Browsing by Author "Altin, Cihan"

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Admission Tpe interval predicts reperfusion success in STEMI patients treated with fibrinolytic agents
(2020) Coner, Ali; Akinci, Sinan; Akkucuk, Mehmet Husamettin; Altin, Cihan; Muderrisoglu, Haldun; 0000-0002-9635-6313; 0000-0003-4569-1143; 0000-0001-5250-5404; 31974326; AAG-8233-2020; AAJ-2828-2021; AAD-5564-2021
Objective: Myocardial infarction is a leading cause of morbidity and mortality. Fibrinolytic administration is still a life-saving choice in ST-segment elevated myocardial infarction (STEMI), but the rate of successful reperfusion can be inconsistent. Failed reperfusion adds additional clinical risks to rescue percutaneous coronary intervention for STEMI patients. The interval between the peak of the T wave and the end of the T wave (Tpe) and the ratio of Tpe and a corrected measurement of the time from the start of the Q wave to the end of the T wave (Tpe/QTc ratio) are relatively new electrocardiogram (ECG) indices and have not yet been tested in STEMI patients treated with fibrinolytic agents. Methods: A total of 177 STEMI patients (mean age: 60.5 +/- 11.1 years; 138 men and 39 women) were enrolled in this retrospective study to evaluate ECG parameters. The Tpe interval and the Tpe/QTc ratio at baseline and at the 90th minute following the administration of fibrinolytic therapy were analyzed. The clinical and ECG findings of successful and failed reperfusion groups were compared. Results: Successful reperfusion was achieved in 119 patients (67.2%). The average Tpe interval on the admission ECG was shorter (91.7 vs. 100.9 milliseconds [ms]) (p<0.001) and shortened more in the successful reperfusion group (9.3 vs. 4.5 ms) (p<0.001). A cut-off value of 89.0 ms for the Tpe interval on the admission ECG was found to be related to reperfusion success with a sensitivity of 90.9%. Conclusion: The Tpe interval was a predictor for reperfusion success in STEMI patients treated with fibrinolytic agents.
Angiotensin receptor neprilysin inhibitor for patients with heart failure and reduced ejection fraction: Real-world experience from Turkey (ARNi-TR)
(2021) Ekici, Berkay; Yaman, Mehmet; Kucuk, Murathan; Dereli, Seckin; Yenercag, Mustafa; Yigit, Zerrin; Bas, Mehmet Memduh; Karavelioglu, Yusuf; Cakmak, Huseyin Altug; Kivrak, Tarik; Ozkan, Hakan; Altin, Cihan; Sabanoglu, Cengiz; Demirkan, Burcu; Atas, Ali Ekber; Kilicaslan, Fethi; Altay, Hakan; Tengiz, Istemihan; Erkan, Aycan Fahri; Kilicaslan, Baris; Olgun, Fatih Erkam; Durakoglugil, Murtaza Emre; Alhan, Aslihan; Zoghi, Mehdi; 34308869
Objective: Heart failure (HF) is a growing public health problem with high morbidity and mortality. Recently, angiotensin receptor neprilysin inhibitor (ARNi) has emerged as a promising treatment for HF with reduced ejection fraction (HFrEF). Here, we shared our experience with the use of ARNi in HFrEF from multiple centers in Turkey. Methods: The ARNi-TR is a multicenter, nonintervention al, retrospective, observational study. Overall, 779 patients with HF from 22 centers in Turkey who were prescribed sacubitril/valsartan were examined. Initial clinical status, biochemical and echocardiographic parameters, and New York Heart Association functional class (NYHA-FC) values were compared with follow-up values after 1 year of ARNi use. In addition, the effect of ARNi on number of annual hospitalizations was investigated, and the patients were divided into 2 groups, depending on whether ARNi was initiated at hospitalization or under outpatient clinic control. Results: N-terminal pro-brain natriuretic peptide (NT-proBNP), left-ventricle ejection fraction (LV-EF), and NYHA-FC values improved significantly in both groups (all parameters, p<0.001) within 1-year follow-up. In both groups, a decrease in hemoglobin A1c (HbA1c) values was observed in ARNi use (p<0.001), and a decrease in daily diuretic doses and hospitalizations owing to HF were observed after ARNi use (all comparisons, p<0.001). Hypotension (16.9%) was the most common side effect in patients using ARNi. Conclusion: The ARNi-TR study offers comprehensive real-life data for patients using ARNi in Turkey. The use of ARNi has shown significant improvements in FC, NT-proBNP, HbA1c levels, and LV-EF. Likewise, reductions in the number of annual hospitalizations and daily furosemide doses for HF were seen in this study.
Assessment of Atrial Fibrillation and Ventricular Arrhythmia Risk after Bariatric Surgery by P Wave/QT Interval Dispersion
(2018) Yilmaz, Mustafa; Altin, Cihan; Tekin, Abdullah; Erol, Tansel; Arer, Ilker; Nursal, Tarik Zafer; Torer, Nurkan; Erol, Varlik; Muderrisoglu, Haldun; 0000-0002-3628-4661; 0000-0002-5658-870X; 0000-0002-2557-9579; 0000-0002-9635-6313; 28900850; AAN-5153-2021; ABD-7304-2021; IQV-1169-2023; S-6973-2016; AAG-8233-2020
The association of obesity with atrial fibrillation (AF) and with ventricular arrhythmias is well documented. The aim of this study was to investigate whether weight reduction by a laparoscopic sleeve gastrectomy has any effect on P wave dispersion (PWD), a predictor of AF, and corrected QT interval dispersion (CQTD), a marker of ventricular arrhythmias, in obese individuals. In a prospective study, a total of 114 patients (79 females, 35 males) who underwent laparoscopic sleeve gastrectomy were examined. The patients were followed 1 year. PWD and CQTD values before and 3rd, 6th, and 12th months after the surgery were calculated and compared. There was a statistically significant decline in body mass index (BMI), PWD, and CQTD values among baseline, 3rd, 6th, and 12th months (p < 0.001 for all comparisons). Correlation analysis showed a statistically significant correlation between Delta PWD and Delta BMI (r = 0.719, p < 0.001), Delta PWD and Delta left ventricular end-diastolic diameter (LVEDD) (r = 0.291, p = 0.002), Delta PWD and Delta left atrial diameter (LAD) (r = 0.65, p < 0.001), Delta CQTD and Delta BMI (r = 0.266, p = 0.004), Delta CQTD and Delta LVEDD (r = 0.35, p < 0.001), Delta CQTD and Delta LAD (r = 0.289, p = 0.002). In multiple linear regression analysis, there was a statistically significant relationship between Delta PWD and Delta BMI (beta = 0.713, p < 0.001), Delta PWD and Delta LVEDD (beta = 0.174, p = 0.016), Delta PWD and Delta LAD (beta = 0.619, p < 0.001), Delta CQTD and Delta BMI (beta = 0.247, p = 0.011), Delta CQTD and Delta LVEDD (beta = 0.304, p < 0.001), Delta CQTD and Delta LAD (beta = 0.235, p = 0.009). PWD and CQTD values of patients were shown to be attenuated after bariatric surgery. These results indirectly offer that there may be a reduction in risk of AF, ventricular arrhythmia, and sudden cardiac death after obesity surgery.
Assessment of Atrial Fibrillation and Ventricular Arrhythmia Risk after Transplantation in Patients with End Stage Renal Disease by P Wave/QT Interval Dispersion, Tp-e Interval, Tp-e/QT Interval Ratio
(2018) Yilmaz, Mustafa; Altin, Cihan; Tekin, Abdullah; Arer, Ilker; Yabanoglu, Hakan; Caliskan, Kenan; Moray, Gokhan; Ozin, Bulent; Muderrisoglu, Haldun; Haberal, Mehmet; https://orcid.org/0000-0002-2557-9579; https://orcid.org/0000-0002-5658-870X; https://orcid.org/0000-0002-1161-3369; https://orcid.org/0000-0002-8767-5021; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0003-3821-412X; https://orcid.org/0000-0002-9635-6313; https://orcid.org/0000-0002-3462-7632; S-6973-2016; ABD-7304-2021; AAJ-7865-2021; AAJ-7201-2021; AAE-1041-2021; AAD-9938-2021; AAG-8233-2020; AAJ-8097-2021
Assessment of Carotid Artery Distensibility and Elasticity After Laparoscopic Sleeve Gastrectomy: a Prospective Study
(2020) Gunesli, Aylin; Yilmaz, Mustafa; Altin, Cihan; Gezmis, Esin; Yabanoglu, Hakan; Erol, Varlik; 0000-0002-2557-9579; 0000-0002-8337-6905; 0000-0002-1161-3369; 0000-0002-1001-6028; 0000-0003-0268-8999; 32813160; S-6973-2016; AAK-3065-2021; AAJ-7865-2021; AAE-8301-2021; AAK-2011-2021
Purpose Although it is well known that obesity increases the risk of atherosclerosis in carotid arteries, it is not clear whether this risk changes after obesity surgery. The aim of this study was to investigate whether weight reduction with a laparoscopic sleeve gastrectomy (LSG) has any effect on distensibility and elasticity which show subclinical atherosclerosis in the carotid arteries of obese individuals. Materials and Methods This prospective study included 130 patients (body mass index (BMI) 48.21 +/- 6.97 kg/m(2)) who underwent LSG. The patients were followed up for 1 year. Comparisons were made of the distensibiliy and elasticity values calculated preoperatively and at 1, 3, 6, and 12 months, postoperatively. Results There was a statistically significant increase in distensibility and elasticity values from baseline to 1, 3, 6, and 12 months postoperatively (p < 0.001 for both comparisons). The multiple linear regression analysis was used to find the variables affecting both distensibility and elasticity. According to the results, the presence of BMI decreases distensibility percentage change level by 0.38 units (beta= - 0.38, 95% CI - 0.51;- 0.25,p < 0.001). The presence of fasting plasma glucose decreases elasticity percentage change level by 0.20 units. (beta= - 0.20, 95% CI - 0.39; - 0.01,p = 0.037). Conclusion Carotid artery distensibility and elasticity values increase after LSG, and this change could be caused by the change in metabolic parameters and heart geometry. These results may indirectly suggest that subclinical atherosclerosis in carotid arteries has decreased after obesity surgery.
Assessment of Epicardial Fat and Carotid Intima Media Thickness in Gestational Hypertension
(2018) Altin, Cihan; Yilmaz, Mustafa; Ozsoy, Hasmet M.; Gezmis, Esin; Balci, Serdar; Tekindal, Mustafa A.; Sade, Leyla E.; Muderrisoglu, Haldun; 0000-0002-3996-5681; 0000-0002-2557-9579; 0000-0002-1001-6028; 0000-0002-1782-7325; 0000-0002-4060-7048; 0000-0003-3737-8595; 0000-0002-9635-6313; 29603491; S-6973-2016; AAE-8301-2021; AAJ-1097-2021; U-9270-2018; AAQ-7583-2021; AAG-8233-2020
AimGestational hypertension (GHT) is a common disorder of pregnancy characterized by new onset hypertension without the presence of detectable proteinuria after 20 weeks of gestation. Epicardial fat thickness (EFT) and carotid intima media thickness (CIMT) are suggested as new predictors of subclinical atherosclerosis. Although the relationship between these parameters and essential hypertension has been demonstrated, this association in patients with GHT is still unknown. We aimed to investigate CIMT and EFT in patients with GHT. MethodsA total of 90 patients (44 GHT and 46 controls) were enrolled. Patients with diabetes mellitus, chronic hypertension and cardiovascular disease (CVD) were excluded. In the third trimester, the mean CIMT at the far wall of both left and right common carotid arteries was measured on B-mode duplex ultrasound. EFT was measured on the free wall of the right ventricle at the end systole in the parasternal long-axis view by standard transthorasic 2D echocardiography. ResultsUnlike the mean CIMT (0.52 0.13 mm vs 0.47 +/- 0.11 mm; P = 0.078), the mean EFT was significantly higher in the GHT group compared to the controls (5.31 +/- 1.68 mm vs 4.17 +/- 1.16 mm; P = 0.002). In multivariate logistic regression analysis, among the most pertinent clinical variables, only EFT is an independent determinant of GHT (OR: 2.903; 95% confidence interval [CI]: 1.454-5.796; P = 0.003). In receiver operating characteristic (ROC) analysis, EFT >5.5 mm had 82.6% specificity and 52.3% sensitivity in predicting a diagnosis of GHT (ROC area under curve: 0.689, 95% CI: 0.577-0.802, P = 0.002). ConclusionMaternal EFT may be higher in pregnant women with GHT in comparison with those of controls.
Assessment of Subclinical Atherosclerosis by Carotid Intima-Media Thickness and Epicardial Adipose Tissue Thickness in Prediabetes
(2016) Altin, Cihan; Sade, Leyla Elif; Gezmis, Esin; Ozen, Necmi; Duzceker, Ozkan; Bozbas, Huseyin; Eroglu, Serpil; Muderrisoglu, Haldun; 0000-0002-1001-6028; 0000-0003-3737-8595; 0000-0002-9635-6313; 0000-0003-3055-7953; 27069111; AAE-8301-2021; AAQ-7583-2021; ABG-1582-2021; AAG-8233-2020
Impaired fasting glucose (IFG) and impaired glucose intolerance (IGT) are predictors of cardiovascular disease (CVD). We tested the hypothesis that epicardial fat thickness (EFT) and carotid intima-media thickness (cIMT), as markers of early atherosclerosis, are increased in patients with prediabetes. We prospectively enrolled 246 patients (162 with prediabetes and 84 controls). Prediabetes was defined according to American Diabetes Association criteria, and patients were divided into 3 groups: group 1IFG, group 2IGT, and group 3IFG + IGT. Both cIMT and EFT were significantly greater in patients with prediabetes compared with controls (0.81 +/- 0.20 mm vs 0.68 +/- 0.16 mm, P < .001 and 7.0 +/- 2.0 mm vs 5.6 +/- 1.6 mm, P < .001, respectively). This difference was mainly attributed to patients with IGT. Age, waist circumference, and 2-hour glucose independently predicted cIMT, while 2-hour glucose was the only independent predictor of EFT in multivariate analysis among other relevant parameters for cIMT and EFT. The cIMT and EFT (measured noninvasively) could be useful indicators of CVD risk in these patients. In order to prove this hypothesis, long-term prospective studies with greater patient numbers are required.
Assessment of Subclinical Atherosclerosis in Vitamin D Deficiency
(2019) Aydin, Elcin; Altin, Cihan; Soylev, Gozde Ozcan; Tekindal, Mustafa Agah; Agildere, Muhtesem; 30300321; AAB-5802-2020
Purpose Patients with vitamin D deficiency (VDD) have potential to have increased cardiovascular morbidity and mortality. In this study, we aimed to discover the findings of early atherosclerosis in patients with VDD by measuring carotid intima-media thickness (CIMT) and epicardial fat thickness (EFT). Materials and Methods The study population includes 52 patients with VDD (n = 30 [57% female], mean +/- SD age 54.28 +/- 8.77 years, mean +/- SD serum 25-hydroxyvitamin D (25 [OH] D) 11 +/- 2.4 ng/mL) and 82 participants for control group (n = 52 [63.4% female], mean +/- SD age 56.40 +/- 7.90 years, mean +/- SD serum (25 [OH] D) 53 +/- 4.2 ng/mL) who have no cardiovascular disease. Carotid intima-media thickness was assessed by using ultrasonography, and EFT was measured on the free wall of the right ventricle at end diastole from the parasternal long-axis views by standard transthoracic 2-dimensional echocardiography. Results Both CIMT and EFT were significantly higher in patients with VDD compared with controls (0.75 +/- 0.16 mm vs 0.68 +/- 0.21 mm, P < 0.05, and 0.66 +/- 0.15 cm vs 0.56 +/- 0.15 cm, P < 0.001). Conclusions Patients with VDD seem to have increased CIMT and EFT, which are predictors of atherosclerotic process. Further studies are needed to confirm these results.
Assessment of vascular inflammation and subclinical nephropathy in exaggerated blood pressure response to exercise test
(2019) Coner, Ali; Genctoy, Gultekin; Akinci, Sinan; Altin, Cihan; Muderrisoglu, Haldun; 0000-0002-9635-6313; 30969228; AAG-8233-2020
Objectives Exaggerated blood pressure response (EBPR) to exercise tests is an additional cardiovascular risk factor and predictor of future development of hypertension. However, there are conflicting data on the diagnostic threshold of EBPR and its clinical importance in kidney disease. The aim of this study was to investigate vascular inflammation and subclinical nephropathy in otherwise healthy volunteers with EBPR. Patients and methods The study included 170 middle-aged, healthy volunteers (mean age: 43.3 +/- 6.9; range: 35-65 years: 100 men and 70 women). Participants performed a treadmill exercise test until they reached their age-adjusted maximum heart rate and were divided into EBPR and normal/physiological blood pressure response groups. Before exercise tests, serum high sensitive C-reactive protein (hs-CRP) and urine albumin-to-creatinine ratio were measured to evaluate vascular inflammation and subclinical nephropathy, respectively. Anthropometrical measurements, fasting serum glucose, fasting lipid profile, and the full blood count of participants were also evaluated. Results EBPR was detected in 31 (18.2%) participants. Hs-CRP levels (1.03 vs. 0.46 mg/l) (P<0.001) and albumin-to-creatinine ratio levels (6.90 vs. 5.22 mg/g) (P=0.002) were higher in the EBPR group. BMI, abdominal obesity, and hs-CRP levels were found to be related to increased development of EBPR. Conclusion EBPR is an overlooked clinical finding during exercise tests and should be evaluated in apparently healthy, middle-aged populations for the early detection of possible subclinical nephropathy. Copyright (C) 2019 Wolters Kluwer Health, Inc. All rights reserved.
Blood pressure limits affecting carotid artery injury: a cross sectional study
(2020) Guenesli, Aylin; Acibuca, Aynur; Altin, Cihan; Gezmis, Esin; Tekindal, Mustafa Agah; Yalcin, Cigdem; Alkan, Ozlem; 0000-0002-3444-8845; 0000-0001-7526-3460; 0000-0002-1001-6028; 0000-0001-5483-8253; AAE-8301-2021; ABG-4047-2020; AAM-4169-2021; AAM-4284-2021
Purpose: Although it is well known that high blood pressure causes undesirable effects on carotid arteries, it is not clear as to which threshold value this effect starts. The aim of this study is to evaluate and determine this threshold. Materials and Methods: This cross-sectional study included a total of 308 individuals in the following groups; group 1: individuals with systolic blood pressure (SBP) <120 mmHg and diastolic blood pressure (DBP) <80 mmHg (optimal), group 2: SBP 120-129 mmHg and/or DBP 80-84 mmHg (normal), group 3: SBP 130-139 mmHg and/or DBP 85-89 mmHg (high-normal), group 4: SBP 140-159 mmHg and/or DBP 90-99 mmHg, group 5: SBP 160-179 mmHg and/or DBP 100-109 mmHg, and group 6: SBP >= 180 mmHg and/or DBP >= 110 mmHg. Carotid distensibility and elasticity were measured in all groups. Results: A statistically significant difference was determined between the groups in carotid distensibility and elasticity. SBP>135.5 mmHg started to affect carotid distensibility with 78.2% sensitivity and 74.6% specificity, and DBP>86.5 mmHg with 79.3% sensitivity and 71.6% specificity. Carotid elasticity was seen to be affected by SBP>137.5 mmHg with 80.4% sensitivity and 73.1% specificity, and DBP>88.5 mmHg with 79.1% sensitivity and 73.8% specificity. Conclusion: Carotid distensibility and elasticity decreases with increasing blood pressure. Individuals in high-normal group should be evaluated in terms of carotid disease, and it may be necessary to start treatment early in these patients.
Clinical characteristics and in-hospital outcomes of acute decompensated heart failure patients with and without atrial fibrillation
(2020) Kocabas, Umut; Sinan, Umit Yasar; Arugaslan, Emre; Kursun, Mustafa; Coner, Ali; Celebi, Ozlem Ozcan; Ozturk, Cengiz; Dalgic, Onur; Turkoglu, Ebru Ipek; Kemal, Hatice Soner; Gazi, Emine; Altin, Cihan; Zoghi, Mehdi; 32352420
Objective: Atrial fibrillation (AF) and heart failure (HF) are common cardiovascular diseases. The impact of AF on in-hospital outcomes in acute decompensated heart failure (ADHF) is controversial. The aim of this study is to determine the prevalence of AF among hospitalized patients with ADHF and describe the clinical characteristics and in-hospital outcomes of these patients with and without AF. Methods: We examined the multicenter, observational data from the real-life data of hospitalized patients with HF: Journey HF-TR study in Turkey that studied the clinical characteristics and in-hospital outcomes of hospitalized patients with ADHF between September 2015 and September 2016. Results: Of the 1,606 patients hospitalized with ADHF, 626 (39%) had a history of AF or developed new-onset AF during hospitalization. The patients with AF were older (71 +/- 12 vs. 65 +/- 13 years; p<0.001) and more likely to have a history of hypertension, valvular heart disease, and stroke. The AF patients were less likely to have coronary artery disease and diabetes. In-hospital adverse event rates and length of in-hospital stay were similar in ADHF patients, both with and without AF. In-hospital all-cause mortality rate was higher in patients with AF than in patients without AF, although the difference was not statistically significant (8.9% vs. 6.8%; p=0.121). Conclusion: AF has been found in more than one-third of the patients hospitalized with ADHF, and it has varied clinical features and comorbidities. The presence of AF is not associated with increased adverse events or all-cause mortality during the hospitalization time.
A clinical dilemma about a new oral anticoagulant treatment
(2014) Altin, Cihan; Ozturkeri, Ovgu Anil; Gezmis, Esin; Muderrisoglu, Haldun; 25341482
Coronary anatomy, anatomic variations and anomalies: a retrospective coronary angiography study
(2015) Altin, Cihan; Kanyilmaz, Suleyman; Koc, Sahbender; Gursoy, Yusuf Cemil; Bal, Ugur; Aydinalp, Alp; Yildirir, Aylin; Muderrisoglu, Haldun; 25502334
INTRODUCTION The incidence of coronary artery anomalies (CAAs) varies from 0.2% to 8.4%. Knowledge of such anatomical variations is important as coronary procedures are regularly performed these days. We aimed to find the coronary dominance pattern, intermediate artery (IMA) frequency and CAA incidence in our clinic, and compare them to those in the literature. METHODS The medical reports of 5,548 patients who had undergone coronary angiography (CAG) between 2005 and 2009 were retrospectively investigated. Dominance pattern and presence of IMA and CAA were recorded. CAAs were described using two different classifications: Angelini and Khatami's classification, and a new modified classification that was derived from Angelini and Khatami's classification. Some procedural details and clinical features of the patients with CAA were also investigated. RESULTS Coronary dominance pattern was: 81.6% right coronary artery, 12.2% circumflex artery and 6.2% co-dominant. IMA was present in 613 (11.0%) patients. The incidences of overall anomaly were 2.7% and 1.4%, according to the different classifications. Absent left main coronary artery, which was the most common anomaly in the present study, was found in 51 (0.9%) patients. Incidences of myocardial bridge, coronary arteriovenous fistulae and aneurysms were 1.1%, 0.2% and 0.3%, respectively. CONCLUSION CAAs are generally asymptomatic, isolated lesions. Some may lead to anginal symptoms, myocardial infarction or sudden death. We found that CAA was associated with increased radiation and contrast exposure in patients who underwent CAG. This risk could be reduced if appropriate catheters were designed and training programmes on ostial cannulation were developed.
Dabigatran for Stroke Prevention in Real Life in a Sample of Population from Turkey: D-SPIRIT Registry
(2021) Altin, Cihan; 34881702
Objective: The D-SPIRIT registry is designed to investigate the safety and effectiveness of dabigatran etexilate in patients with atrial fibrillation in routine clinical practice. Methods: D-SPIRIT is the first national, multicenter, prospective, observational, postmarketing registry that investigates the usage of dabigatran in real life. A total of 326 noveloral anticoagulant-eligible patients with atrial fibrillation who have been taking dabigatran etexilate therapy for stroke prevention at least 6 months from 9 different centers were enrolled into the registry. Patients were followed up for 2 years to evaluate the effectiveness and safety of the treatment. All adverse clinical events including bleeding, thromboembolic events, stroke, systemic embolism, transient ischemic attack, myocardial infarction, and all-cause death were recorded. Results: The mean age was 71.1 +/- 9.6 years, and 57.4% of the study participants were female. The mean CHA(2)DS(2)-VASc (congestive heart failure, hypertension, age >= 75 years, diabetes mellitus, stroke or transient ischemic attack [TIA], vascular disease, age 65-74 years, sex category) score was 3.4 +/- 1.6. The cumulative adverse clinical events rate was 6.30% per year. The rate for embolic events including TIA, ischemic stroke, and peripheral embolism was 1.26% per year. The rate for major bleeding was 2.20% per year, and the mortality rate was 0.94% per year. Conclusion: This registry obtained an important overview of the current safety and effectiveness of the dabigatran etexilate in Turkey. Our results indicate similar rates of thromboembolic and bleeding events with pivotal phase 3 trial and other real-life registries. However, rate of undertreatment usage of dabigatran etexilate in real life was found to be considerable.
Design and rationale of dabigatran's stroke prevention in real life in Turkey (D-SPIRIT)
(2016) Turk, Ugur Onsel; Alioglu, Emin; Tuncer, Esref; Ozpelit, Mehmet Emre; Pekel, Nihat; Tengiz, Istemihan; Cetin, Nurullah; Dalgic, Onur; Topaloglu, Caner; Bilgin, Nazile; Altin, Cihan; Ozdemirkiran, Tolga; Tuluce, Kamil; Turkoglu, Ebru Ipek; Ozpelit, Ebru; 27138311
Objective: The D-SPIRIT registry is designed to investigate the safety and efficacy of dabigatran etexilate in patients with nonvalvular atrial fibrillation (NVAF) and to collect data on outcomes in clinical practice. Methods: The D-SPIRIT is a national, prospective, observational, post-marketing registry involving patients with NVAF who have been taking dabigatran etexilate therapy for stroke prevention for a minimum of 6 months prior to enrollment. The registry will collect and analyze data from routine care, enrolling up to 600 patients in 9 centers. Patients will be followed up for 2 years to evaluate effectiveness and safety. A sample size of 600 subjects is proposed based on the following assumptions; Two-sided significance level of 0.05 (1-sided significance level of 0.025), ischemic stroke incidence rate of 0.768%-1.111%, hemorrhagic stroke incidence rate of 0.109%-0.130%, transient ischemic attack incidence rate of 0.722%-0.623%, therapy discontinuation incidence rate of 40% at day 730, and duration of enrollment period of 12 months with non-uniformed enrollment rate. Ethics approval was given by Dokuz Eyll University Ethics Committee of Clinical Research (2014/54) and approved by the Turkish Ministry of Health. Conclusion: Potential results of D-SPIRIT registry will add data from clinical practice to those from the RE-LY trial to expand knowledge of dabigatran etexilate treatment in patients with NVAF.
The Effects of Niacin on Inflammation in Patients with Non-ST Elevated Acute Coronary Syndrome
(2015) Karacaglar, Emir; Atar, Ilyas; Altin, Cihan; Yetis, Begum; Cakmak, Abdulkadir; Bayraktar, Nilufer; Coner, Ali; Ozin, Bulent; Muderrisoglu, Haldun; 0000-0002-2538-1642; 0000-0002-5711-8873; 0000-0003-3821-412X; 0000-0002-7886-3688; 0000-0002-9635-6313; 27122858; ABI-6723-2020; ABD-7321-2021; AAD-9938-2021; Y-8758-2018; AAG-8233-2020
Background: In this study, we aimed to evaluate the effects of niacin on high sensitivity C reactive protein (hs-CRP) and cholesterol levels in non-ST elevated acute coronary syndrome (NSTE-ACS) patients. Methods: In this prospective, open label study, 48 NSTE-ACS were randomized to niacin or control group. Patients continued their optimal medical therapy in the control group. In the niacin group patients were assigned to receive extended-release niacin 500 mg/day. Patients were contacted 1 month later to assess compliance and side effects. Blood samples for hs-CRP were obtained upon admittance to the coronary care unit, in the third day and in the first month of the treatment. Fasting blood samples for cholesterol levels were obtained before and 30 days after the treatment. The primary end point of the study was to evaluate changes in hs-CRP, cholesterol levels, short-term cardiovascular events, and the safety of niacin in NSTE-ACS. Results: Baseline demographic, clinical and laboratory characteristics were similar between the two groups. Logarithmic transformation of baseline and 3rd day hs-CRP levels were similar between the groups; but 1 month later, logarithmic transformation of hs-CRP level was significantly lower in the niacin group (0.43 +/- 0.39 to 0.83 +/- 0.91, p = 0.04). HDL-C level was significantly increased in the niacin group during follow-up. Drug related side effects were seen in 7 patients in the niacin group but no patients discontinued niacin. Conclusions: Our findings demonstrate that lower dose extended release niacin can be used safely and decreases hs-CRP and lipid parameters successfully in NSTE-ACS patients.
Effects of Paclitaxel and Carboplatin Combination on Mechanical Myocardial and Microvascular Functions: A Transthoracic Doppler Echocardiography and Two-Dimensional Strain Imaging Study
(2015) Altin, Cihan; Elif Sade, Leyla; Demirtas, Saadet; Karacaglar, Emir; Kanyilmaz, Suleyman; Simsek, Vahide; Ayhan, Ali; Muderrisoglu, Haldun; 24814007
AimPaclitaxel and carboplatin are frequently used chemotherapy drugs in the treatment of gynecologic malignancies. Little is known about their effects on left ventricular mechanical and coronary microvascular functions. MethodsThirty consecutive patients were prospectively enrolled. Patients underwent transthoracic echocardiography (TTE) before and after chemotherapy, to evaluate left ventricular mechanical functions and coronary flow reserve (CFR). A comprehensive TTE, tissue Doppler and two-dimensional (2D) strain imaging were performed and coronary flow velocity was measured at baseline and after dipyridamole infusion. CFR was calculated as the ratio of hyperemic to baseline diastolic peak flow velocities. Mitral annular velocities by tissue Doppler, peak strain, and systolic strain rate by velocity vector imaging (VVI) were measured. Baseline measurements were compared with healthy controls (n=26). ResultsNo patient developed heart failure (HF) symptoms, no significant change occurred in left ventricular ejection fraction or cardiac output and no significant difference was observed in CFR after chemotherapy. Baseline mean longitudinal peak strain and systolic stain rate were similar between patients and controls: -17.52.6% versus -17.6 +/- 2.2% (P=NS) and -1.04 +/- 0.14/sec versus -1.05 +/- 0.12/sec (P=NS). Peak strain and systolic strain rate decreased significantly after chemotherapy (from -17.5 +/- 2.6% to -16.2 +/- 2.5%, P<0.02; and from -1.05 +/- 0.12/sec to -0.96 +/- 0.11/sec, P=0.01, respectively). However, mean longitudinal velocity did not change significantly. ConclusionPaclitaxel and carboplatin combination did not impair CFR; however, this chemotherapy combination could induce subtle impairment in myocardial mechanical function which can be detected by advanced deformation imaging techniques rather than by tissue Doppler imaging or conventional 2D and Doppler echocardiography.
Epicardial Adipose Tissue Thickness and Carotid Intima-Media Thickness in Hemodialysis Patients
(2017) Aydin, Elcin; Altin, Cihan; Sakalhoglu, Onur; Yilmaz, Mustafa; Gezmis, Esin; Sade, Leyla Elif; Muderrisoglu, Haldun; 0000-0002-9635-6313; 0000-0003-0907-3647; 0000-0002-1001-6028; 0000-0003-3737-8595; 28559657; AAG-8233-2020; AAI-8276-2021; AAE-8301-2021; AAQ-7583-2021; HGC-1839-2022
Background: It is well-known that cardiovascular risk and all-cause mortality is increased in hemodialysis patients. Epicardial fat thickness (EFT), which reflects visceral adiposity, has been suggested as a new cardiometabolic risk factor. The purpose of this study was to investigate EFT in hemodialysis patients. Methods: A total of 144 consecutive patients (60 hemodialysis patients and 84 controls) were enrolled into the study, and patients with diabetes mellitus and cardiovascular diseases (CVD) were excluded. EFT was measured on the free wall of the right ventricle at end-diastole from the parasternal long-axis view by standard transthorasic 2D echocardiography. Results: The groups were similar in terms of sex distribution, age, blood pressure, heart rate and frequencies of CAD risk factors including smoking status, family history of CAD and hypertension. There were no significant differences between the hemodialysis patients and controls in 2D echocardiographic parameters, including ejection fraction and biochemical parameters except low-density lipoprotein, high-density lipoprotein and c-reactive protein. Despite having lower body mass index, EFT levels were significantly higher in hemodialysis patients compared to the controls (8.0 +/- 2.2 mm vs. 5.8 +/- 1.9 mm; p < 0.01). In multivariate linear regression analysis we determined that hemodialysis patient status was found to be an independent predictor for both EFT ((3 = 0. 700, p = 0.014) and carotid intima-media thickness (CIMT, beta = 0. 614, p = 0.047). Conclusions: Hemodialysis patients are independently associated with high EFT and CIMT.
Impact of Sleeve Gastrectomy on Epicardial Fat Tissue and Carotid Intima Media Thickness
(2017) Altin, Cihan; Erol, Varlik; Aydin, Elcin; Yilmaz, Mustafa; Sade, Leyla Elif; Gulay, Huseyin; Muderrisoglu, Haldun; 0000-0002-2557-9579; 0000-0003-0907-3647; 0000-0003-3737-8595; 0000-0002-0442-6178; 0000-0002-9635-6313; S-6973-2016; AAI-8276-2021; AAQ-7583-2021; AAJ-6407-2021; AAG-8233-2020
Investigation of The Relationship Between Asthma and Subclinical Atherosclerosis by Carotid/Femoral Intima Media and Epicardial Fat Thickness Measurement
(2018) Yilmaz, Mustafa; Yilmaz, Hatice Eylul Bozkurt; Sen, Nazan; Altin, Cihan; Tekin, Abdullah; Muderrisoglu, Haldun; https://orcid.org/0000-0002-2557-9579; https://orcid.org/0000-0002-4171-7484; https://orcid.org/0000-0002-5658-870X; https://orcid.org/0000-0002-9635-6313; 28453377; S-6973-2016; AAI-8947-2021; ABD-7304-2021; AAG-8233-2020
Objective: Since asthma and atherosclerosis may share similar pathophysiological mechanism, this study is planned to investigate whether epicardial fat thickness (EFT), carotid and femoral intima media thicknesses, which are markers of subclinical atherosclerosis, are increased in patients with asthma. Methods: The study was designed as a cross-sectional study. A total of 154 participants (83 patients with asthma and 71 healthy volunteers) were enrolled into the study. Epicardial fat, carotid, and femoral intima media thicknesses were measured and recorded in both groups. The statistical difference between the two groups was examined. Results: Both carotid and femoral intima media thicknesses were significantly higher in patients with asthma compared to control group (5.52 +/- 0.4 mm vs. 5.36 +/- 0.4 mm; p = 0.038 and 5.64 +/- 0.4 mm vs. 5.46 +/- 0.5 mm; p = 0.036, respectively). However, there was not a significant difference in EFT between the groups [5.9 mm (5.3-6.6; IQR = 1.3) vs. 5.6 mm (4.7-6.5; IQR = 1.8); p = 0.1]. On comparison of control group and asthma subgroups (mild, moderate, and severe), there was a statistically significant difference among these four groups in terms of carotid and femoral intima media thicknesses (p = 0.002 and p < 0.001, respectively). Subgroup analyses showed that this difference was mainly due to patients with severe asthma. Conclusions: Carotid and femoral intima media thicknesses in asthmatic patients were found to be increased compared to the normal population. As a result, the risk of subclinical atherosclerosis in asthmatic patients may be high.