Dahili Tıp Bilimleri Bölümü

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Aging and cardiac implantable electronic device complications: is the procedure safe in older patients?
(ELSEVIER, 2023) Güzel, Tuncay; Aktan, Adem; Kılıç, Raif; Günlü, Serhat; Arslan, Bayram; Arpa, Abdulkadir; Güzel, Hamdullah; Tatlı, İsmail; Aydın, Saadet; Suzan, Veysel; Demir, Muhammed
Background In this study, we investigated whether there is a higher incidence of cardiac implantable electronic devices (CIED) procedures related complications in older (≥75 years) than in younger (<75 years) patients. Methods This retrospective cohort study enrolled patients who had undergone CIED procedures (de novo implantation, system upgrade, generator substitution, pocket revision or lead replacement) at two heart centers in Turkey between January 2011 and May 2023. The primary composite endpoint included clinically signifcant hematoma (CSH), pericardial efusion or tamponade, pneumothorax, and infection related to the device system. Secondary outcomes included each component of the composite end point. Results The overall sample included 1923 patients (1419<75 years and 504 aged≥75 years). There was no diference between the groups in terms of cumulative events defned as primary outcome (3.5% vs. 4.4%, p=0.393). Infection related to device system was signifcantly higher in the≥75 age group (1.8% vs. 3.4%, p=0.034). There was no signifcant diference between the groups in terms of clinically signifcant hematoma and pneumothorax (0.7% vs. 0.4%, p=0.451, 1.4% vs. 1.0%, p=0.477, respectively). In multivariate model analysis, no association was found between age≥75 years and infection related to the device system. Conclusion Infection rates were relatively higher in the patient group aged≥75 years. This patient group should be evaluated more carefully in terms of infection development before and after the procedure.
Aging and cardiac implantable electronic device complications: is the procedure safe in older patients?
(Springer, 2023) Güzel, Tuncay; Aktan, Adem; Kılıç, Raif; Günlü, Serhat; Arslan, Bayram; Arpa, Abdulkadir; Güzel, Hamdullah; Tatlı, İsmail; Aydın, Saadet; Suzan, Veysel; Demir, Muhammed
Background: In this study, we investigated whether there is a higher incidence of cardiac implantable electronic devices (CIED) procedures related complications in older (≥ 75 years) than in younger (< 75 years) patients. Methods: This retrospective cohort study enrolled patients who had undergone CIED procedures (de novo implantation, system upgrade, generator substitution, pocket revision or lead replacement) at two heart centers in Turkey between January 2011 and May 2023. The primary composite endpoint included clinically significant hematoma (CSH), pericardial effusion or tamponade, pneumothorax, and infection related to the device system. Secondary outcomes included each component of the composite end point. Results: The overall sample included 1923 patients (1419 < 75 years and 504 aged ≥ 75 years). There was no difference between the groups in terms of cumulative events defined as primary outcome (3.5% vs. 4.4%, p = 0.393). Infection related to device system was significantly higher in the ≥ 75 age group (1.8% vs. 3.4%, p = 0.034). There was no significant difference between the groups in terms of clinically significant hematoma and pneumothorax (0.7% vs. 0.4%, p = 0.451, 1.4% vs. 1.0%, p = 0.477, respectively). In multivariate model analysis, no association was found between age ≥ 75 years and infection related to the device system. Conclusion: Infection rates were relatively higher in the patient group aged ≥ 75 years. This patient group should be evaluated more carefully in terms of infection development before and after the procedure.
Akut Kalp Yetmezliğinde Tedavi Yaklaşımı
(AKADEMİSYEN, 2023) Günlü, Serhat
GIRIŞ Akut Kalp Yetmezliği (AKY) hastanın acil tıb- bi yardım alması için yeterince şiddetli bir kli- nik duruma, plansız bir hastaneye yatışa veya acil servis başvurusuna yol açan kalp yetmezliği semptomlarının ve/veya belirtilerinin hızlı veya aşamalı olarak başlamasını ifade eder (1). AKY’li hastalarının tedavilerinin planlanması için acil değerlendirilmesi gerekir. AKY, 65 yaş üstü kişi- lerde hastaneye yatışların önde gelen nedenidir (2). Yüksek mortalite ve tekrarlayan hastaneye yatış oranları mevcuttur. Hastane içi ölüm oranı %4 ila %10 arasında değişmektedir (3). Tabur- culuk sonrası 1 yıllık ölüm oranı %25-30, ölüm veya tekrar yatış oranları %45’ten fazladır (4). AKY, yeni başlayan KY’nin ilk belirtisi olabilir veya daha sıklıkla kronik KY’nin akut dekom- pansasyonuna bağlı ortaya çıkabilir (5). Akut de- kompanse kronik KY’si olan hastalarla akut pul- moner ödemli hastalar karşılaştırıldığında, akut pulmoner ödemi olanlar daha yüksek hastane içi mortaliteye sahiptirler ancak taburculuk sonra- sı mortalite ve yeniden hastaneye yatış oranları daha düşüktür (6). AKY’nin en sık tetikleyici fak- törleri atriyal fibrilasyon, akut MI veya iskemi, ilaç alımının (diüretik) kesilmesi, artmış sodyum yükü,miyokard fonksiyon bozukluklarına sebep olan ilaçlar ve aşırı fiziki efordur (7). Önceden var olan kardiyak disfonksiyonu olan hastalarda spesifik dış faktörler (anemi, GİS kanama, enfeksiyon vb.) AKY’yi hızlandırabilir (8).
Atriyal Fibrilasyonda Kanama Riski Belirleme
(2023) Kayan, Fethullah
GİRİŞ risk faktörlerinin modifikasyonu ile AF’nin ve kullanılan ilaçlarının(özellikle de antikoagülan- ların) komplikasyonlarının azaltılması önem arz etmektedir. Persistan ve Permanent AF’li olgularda eş- lik eden komorbiditelerin daha fazla olması ve yaşın daha ileri olması gibi nedenlerle, Parok- sismal AF’li olgulara göre, AF nin komplikas- yonları ve özellikle de antikoaülasyon tedavinse bağlı kanama riski daha yüksektir. AF tedavisinde, tromboembolik olayların önlenmesi için kullanılan Vitamin K Antago- nisti (VKA) ve Yeni Nesil Oral Antikoagülan- ların (YOAK) faydası; iskemik inme riskinde azalma ile major kanama olaylarındaki artma arasındaki dengeye bağlıdır. AF’nin tromboembolik riskinin önlenmesi için kullanılan oral antikoagülan tedavilere bağ- lı meydana gelebilecek kanamalar için gelişti- rilmiş olan Kanama Risk Skorlamaları; ORBİT, ATRİA, HAS-BLED, HEMORR2HAGES, ABC Skorlamalarıdır. Kullanılan bu skorlamalar ve risk grupları tablolar halinde gösterilmiştir. HAS-BLED Skoru: 0-2 puan alanlar düşük kanama risk grubunda bulunurken, HAS-BLED Atriyal Fibrilasyon (AF), dünya çapında erişkin- lerde en sık görülen aritmidir. AF, populasyon- da morbidite ve mortalitenin önemli bir nedeni olduğundan dolayı, hastalara, toplum sağlığına ve sağlık ekonomisine önemli bir yüktür. AF’ nin prevalansı, erişkinlerde yaklaşık ola- rak %2 ile %4 arasındadır. Yapılan çalışmalarda daha uzun yaşam süresi ile genel populasyonda tanı konmamış AF oranının 2,3 kat daha yüksek olduğu tahmin edilmektedir. İlerleyen yaş, AF nin önemli bir risk faktörü olmakla birlikte, Diyabetüs Mellitüs (DM), Hi- pertansiyon (HT), Kronik Böbrek Hastalığı(K- BH), Kalp Yetmezliği(KY), Koroner Arter Has- talığı (KAH), Obezite, Obstrüktif Sleep Apne Sendromu (OSAS) gibi bazı risk faktörleri de AF gelişiminde önemli rol oynar. Avrupa kökenli index yaşı 55 olanlarda, ya- şam boyu AF risk tahmini 4 kişiden 1 kişiyken, son yapılan revizyon ile 3 kişiden 1 kişi olmuş- tur. AF’ nin artan bu sayısı ile AF’ nin kendisi- ne ve kullanılan ilaçlara bağlı komplikasyonları da artmıştır. Değiştirilebilir ve kontrol edilebilir
Comparison of Evolut-R 34 mm Valve and Smaller Evolut-R Valves in Patients Undergoing Transcatheter Aortic Valve Implantation and Determination of Mild Paravalvular Leak Predictors
(Turkish Society of Cardiology, 2024) Kılıç, Raif; Güzel, Tuncay; Aktan, Adem; Demir, Muhammed; Günlü, Serhat; Arslan, Bayram; Ertaş, Faruk
Objective: The main purpose of this study was to evaluate and compare the in-hospital, 1-month and 1-year post-procedure outcomes of patients treated with Evolut-R 34 mm and Evolut-R 23/26/29 mm devices. Additionally, the study aimed to identify factors that could predict the occurrence of ≥ mild paravalvular leaks (PVL). Methods: Between April 2015 and May 2022, 269 consecutive patients who underwent transcatheter aortic valve implantation (TAVI) with Evolut-R 34 mm (n = 66, 24.5%) and Evolut-R 23/26/29 mm (n = 203, 75.5%) devices in a single center were retrospectively analyzed. Results: Patients in the Evolut-R 34 mm group had a lower female sex ratio (16.7% vs. 66.5%, P < .001, respectively), ejection fraction (50.7 ± 10.1% vs. 54.5 ± 9.3%, P= .016, respectively), and mean aortic gradient (7.4 ± 3.3 vs. 9.2 ± 5.0, P= .026, respectively) compared to the Evolut-R 23/26/29 mm group. The groups did not exhibit any statistically significant distinctions with regard to technical success, the need for a permanent pacemaker, occurrences of stroke, major vascular complications, PVL, major adverse cardiovascular and cerebrovascular events, or mortality. Peak velocity was confirmed as a significant predictor of ≥mild PVL in both patient groups in the receiver operating characteristic curve analysis. In logistic regression analysis; In patients with Evolut-R 34 mm valve, pre-TAVI aortic valve peak velocity (odds ratio (OR) = 23.202; P= .019) and calcium volume 800 Hounsfield Units (mm3) (OR = 1.017; P < .001) were independent predictors of ≥mild PVL. Conclusion: The Evolut-R 34 mm valve has shown comparable in-hospital results with smaller valve sizes. Pre-TAVI aortic valve peak velocity and calcium volume predicted ≥ mild PVL in Evolut-R 34 mm patients.
Comparison of pain levels of traditional radial, distal radial, and transfemoral coronary catheterization
(ScieLO, 2023) Kılıç, Raif; Güzel, Tuncay; Aktan, Adem; Arslan, Bayram; Aslan, Muzaffer; Günlü, Serhat; Karahan, Mehmet Zülkif
OBJECTIVE: The aim of our study was to compare the traditional radial artery, distal radial artery, and transfemoral artery, which are vascular access sites for coronary angiography, in terms of pain level using the visual analog scale. METHODS: Between April 2021 and May 2022, consecutive patients from three centers were included in our study. A total of 540 patients, 180 from each of the traditional radial artery, distal radial artery , and transfemoral artery groups, were included. The visual analog scale was applied to the patients as soon as they were taken to bed. RESULTS: When the visual analog scale was compared between the groups, it was found to be significantly different (transfemoral artery: 2.7±1.6, traditional radial artery: 3.9±1.9, and distal radial artery: 4.9±2.1, respectively, p<0.001). When the patients were classified as mild, moderate, and severe based on the visual analog scale score, a significant difference was found between the groups in terms of body mass index, process time, access time, and number of punctures (p<0.001). Based on the receiver operating characteristic analysis, body mass index>29.8 kg/m2 predicted severe pain with 72.5% sensitivity and 73.2% specificity [(area under the curve: 0.770, 95%CI: 0.724–0.815, p<0.0001)]. CONCLUSION: In our study, we found that the femoral approach caused less access site pain and a high body mass index predicts severe pain.
The Diagnostic Role Of End-Tidal CO2 To Distinguish Unstable Angina Pectoris In Patients With Chest Pain
(2023) Günlü, Serhat; Yeşil, Ahmet; Kayan, Fethullah; Karahan, Mehmet Zülkif
Objective: Unstable angina pectoris (UAP), one of the acute coronary syndrome (ACS) types, is difficult to identify from non-cardiac chest pain (non-CCP), hence various strategies are applied for accurate diagnosis. This study aims to examine whether non-invasively measured end-tidal CO2 (ETCO2) can detect UAP in patients admitted to the emergency department (ED) with chest pain in the lack of a cardiovascular history. Methods: This research was conducted as a prospective observational study. The individuals were separated into two groups based on the inclusion and exclusion criteria: 75 patients with non-CCP and 75 UAP. Analyses of receiver operating characteristics (ROC) were utilized to define the diagnostic value cutoff. Using univariate regression analysis, the odds ratio of ETCO2 (with 95%CI) was computed for UAP prediction. Results: ETCO2 levels were substantially lower in the UAP group compared to the non-CCP group (p<0.001). Analysis of the ROC curve revealed that a decreased ETCO2 <35 predicted UAP with 78% sensitivity and 89% specificity (AUC:0.81, p <0.001). In addition, the negative predictive value was 71.6%, and the positive predictive value was 79.4%. Patients with UAP were 8.84 times more likely to have ETCO2 <35 than patients with non-CCP. Conclusion: UAP may be differentiated from non-CCP by ETCO2 measured as a non-invasive parameter in patients with chest pain.
Diyastolik Disfonksiyon Tanısında Elektrokardiyografik Diyastolik Endeksinin Prognostik Rolü
(2023) Günlü, Serhat
Amaç: Sol ventrikülün diyastolik disfonksiyonu (LVDD), korunmuş ejeksiyon kalp yetmezliği olan bireylerde baskın etiyolojidir. Yüksek tansiyon miyokardda yapısal anormalliklere neden olur ve LVDD'nin seyrini hızlandırır. EKG özelliklerinden belirlenen elektrokardiyografik diyastolik indeks (EDI), sol ventrikül hipertrofisi ile LVDD'nin varlığı arasındaki bağlantı hakkında bilgi verebilir. Bu çalışmanın amacı, hipertansif bireylerde LVDD'yi tanımlamak için EDI göstergesini belirlemekti. Metod: Bu araştırmaya 2022 yılının Ocak ve Aralık ayları arasında sırayla 162 hipertansif hasta dahil edildi. Hastalar, LVDD'si olan ve olmayanlar olarak ayrıldı. [aVL R genliği (V1S genliği + V5R genliği)/PWLI genliği], EDI için formüllerdir. ROC eğrisi analizi kullanılarak, EDI'nin LVDD için öngörü değeri değerlendirildi. Tek değişkenli ve çok değişkenli lojistik regresyon analizi kullanılarak, LVDD'nin bağımsız faktörleri değerlendirildi. İki çok değişkenli model kullanıldı (model I: sürekli değişken olarak EDI ve kategorik değişken olarak model II). Sonuç: Hastalar LVDD olup olmamasına göre iki gruba ayrıldı (LVDD'si olmayan 85 hasta, grup 1; LVDD'si olan 77 hasta, grup 2). Araştırma örnekleminin ortalama yaşı 49±14 idi ve hastaların %42,6'sı erkekti. Çalışmaya katılanların EDI düzeyi 8,50±7,30 idi (Tablo 1). Tablo 1. Clinicalcharacteristics of the studypopulation PARAMETERS LVDD (-) n=85 LVDD (+) n=77 P-value Age (Years) 52.7±1.4 46.1±2.3 0.018 Gender, male, n(%) 28 (33.2) 40 (52.6) 0.009 Smoking, n (%) 36 (41.9) 39 (50.5) 0.305 Diabetesmellitus, n (%) 9 (10.5) 17 (22.7) 0.033 LVEDD, mm 46±4 46±3 0.124 LVESD, mm 28±3 29±2 0.057 IVST, mm 1.0±0.1 1.1±0.2 <0.001 LVEF, % 62±5 60±3.5 0.028 LA, mm 35±4 36±3 0.031 E/A ratio 1.4±0.3 0.9±0.5 <0.001 D1 P waveamplitude, mV 0.1±0.04 0.1±0.05 0.181 aVL R amplitude, mV 0.3±0.3 0.5±0.3 <0.001 V1S amplitude, mV 0.7±0.4 0.7±0.5 0.043 V5R amplitude, mV 1.0±0.5 1.1±0.7 0.093 V1S +V5R amplitude, mV 1.7±0.7 2.0±0.9 0.005 EDI 5.2±3.7 10.6±8.5 <0.001 LVEDD: Leftventricularend-diastolicdimension, LVESD: Leftventricularend-systolicdimension, IVST: Interventricularseptumthickness, LVEF: Leftventricularejectionfraction, LA: Leftatrial, EDI: ElectrocardiographicDiastolic Index. Grup 2'nin EDI puanı, grup 1'inkinden önemli ölçüde daha yüksekti (p <0.001). LVDD'yi tahmin etmek için EDI eğrisi altında kalan alan %0,752 olarak hesaplandı (%95 güven aralığı = 0,651-0,853; p<0,001) (Şekil 1). Şekil 1. ROC analysis of the EDI toestimatediastolicdysfunction EDI eşik değeri 7,4 mV'den büyük olduğunda, LVDD'yi %70'lik bir duyarlılık ve %69'luk bir özgüllükle tahmin eder. Tek değişkenli lojistik regresyon kullanılarak LVDD, EDI ile ilişkilendirildi [OR=1,248, %95 güven aralığı (CI)=1,159 - 1,345, p <0,001]. EDI'yi hem sürekli değişken hem de kategorik değişken olarak incelemek için iki farklı çok değişkenli regresyon modeli oluşturuldu. Her iki modelde de EDI'nin LVDD'nin erken bir göstergesi olduğu ortaya çıktı. Tartışma: Sol atriyal boyutlardaki değişikliklere tipik olarak septal veya arka sol ventrikül duvar kalınlığında bir artış eşlik eder ve bu da sonunda sol ventrikülün hipertrofisi veya yeniden şekillenmesi olarak kendini gösterir. Bu sonuçlar oldukça yaygın olduğundan ve hipertansif kalp hastalığı olan bireylerde artış gösterdiğinden, DD'li hastalarda görülen en yaygın anormalliklerden biridir. Birden fazla grup, DD'de sol ventrikül hipertrofisini ve anlamlı kardiyomiyosit hipertrofisinin histolojik kanıtları ve normalden daha büyük bir sol ventrikül kas kütlesi ile sistolik fonksiyonun korunduğu kalp yetmezliğini belgelemiştir. Arteriyel hipertansiyonu olan bireylerde, uzamış QRS ve QT/QTc aralığı gibi elektrokardiyografik karakteristiklerin genişlemiş bir sol ventrikül kas kütlesini düşündürdüğü bilinmektedir. Bu, DD ve QTc süresinin Doppler'den türetilen parametreleri arasında bir korelasyon olduğunu gösteren önceki çalışmalarla uyumludur. İkincisi ayrıca, uzun QT aralığı ile anormal mekanik fonksiyon arasındaki ilişkinin gözlemlendiği ve hayvan ve hücresel deneylerle desteklendiği kalıtsal uzun QT Sendromları kapsamındaki hastalar için literatürde kapsamlı bir şekilde tartışılmıştır. Patofizyolojik olarak, aksiyon potansiyeli süresinin uzaması, hücre içi kalsiyum birikimi yoluyla belirgin mekanik işlev bozukluğuna neden olabilir. Bununla birlikte, yukarıda belirtilen analizlerin tanısal performansının yanı sıra korelasyonu da, muhtemelen yalnızca bir elektrokardiyografik parametre kullanılarak belirli bir derecede basitleştirme nedeniyle oldukça mütevazıydı. Aslında, aynı grup tarafından daha yeni bir analizde önerildiği gibi, QTc uzamasına Ttepe – Eğilim aralığının uzaması neden olabilir. Önceki çalışmalardan farklılık büyük olasılıkla, ilkinde psödonormal ve/veya kısıtlayıcı dolum paterni olan hastaların daha büyük yüzdesi ile açıklanabilir, bu da daha ileri bir kardiyak hastalık aşamasını ve dolayısıyla daha belirgin repolarizasyon değişikliklerini düşündürür. Tedavi: EDI, ucuz olması, kolayca bulunabilmesi ve uygulanmasının basit olması nedeniyle hipertansiyon nedeniyle takip edilen bireylerde DD'yi tahmin etmek için önemli bir tarama modelidir.
The effect of body mass index on complications in cardiac implantable electronic device surgery
(WILEY, 2023) Güzel, Tuncay; Demir, Muhammed; Aktan, Adem; Kılıç, Raif; Arslan, Bayram; Günlü, Serhat; Altıntaş, Bernas; Karahan, Mehmet Zülkif; Özbek, Mehmet; Aslan, Burhan; Arpa, Abdulkadir; Coşkun, Mehmet Sait; Altunbaş, Mahsum; Tüzün, Rohat; Akgümüş, Alkame; Karadeniz, Muhammed; Aydın, Saadet; Güzel, Hamdullah; Aslan, Selen Filiz; Söner, Serdar; Taş, Ahmet; Ertaş, Faruk
Background: Cardiac implantable electronic device (CIED) procedures are prone to complications. In our study, we investigated the effect of body mass index (BMI) on CIED-related complications. Methods: 1676 patients who had undergone CIED surgery (de novo implantation, system upgrade, generator change, pocket revision or lead replacement) at two heart centers in Turkey and met the study criteria were included in our study. For analysis of primary and secondary endpoints, patients were classified as non-obese (BMI < 25 kg/m2), overweight (25 ≤ BMI < 30 kg/m2), and obese (BMI ≥ 30 kg/m2). The primary endpoint was accepted as cumulative events, including the composite ofclinically significant hematoma (CSH), pericardial effusion or tamponade, pneumoth- orax, and infection related to the device system. Secondary outcomes included each component of cumulative events. Results: The rate of cumulative events, defined as primary outcome, was higher in the obese patient group, and we found a significant difference between the groups (3.0%, 4.3%, 8.9%, p = .001). CSH and pneumothorax rates were significantly higher in the obese patient group (0.3%, 0.9%, 1.9%, p = .04; 1.0%, 1.4%, 3.3%, p = .04, respectively). According to our multivariate model analysis; gender (OR:1.882, 95%CI:1.156–3.064, p = .01), hypertension (OR:4.768, 95%CI:2.470–9.204, p < .001), BMI (OR:1.069, 95%CI:1.012–1.129, p = .01) were independent predictors of cumulative events rates. Conclusions: Periprocedural complications associated with CIED (especially hematoma and pneumothorax) are more common in the group with high BMI.
Effect of cardio-gastric interaction on atrial fibrillation in GERD patients
(2023) Günlü, Serhat; Araç, Eşref; Aktan, Adem; Kayan, Fethullah; Bernas, Altıntaş; Karahan, Mehmet Zülkif
Objective: Atrial fibrillation (AF) and gastroesophageal reflux disease (GERD) are very common in daily clinical practice. Post-prandial AF episodes have been reported in GERD patients. Although it was reported in previous studies that it was caused by sympathovagal imbalance, there are no studies on cardiac conduction system involvement. In this study, we aimed to evaluate whether the risk of developing AF increases in untreated GERD patients with non-invasive electrophysiological tests. Methods: The research was prospectively performed. Endoscopy was performed on the individuals due to reflux complaints. ECG was recorded at 25mm/s and 10 mm/mV amplitude, and 24-hour Holter ECG (three-channel; V1, V2, and V5) was performed. ECG parameters were measured and Holter ECG results were analyzed. Results: A total of 120 individuals, 60 patients and 60 controls, were included. No significant statistically differences existed between groups for hypertension, diabetes, smoking, or dyslipidemia (p>0.05). In terms of heart rate, Pmax, Pmin, QTd, and QTcd, there were no significant differences across the two groups (p>0.05). P-wave dispersion (Pd) was substantially higher in the study group (p=0.014). Comparing the heart rate variabilities of 24-hour Holter ECG recordings across the groups, the standard deviation of R-R intervals (SDNN) was substantially higher in the study group (p<0.001). Low Frequency (LF) and LF/HF were significantly higher in the control group (p<0.001 and p=0.003, respectively). AF was detected in nine individuals on Holter ECG. Conclusion: Pd duration and risk of developing AF were higher in GERD patients.
The effect of coronary slow flow on ventricular repolarization parameters
(ScienceDirect, 2023) Karahan, Mehmet Zülkif; Aktan, Adem; Güzel, Tuncay; Günlü, Serhat; Kılıç, Raif
Introduction: Ischemia due to microvascular dysfunction may be responsible for the heterogeneity of ventricular repolarization in coronary slow flow. To our knowledge, there is no study in which QT interval, Tp-Te interval, index of cardiac-electrophysiological balance (iCEB), and frontal QRS-T angle were evaluated together in patients with CSF. In this study, we examined for the first time the relationship between all these myocardial repolarization parameters and CSF. Materials and methods: The study group included 178 patients (99 female, mean age: 50.6 ± 8.6 years) with isolated CSF without stenotic lesions and with angiographically proven normal coronary arteries. The control group included 120 patients (71 female, mean age: 49.3 ± 9.4 years) with normal coronary angiography. QRS duration, QT interval, QTc interval, Tp-Te interval, Tp-Te/QT, Tp- Te/QTc, iCEB score, and frontal QRS-T angle were calculated from 12‑lead ECGs. Results: There was no significant difference in demographic parameters between the two groups. Compared with the control group, patients with CSF had significantly longer QTmax duration, QT dispersion, Tp-Te interval, and higher iCEB score, wider frontal QRS-T angle. Conclusion: In our study, we found that many of the ventricular repolarization parameters were adversely affected in patients with CSF. Impaired parameters may be associated with the risk of malignant ventricular arrhythmias.
The effect of coronary slow flow on ventricular repolarization parameters
(ELSEVIER, 2023) Karahan, Mehmet Zülkif; Aktan, Adem; Güzel, Tuncay; Günlü, Serhat; Kılıç, Raif
Introduction: Ischemia due to microvascular dysfunction may be responsible for the heterogeneity of ventricular repolarization in coronary slow flow. To our knowledge, there is no study in which QT interval, Tp-Te interval, index of cardiac-electrophysiological balance (iCEB), and frontal QRS-T angle were evaluated together in patients with CSF. In this study, we examined for the first time the relationship between all these myocardial repolarization parameters and CSF. Materials and methods: The study group included 178 patients (99 female, mean age: 50.6 ± 8.6 years) with isolated CSF without stenotic lesions and with angiographically proven normal coronary arteries. The control group included 120 patients (71 female, mean age: 49.3 ± 9.4 years) with normal coronary angiography. QRS duration, QT interval, QTc interval, Tp-Te interval, Tp-Te/QT, Tp- Te/QTc, iCEB score, and frontal QRS-T angle were calculated from 12‑lead ECGs. Results: There was no significant difference in demographic parameters between the two groups. Compared with the control group, patients with CSF had significantly longer QTmax duration, QT dispersion, Tp-Te interval, and higher iCEB score, wider frontal QRS-T angle. Conclusion: In our study, we found that many of the ventricular repolarization parameters were adversely affected in patients with CSF. Impaired parameters may be associated with the risk of malignant ventricular arrhythmias.
An Evaluation of Cardiovascular Risk Factors Among Military Personnel: A Study Conducted in Turkey
(2022) Günlü, Serhat; Karahan, Mehmet Zülkif
Background: Cardiovascular (CV) risk factors are associated with high morbidity and mortality rates; however, prevalence data for Turkish military members are unknown. Aim: This study determines how common cardiovascular risk factors are among military members in the Corps Command Military Unit and how they relate to socio-demographic parameters. Materials and Methods: A cross-sectional research was conducted with 25222 active-duty individuals. A questionnaire was used to assess cardiovascular risk factors. This study included patients with more than two risk factors or current cardiac complaints. ECGs, echocardiograms, and biochemical testing were performed. Results: The study employed 835 individuals with an average age of 19.43±2.12 years. 19.6% of them had hypertension, 5.6% had dyslipidemia, 39.6% were smokers, 2.4% had diabetes mellitus, and 9.8% had a positive family history. Physical activity frequency was not observed in 54% of the patients before enlisting in the military. There was a significant positive correlation between smoking and mental stress (r=1.07, p<0.001). Conclusion: In terms of cardiovascular risk, hypertension and smoking were found to be the most prevalent among the Corps command staff. Therefore, this study provides compelling evidence that military healthcare providers should conduct annual periodic checks on those at risk for cardiovascular diseases.
Evaluation of Frontal QRS-T Angle in Patients with Coronary Artery Ectasia
(Sociedade Brasileira de Cardiologia – SBC, 2023) Karahan, Mehmet Zülkif; Aktan, Adem; Güzel, Tuncay; Kayan, Fethullah; Günlü, Serhat
Background: Coronary artery ectasia (CAE) is defined by focal enlargement of the coronary artery exceeding 1.5 times the adjacent normal segment. CAE can often cause arrhythmias, heart failure, sudden death, and myocardial ischemia. Ischemia due to microvascular dysfunction may be responsible for the ventricular heterogeneity in CAE. Objectives: The aim of our study was to evaluate the frontal QRS-T angle in patients with CAE. Methods: Our study included 55 patients with CAE and 50 individuals in the control group. Demographic characteristics and electrocardiographic parameters were compared between the two groups. Categorical variables were compared using the chi-square test. Continuous variables were compared using unpaired Student’s t-test. P values < 0.05 were considered statistically significant. The frontal QRS-T angle was calculated from 12-lead electrocardiograms (ECGs) using the automatic report from the electrocardiography machine. Results: The average age of patients with CAE was 63.2 ± 3.4 years, with 18 women among them. The control group had an average age of 61.1 ± 3.2 years, with 28 women included. There was no significant difference in demographic parameters between the two groups. Compared to the control group, patients with CAE had significantly wider frontal QRS-T angle (p < 0.001), as well as longer QTmax duration, p = 0.002; Tp-Te interval, p = 0.02; and QT dispersion (QTd), p = 0.04. Conclusion: The frontal QRS-T angle can be calculated easily and time-efficiently using surface electrocardiography. In this study, we showed for the first time that the frontal QRS-T angle was significantly increased in patients with CAE.
Evaluation of Frontal QRS-T Angle in Patients with Coronary Artery Ectasia
(Sociedade Brasileira de Cardiologia, 2023) Karahan, Mehmet Zülkif; Aktan, Adem; Güzel, Tuncay; Kayan, Fethullah; Günlü, Serhat
Background: Coronary artery ectasia (CAE) is defined by focal enlargement of the coronary artery exceeding 1.5 times the adjacent normal segment. CAE can often cause arrhythmias, heart failure, sudden death, and myocardial ischemia. Ischemia due to microvascular dysfunction may be responsible for the ventricular heterogeneity in CAE. Objectives: The aim of our study was to evaluate the frontal QRS-T angle in patients with CAE. Methods: Our study included 55 patients with CAE and 50 individuals in the control group. Demographic characteristics and electrocardiographic parameters were compared between the two groups. Categorical variables were compared using the chi-square test. Continuous variables were compared using unpaired Student’s t-test. P values < 0.05 were considered statistically significant. The frontal QRS-T angle was calculated from 12-lead electrocardiograms (ECGs) using the automatic report from the electrocardiography machine. Results: The average age of patients with CAE was 63.2 ± 3.4 years, with 18 women among them. The control group had an average age of 61.1 ± 3.2 years, with 28 women included. There was no significant difference in demographic parameters between the two groups. Compared to the control group, patients with CAE had significantly wider frontal QRS-T angle (p < 0.001), as well as longer QTmax duration, p = 0.002; Tp-Te interval, p = 0.02; and QT dispersion (QTd), p = 0.04. Conclusion: The frontal QRS-T angle can be calculated easily and time-efficiently using surface electrocardiography. In this study, we showed for the first time that the frontal QRS-T angle was significantly increased in patients with CAE
Evaluation of Hematological Parameters After Transcatheter Aortic Valve Replacement
(SAGE, 2023) Karahan, Mehmet Zülkif; Aktan, Adem; Güzel, Tuncay; Kılıç, Raif; Günlü, Serhat; Demir, Muhammed; Ertaş, Faruk
Although transcatheter aortic valve replacement (TAVR) is safe and effective, mortality and bleeding events post procedure are important. The present study investigated the changes in hematologic parameters to evaluate whether they predict mortality or major bleeding. We enrolled 248 consecutive patients (44.8% male; mean age 79.0 ± 6.4 years) undergoing TAVR. In addition to demographic and clinical examination, blood parameters were recorded before TAVR, at discharge, 1 month and 1 year. Hemoglobin levels before TAVR 12.1 ± 1.8 g/dL, 10.8 ± 1.7 g/dL at discharge, 11.7 ± 1.7 g/dL at first month, 11.8 ± 1.4 g/dL at first year (Hemoglobin values compared with pre-TAVR, P < .001, P = .019, P = .047, respectively). Mean platelet volume (MPV) before TAVR 8.72 ± 1.71 fL, 8.16 ± 1.46 fL at discharge, 8.09 ± 1.44 fL at first month, 7.94 ± 1.18 fL at first year (MPV values compared with pre-TAVR, P < .001, P < .001, P < .001, respectively). Other hematologic parameters were also evaluated. Hemoglobin, platelet count, MPV, and red cell distribution width before the procedure, at discharge, and at the first year did not predict mortality and major bleeding in receiver operating characteristic analysis. After multivariate Cox regression analysis, hematologic parameters were not independent predictors of in-hospital mortality, major bleeding, and death at 1 year after TAVR.
Evaluation of Hematological Parameters After Transcatheter Aortic Valve Replacement
(Sage Journals, 2023) Karahan, Mehmet Zülkif; Aktan, Adem; Güzel, Tuncay; Kılıç, Raif; Günlü, Serhat; Demir, Muhammed; Ertaş, Faruk
Although transcatheter aortic valve replacement (TAVR) is safe and effective, mortality and bleeding events post procedure are important. The present study investigated the changes in hematologic parameters to evaluate whether they predict mortality or major bleeding. We enrolled 248 consecutive patients (44.8% male; mean age 79.0 ± 6.4 years) undergoing TAVR. In addition to demographic and clinical examination, blood parameters were recorded before TAVR, at discharge, 1 month and 1 year. Hemoglobin levels before TAVR 12.1 ± 1.8 g/dL, 10.8 ± 1.7 g/dL at discharge, 11.7 ± 1.7 g/dL at first month, 11.8 ± 1.4 g/dL at first year (Hemoglobin values compared with pre-TAVR, P < .001, P = .019, P = .047, respectively). Mean platelet volume (MPV) before TAVR 8.72 ± 1.71 fL, 8.16 ± 1.46 fL at discharge, 8.09 ± 1.44 fL at first month, 7.94 ± 1.18 fL at first year (MPV values compared with pre-TAVR, P < .001, P < .001, P < .001, respectively). Other hematologic parameters were also evaluated. Hemoglobin, platelet count, MPV, and red cell distribution width before the procedure, at discharge, and at the first year did not predict mortality and major bleeding in receiver operating characteristic analysis. After multivariate Cox regression analysis, hematologic parameters were not independent predictors of in-hospital mortality, major bleeding, and death at 1 year after TAVR.
Evaluation of Right Ventricular Global Longitudinal Strain in COVID-19 Patients After Intensive Care Unit Discharge
(2023) Günlü, Serhat; Arpa, Abdulkadir; Aktan, Adem; Güzel, Tuncay; Kılıç, Raif; Kayan, Fethullah; Işık, Mehmet Ali; Çelikten, Murat; Arslan, Bayram; Karahan, Mehmet Zülkif
Background and Aim: Using two-dimensional speckle tracking echocardiography (2D-STE), the ventricular functions of hospitalized coronavirus disease-2019 (COVID-19) patients were assessed. However, there is limited information about cardiac functions in the first year after recovery from the intensive care unit (ICU). This research aims to assess the right ventricular functions of COVID-19 patients and their changes within the first year after ICU discharge using 2D-STE. Materials and Methods: The study was conducted prospectively. The study included 68 consecutive patients and 70 control patients. Echocardiography was performed in the ICU and the first year after discharge from the hospital. Right ventricular global longitudinal strain (RVGLS) was measured using the 2D-STE method. Results: The mean age of the study group was 48.67±8.10 and 37 (54.4%) patients were males. There were no substantial differences across the groups, including age, gender, body mass index, heart rate, diabetes, dyslipidemia, and smoking (P > 0.05). A substantially significant positive correlation was detected between right ventricular dimension (RAD) (r = 0.644, P < 0.001), right ventricular diastolic dimension (RVDD) (r = 0.573, P < 0.001), ferritin (r = 0.454, P < 0.001), D-dimer (r = 0.305, P = 0.011) values and RVGLS in the in-hospital and after-discharge first-year groups. The RVGLS values of the control, in-hospital, and after-discharge first-year groups were -20.36±3.06, -16.98±3.78, and -17.58±6.45, indicating a statistically significant difference across the groups (P < 0.001). Tricuspid annular plane systolic excursion was higher in the control group (P < 0.05). Conclusion: RVGLS was found to be depressed during the in-hospital period and showed no improvement in the 1 year post discharge.
The Importance of Frontal QRS-T Angle in Predicting the Effectiveness and Success of Thrombolytic Therapy in Patients With Acute Pulmonary Embolism
(Cureus, 2023) Durgun, Mehmet; Karahan, Mehmet Zülkif
Objective: The frontal QRS-T angle (fQRS-T) is associated with myocardial ischemia and ventricular arrhythmias. On the other hand, acute pulmonary embolism (APE) is a major risk factor for cardiac adverse events. This research aimed to determine whether the fQRS-T, a marker of ventricular heterogeneity, can be used to predict successful thrombolytic therapy in patients with APE. Methods: This was a retrospective observational study. Patients diagnosed with APE and hospitalized in the intensive care unit between 2020 and 2022 were included in the research. A total of 136 individuals with APEs were enrolled in this research. The patients were divided into two groups: thrombolytic-treated (n=64) and non-treated (moderate to severe risk, n=72). An ECG was conducted for each patient, and echocardiography was performed. Results: The mean age of the thrombolytic group was 58.2±17.6 years, with 35 females (55.1% of the group) and 29 males (44.9%). The non-thrombolytic group had a mean age of 63.1±16.2, with 41 females (56.5%) and 31 males (43.5%). Respiratory rate, heart rate, and fQRS-T were higher in the thrombolytic group, and oxygen saturation ratio and systolic and diastolic blood pressure were higher in the non-thrombolytic group (p=0.006, p<0.001, p=0.021; p<0.001, p=0.015, p<0.001, respectively). In the thrombolytic therapy group, comparing pre- and post-treatment ECG data revealed a statistically significant change in the fQRS-T value (p=0.019). Conclusion: The fQRS-T may provide important clues for the successful treatment of APEs
Is atrial fibrillation a risk factor for hearing loss?
(2023) Karahan, Mehmet Zülkif; Can, Sermin
Abstract. – OBJECTIVE: In the present study, we sought to evaluate the results of hearing loss in AF patients. PATIENTS AND METHODS: This study involved 50 patients with AF, as determined by means of electrocardiogram, and 50 patients without AF. The pure-tone audiometry (PTA) threshold values were measured at low, medium and high frequencies for both ears. The signalto-noise ratio (SNR) DPOAEs and TEOAEs were also analyzed for both ears separately. RESULTS: Both the airway and bone conduction PTA thresholds at 3, 4 and 6 kHz (kilohertz) were significantly lower in the AF group than in the control group (p<0.05). The AF patients exhibited worse hearing and worse TEOAE results at 1, 2, 3 and 4 kHz. In fact, the TEOAE amplitudes of the AF group were significantly lower in both the right and left ears at 2, 3 and 4 kHz when compared with the control group (p<0.05). Moreover, the DPOAE amplitudes in the AF group were statistically significantly lower at 3.4 kHz in both ears when compared with the control group (p<0.05). CONCLUSIONS: In light of these findings, we believe that AF is a risk factor for hearing.

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