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Kardiyoloji Anabilim Dalı Koleksiyonu

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    Article
    Citation - WoS: 2
    Citation - Scopus: 2
    Aging and cardiac implantable electronic device complications: is the procedure safe in older patients?
    (Springer, 2023) Günlü, Serhat; Aktan, Adem; Kılıç, Raif; Günlü, Serhat; Arslan, Bayram; Arpa, Abdulkadir; Güzel, Hamdullah; Tatlı, İsmail; Aydın, Saadet; Suzan, Veysel; Demir, Muhammed; Department of Internal Medical Sciences / Dahili Tıp Bilimleri Bölümü
    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.
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    Article
    Citation - WoS: 2
    Aging and cardiac implantable electronic device complications: is the procedure safe in older patients?
    (ELSEVIER, 2023) Günlü, Serhat; Aktan, Adem; Kılıç, Raif; Günlü, Serhat; Arslan, Bayram; Arpa, Abdulkadir; Güzel, Hamdullah; Tatlı, İsmail; Aydın, Saadet; Suzan, Veysel; Demir, Muhammed; Department of Internal Medical Sciences / Dahili Tıp Bilimleri Bölümü
    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.
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    Article
    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; Department of Internal Medical Sciences / Dahili Tıp Bilimleri Bölümü
    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.
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    Presentation
    Diyastolik Disfonksiyon Tanısında Elektrokardiyografik Diyastolik Endeksinin Prognostik Rolü
    (2023) Günlü, Serhat; Department of Internal Medical Sciences / Dahili Tıp Bilimleri Bölümü
    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.
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    Article
    Citation - WoS: 1
    Citation - Scopus: 1
    The effect of body mass index on complications in cardiac implantable electronic device surgery
    (WILEY, 2023) Günlü, Serhat; Aktan, Adem; Kılıç, Raif; 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; Department of Internal Medical Sciences / Dahili Tıp Bilimleri Bölümü
    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.
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    Article
    Effect of cardio-gastric interaction on atrial fibrillation in GERD patients
    (2023) Günlü, Serhat; Aktan, Adem; Kayan, Fethullah; Karahan, Mehmet Zülkif; Bernas, Altıntaş; Karahan, Mehmet Zülkif; Department of Internal Medical Sciences / Dahili Tıp Bilimleri Bölümü
    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.
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    Article
    Citation - Scopus: 5
    The effect of coronary slow flow on ventricular repolarization parameters
    (ScienceDirect, 2023) Karahan, Mehmet Zülkif; Aktan, Adem; Günlü, Serhat; Kılıç, Raif; Kılıç, Raif; Department of Internal Medical Sciences / Dahili Tıp Bilimleri Bölümü
    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.
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    Article
    The effect of coronary slow flow on ventricular repolarization parameters
    (ELSEVIER, 2023) Günlü, Serhat; Karahan, Mehmet Zülkif; Aktan, Adem; Kılıç, Raif; Kılıç, Raif; Department of Internal Medical Sciences / Dahili Tıp Bilimleri Bölümü
    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.
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    Article
    An Evaluation of Cardiovascular Risk Factors Among Military Personnel: A Study Conducted in Turkey
    (2022) Günlü, Serhat; Karahan, Mehmet Zülkif; Department of Internal Medical Sciences / Dahili Tıp Bilimleri Bölümü
    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.
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    Article
    Evaluation of Frontal QRS-T Angle in Patients with Coronary Artery Ectasia
    (Sociedade Brasileira de Cardiologia – SBC, 2023) Günlü, Serhat; Karahan, Mehmet Zülkif; Aktan, Adem; Kayan, Fethullah; Günlü, Serhat; Department of Internal Medical Sciences / Dahili Tıp Bilimleri Bölümü
    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.
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    Article
    Citation - Scopus: 2
    Evaluation of Frontal QRS-T Angle in Patients with Coronary Artery Ectasia
    (Sociedade Brasileira de Cardiologia, 2023) Karahan, Mehmet Zülkif; Aktan, Adem; Kayan, Fethullah; Günlü, Serhat; Günlü, Serhat; Department of Internal Medical Sciences / Dahili Tıp Bilimleri Bölümü
    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
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    Article
    Citation - WoS: 1
    Evaluation of Hematological Parameters After Transcatheter Aortic Valve Replacement
    (SAGE, 2023) Günlü, Serhat; Karahan, Mehmet Zülkif; Aktan, Adem; Kılıç, Raif; Günlü, Serhat; Demir, Muhammed; Ertaş, Faruk; Department of Internal Medical Sciences / Dahili Tıp Bilimleri Bölümü
    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.
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    Article
    Citation - WoS: 1
    Citation - Scopus: 2
    Evaluation of Hematological Parameters After Transcatheter Aortic Valve Replacement
    (Sage Journals, 2023) Karahan, Mehmet Zülkif; Aktan, Adem; Kılıç, Raif; Günlü, Serhat; Günlü, Serhat; Demir, Muhammed; Ertaş, Faruk; Department of Internal Medical Sciences / Dahili Tıp Bilimleri Bölümü
    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.
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    Citation - WoS: 0
    The Importance of Frontal QRS-T Angle in Predicting the Effectiveness and Success of Thrombolytic Therapy in Patients With Acute Pulmonary Embolism
    (Cureus, 2023) Karahan, Mehmet Zülkif; Karahan, Mehmet Zülkif; Department of Internal Medical Sciences / Dahili Tıp Bilimleri Bölümü
    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
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    Local Against General Anesthesia For Transcatheter Aortic Valve Replacement
    (Bandırma Onyedi Eylül Üniversitesi Tıp Fakültesi, 2023) Günlü, Serhat; Kayan, Fethullah; Aktan, Adem; Karahan, Mehmet Zülkif; Tanırcan, Muhammed Raşid; Karahan, Mehmet Zülkif; Department of Internal Medical Sciences / Dahili Tıp Bilimleri Bölümü
    Background/Aims: Transcatheter aortic valve replacement (TAVR) poses significant challenges concerning anesthesia management. There is no consensus on the type of safer anesthesia for TAVR procedures. We aimed to evaluate the effectiveness and safety of TAVR performed with trans-femoral approach under local anesthesia with sedation (LAS) against general anesthesia (GA). Methods: This observational and retrospective analysis included individuals who were admitted on a planned basis from 2016 to 2022 and underwent Transfemoral TAVR. Effectiveness and safety outcomes were evaluated at 30 days. İndividuals were separated into two groups: GA and LAS. Demographic characteristics and procedural data were recorded during hospitalization. Results: 115 patients were included, of whom 62 (53.9%) received LAS and 53 received GA (46.1%). 59 female (48.8%) patients with a mean age of 83.2±5.7 participated in the study. Successful TAVR procedure was performed in 100 (86.9%) of 115 patients with the transfemoral approach. The mean procedure time was 136.7±46.7 minutes, and the procedure time was shorter in patients who underwent LAS against GA (p=0.001). There were no differences among the groups including fluoroscopy time, contrast, and radiation dose (p>0.05). In 2 patients (3.2%), significant vascular complications necessitated immediate surgical intervention, necessitating a change in the anesthesia technique. Overall 30-day mortality was 5.2%, with no significant differences among the groups (GA 7.5% vs. LAS 3.2%, p =0.28). GA had substantially longer ICU and total hospitalization stays than LAS (p=0.009 and p =0.004, respectively). Conclusions: In our study, TAVR via the transfemoral route using LAS was an alternative for GA.
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    Citation - WoS: 2
    Non-Dipper Blood Pressure Impact on Coronary Slow Flow in Hypertensive Patients With Normal Coronary Arteries
    (Cureus, 2023) Karahan, Mehmet Zülkif; Karahan, Mehmet Zülkif; Department of Internal Medical Sciences / Dahili Tıp Bilimleri Bölümü
    Objective: Coronary slow flow (CSF) is linked to myocardial ischemia, malignant arrhythmias, and cardiovascular mortality. On the other hand, hypertension (HTN) is an important risk factor for vascular disorders. There is limited research on the relationship between CSF and HTN. This study aimed to investigate TIMI frame count (TFC), which is an indicator of CSF, in dipper and non-dipper hypertensive individuals with normal coronary arteries. Methods: The study was conducted as a retrospective observational study. Patients diagnosed with CSF and dipper or non-dipper hypertension were included in this study. Blood tests were routinely conducted for all patients. ECG was conducted for each patient, and echocardiography was performed. Coronary artery images were obtained in the CAG laboratory. Blood pressure (BP) measurements were obtained from the ambulatory Holter records. The patients were separated into two groups based on ambulatory Holter monitoring. The relationship between CSF and HTN was also examined. Results: A total of 71 patients, comprising 25 women (37.2%) and 46 men (62.8%) with an average age of 52.75±9.42 years, were enrolled in the research. Based on ambulatory BP, the individuals were separated into two groups: non-dipper (n=36) and dipper (n=35). The pulse rate was significantly higher in the non-dipper group (p<0.001). In terms of mean systolic and diastolic blood pressure, there were no substantial differences across the groups (p = 0.326 and p = 0.654, respectively). The daytime mean systolic and diastolic BP did not significantly differ across the groups (p = 0.842 and p = 0.421). The dipper group had substantially lower nighttime systolic and diastolic BP values (p <0.001). The LAD, Cx, and RCA TIMI frame scores were significantly lower in the dipper group (p<0.001). Conclusion: In this study, non-dipper patients had a greater CSF rate than dipper.
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    Predicting the mortality in patients with carotid artery stenosis by monocyte to high density lipoprotein ratio
    (2023) Günlü, Serhat; Department of Internal Medical Sciences / Dahili Tıp Bilimleri Bölümü
    Introduction: Background: Monocytes, which produce a variety of cytokines and molecules, interact with platelets and endothelial cells, causing inflammatory and thrombotic pathways to become worse. Macrophage migration and oxidation of low-density lipoprotein cholesterol molecules are both inhibited by high-density lipoprotein cholesterol (HDL-C). HDL-C neutralizes monocytes' pro-inflammatory and pro-oxidant effects through several mechanisms. As a result, characteristics like the monocyte to HDL-C ratio (MHR) may reveal a patient's inflammatory status. Objective: The development of carotid artery stenosis (CAS) is influenced by inflammation, oxidative stress, and endothelial dysfunction. Recent research suggests that inflammatory biomarkers are important for assessing mortality in carotid artery stenosis. This study aims to determine the association between MHR and mortality after carotid artery stenting. Tools and Method: We enrolled 260 patients with CAS who underwent carotid artery stenting between 2019 and 2021. MHR was calculated using the formula: the monocyte value dividing by the high-density lipoprotein cholesterol value. According to 30-day mortality, the patients were divided into two groups; surviving and non-surviving. Monocyte counts, HDL-C, and MHR values were compared between the groups. Results: The patient group had significantly higher monocyte counts and lower HDL levels than the control group, resulting in higher MHR values. In addition, non-surviving patients had a higher monocyte count and MHR value, as well as a lower HDL-C level (p<0.001). In patients with CAS, the MHR value was also found to be a significant independent determinant of 30-day mortality (p<0.001). MHR had the optimum cut-off value of 17.52 with 78.3% sensitivity and 83.4% specificity (AUC:0.724, p<0.001) for predicting 30-day mortality in patients with CAS. Comparison of the monocyte count, HDL level, and MHR value according to the mortality within the 30 days. Non-surviving group n=48 Surviving group n=212 P-values Monocyte (x109 µL) 915.42±53.21 524.03±9.98 <0.001 HDL-C (mg/dL) 37.03±1.16 46.22±0.9 <0.001 MHR 18.86±5.25 12.21±2.21 <0.001 Values are presented as mean ± SD and median [interquartile range]. HDL-C; high-density lipoprotein cholesterol, MHR; monocyte to high-density lipoprotein ratio. Discussion: Conclusion: In patients with CAS, a high MHR value was found to be an independent predictor of 30-day mortality.
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    Citation - Scopus: 1
    The predictive effect of shock index on mortality in patients with acute heart failure
    (AME Publishing, 2023) Günlü, Serhat; Kayan, Fethullah; Karahan, Mehmet Zülkif; Department of Internal Medical Sciences / Dahili Tıp Bilimleri Bölümü
    Background: The predictive usefulness of the shock index (SI), which is determined as a proportion of heart rate (HR) to systolic blood pressure (SBP), and age-adjusted SI (SI × age) for clinical outcomes other than mortality in acute heart failure (AHF) is not well established. This research aimed to examine whether SI and SI × age measured non-invasively at a patient’s bedside can identify mortality risk in patients admitted to the coronary care unit (CCU) with AHF. Methods: This research was carried out as a retrospective case-control study. Indices were calculated. The receiving operating characteristic (ROC) and Youden index were applied to calculate the optimal SI and SI × age cut-off for estimating mortality. Using multivariate analysis to determine independent indicators of mortality in patients with AHF. Results: A total of 1,468 patients who were hospitalized at the CCU with AHF were included. The population’s median age was 81 (73–91) years and 53.7% were male. In the survivor group, the median SI was 0.6 (0.5–0.75), and the median SI × age was 46 (38–58). In the non-survivor group, the median SI was 0.62 (0.55–0.81) and the median SI × age was 53 (44–66). According to the Youden index, the best value of SI was 0.56 with a specificity of 46% and a sensitivity of 70%, and the best value of SI × age was 44.8 with a specificity of 48% and a sensitivity of 76%. In the multivariate analysis, the power of SI × age to predict mortality was 2.39 times greater than other independent predictors. Conclusions: SI and SI × age calculated in the CCU may be valuable prognostic markers for identifying AHF patients at high risk for adverse outcomes.
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    Prevalence of Hypertension in Military Personnel: A Study Conducted in Türkiye
    (2023) Günlü, Serhat; Karahan, Mehmet Zülkif; Department of Internal Medical Sciences / Dahili Tıp Bilimleri Bölümü
    Abstract: Hypertension is a major global public health concern. There is a paucity of studies describing military populations with hypertension. We aimed to demonstrate Turkish military personnel with hypertension and review associated factors in a garrison of Diyarbakır City. This retrospective cross-sectional study comprised 22,141 individuals referred to an outpatient cardiology clinic between August 2016 and June 2022 with complaints of early morning headaches, abnormal heart rhythms, nosebleeds, visual problems, and buzzing in the ears. Sociodemographic characteristics were collected. Analyses of laboratory test findings and blood pressure measurements were conducted. The study comprised a total of 174 patients with an average age of 32.68±6.51 years. 94.8 percent of the patients were not drug users, and 68.3 percent had no strong family history. The prevalence of hydration habits (29.4%) and sleep disturbances (22.5%) were lower. According to body mass index (BMI), the rate of overweight was higher (56.8%). Most patients' educational status was bachelor’s degrees (46.5%). The smoking rate was high (73%). Body mass index was a statistically significant predictive factor of hypertension (OR [95% CI], 2.69 [1.0-7.17], p= 0.048). Physical exercise rate in the past three months was a statistically significant predictive factor for hypertension (OR [95%CI], 2.98 [1.42-6.23], P= 0.021). Hypertension was detected in 0.78 percent of all participants and was associated with being overweight and a lower frequency of physical exercise.
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    Citation - WoS: 3
    The prognostic value of ORBIT risk score in predicting major bleeding in patients with acute coronary syndrome
    (ELSEVIER, 2023) Günlü, Serhat; Kayan, Fethullah; Kılıç, Raif; Aktan, Adem; Kılıç, Raif; Aktan, Adem; Bernas, Altıntaş; Karahan, Mehmet Zülkif; Department of Internal Medical Sciences / Dahili Tıp Bilimleri Bölümü
    Background: The most significant adverse effect of antithrombotic medication in acute coronary syndrome (ACS) is major bleeding, which is related to increased mortality. Studies on ORBIT risk score in predicting major bleeding in ACS patients are limited. Objective: This research aimed to examine whether the ORBIT score calculated at the bedside can identify major bleeding risk in patients with ACS. Methods: This research was retrospective, observational, and conducted at a single center. Analyses of receiver operating characteristics (ROC) were utilized to define the diagnostic value of CRUSADE and ORBIT scores. The predictive performances of the two scores were compared using DeLong's method. Discrimination and reclassification performances were evaluated by the integrated discrimination improvement (IDI), and net reclassification improvement (NRI). Results: The study included 771 patients with ACS. The mean age was 68.7 ± 8.6 years, with 35.3 % females. 31 patients had major bleeding. Twenty-three of these patients were BARC 3 A, five were BARC 3 B, and three were BARC 3 C. Bleeding history [OR (95 % CI), 2.46 (1.02–5.94), p = 0.021], hemoglobin levels [OR (95 % CI), 0.54 (0.45–0.63), p < 0.001], and age > 74 years [OR (95 % CI), 1.03 (1.01–1.06), p = 0.039] were independent predictors of major bleeding. The ORBIT score was an independent predictor of major bleeding in the multivariate analysis: continuous variables [OR (95 % CI), 2.53 (2.61–3.95), p < 0.001] and risk categories [OR (95 % CI), 3.06 (1.69–5.52), p < 0.001]. Comparison of c-indexes for major bleeding events revealed a non-significant difference for the discriminative ability of the two tested scores (p = 0.07) with a continuous NRI of 6.6 % (p = 0.026) and an IDI of 4.2 % (p < 0.001). Conclusion: In ACS patients, the ORBIT score independently predicted major bleeding.