poor CCC, and Rentrop 2 and 3 were considered to be good CCC. Non-HDL-C was calculated by subtracting HDL-C from total cholesterol (TC).Results 84 patients were included in the study. While 44 patients (52%) had good CCC, 40 patients (48%) had poor CCC. TC was found to be higher in the poor CCC group than in the good CCC group (224.3 ± 35.6 vs 179.2 ± 25.5 p = 0.000). HDL-C levels were found to b...
Objective: Bleeding is one of the most important causes of mortality in patients with acute coron... more Objective: Bleeding is one of the most important causes of mortality in patients with acute coronary syndrome (ACS). This study therefore aimed to investigate bleeding risk in patients with ACS who were scheduled to receive dual antiplatelet therapy (DAPT) in Turkey. Methods: This was a multicentre, observational, cross-sectional cohort study. The study population included 963 patients with ACS from 12 centres in Turkey. We used the Predicting Bleeding Complication in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) score to predict the bleeding risk for all the patients. The patients were divided into high (≥25) or low (˂25) bleeding risk groups based on their PRECISE-DAPT scores. Results: The mean PRECISE-DAPT score was 21.9. Overall, 32.2% of the patients had high PRECISE-DAPT scores (≥25). Compared with the male patients, the female patients had higher PRECISE-DAPT scores (28.2 ± 15.7 vs 18.4 ± 13.6, P ˂ .001). Among the females, the rate of patients with a PRECISE-DAPT score ≥25 was 53%, while among the male patients, the score occurred at a rate of 22%. The female patients had lower haemoglobin (Hb) levels than the male patients (12.1 ± 1.7 vs 13.8 ± 1.9, P ˂ .001) and lower creatinine clearance (70.7 ± 27.5 vs 88.7 ± 26.3, P ˂ .001). The in-hospital bleeding rates were higher among the patients with high PRECISE-DAPT scores than among those who did not have high scores. Furthermore, the patients with high PRECISE-DAPT scores had a higher in-hospital mortality rate compared with those with low PRECISE-DAPT scores (1% vs 0%, P = .11). Conclusions: The mean PRECISE-DAPT score was high among the patients with ACS in this study, indicating that the bleeding tendency was high. This study showed 2 of 11 | AVCI et Al. How to cite this article: Avci E, Kiriş T, Akgün DE, et al. Bleeding risk in patients with acute coronary syndrome in a Turkish population: Results from the Turkish Acute Coronary Syndrome Registry (TACSER) study.
Aim: Coronary artery anomalies (CAAs) most of the time are detected at birth. The aim of this stu... more Aim: Coronary artery anomalies (CAAs) most of the time are detected at birth. The aim of this study was to report the prevalence of CAAs by investigating coronary artery angiography (CAG) images of patients admitted to the authors' hospital, a tertiary healthcare provider. Methods: Images of 16,768 patients who underwent CAG in our hospital were evaluated regarding CAAs. Results: CAAs were detected in 120 (0.7%) cases. Anomalous origin and course of arteries were observed in 86 (0.51%) cases. Seven of these cases were diagnosed with acute coronary syndrome and 5 of them were treated with angioplasty without any complication. Absence of LMCA was revealed as the most frequent anomaly in the subgroup analysis of origin and course anomalies by being spotted in 59 (49.9 %) cases of total 120. Myocardial bridge, which constituted all intrinsic coronary anomalies in our study, was determined in 18 (0.1%) patients. All of the anomalies of coronary termination were coronary artery fistulas which were seen in 16 (0.09%) of patients and 2 of them were occluded with coil. Conclusion: Absence of LMCA was the most frequently encountered anomaly. Although CAAs are rare cases, they can cause difficulties in CAG interventions and surgical operations. This study presents CAA frequencies of patients who performed CAG.
The aim of the study is to evaluate the predictive value of the model for end-stage liver disease... more The aim of the study is to evaluate the predictive value of the model for end-stage liver disease (MELD) score for mortality in stable angina pectoris patients undergoing coronary artery bypass graft (CABG) surgery. METHODS: We retrospectively analyzed 261 consecutive patients with stable angina pectoris who underwent CABG while not being on anticoagulant therapy. The patients were divided into two groups: survivors and non-survivors. The MELD score was calculated for all patients. The all-cause mortality within postoperative 12 months was the primary end point of the study. RESULTS: The follow-up period was 12 months. The non-survivors were older (72.0 ± 6.1 vs 62.4 ± 8.4 p<0.001). The MELD score was signifi cantly higher in the non-survivors group (7.5 ± 1.2 vs 6.7 ± 0.7, p<0.001). The MELD score (p = 0.001) was an independent predictor of postoperative one-year mortality. The addition of MELD score to EuroSCORE II signifi cantly improved the prognostic performance of the EuroSCORE II (EuroSCORE II vs EuroSCORE II plus MELD score: AUCs: 0.792 vs 0.842). CONCLUSION: Our research showed that the MELD score could be useful to predict mortality in patients who have stable coronary artery disease, and are undergoing CABG surgery (Tab. 3, Fig. 2, Ref. 25).
Arrhythmogenic right ventricular dysplasia (ARVD) is a rare form of cardiomyopathy. It commonly p... more Arrhythmogenic right ventricular dysplasia (ARVD) is a rare form of cardiomyopathy. It commonly presents in young adults with ventricular tachycardia or sudden death. Right ventricular (RV) dilatation and apical aneurysm are the typical findings in imaging methods. However intraventricular thrombus is rarely seen in ARVD cases. A 19 year old male was admitted to hospital with palpitation and syncope. T wave inversion was detected on anterior surface electrocardiogram. Transthoracic echocardiography revealed dilated RV and apical aneurysm in which thrombus located (Fig-1). Cardiac magnetic rezonans imaging comfirmed RV enlargement, fatty infiltration, fibrosis, wall motion abnormalities and apical aneursym with thrombus. Anticoagulation theraphy commenced to the patient. After three months later trombus resoluted and ICD was implanted. Imaging methods have a great importance in the diagnosis of ARVD besides electrocardiographic, arrhythmic, histological and familial characteristics. While right ventricular dilatation and apical aneurysm are important criteria for the diagnosis process, the presence of thrombus should be evaluated carefully.
Background: Gender-related clinical variations in patients with acute heart failure have been des... more Background: Gender-related clinical variations in patients with acute heart failure have been described in previous studies. However, there is still a lack of research on gender differences in patients hospitalized for acute heart failure in Türkiye. The aim of this study is to compare the clinical features, in-hospital approaches, and outcomes of male and female patients hospitalized for acute heart failure. Methods: Differences in clinical characteristics, medication prescription, hospital management, and outcomes between males and females with acute heart failure were investigated from the Journey Heart Failure-Turkish Population study. Results: Nine hundred eighteen patients (57.2%) were men and 688 (42.8%) were women. Women were older than men (70.48 ± 13.20 years vs. 65.87 ± 12.82 years; P <.001). The frequency of comorbidities such as hypertension (72.7% vs. 62.4%, P <.001), diabetes (46.5% vs. 38.5%, P = .001), atrial fibrillation (46.5% vs. 33.4%, P <.001), New York Heart Association class III-IV symptoms (80.6% vs. 71.2%, P =.001), and dyspnea in the rest (73.8% vs. 68.3%, P =.044) were more common in women on admission. Male patients were more frequently hospitalized with reduced left ventricular ejection fraction (51.0% vs. 72.4%, P <.001). In-hospital mortality was higher among female patients (9.3% vs. 6.4%, P =.022). Higher New York Heart Association class, lower estimated glomerular filtration rate, higher N-terminal pro-B type natriuretic peptide on admission, and mechanical ventilation usage were the independent parameters of in-hospital mortality, whereas the female gender was not. Conclusion: Our study clearly demonstrated the diversity in presentation, management, and in-hospital outcomes of acute heart failure between male and female patients. Although left ventricular systolic functions were better in female patients, in-hospital mortality was higher. Recognizing these differences in the management of heart failure in different sexes will serve better results in clinical practice.
Nutritional status and its index (Prognostic Nutritional Index, PNI) is an important prognostic f... more Nutritional status and its index (Prognostic Nutritional Index, PNI) is an important prognostic factor for ST-segment elevation myocardial infarction (STEMI). The present study investigated whether PNI it is associated with no-reflow in patients with STEMI. In this retrospective study, 404 patients with STEMI and underwent primary percutaneous coronary intervention (pPCI) were consecutively included, between January 2016 and December 2018. No-reflow phenomenon (NRP) was detected in 103 (25.4%) patients. In multivariate logistic regression analysis C-reactive protein (CRP) (odds ratio (OR): 1.693, 95% confidence interval (CI): 1.126–2.547, P = .011), left ventricle ejection fraction (LVEF) (OR: 0.777, 95% CI: 0.678–0.891, P < .001), SYNTAX score (OR: 1.114, 95% CI: 1.050–1.183, P = .001), low density lipoprotein cholesterol (LDL-C) (OR: 1.033, 95% CI: 1.013–1.055, P = .002), hemoglobin level (OR: 0.572, 95% CI: 0.395–0.827, P = .003), PNI (OR: 0.554, 95% CI: 0.448–0.686, P < .0...
European review for medical and pharmacological sciences, 2018
OBJECTIVE We aimed to determine whether the combination of a CHA2DS2-VASc score (C: Congestive He... more OBJECTIVE We aimed to determine whether the combination of a CHA2DS2-VASc score (C: Congestive Heart Failure, H: Hypertension, A2: Age ≥ 75 years, D: Diabetes mellitus, S: Stroke history, V: Vascular disease, A: Age ≥ 65 years, Sc: Sex category) and pre-percutaneous coronary intervention (PCI) thrombus load score was more sensitive at detecting the no-reflow phenomenon compared to the CHA2DS2-VASc score alone or to the thrombus load score alone in patients with acute ST-elevation myocardial infarction (STEMI) who had underwent primary PCI (PPCI). PATIENTS AND METHODS 497 patients with acute STEMIs were divided into two groups: no-reflow group (n: 194) and control group (n: 303). The Thrombolysis In Myocardial Infarction (TIMI) flow grading and Myocardial Blush Grade (MBG) were used together to define angiographic no-reflow as TIMI flow < 3 (with any MBG grade) or TIMI flow 3 with MBG 0 or 1. Successful reperfusion was defined as TIMI flow 3 with MBG 2 or 3. RESULTS CHA2DS2-VASc s...
bradyarrhythmia due to drug intoxication (109 patients, 13.9%), symptomatic sick sinus syndrome (... more bradyarrhythmia due to drug intoxication (109 patients, 13.9%), symptomatic sick sinus syndrome (83 patients, 10.7%). The route of insertion was via the internal jugular vein in 100% of the cases. The duration of transvenous pacing use was 3.8 days (range, 1 to 24 days). A total of 184 patients (23.5%) required a permanent pacemaker. No deaths were seen attributable to transvenous pacemaker implantation. Other minor complications were seen in 12 patients (1.5%). Malfunction of the temporary pacing lead occurred in 14 patients (1.8%) because of electrode displacement. Conclusions: Temporary pacemakers are used in extreme bradyarrhythmias and during acute myocardial infarction. Complications are rarely seen. In 1.8% of the patients the electrode needed to be repositioned because of failure of sensing or loss of ventricular capture.
Departmental sources Background: Epicardial adipose tissue (EAT) has been shown to be associated ... more Departmental sources Background: Epicardial adipose tissue (EAT) has been shown to be associated with diabetes mellitus (DM), hypertension (HT), coronary artery calcification, and atherosclerotic disease. Mitral annular calcification (MAC) is also associated with atherosclerosis. The purpose of this study was to assess the relationship between EAT and severe MAC. Material/Methods: The study enrolled 102 patients who had severe MAC and 107 patients who did not have MAC, as determined by echocardiographic examination. EAT was measured by transthoracic echocardiography. The parasternal long-axis view was used to measure the maximal EAT thickness. Results: Patients with severe MAC were older (p<0.001) and were more likely to be female (p<0.001). Epicardial adipose tissue (p=0.001) and urea (p=0.004) were also higher and eGFR was lower (p<0.001) in patients with severe MAC. EAT (OR: 15.96, CI %: 1.04-24.604, p<0.05), female sex, CAD, DM, eGFR, and age were independent predictors of severe MAC. The AUC for the EAT to predict severe MAC was 0.699 (95%, CI: 0.625-0.774, p<0.001). Conclusions: Our data suggest that EAT is an independent predictor for the presence of severe MAC. Routine echocardiographic assessment of EAT is a cheap and noninvasive method for evaluating patient cardiovascular risk classification.
Kounis syndrome is a condition characterized by temporary coronary spasm, reduction in coronary b... more Kounis syndrome is a condition characterized by temporary coronary spasm, reduction in coronary blood flow and myocardial ischemia by activated mast cells as a result of an abnormal immune reaction to a drug or molecule. It is also called allergic angina and allergic myocardial infarction. It was first described by Kounis and Zarvas in 1991. (1) Kounis syndrome can be observed in all age groups regardless of the history of coronary artery disease. Kounis syndrome may occur due to environmental factors such as drugs, intracoronary stent implantation, foods, insect bites, bee stings, pollen, latex exposure etc. In our case report, acute coronary syndrome occurring during anaphylaxis secondary to vitamin B and C infusion, which is frequently used in clinical practice, will be explained.
International Journal of the Cardiovascular Academy
This is an open access journal, and articles are distributed under the terms of the Creative Comm... more This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Background: We aimed to evaluate whether heart rate variability (HRV) could predict prolonged asy... more Background: We aimed to evaluate whether heart rate variability (HRV) could predict prolonged asystole before head-up tilt table test (HUTT) by comparing time domain HRV parameters of patients with type 2B vasovagal syncope (VVS) and patients with other types of VVS. Methods: Ninety-eight patients who examined with 24-hour Holter electrocardiogram monitoring before HUTT and diagnosed with VVS were enrolled. Patients were divided into two groups in accordance with their VVS type as group 1 (n = 43) consisting of patients with type 2B VVS and group 2 (n = 57) consisting of patients with other types of VVS. Time domain HRV parameters (SDNN, SDANN, SDNN index, RMSSD, pNN50) of two groups were compared. ROC curve analysis was performed to predict best cutoff values that could prognosticate occurrence of prolonged asystole during HUTT. Results: SDNN, SDANN, SDNN index values were significantly longer for group 1 compared to group 2 (P = 0.009, P = 0.006, P = 0.004; respectively). While a SDNN cutoff value of ࣙ151 ms predicted occurrence of type 2B VVS before HUTT with 69% sensitivity and 56% specificity, a SDANN value of ࣙ164 ms had 47% sensitivity and 87% specificity and a SDNN index value of ࣙ102 ms showed 40% sensitivity and 85% specificity. Conclusions: In our study, we tried to demonstrate prediction of prolonged asystole by analyzing HRV parameters before HUTT. We found out that time domain HRV parameters were longer in patients with type 2B VVS than patients with other types of VVS. Our results need to be supported by extensive studies.
Journal of Clinical and Experimental Investigations, 2013
Amac: Koroner arter hastaliginda orta dereceli lezyonlarin ciddiyetinin degerlendirilmesinde, co... more Amac: Koroner arter hastaliginda orta dereceli lezyonlarin ciddiyetinin degerlendirilmesinde, cok gozlemci ile yapilan degerlendirmenin fraksiyonel akim rezervi ile benzer sonuclar elde edip edemeyecegi belirlenmek istenmistir. Yontemler: Hastanemizin veritabani fraksiyonel akim rezervi islemleri acisindan tarandi ve hastalara ait lezyonlar uc deneyimli girisimsel kardiyolog tarafindan gorsel olarak degerlendirildi. Bulgular: 46 olgunun 8\'i (%17,4) kadin ve 38\'i (%82,6) erkekti. Yas ortalamasi 61±11 yil idi. (Erkek: 60±11 / Kadin: 70±7 yil). Tek gozlemcinin ciddi lezyonlarin ancak %66,7\'sini saptayabildigi, ciddi olmayan lezyonlarin ise en fazla %76,2\'sini saptayabildigi gozlendi. Iki gozlemcinin ortak kararina bakildiginda ise ciddi lezyonlari saptama olasiliginin maksimum %76,7, ciddi olmayan lezyonlari saptama olasiliginin ise maksimum %66,7 oldugu saptandi, yani iki gozlemcinin ortak karari ile ciddi olmayan lezyonlarin degerlendirilmesinde yanlislik olasiliginin arttigi goruldu. Uc gozlemciden biri lezyona ciddi dediginde ciddi cikma ihtimalinin %83,3 e yukseldigi (p=0,017), uc gozlemcinin de ciddi degil olarak degerlendirdigi lezyonlarin ciddi cikmama olasiliginin %90,5\'e yukseldigi (p
Sexual dysfunction after acute coronary syndrome (ACS), is a frequently encountered problem in cl... more Sexual dysfunction after acute coronary syndrome (ACS), is a frequently encountered problem in clinical practice. The aim of our study is to determine the time it takes for patients to switch to a healthy sexual life, which is one of the basic elements of a healthy social life, after a cardiovascular event in Turkish society and investigation of the effect of drugs related to ACS on sexual activity. Method: In our study, volunteer women and men who had a cardiovascular event at least 3 months before and were sexually active before the ACS between January 2017-December 2019 were evaluated using a closed questionnaire. The demographic characteristics of the patients, their comorbidities and medications, and their sexual activity levels before and after the ACS were compared. Results: After ACS, sexual dysfunction developed in 36% (n=117) of the patients. In the group with sexual dysfunction, heart failure [21% (n=25)-9% (n=18)-p=0.001], chronic renal failure [9% (n=11)-0% (n=0) p<0.001], and BPH presence [34% (n=40)-(11% (n=23) p<0.001] were higher. Similarly, beta-blocker use [95% (n=111)-84% (n=172) p=0.001] and ACE-I/ARB use [62% (n=73)-54% (n=111) p=0.05] were also higher in participants with sexual dysfunction. Conclusion: In our study, an increase in the prevalence of sexual dysfunction was observed in patients with multiple comorbidities, especially heart failure. Sexual dysfunction was found to be higher in patients using beta-blockers.
Background: Ascending aortic aneurysms are one of the primary causes of mortality. However, not m... more Background: Ascending aortic aneurysms are one of the primary causes of mortality. However, not much is known about the etiologies of aortic aneurysm. Recently, in hypertensive (HT) patients, blood pressure variability (BPV) has been recommended as a remarkable risk factor for adverse cardiovascular outcomes. This study aimed to explore the association between short-term BPV and ascending aortic dilatation (AAD). Methods: In this study, a total of 53 HT patients with AAD (aortic size index [ASI] ≥21 mm/m2) and 126 HT patients with a normal ascending aortic diameter (ASI <21 mm/m2) were included. Baseline, echocardiographic, and 24-h ambulatory blood pressure (BP) monitoring results were compared between groups. Standard deviation (SD) and coefficient of variation (CV) of BP were used to determine short-term BPV. Results: Except for daytime SBP values, daytime, nighttime, and 24-h mean systolic (SBP) and diastolic (DBP) BP levels were similar between groups. Compared with the HT p...
Carotid artery stenosis (CAS), mainly caused by carotid atherosclerosis, is related to ischemic s... more Carotid artery stenosis (CAS), mainly caused by carotid atherosclerosis, is related to ischemic stroke. We investigated whether C-reactive protein (CRP) to albumin ratio (CAR) was associated with increased severity of carotid stenosis in patients undergoing carotid angiography. A total of 269 patients who were undergoing carotid angiography were included in this study. The patients were divided into 2 groups with respect to the severe CAS: group 1 (stenosis < 70%, n = 189) or group II (stenosis ≥ 70%, n = 80). C-reactive protein to albumin ratio was higher in group II compared to group I (0.56 ± 0.25 vs 0.14 ± 0.01, P < .001). The CAR (odds ratio [OR]: 1.051, 95%CI: 1.027-1.076, P < .001), neutrophil to lymphocyte ratio (NLR), and total cholesterol levels were independent predictors of severe CAS. The area under the receiver operating characteristic curve (area under the curve) for the CAR to predict severe CAS was 0.798 (95% CI: 0.741-0.854, P < .001). C-reactive to pro...
Objective Non high density lipoprotein cholesterol (non HDL-C) covers all aterojenic lipoproteins... more Objective Non high density lipoprotein cholesterol (non HDL-C) covers all aterojenic lipoproteins and correlates with C reactive protein (CRP) which is reliable marker of inflammation. CRP is related to poor angiographic coronary collateral circulation (CCC). We aimed to show whether non HDL-C is associated with CCC.Methods Patients who underwent coronary angiography for stable coronary artery disease and at least one epicardial coronary artery occluded in the proximal or middle region were included in the study. Accrording to the Rentrop scoring system Rentrop 0 and 1 were considered to be poor CCC, and Rentrop 2 and 3 were considered to be good CCC. Non-HDL-C was calculated by subtracting HDL-C from total cholesterol (TC).Results 84 patients were included in the study. While 44 patients (52%) had good CCC, 40 patients (48%) had poor CCC. TC was found to be higher in the poor CCC group than in the good CCC group (224.3 ± 35.6 vs 179.2 ± 25.5 p = 0.000). HDL-C levels were found to b...
Objective: Bleeding is one of the most important causes of mortality in patients with acute coron... more Objective: Bleeding is one of the most important causes of mortality in patients with acute coronary syndrome (ACS). This study therefore aimed to investigate bleeding risk in patients with ACS who were scheduled to receive dual antiplatelet therapy (DAPT) in Turkey. Methods: This was a multicentre, observational, cross-sectional cohort study. The study population included 963 patients with ACS from 12 centres in Turkey. We used the Predicting Bleeding Complication in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) score to predict the bleeding risk for all the patients. The patients were divided into high (≥25) or low (˂25) bleeding risk groups based on their PRECISE-DAPT scores. Results: The mean PRECISE-DAPT score was 21.9. Overall, 32.2% of the patients had high PRECISE-DAPT scores (≥25). Compared with the male patients, the female patients had higher PRECISE-DAPT scores (28.2 ± 15.7 vs 18.4 ± 13.6, P ˂ .001). Among the females, the rate of patients with a PRECISE-DAPT score ≥25 was 53%, while among the male patients, the score occurred at a rate of 22%. The female patients had lower haemoglobin (Hb) levels than the male patients (12.1 ± 1.7 vs 13.8 ± 1.9, P ˂ .001) and lower creatinine clearance (70.7 ± 27.5 vs 88.7 ± 26.3, P ˂ .001). The in-hospital bleeding rates were higher among the patients with high PRECISE-DAPT scores than among those who did not have high scores. Furthermore, the patients with high PRECISE-DAPT scores had a higher in-hospital mortality rate compared with those with low PRECISE-DAPT scores (1% vs 0%, P = .11). Conclusions: The mean PRECISE-DAPT score was high among the patients with ACS in this study, indicating that the bleeding tendency was high. This study showed 2 of 11 | AVCI et Al. How to cite this article: Avci E, Kiriş T, Akgün DE, et al. Bleeding risk in patients with acute coronary syndrome in a Turkish population: Results from the Turkish Acute Coronary Syndrome Registry (TACSER) study.
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