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    Determinants of coronary angiography in Non-ST-elevation myocardial infarction with low ejection fraction
    (Coll Physicians & Surgeons Pakistan, 2022) Emren, Sadık Volkan; Emren, Zeynep Yapan; Erseçgin, Ahmet; Şenöz, Oktay
    Objective: To investigate the clinical and demographic factors affecting the selection of angiography in patients with severe left ventricular systolic dysfunction (SLVSD, ejection fraction lower than 30%) developing non-ST-segment elevation (NSTEMI). Study Design: Descriptive study. Place and Duration of Study: This study was conducted at the Department of Cardiology, School of Medicine, Izmir Katip Celebi University, Izmir, Turkey, between March 2018 and March 2021. Methodology: Patients with SLVSD (Ejection fraction <30%) developing Clinical and demographic factors were compared between the patients who were or were not decided for angiography. Associated factors for the decision of angiography were evaluated. Results: Overall, 68 (46%) out of 147 patients underwent coronary angiography. Angiography led to coronary artery bypass grafting (CABG) in 14 (21%), percutaneous coronary intervention (PCI) in 30 (44%), and medical treatment in 24 (35%). Among the patients who decided for CABG, 10 (71%) underwent surgery. In multivariate analysis; Killip score >= 2 [Odds ratio (OR) :33.85, 95% Confidence Interval (CI): 5.03-227.405 p<0.001], lower education level (OR: 17.66, 95% CI: 2.25-138.44, p=0.006), anaemia (OR: 10.60, 95% CI: 2.07-54.28, p=0.005), age >= 65 years (OR: 7.124, 95% CI: 1.33-38.12, p=0.02), and PCI history (OR: 0.132, 95% CI: 0.02-0.84, p=0.032) were associated factors with the decision of only medical treatments instead of angiography. Conclusion: Demographic factors such as age and education level and clinical factors such as decompensation, PCI history, and anaemia significantly affect the decision of angiography in the patients with SLVSD and NSTEMI.
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    The effect of hemodialysis on left ventricular global longitudinal strain in chronic hemodialysis patients with preserved left ventricular ejection fraction
    (2022) Emren, Zeynep Yapan; Yurdam, Ferhat Siyamend; Erseçgin, Ahmet; Atay, Gökhan; Arda, Hayri Üstün; Şenöz, Oktay
    Objectives: In the present study, we aimed to evaluate the acute effects of hemodialysis (HD) on left ventricular functions with left ventricular (LV) global longitudinal strain (GLS). Patients and methods: This prospective study included a total of 38 patients (24 males, 14 females; mean age: 60.8±13.8 years; range, 31 to 82 years) who were on chronic HD for at least six months and had a LV ejection fraction of ?50% between December 2021 and January 2022. The clinical and echocardiographic features of the patients were recorded before and after HD. The GLS was calculated using two-dimensional speckle-tracking method. Results: The mean dialysis time of the patients was 6.3±3.9 years. The left atrial volume index was significantly lower after HD than before (30.1±10.0 vs. 27.5±8.2 mL/m 2 , p=0.005). Pulsed Doppler echocardiography showed significantly decreased E and A wave peak velocity after HD (99.3±38.2 vs. 80.4±27.8 cm/s, p=0.001 and 99.4±23.2 vs. 90.4±25.5 cm/s, p=0.022), but no significant change in the E/A ratio (1.1±0.5 vs. 1±0.6, p=0.660). There was no significant change on the LV GLS between before and after HD (-17.3±2.6 vs. -16.9±2.6%, p=0.088). Conclusion: Hemodialysis has no significant effect on LV GLS in the acute phase in patients with end-stage chronic renal disease.
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    Evaluation of bleeding rate and time in therapeutic range in patients using warfarin before and during the COVID-19 pandemic-warfarin treatment in COVID-19
    (Sage Publications Inc, 2021) Emren, Zeynep Yapan; Şenöz, Oktay; Ersecgin, Ahmet; Emren, Sadık Volkan
    The treatment process of patients using warfarin is expected to be hindered during the COVID-19 pandemic. Therefore we investigated whether the time in therapeutic range (TTR) and bleeding complications were affected during the COVID-19 pandemic. 355 patients using warfarin were included between March 2019 to March 2021. Demographic parameters, INR (international normalized ratio), and bleeding rates were recorded retrospectively. The TTR value was calculated using Rosendaal's method. The mean age of the patients was 61 +/- 12 years and 55% of them were female. The mean TTR value during the COVID-19 pandemic was lower than the pre-COVID-19 period (56 +/- 21 vs 68 +/- 21, P < 0.001). Among the patients, 41% had a lack of outpatient INR control. During the COVID-19 pandemic, 71 (20%) patients using VKA suffered bleeding. Among patients with bleeding, approximately 60% did not seek medical help and 6% of patients performed self-reduction of the VKA dose. During the COVID-19 pandemic, TTR values have decreased with the lack of monitoring. Furthermore, the majority of patients did not seek medical help even in case of bleeding.
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    Investigation of left ventricular systolic and diastolic functions before and after levosimendan administration in patients with heart failure
    (2021) Yurdam, Ferhat; Emren, Zeynep Yapan; Şenöz, Oktay
    Background: we aimed to investigate effect of levosimendan treatment on left ventricle systolic and diastolic parameters with transthoracic echocardiography in patients with heart failure Method: Patients over 18 years old with lower than %35 of ejection fraction and New York Heart Association (NYHA) class III-IV were included. Left ventricle systolic and diastolic parameters before and after levosimendan treatment were compared. Approval was obtained from the local ethics committee of Celal Bayar University Medical Faculty for our study. Results: With levosimendan treatment; E/A ratio(2,25±0,76 vs 1,67±0,75 , p:0,03 ) and E/E’ ratio (23,03±13,60 vs 15,96±8,43 , p:0,01) decreased significantly. Furthermore there was an increase in ejection fraction(20,60±5,65 vs 27,00±7,11 , p:0,01) and A velocity( 0,45±0,14 vs 0,61±0,30 , p:0,03). Conclusion: Levosimendan treatment has an acute favoruble effect in ejection fraction and diyastolic mitral inflow parameters that showed ventricle overload
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    Is coronary artery tortuosity a predisposing factor for drug-eluting stent restenosis?
    (Urban & Vogel, 2021) Levent, Fatih; Şenöz, Oktay; Emren, Sadık Volkan; Emren, Zeynep Yapan; Gediz, Rahman Bilal
    Background Coronary artery tortuosity (CAT) is a relatively common finding on coronary angiography and may be associated with impaired left ventricular relaxation and coronary ischemia However, the significance of CAT remains unknown. This study aimed to investigate whether the severity of tortuosity in the targeted coronary segment is a predictor of stent restenosis. Methods The study included a total of 637 patients undergoing drug-eluting stent implantation due to stable or unstable angina and who had no native coronary artery stenosis on their last coronary angiogram. The patients were separated into two groups: 312 patients with in-stent restenosis and 325 patients without in-stent restenosis. All patients underwent computed tomography (CT) coronary angiography after invasive angiography and CAT was calculated using the computer software. Results Patients with in-stent restenosis had higher CAT than those without restenosis (1.25 +/- 0.11 vs. 1.11 + 0.07, p < 0.001). Multivariate Cox regression analysis showed that the tortuosity index (hazard ratio [HR]: 1.246 95% confidence interval [CI]: 1.127-1.376 p < 0.001) and the circumflex lesion (HR: 1.437 95% CI: 1.062-1.942 p = 0.019) were independently associated with in-stent restenosis. With the threshold value of severe tortuosity set at 1.15, the prediction of could be made with 81% sensitivity and 80% specificity. Conclusion The severity of tortuosity is proportional to coronary in-stent stenosis in patients with stable and unstable angina pectoris undergoing drug-eluting stent implantation for a severe single coronary artery.
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    Is myocardial bridge more frequently detected on radial access coronary angiography?
    (BMC, 2021) Şenöz, Oktay; Emren, Zeynep Yapan
    Background: Although the incidence of myocardial bridge (MB) has been defined in different femoral access conventional coronary angiography (FACCA) studies, the frequency of MB on radial access coronary angiography (RACA) is unknown. The aim of this study was to determine the difference in the incidence of MB between patients undergoing RACA and FACCA. Method: A total of 2500 consecutive patients who underwent RACA and a total of 1455 consecutive patients who underwent FACCA were retrospectively investigated to detect the presence of MB. The incidences of the groups were calculated separately and compared. The clinical and angiographic features of the patients with MB were analyzed. Results: MB was detected at an incidence of 10.2%, in 255/2500 patients who underwent RACA, and 1.8% in 27/1455 patients who underwent FACCA (p < 0.001). In both RACA and FACCA patients, the most involved coronary artery was the left anterior descending artery (LAD) (86.9% and 93.1%) and the mid-segment (84.9% and 88.9%) was the most affected section. Co-involvement of multiple coronary arteries by MB was 7.8% in patients who underwent RACA and 7.4% in patients who underwent FACCA. Coronary artery disease (CAD) was determined in 111 (35.7%) of the coronary arteries with MB, of which 81.9% were proximal to the MB. No significant CAD was detected in any of the vessels of 69.8% (178/255) of the patients who underwent RACA for different clinical indications. Conclusion: These data demonstrated that the incidence of myocardial bridge able to be detected on RACA was much higher than FACCA.
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    Mitral valve obstruction caused by heart-shaped large left atrial myxoma
    (2021) Şenöz, Oktay; Yurdam, Ferhat; Emren, Zeynep Yapan; Emren, Volkan; Tomakin, Fatma Nur
    Myxoma is one of the most common benign primary cardiac tumors, usually detected at ages between 30 and 60 years. It accounts for 50% of the primary cardiac tumors. The most common location of a myxoma is the left atrium. Myxomas are more prevalent in females. The clinical outcomes can differ depending on the tumor’s size, location, and architecture. The clinical picture can mimic mitral stenosis, which causes mitral valve obstruction. Syncope is a rare but life-threatening symptom and requires early surgical treatment. This paper describes a patient with a large left atrial myxoma, causing mitral valve obstruction
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    Spontaneous right coronary artery dissection in a patient with COVID-19 infection: A case report and review of the literature
    (Turkish Soc Cardiology, 2021) Emren, Zeynep Yapan; Emren, Sadık Volkan; Özdemir, Emre; Karagöz, Uğur; Nazlı, Cem
    Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the global coronavirus disease 2019 (COVID-19) pandemic. Although SARS-CoV-2 predominantly causes viral pneumonia, it is also associated with many cardiovascular complications such as myocarditis, acute myocardial infarction, and thrombosis. Spontaneous coronary artery dissection (SCAD) is a rare form of coronary artery disease, which a few recent case reports have shown to be associated with COVID-19. The case reported here is a COVID-19 associated SCAD in a patient with no history of cardiovascular disease. The SCAD was treated with stent implantation.