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    Association between coronary artery lesion severity in coronary computed tomography angiography and hemoglobin A1c in nondiabetic patients with chronic coronary syndrome
    (2023) Yurdam, Ferhat Siyamend; KIŞ, Mehmet
    Objectives: In this study, we aimed to investigate whether there is a relationship between coronary artery lesion severity detected on coronary computed tomography angiography (CTA) and the hemoglobin A1c (HbA1c) value in nondiabetic patients with chronic coronary syndrome (CCS). Patients and methods: The retrospective observational study included 125 patients (64 males, 61 females; median age: 55 years; IQR, 46.5-63.0) who underwent coronary CTA with the diagnosis of CCS and applied between March 2020 and July 2022. Two groups were formed according to the severity of coronary artery lesion by coronary CTA: Group 1 (n=71), with <70% coronary lesion severity, and Group 2 (n=54), with >70% coronary lesion severity. Results: The two groups were similar in terms of median age, (p=0.09) and male sex ratios (47% vs. 55%, p=0.47). The HbA1c value in Group 2 was statistically significantly higher than in Group 1 [5.89 (5.43-6.15) vs. 5.42 (5.1-5.8), p=0.001]. The HbA1c cut-off value was determined as 5.66. The ideal HbA1c cut-off value, calculated by the Youden index, had a sensitivity of 64% and a specificity of 63% in predicting the severity of coronary artery lesions in nondiabetic patients with CCS. Conclusion: In nondiabetic patients with CCS, HbA1c is associated with the presence of severe CAD lesions detected in coronary CTA.
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    The Predictive Role of Systemic Immune Inflammation Index to the Aortic Valve Calcification in the Elderly Population with Chronic Renal Failure
    (2023) YURDAM, Ferhat Siyamend; KIŞ, Mehmet
    Objectives: Aortic valve calcification (AVC) is a chronic, degenerative and progressive condition that results of endothelial injury, cholesterol deposition, myofibroblast differentiation and subsequent valve calcification, involving complex pathophysiological mechanisms such as the activation of inflammatory and immune system cells. The frequency of AVC increased in the presence of chronic renal failure (CRF) and with age. The study aimed to reveal the relationship between AVC and systemic immune inflammation index (SII) that includes peripheral neutrophil, lymphocyte and platelet counts in the elderly population with chronic renal failure. Materials and Methods: Patients over 65 years of age who applied to the cardiology outpatient clinic with chronic renal failure between March 2018 and October 2022 were included in the study. The patients were divided into two groups as group 1 (control group- undetected AVC on echocardiography) (70 patients) and group 2 (AVC detected on echocardiography) (70 patients). SII of all patients was defined as: SII = neutrophil count × platelet count/lymphocyte count. Our study was a retrospective, observational study. Results: The mean SII value was statistically significantly higher in group 2 (754.2±268.7) than group 1 (622.79±297.2, p=0.007). In the univariable regression analysis of the factors affecting AVC in elderly patients with CRF, neutrophil [odds ratio (OR): 0.752; 95% confidence interval (CI): 0.605-0.934, p=0.01], lymphocytes (OR: 2,197; 95% CI: 1,346-3,585, p=0.002), and SII (OR: 0.998; 95% CI: 0.997-1.000, p=0.009) were predictors. In the multivariable regression analysis: SII (OR: 1.002; 95% CI: 1.000-1.005, p=0.034), lymphocytes (OR: 5,660; 95% CI: 2,349-13,637, p<0.001) and neutrophil (OR: 497; 95% CI: 0.344-0.717, p<0.001) were found to be independent predictors. SII> 633.4, 64% sensitivity, and 65% specificity (receiver operating characteristic area under curve: 0.672, 95% CI: 0.582-0.762, p<0.001) are associated with aortic valve sclerosis. Conclusion: High SII in the elderly with chronic renal failure is associated with the presence of AVCs.