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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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    Clinical features and factors affecting in-hospital mortality of patients who underwent pericardiocentesis due to moderate to severe pericardial effusion
    (2021) Şenöz, Oktay; Yapan Emren, Zeynep; Erseçgin, Ahmet; Emren, Volkan; Yurdam, Ferhat Siyamend; Nazlı, Cem
    Introduction: The aim of this study was to determine the primary etiology of pericardial effusion in patients undergoing percutaneous pericardiocentesis. Possible in-hospital mortality related predictors were also investigated. Patients and Methods: A retrospective analysis was made of the clinical and laboratory features of 268 patients who underwent pericardiocentesis due to moderate to severe pericardial effusion between January 2009 and March 2020. Results: The patients comprised 57.5% males and 42.5% females with a mean age of 62.3 ± 15.4 years. Cardiac compression was detected in 220 (82.1%) patients, of which 208 (77.6%) were clinically tamponade and 12 (4.5%) were asymptomatic cardiac compression. The most common symptom was dyspnea (58.6%) and 10.8% of patients were asymptomatic. Pericardial fluid was exudate in 235 (87.7%) patients. The most common causes were malignancy (37.3%) followed by idiopathic (22.1%) and iatrogenic (12.7%) causes. The patients with asymptomatic cardiac compression were more likely to have malignant effusion than those with other etiologies (p= 0.001). In-hospital mortality developed in 37 (13.8%) patients. The independent predictors of in-hospital mortality were determined as follows; etiology other than infectious or idiopathic (OR= 3.447; 95% CI= 1.266, 9.386; p= 0.015), and receiving antithrombotic therapy (OR= 2.306; 95% CI= 1.078, 4.932; p= 0.031). Conclusion: Malignancy is the most common cause of moderate to severe pericardial effusions. The detection of cardiac compression in asymptomatic patients may be an important indicator of malignancy. Receiving antithrombotic therapy and having a non-idiopathic and non-infectious etiology may be predictors of in-hospital mortality.
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    Clues on electrocardiography to predict the presence of paroxysmal atrial fibrillation in patients with acute ischemic stroke: A propensity score-matched study
    (2022) Yurdam, Ferhat Siyamend; Şenöz, Oktay
    Objectives: In this study, we aimed to detect surface electrocardiography (ECG) markers that could be predictive of paroxysmal atrial fibrillation (PAF) attacks in patients with ischemic stroke. Patients and methods: Between November 2017 and April 2021, a total of 112 patients (65 males, 47 females; mean age: 70.5±6.8 years; range, 51 to 84 years) hospitalized for acute ischemic stroke with sinus rhythm on surface ECG who underwent Holter ECG monitoring for PAF were retrospectively analyzed. The patients were divided into two groups of 56 patients in each (Group 1: those with PAF on Holter ECG and Group 2: those without PAF). Both groups were matched according to demographic, clinical, and echocardiographic features using the propensity score matching method. Results: Demographic, clinical, and echocardiographic features were similar between groups (p>0.05). The mean maximum P-wave duration (PWD) and P-wave dispersion (PWDis) were longer in Group 1 than Group 2 (108.4±9.9 vs. 102.5±10.2 ms; p=0.002, 49.4±13.6 vs. 36.8±11.7 ms; p<0.001). Similarly, the mean P-wave terminal force in lead V1 (PTFV 1) was higher in Group 1 than Group 2 (4415±909 vs. 3826±568 ?V·ms; p<0.001). Logistic regression analysis revealed high PWDis (odds ratio [OR]: 1.164; 95% confidence interval [CI]: 1.069-1.268; p<0.001) and PTFV 1 (OR: 1.156; 95% CI: 1.065-1.254; p=0.001) as independent predictors of PAF. Conclusion: PWDis and PTFV1 are independent predictors of PAF in patients with acute ischemic stroke. These simple and easily accessible predictors that can be detected via surface ECG may be used as a guide to identify patients who require longer rhythm monitoring to better detect occult PAF, thereby preventing recurrent strokes.
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    COVID-19 Salgını döneminde valvüler olmayan atriyal fibrilasyon nedeniyle yeni nesil oral antikoagülan kullanan hastalarda kanama komplikasyonlarının araştırılması
    (2022) Şenöz, Oktay; Emren, Sadık Volkan; Yapan Emren, Zeynep; Yurdam, Ferhat Siyamend
    Amaç: COVID?19 pandemisi döneminde hastane başvurularının azalması; yeni oral antikoagülan kullanan hastaların takibini zorlaştır? maktadır. Bu bağlamda COVID?19 pandemisi döneminde yeni oral antikoagülan kullanan hastalarda kanama sıklığının araştırılması amaçlandı. Gereç ve Yöntem: Bu çalışma Mayıs 2020 ve Mayıs 2021 tarihleri arasında yapılmış kesitsel bir çalışmadır. COVID?19 pandemi döne? minde en az bir yıldır yeni oral antikoagülan kullanan 216 hasta dahil edilmiştir. Hastaların majör ve minör kanama oranları ve buna et? ki eden ön gördürücüler araştırılmıştır. Bulgular: Hastaların yaş ortalaması 72±10’du ve 129 (%60) hasta kadındı. 46 (%21) hastada kanama saptandı (%3 majör, %18 minör kanama). Kanama gelişen %12 hastada doz azaltımı yapılırken, %7 hastada ilaç kesilmiştir. Çok değişkenli analizlerde düzensiz ilaç kul? lanımı risk oranı: 14,91 (%95 Güven aralığı: 2,451?90,692, p=0,003), kadın cinsiyet risk oranı: 5,507 (%95 güven aralığı: 2,117?14,327, p<0,001), diyabet risk oranı: 2,319 (%95 güven aralığı: 1,069?5,031, p=0,033), HAS?BLED skoru risk oranı: 1,571 (%95 güven aralığı: 1,035?2,384 p=0,034) kanama ile ilişkili bağımsız değişken olarak bulunmuştur. Sonuç: Yeni oral antikoagülan kullanan hastalarda kanama komplikasyonları COVID?19 döneminde de hala bir sorun olmaya devam et? mektedir
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    Effect of COVİD-19 pandemic and coronavac vaccine on blood pressure regulation in chronic hypertensive patients
    (2021) Şenöz, Oktay; Erseçgin, Ahmet; Demir, Yusuf; Yurdam, Ferhat Siyamend; Yapan Emren, Zeynep; Gürses, Ecem
    Objective: The most common comorbidity in patients with Covid-19 infection is hypertension. Apart from the direct effects of the virus on hypertensive patients, the pandemic period also negatively affected these patients. In addition, the effect of the newly discovered CoronaVac vaccine, which has been widely used in our country in recent months for the prevention of covid-19 infection, on blood pressure regulation is unknown. In this study, we aimed to investigate the effects of the pandemic period and the CoronaVac vaccine in patients receiving treatment for essential hypertension.Method: One hundred ninety-six patients who applied to the cardiology outpatient clinic between 4 June - 9 July 2021, were treated for essential hypertension and had at least 1 dose of CoronaVac vaccine were included in the study. In the pre-pandemic, pre-vaccine and post-vaccine period, mean home and office blood pressures of the patients were examined separately. Results: While the mean home blood pressures of the patients differed significantly between the pre-pandemic and pre-vaccine pandemic period (systolic: 125.1±12.6 vs 129.1±14.1 mmhg, p<0.001, diastolic: 75.3±9.7 vs 77.1±9.8 mmhg, p=0.004), there was no significant difference between the pre- and post-vaccination period (systolic: 129.1±14.1 vs 129.7±13.7 mmhg, p=0.229, diastolic: 77.1±9.8 vs 77.9±9.9 mmhg, p=0.091). Similarly, while office blood pressures differed significantly between the pre-pandemic and pre-vaccine pandemic period (systolic: 133.5±16.5 vs 136.1±16.4 mmhg, p=0.015, diastolic: 79.4±10.9 vs 81.2±12.1 mmhg, p=0.036), there was no significant difference between the pre- and post-vaccination period (systolic: 136.1±16.4 vs 135.6±16.9 mmhg, p=0.651, diastolic: 81.2±12.1 vs 81.1±11.2mmhg, p=0.914). Conclusion: While the Covid-19 pandemic increased the blood pressure of chronic hypertensive patients, the CoronaVac vaccine did not affect the blood pressure regulation of these patients.
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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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    İmplante Edilebilir Kardiyak Defibrilatör Takılan Hastalarda ACEF Risk Skoru ile Uygun Kardiyak Şoklama Arasındaki İlişki
    (2023) DEMİR, Yusuf; Yurdam, Ferhat Siyamend
    Amaç: On yıldan fazla bir süre önce, ICD’ lerin (implante edilebilir kardiyak defibrilatör) ani kardiyak ölüm riski altındaki hastalarda sağkalımı iyileştirdiği gösterilmiştir. ICD implantasyonu en çok iskemik kalp hastalığı nedeniyle olmak üzere, diğer yapısal kalp hastalıkları için de yapılabilmektedir. Çok merkezli otomatik defibrilatör implantasyonu çalışması (MADIT) II, birincil ICD tedavisinin, önceden MI geçirmiş ve ileri evre sol ventrikül disfonksiyonu olan hastalarda sağkalımı iyileştirdiğini göstermiştir. MADIT-ICD adı verilen bir skor geliştirilerek öncelikle birincil korunma hastalarında kullanıldı ve tüm nedenlere bağlı ölüm ile ilişkisi araştırıldı. Ranucci ve arkadaşları elektif kalp cerrahisi geçiren hastalarda mortaliteyi tahmin etmek için basit, üç değişkenli bir model olan yaş, kreatinin ve ejeksiyon fraksiyonu (ACEF) skorunu tanıttı. ACEF risk skoru, sadece kısa ve uzun vadeli mortalite açısından değil, aynı zamanda majör istenmeyen vasküler olayları da tahmin edici prediktif değerler ile ilişkilidir. Bu çalışmadaki amacımız hastanemizde primer veya sekonder koruma nedeniyle ICD takılmış hastalarda ACEF risk skoru ile uygun kardiyak şoklama arasındaki ilişkiyi saptamaktır. Yöntem: Çalışmaya hastanemizde 2019 Ocak – 2022 Ağustos tarihleri arasında ICD implantasyonu yapılan 104 hasta ardışık olarak alındı. Hastalar rutin vizitlerdeki kontrollerde yapılan pil ölçümlerinde uygun kardiyak şoklama alanlar (n=25) ve uygun kardiyak şoklama almayanlar (n=79) olarak 2 gruba ayrılarak incelendi. ACEF risk skoru şu formül ile hesaplandı: yaş / sol ventrikül ejeksiyon fraksiyonu (EF) (kreatinin>2.0 ise +1 puan eklendi). Çalışmamız retrospektif, gözlemsel bir araştırmadır. Bulgular: Çalışmamızdaki ICD implantasyonu yapılmış 104 hastanın, grup 1 (ortalama yaş 68.36±9.66 yıl, %96 erkek) ve grup 2 (ortalama yaş 62.58±11.01 yıl, %81 erkek)’ den oluşmaktaydı. Grup 1’ deki hastaların sol ventrikül EF ortalama değerleri istatistiksel olarak anlamlı düşüktü (Grup 1: %26.04±5.53 ve Grup 2: %30.77±10.55, p=0.03). Grup 1’ deki hastaların kreatinin değerleri ortalaması Grup 2’ den anlamlı oranda yüksekti (Grup 1: 1.25±0.44 ve Grup 2: 1.06±0.27, p=0.01). ACEF risk skoru grup 1 lehine anlamlı yüksekti (Grup 1: 2.84±0.81 ve Grup 2: 2.21±0.69, p<0.001). ACEF risk skoru>2.49 değerinde %68 duyarlılık ve %69 özgüllük ile ICD implantasyonu yapılan hastalarda uygun kardiyak şoklama için bir öngördürücü olarak saptandı (eğri altındaki ROC alanı: 0.726, %95 CI: 0.611-0.840, p=0.001). Sonuç: ICD implantasyonu yapılan hastalarda basit şekilde hesaplanabilen ACEF risk skorunun yüksekliği uygun kardiyak şoklamanın öngördürücüsüdür ve ICD implantasyonu sonrası takiplerde bu skorun kullanılması hangi hastaların uygun kardiyak şok almaya daha yatkın olduğunu anlamamıza fayda sağlayabilir.
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    Karotis Arter Stentleme Yapılan Hastalarda ACEF Risk Skorunun Mikroemboli Gelişimini Öngördürmedeki Rolü
    (2022) ŞENÖZ, Oktay; Yurdam, Ferhat Siyamend; SEVİNÇ, Samet
    Amaç Karotis arter darlığı serebrovasküler olay etiyolojisinde kritik öneme sahip bir hastalıktır Bu hastalığın tedavisinde perkütan invaziv girişim ve cerrahi olarak iki seçenek mevcuttur Her iki seçenek için de istenmeyen bir komplikasyon olan serebral embolinin öngörülmesi ve serebral emboliden kaçınılması hedeflenmektedir ACEF risk skoru kolay ve hızlı hesaplanabilen, 3 parametreden oluşan ( kreatinin sol ventrikül ejeksiyon fraksiyonu) prediktivitesi majör istenmeyen vasküler olaylar için kabul edilebilir derecede ilişkilendirilmiş bir skor yöntemidir Çalışmanın amacı karotis arter darlığının stentleme yöntemi ile tedavisinde ACEF risk skorunun serebral mikroemboliyi ön gördürücülüğünü saptamaktır Yöntem Karotis arter stentleme ( yapılan 93 hasta ardışık olarak alındı Hastalar kranial MRG magnetik rezonans görüntüleme)’ de serebral mikroemboli saptanmayan (Grup 1 ve saptananlar (Grup 2 olarak 2 gruba ayrılarak incelendi ACEF risk skoru şu formül ile hesaplandı yaş sol ventrikül ejeksiyon fraksiyonu ( kreatinin 2 0 ise 1 puan eklendi) Bulgular Çalışmamızdaki KAS yapılmış 93 hasta, grup 1 (ortalama yaş 72 7 7 2 yıl, 63 erkek) ve grup 2 (ortalama yaş 76 3 8 1 yıl, 83 erkek)’ den oluşmaktaydı Grup 1 deki hastaların sol ventrikül EF değerleri istatistiksel olarak anlamlı yüksekti (Grup 1 57 7 7 2 ve Grup 2 50 2 7 7 p 0 001 ACEF risk skoru grup 1 lehine anlamlı yüksekti (Grup 1 1 3 0 31 ve Grup 2 1 5 0 35 p= 0 001 ACEF risk skoru 1 45 değerinde 65 duyarlılık ve 80 özgüllük ile KAS yapılan hastalarda serebral mikroemboli için bir öngördürücü olarak saptandı (eğri altındaki ROC alanı 0 735 95 CI 0 612 0 858 p= 0 001 Sonuç KAS yapılan hastalarda basit şekilde hesaplanabilen ACEF risk skorunun yüksekliği serebral mikroembolinin öngördürücüsüdür ve girişimsel işlem öncesi bu skorun kullanılması embolik komplikasyonların engellenmesinde kolaylık sağlayabilir
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    Predictors of coronary tortuosity in patients with chronic coronary syndrome
    (Russian Heart Failure Soc, 2023) Yurdam, Ferhat Siyamend; Kis, Mehmet; Demir, Yusuf; Bakir, Eren Ozan; Akhan, Onur; Guzel, Tuncay
    Aim Coronary artery tortuosity is a common coronary angiographic finding. This tortuosity can cause myocardial ischemia even in the absence of significant coronary artery stenosis. Our aim was to compare the demographic, clinical and echocardiographic features of patients with chronic coronary syndrome (CCS) and with and without coronary artery tortuosity. Material and methods 361 patients who underwent elective coronary angiography (CAG) due to CCS were included in the study. These patients divided into two groups, those with coronary tortuosity (Group 1) and those without (Group 2). Univariable and multivariable logistic regression analysis was performed to identify predictors associated with coronary artery tortuosity. Results The mean age of the 361 CCS patients (44 % female; 56 % male) was 56.7 +/- 11.5 years. In the univariable regression analysis, age, female sex, hypertension (HT), PR interval, QTc interval, ST /T segment changes, left ventricle diastolic dysfunction (LVDD), left ventricle hypertrophia (LVH) were identified as predictors of coronary tortuosity. In the multivariable regression analysis, age (OR: 1.059; 95 %CI: 1.032-1.087, p<0.001) and hypertension (OR: 0.484; 95%CI: 0.278-0.843, p=0.01) were identified as independent predictors of coronary tortuosity. Conclusion Coronary artery tortuosity is an angiographic finding that develops as a result of adaptive mechanisms in the heart and can cause myocardial ischemia. Predictors of coronary artery tortuosity in patients with CCS were long PR and QTc intervals, ST/T segment changes, LVH, LVDD, advanced age, and female gender. Evaluation of these demographic, electrocardiographic, and echocardiographic data may help clinicans to anticipate coronary artery tortuosity in patients with CCS and to be precautious for PCI.