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  • Küçük Resim
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    A New Scoring System for the Evaluation of Ibrutinib-Associated Arrhythmias in Chronic Lymphocytic Leukemia: The ACEF Score
    (Galenos Publ House, 2024) Koyuncu, Ilhan; Koyuncu, Betuel; Ugur, Mehmet Can; Koyun, Emin; Senoz, Oktay; Dogdus, Mustafa; Bilgir, Oktay
    Objective: Bruton tyrosine kinase inhibition in cardiac tissue causes inhibition of the PI3K-AKT signaling pathway, which is responsible for protecting cardiac tissue during stress. Therefore, there is an increase in the risk of arrhythmia. This study explores the prediction of that risk with the Age-Creatinine-Ejection Fraction (ACEF) score as a simple scoring system based on the components of age, creatinine, and ejection fraction. Materials and Methods: Patients diagnosed with chronic lymphocytic leukemia (CLL) and receiving ibrutinib treatment for at least 1 year were evaluated with echocardiography and Holter electrocardiography and the results were compared with a control group of CLL patients who had not received treatment. ACEF score was calculated with the formula age/left ventricular ejection fraction+1 (if creatinine >2.0 mg/dL). Results: When the arrhythmia development of the patients was evaluated, no statistically significant difference was found between the control and ibrutinib groups in terms of types of arrhythmias other than paroxysmal atrial fibrillation (PAF). PAF was found to occur at rates of 8% versus 22% (p=0.042) among ibrutinib non -users versus users. For patients using ibrutinib, an ACEF score of >1.21 predicted the development of PAF with 77% sensitivity and 75% specificity (area under the curve: 0.830, 95% confidence interval: 0.698-0.962, p<0.001). Conclusion: The ACEF score can be used as a risk score that predicts the development of PAF in patients diagnosed with CLL who are scheduled to start ibrutinib.
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    Relationship between cryptogenic ischemic stroke and P wave peak time
    (2024) Koyun, Emin; Koyuncu, İlhan; Dindaş, Ferhat; Dogdus, Mustafa; Öcek, Levent
    Objectives: This study aimed to examine whether P wave peak time (PWPT), a predictor of atrial fibrillation (AF), is significantly higher at the time of diagnosis in cryptogenic ischemic stroke patients. Patients and methods: The retrospective was conducted with 118 individuals (72 males, 46 females; mean age: 66.4±13.8 years) with cryptogenic ischemic stroke in the patient group and 118 individuals (77 males, 41 females; mean age: 63.2±16.1 years) without cerebrovascular disease in the control group between January 2021 and December 2023. The groups were compared regarding PWPT. Results: As a result of multivariate regression analysis, PWPT-D2 and PWPT-V1 were found to be independent predictors of cryptogenic ischemic stroke. In the ROC analysis, when PWPT-D2 was >51.5 msec, the sensitivity for the diagnosis of cryptogenic ischemic stroke was found to be 80%, and the specificity was 76%. When PWPT-V1 was >46 msec, the sensitivity for the diagnosis of cryptogenic ischemic stroke was found to be 75%, and the specificity was 73%. Conclusion: P wave peak time is an important predictor of cryptogenic ischemic stroke. The reason for the high PWPT level in these patients may be undetected AF. Therefore, longer-term rhythm Holter may be recommended in these patients.
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    Relationship between HALP and PNI score with 1-month mortality after CABG
    (Frontiers Media Sa, 2024) Koyuncu, İlhan; Koyun, Emin
    Background: Coronary heart disease (CHD) is the most common cause of cardiovascular disease (CVD). CHD is among the most common causes of mortality and morbidity world wide. In addition, CHD is one of the most important causes of health expenditures world wide. Today, coronary artery bypass grafting (CABG) operations are a widely used surgical procedure and have an important place in the treatment of CHD. Many scoring systems have been evaluated to estimate the risk of mortality and morbidity. 30-day mortality rates after CABG have been reported as 1-4% in large-scale studies. Objectives: The aim of our study was to evaluate the relationship between 1-month mortality in patients undergoing CABG and the Hemoglobin, albumin, lymphocyte, platelet index (HALP score) and Prognostic nutritional index (PNI) calculated using laboratory data in the preoperative period. Methods and design: A total of 239 patients who underwent CABG were evaluated retrospectively. Preoperative biochemical and hemogram values, demographic characteristics, comorbidities, HALP score and PNI values of the patients were recorded. The patients were divided into two groups: Exitus group (n = 51) and survival group (n = 188). The data of the two groups were compared, mainly HALP score and PNI. Results: It was observed that 51 of 239 patients (21.3%) developed exitus during the 30-day follow-up after CABG. When demographic data are compared; advanced age, female gender, history of DM (Diabetes Mellitus), history of HL (hyperlipidemia) and smoking were found to be associated with mortality. When laboratory data are compared; high troponin levels, low hemoglobin, low lymphocyte and low albumin levels were found to be associated with mortality. Low HALP score (p < 0.001) and low PNI (p < 0.001) were also found to be associated with mortality. In univariate and multivariate regression analysis; advanced age, history of DM, HALP score and PNI were found to be independent predictors of 30-day mortality after CABG. It was determined that a cut-off value of 0.29 for the HALP score and 39.1 for PNI had found, respectively, 81 and 79% sensitivity and 82 and 80% specificity. Conclusion: Preoperatively measured HALP score and PNI can be used to predict 1-month mortality after CABG.