Browsing by Author "Muderrisoglu, Ibrahim Haldun"

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Acute Coronary Syndrome In Geriatric Patients In An Intensive Care Unit
(2021) Keskin, Suzan; Akgun, Arzu Neslihan; Ciftci, Orcun; Muderrisoglu, Ibrahim Haldun
Objective: The advancing age of acute coronary syndrome and the ageing population are leading to an increase in the number of elderly patients with acute coronary syndrome in our clinical practice. In our study, we aimed to investigate the effect of acute coronary syndrome in the geriatric patient group. Materials and Method: We retrospectively included geriatric patients who were in intensive care units because of different diagnoses, who also showed an acute coronary syndrome, and who had been diagnosed using the sequential organ failure assessment score. This score is used to describe the condition of a patient with sepsis and the extent of organ damage during treatment in an intensive care unit. We reviewed patients who were at Baskent University Faculty of Medicine between 25 March 2015 and 12 March 2020. Results: We included 63 patients aged 77.27 +/- 7.65 years. There were 40 (63.5%) males and 23 (36.5%) females. A total of 42 (89.4%) patients died in the first 5 months, one (2.1%) died between the 6th and 10th months, two (4.3%) between the 11th and 20th months, and two (4.3%) between the 21st and 30th months. We found a significant relationship between the sequential organ failure assessment score and mortality rate (p<0.05). The sequential organ failure assessment score was reliable in predicting mortality in geriatric patients with acute coronary syndrome, with 57% sensitivity and 75% specificity. Conclusion: Mortality of geriatric patients with acute coronary syndrome can be significantly determined using the sequential organ failure assessment scores.
Assessment of Mental Workload and Academic Motivation in Medical Students
(2016) Atalay, Kumru Didem; Can, Gulin Feryal; Erdem, Saban Remzi; Muderrisoglu, Ibrahim Haldun; https://orcid.org/0000-0002-7537-2170; 27183939; AAJ-2370-2021
Objectives: To investigate the level of correlation and direction of linearity between academic motivation and subjective workload. Method: The study was conducted at Baskent University School of Medicine, Ankara, Turkey, from December 2013 to February 2014, and comprised Phase 5 Phase 6 medical students. Subjective workload level was determined by using National Aeronautics and Space Administration Task Load Index scale that was adapted to Turkish. Academic motivation values were obtained with the help of Academic Motivation Scale university form. SPSS 17 was used for statistical analysis. Results: Of the total 105 subjects, 65(62%) students were in Phase 5 and 40(38%) were in Phase 6. Of the Phase 5 students, 18(27.7%) were boys and 47(72.3%) were girls, while of the Phase 6 students, 16(40%) were boys and 24(60%) were girls. There were significant differences in Phase 5 and Phase 6 students for mental effort (p= 0.00) and physical effort (p= 0.00). The highest correlation in Phase 5 was between mental effort and intrinsic motivation (r= 0.343). For Phase 6, highest correlation was between effort and amotivation (r= -0.375). Conclusion: Subjective workload affected academic motivation in medical students.
Cardiac autonomic nervous dysfunction detected by both heart rate variability and heart rate turbulence in prediabetic patients with isolated impaired fasting glucose
(2016) Balcioglu, Akif Serhat; Akinci, Sinan; Cicek, Davran; Coner, Ali; Bal, Ugur Abbas; Muderrisoglu, Ibrahim Haldun; 0000-0002-9446-2518; 0000-0002-5711-8873; 0000-0001-5250-5404; 27025199; AAK-4322-2021; ABD-7321-2021; AAD-5564-2021; AAC-8036-2020
Objective: Cardiac autonomic nervous dysfunction (CAND), a severe complication of diabetes, has also been shown to affect prediabetic patients. The role of isolated impaired fasting plasma glucose (IFG), a subtype of prediabetes, is not clear in the pathogenesis of CAND. The aim of this study was to examine the relationship between isolated IFG and cardiac autonomic function using heart rate variability (HRV) and heart rate turbulence (HRT) indices derived from 24-h Holter-electrocardiogram recordings. Methods: This observational, prospective, cross-sectional study examined 400 consecutive subjects divided into three groups according to oral glucose tolerance test results: the control group [Group I, fasting plasma glucose (FPG) <100 mg/dL and normal glucose tolerance, n=193], the isolated IFG group (Group II, FPG >= 100 and <126 mg/dL, n=134), and the isolated impaired glucose tolerance (IGT), both IFG and IGT, or newly diagnosed diabetes' group (Group III, n=73). Patients with non-sinus rhythm, known diabetes mellitus, coronary artery disease, heart failure, severe valvular disease, or receiving medical therapy that may affect HRV and HRT indices were excluded. Time domain HRV parameters, turbulence onset (TO), turbulence slope (TS), and HRT category were examined. Chi-square, one-way analysis of variance, Kruskal-Wallis H, and Mann-Whitney U tests were used to compare variables where appropriate. The correlation between Holter data and FPG levels was analyzed using the Spearman's test. Multiple linear regression analysis was performed to identify independent predictors of the HRV and HRT parameters. Results: Median (interquartile range 25-75) FPG levels in Groups I, II, and III were 89 (83/93) mg/dL, 109 (104/116) mg/dL, and 174 (150.5/197) mg/dL, respectively. There were significant differences in HRV and HRT parameters between and among all groups. While HRV parameters and TS decreased from Group I to Group III, TO and HRT category gradually increased. Additionally, FPG level was significantly correlated with SDNN, r=-0.220; SDNN index, r=-0.192; SDANN, r=-0.207; RMSSD, r=-0.228; pNN50, r=-0.226; TO, r=0.354; and TS, r=-0.331 (all p<0.001). Conclusion: CAND, as detected by both HRV and HRT, appear to be present in the isolated IFG subtype of prediabetes.
Cardiotoxicity of Trastuzumab Emtansine (T-DM1): A Single-center Experience
(2021) Acibuca, Aynur; Sezer, Ahmet; Yilmaz, Mustafa; Sumbul, Ahmet Taner; Demircan, Senol; Muderrisoglu, Ibrahim Haldun; Ozyilkan, Ozgur; 0000-0002-3444-8845; 34898302; ABG-4047-2020
Objective New anti-cancer drugs promise to increased survival benefits and reduce adverse events. Trastuzumab emtansine (T-DM1) is a novel anti-human epidermal growth factor receptor 2 agent that has shown minimal cardiotoxicity in clinical trials. However, data on real-life outcomes are required. Methods A retrospective review of our center's medical records was performed, including female patients aged >= 18 years with a diagnosis of metastatic breast cancer who were treated with T-DM1. Descriptive statistics were used to investigate clinical features that could increase the risk of cardiotoxicity. Cardiotoxicity was determined by comparing pre and post-T-DM1 echocardiogram results and was defined as a decrease in the left ventricular ejection fraction (LVEF) >10% to below 55%. Results Data from 41 female patients with a mean age of 52 +/- 11.5 years were evaluated. A significant LVEF decrease (from 59% to 33%) was observed in one patient during T-DM1 treatment. Further investigation showed that this decrease was due to underlying coronary artery disease, and LVEF recovered to the baseline value after coronary revascularization. Conclusion T-DM1 seems to be safe in terms of cardiotoxicity. Real-life data with a larger sample size are still needed to confirm the cardiac safety of T-DM1.
Could Plasma Asymmetric Dimethylarginine Level Be A Novel Predictor Beyond The Classic Predictors of Stent Restenosis?
(2014) Bal, Ugur Abbas; Yildirir, Aylin; Aydinalp, Alp; Kaynar, Gamze; Kanyilmaz, Suleyman; Murat, Koza; Muderrisoglu, Ibrahim Haldun; https://orcid.org/0000-0002-9446-2518; https://orcid.org/0000-0001-8750-5287; https://orcid.org/0000-0002-3761-8782; 25233494; AAK-4322-2021; A-4947-2018; AAD-5841-2021
Objective: The aim of this study was to investigate the factors associated with coronary stent restenosis and if there is an association between plasma asymmetric dimethylarginine (ADMA) levels and stent restenosis. Methods: Ninety-one patients, who had a history of coronary bare metal stent implantation due to any cause in the last one year period, were admitted to this observational cross-sectional study. Coronary angiography was performed to all patients and quantitative angiography was used to determine the presence of stent restenosis. Laboratory parameters and angiographic features that contribute to stent restenosis were evaluated. Plasma ADMA levels were measured by using high performance liquid chromatography. Logistic regression analysis was used to determine the independent factors of stent restenosis. Results: Angiographic restenosis was found in 35 patients (38.5%). Stent diameter (p=0.038) and left ventricular ejection fraction (p=0.023) were lower and stent implantation history due to acute coronary syndrome (p=0.029), plasma ADMA level (5.0 +/- 1.8x10(-4) mmol/L vs. 3.9 +/- 1.0x10(-4) mmol/L, p=0.001), C-reactive protein concentration (p=0.016), white blood cell count (p=0.044) and stent length (p=0.005) were higher in patients with restenosis. Plasma ADMA level (beta=0.536; OR: 1.710; CI: 1.022-2.861; p=0.041), C-reactive protein concentration (beta=0.062; OR: 1.064; CI: 1.003-1.129; p=0.041), stent diameter (beta=-3.047; OR: 0.048; CI: 0.007-0.313; p=0.002) and length (beta=0.165; OR: 1.179; CI: 1.036-1.343; p=0.013) were found to be the independent predictors of stent restenosis in logistic regression analysis. Conclusion: We conclude that plasma ADMA levels may be used as a novel marker for stent restenosis beyond the classic stent restenosis markers.
The effect of high-dose steroid treatment used for the treatment of acute demyelinating diseases on endothelial and cardiac functions
(2017) Caldir, Mehmet Vedat; Celik, Guner Koyuncu; Ciftci, Ozgur; Muderrisoglu, Ibrahim Haldun; 27965510
Objective: The cardiovascular effects of short-term high-dose steroid treatment (pulse steroid treatment) have not yet been clarified. We examined the short-and long-term effects of pulse steroid treatment in demyelinating diseases on endothelial and cardiac functions. Methods: In this prospective study, we included 35 patients (20 females and 15 males; mean age, 32.8 +/- 9.3 years) who were not treated with steroids and who were previously diagnosed with multiple sclerosis or neuromyelitis optica. Patients were evaluated before, 1 week after, and 3 months after the steroid treatment. Brachial artery flow-mediated relaxation and cardiac systolic/diastolic function were evaluated using echocardiography to assess physical examination results, carotid intima-media thickness, and endothelial function. Results: There was no difference between biochemical values, systolic function, left ventricular dimensions, and carotid intima-media thicknesses in the three evaluation periods. There were significant increases in the body mass index, body weight, and systolic/diastolic blood pressure measurements at 1 week and 3 months after treatment (p<0.001). There was a significant decrease in brachial artery flow-mediated relaxation at 1 week and 3 months (1 versus 2, p=0.042; 1 versus 3, p=0.003). In Doppler measurements at 1 week and 3 months, there was an increase in mitral A velocity, IVRT, and EDT values and a decrease in the E/A ratio in line with diastolic dysfunction. Conclusion: Pulse steroid therapy used for demyelinating diseases deteriorated endothelial and left ventricular diastolic functions in the early and late periods. Future studies are needed to evaluate the development of cardiovascular mortality and morbidity in patients receiving this type of treatment.
The Effects of Steroids on Endothelial Function Reply
(2017) Caldir, Mehmet Vedat; Celik, Guner Koyuncu; Ciftci, Ozgur; Muderrisoglu, Ibrahim Haldun; GOE-6067-2022
An epidemiological study to define the recent clinical characteristics and outcomes of infective endocarditis in southern Turkey
(2021) Acibuca, Aynur; Yilmaz, Mustafa; Okar, Sefa; Kursun, Ebru; Acilar, Onur; Tekin, Abdullah; Demiroglu, Yusuf Ziya; Muderrisoglu, Ibrahim Haldun; 0000-0002-9866-2197; 0000-0002-5658-870X; 33830167; AAZ-9711-2021; ABD-7304-2021
Introduction: The aim of this study was to characterise the recent features of patients with infective endocarditis (IE) at one referral centre in southern Turkey, in order to be able to identify the high-risk subgroup and revise preventative measures and management strategies. Methods: Medical records of patients 18 years and older, who had been diagnosed with IE according to the Duke criteria between January 2009 and October 2019, were retrospectively evaluated in a referral general hospital. Results: The total of 139 IE cases comprised 59.7% males and 40.3% females, with a mean age of 55 +/- 16 years. The most encountered symptom was fever (55.4%) and the mitral valve (54%) was the most frequently involved. The most common causative micro-organisms were coagulase-negative staphylococci (30.2%). The in-hospital mortality rate was 30.2%, with congestive heart failure, chronic renal disease and chronic dialysis found to be significantly associated with in-hospital mortality. Conclusion: The study results demonstrate the recent epidemiological features of IE in southern Turkey that are important for clinicians to manage diagnostic and therapeutic processes successfully. Older age, the predominance of staphylococci and higher surgery rates are consistent with the changing trends of IE in some parts the world.
Evaluation of Inflammation-Based Prognostic Risk Scores in Predicting in-Hospital Mortality Risk in Hospitalized COVID-19 Patients: A Cross-Sectional Retrospective Study
(2023) Celik, Casit Olgun; Ozer, Nurtac; Ciftci, Orcun; Torun, Serife; Yavuz Colak, Meric; Muderrisoglu, Ibrahim Haldun; 0000-0002-6530-6153; 0000-0002-7190-5443; 0000-0002-0294-6874; 38633908; ABF-1652-2021; AAD-5477-2021; AAA-4360-2021
Objective: Systemic inflammatory parameters are predictors of poor prognosis in COVID-19 patients. This study evaluated whether the prognostic nutritional index, which was also related to nutrition risk and other inflammation-based prognostic scores, was predictive of in-hospital mortality in COVID-19 patients.Materials and Methods: This was a retrospective cross-sectional single-center study. Based on the exclusion criteria, 151 patients over 18 years old diagnosed with COVID-19 and hospitalized in the intensive care unit between March 2020 and December 2020 were eligible for this study. Multivariable logistic regression analysis was performed to evaluate the predictive value of the Glasgow Prognostic Score (GPS), Prognostic Index (PI), Prognostic Nutritional Index (PNI), and Systemic Inflammatory Index (SII).Results: In the univariate analyses, age, diabetes mellitus (DM), chronic kidney disease, acute kidney injury, hypothyroidism, hospitalization stay, lactate dehydrogenase (LDH), as-partate aminotransferase (AST), D-dimer, ferritin, C-reactive protein (CRP), albumin, hemoglobin level, platelet count, urea, creatinine level, PNI, GPS were significantly associated with mortality. However, in the multivariable logistic regression analysis of the inflamma-tion-based prognostic scores, only PNI was statistically significant in predicting in-hospital mortality (OR=0.83; [95% CI=0.71-0.97]; p=0.019).Conclusion: PNI is a more useful and powerful tool among these inflammation-based prognostic risk scores in predicting in-hospital mortality in COVID-19 patients.
Evaluation of Ventricular Repolarization Parameters in Patients Admitted to Emergency Department with Electrical Injury
(2020) Celik, Casit Olgun; Ciftci, Orcun; Muratoglu, Murat; Muderrisoglu, Ibrahim Haldun
Objective: Prolonged T-peak to T-end (Tp-e), a ventricular repolarization parameter, has been related with ventricular arrhythmias (VAs). Novel electrocardiogram (ECG) parameters of ventricular repolarization have received considerable attention recently. In this study, we sought to investigate ventricular repolarization indexes such as the Tp-e and corrected Tp-e (Tp-ec) intervals, Tp-e/QT, Tp-e/QTc, and Tp-ec/QT ratios in patients with electrical injuries (EIs). Methods: Thirty-six patients diagnosed with EIs and 35 age- and sex-matched healthy control patients were included. Admission ECGs of the EI patients were compared with those of the healthy controls. QT and QTc intervals were measured, and the Tp-e and Tp-ec intervals, Tp-e/QT, Tp-ec/QT, and Tp-e/QTc ratios were then calculated from a 12-lead surface ECG. Results: The QT, Tp-e, Tp-e/QT, Tpe/QTc, Tp-ec/QT were not significantly different between the control group and the EI group (p > 0.05). However, the mean QTc interval was significantly higher in the EI group compared to the control group (412.81 +/- 25.46 vs 396.31 +/- 26.47 ms; p:0.009). Furthermore, the Tp-ec and Tp-ec/QT of the EI subgroup with elevated troponin levels significantly differed from those of the EI patients with normal troponin levels (p:0.033 and p:0.016, respectively). Conclusions: This retrospective study indicated that patients with EIs tend to have a prolonged QTc interval. Additionally, Tp-ec and Tp-ec/QT, which reportedly designate the tendency for VAs, were significantly higher in the EI patients with elevated troponin I levels than the EI patients with normal troponin levels, suggesting that patients with myocardial injury may be prone to VAs.
Experience With Cardiac Implantable Electrical Device Explantation After Cardiac Transplantation: A Report of 16 Cases From a Single Center in a Period of 5 Years
(2018) Ciftci, Orcun; Yilmaz, Kerem Can; Sezgin, Atilla; Ozin, Mehmet Bulent; Muderrisoglu, Ibrahim Haldun; Haberal, Mehmet; 0000-0001-8926-9142; 0000-0002-3462-7632; 29528003; W-5233-2018; AAJ-1331-2021; AAJ-8097-2021
Objectives: Cardiac implantable electrical devices are widely used for patients with advanced heart failure and are usually explanted during orthotopic heart transplant. However, lead fragments and the pulse generator are sometimes left after the procedure. Given the concerns of infectious and thromboembolic complications, their removal is recommended. Herein, we report our experience with cardiac implantable electrical device explantation after orthotopic heart transplant. Materials and Methods: We included recipients of heart transplants performed at Baskent University Faculty of Medicine, Department of Cardiovascular Surgery, who underwent lead and pulse generator explantation by manual traction between January 2012 and June 2017. We analyzed patient demographic, clinical, biochemical, and treatment properties. Results: Sixteen patients (11 males, 5 females) with a median age of 45 years (range, 18-52 y) were included. Two patients (12.5%) died during follow-up but not secondary to device explantation. All patients were using immunosuppressives and 50% were receiving antiplatelet/anticoagulant agents. All pulse generators were located at the left prepectoral area, with tips of lead fragments in the superior vena cava or left subclavian vein. No procedural complications were observed. Aspirin was continued uninterrupted perioperatively, warfarin was stopped 2 days before the procedure, and low-molecular-weight heparins were skipped on the morning and evening of the procedure. One patient (6.3%) complained of postoperative pain, and another (6.3%) developed a pocket hematoma, which was treated conservatively. No patient developed fever, clinical infection, or major bleeding. Preoperative and postoperative levels of hemoglobin, white blood cells, and C-reactive protein were similar. No demographic, procedural, or biochemical variable was significantly correlated with postprocedural complications. Conclusions: In our cohort, explantation of lead fragments and pulse generators of cardiac implantable electrical devices was safe after heart transplant. It appears that neither antiplatelet/anticoagulant agents nor immunosuppressives seem to put patients at increased risk of postoperative complications.
An Experimental Case-Based Role Model Study of Mitral NeoChord Implantation with New Tools via Transapical Approach
(2023) Doganozu, Ersin; Doganozu, Ayse Ceren; Beyazpinar, Deniz Sarp; Sezgin, Atilla; Muderrisoglu, Ibrahim Haldun; Aydinalp, Alp
Increasing fragility with the aging population compels less invasive procedures. Even if cardiac surgeries are getting minimally invasive with new techniques and technological development in the fi eld, many valve surgery candidates suffer from being qualifi ed as inoperable due to fragility, unstable circulatory system, and to be post-myocardial infarction and their life is in danger every day that they are not operated. The main purpose of this case-based role model study is to invent a new technique for implanting a transapical mitral valve NeoChord implantation with new tools.
Fragmented QRS on 12-Lead Electrocardiogram Is Correlated With Severe Coronary Artery Disease and Abnormal Myocardial Perfusion Scintigraphy Results in Renal Transplant Candidates
(2018) Ciftci, Orgun; Keskin, Suzan; Karacaglar, Emir; Yilmaz, Kerem Can; Aktas, Ayse; Sezer, Siren; Moray, Gokhan; Muderrisoglu, Ibrahim Haldun; Haberal, Mehmet; 0000-0001-8926-9142; 0000-0002-2538-1642; 0000-0003-2498-7287; 0000-0002-3462-7632; 30066622; W-5233-2018; ABI-6723-2020; AAJ-1331-2021; AAE-1041-2021; AAJ-8097-2021
Objectives: Coronary artery disease is a major cause of mortality and morbidity after renal transplant. Fragmented QRS on standard 12-lead electrocardiograms has been proposed as a marker of myocardial scar, mainly due to coronary artery disease. Here, we aimed to investigate fragmented QRS to detect severe coronary artery disease in renal transplant candidates. Materials and Methods: We retrospectively reviewed the medical records of 534 patients with end-stage renal failure who were on the deceased-donor renal transplant wait list at Baskent University Faculty of Medicine due to having no living kidney donor available. We evaluated patients with standard 12-lead electrocardiograms, myocardial perfusion scintigraphy, and coronary angiography. We compared fragmented QRS prevalence versus myocardial perfusion scintigraphy abnormalities and severe coronary artery disease. Correlations among these were analyzed. Results: Of 92 renal transplant candidates (median age of 56.5 y; range, 24-80 y), 87 patients (94.6%) had myocardial perfusion defects and 72 (78.3%) had myocardial wall motion abnormalities on myocardial perfusion scintigraphy. Forty-four patients (47.8%) had severe coronary artery disease on coronary angiography, and 51 patients (55.4%) had fragmented QRS. Fragmented QRS was significantly more common among patients with myocardial scar. Coronary artery disease was significantly more common in patients with fragmented QRS (P = .042) and in those with fragmented QRS combined with myocardial perfusion defects (P < .01). Fragmented QRS was significantly correlated with presence of myocardial scar and any perfusion defects. When combined with myocardial perfusion defects, fragmented QRS was significantly correlated with severe coronary artery disease (P < .05). Conclusions: Fragmented QRS was significantly correlated with abnormal myocardial perfusion scintigraphy and severe coronary artery disease in renal transplant candidates.This simple parameter can provide valuable information on severe coronary artery disease and help to prevent excess patient morbidity and mortality from this disease after renal transplant.
Heart Rate Variability And Heart Rate Turbulence In Patients With Vasovagal Syncope
(2021) Akinci, Sinan; Coner, Ali; Akbay, Ertan; Muderrisoglu, Ibrahim Haldun; 0000-0002-9146-0621; 0000-0001-5250-5404; 0000-0002-5711-8873; 34549694; AAD-5479-2021; AAD-5564-2021; ABD-7321-2021
Aim The autonomic nervous system plays an important role in the pathogenesis of vasovagal syncope, but studies on the effect of basal autonomic tone have found confusing results. The aim of this study was to investigate the effect of basal autonomic functions, as assessed by heart rate variability (HRV) and heart rate turbulence (HRT), in patients with vasovagal syncope. Material and methods Patients who underwent head-up tilt test (HUTT) due to unexplained syncope and who had a 24-hr Holter ECG recording in the same period were retrospectively analyzed. Patients with diabetes, a history of myocardial infarction, heart failure, orthostatic hypotension, atrial fibrillation, or use of vasoactive drugs, such as beta blockers, were excluded from the study. 161 patients who met these criteria were included in the study. Time domain HRV parameters from Holter ECG recordings and HRT parameters from patients with sufficient number of ventricular premature contractions were measured. Results The age of the patients varied from 16 to 75 yrs (mean: 44.8 +/- 18.5 yrs). HUTT results of 60 (37.2%) patients were evaluated as positive. There were no significant differences in the basal demographic, clinical, or laboratory findings of the tilt-positive and tilt-negative patient groups. Likewise, there were no significant differences between the time domain HRV parameters and HRT parameters of both groups. Conclusion HRV and HRT parameters reflecting basal autonomic function were not different between HUTT positive and HUTT negative patient groups. These findings suggest that basal autonomic functions have no effect on vasovagal syncope pathogenesis.
Markers of coagulation and fibrinolysis do not detect or predict the presence of left atrial appendage thrombus in patients with atrial fibrillation
(2020) Doganozu, Ersin; Ciftci, Orcun; Hasirci, Senem; Yilmaz, Kerem Can; Karacaglar, Emir; Sade, Leyla Elif; Muderrisoglu, Ibrahim Haldun; Ozin, Mehmet Bulent; 0000-0002-2538-1642; 0000-0001-8926-9142; 0000-0002-8342-679X; 0000-0003-3737-8595; 32147650; ABI-6723-2020; W-5233-2018; AAK-7805-2021; AAJ-1331-2021; AAQ-7583-2021
Objective: This study was designed to evaluate the role of hemostatic variables in arterial blood serum in left atrial thrombosis and to define any hemostatic variables, such as serum biomarkers, that could potentially reduce the need for transesophageal echocardiography. Method: This study included patients with non-valvular asymptomatic atrial fibrillation (AF), either paroxysmal, persistent, or chronic. The presence of an left atrial appendix (LAA) thrombus was used to form 2 groups: thrombus (+) and thrombus (-). The serum levels of the thrombotic/fibrinolytic markers including beta-thromboglobulin, prothrombin fragment 1+2, thrombin/antithrombin complex, human plasminogen activator inhibitor-1/tissue plasminogen activator complex, and D-dimer were compared between 2 groups. Results: The mean age of the study population was 65.6 +/- 12.2 years (range: 30-96 years), and 33 (61.1%) patients were male. Fourteen (25.9%) patients had an LAA thrombus and 40 patients did not. Two groups did not differ significantly with regard to any of the coagulation/fibrinolysis markers. The LAA thrombus (+) group had significantly higher rates of heart failure, peripheral artery disease, coronary artery disease, and chronic obstructive pulmonary disease (p<0.05). Neither the serum levels of the study markers nor demographic and clinical parameters were predictive of an LAA thrombus in binary logistic regression analysis. Conclusion: The arterial blood serum markers did not differ significantly between groups with and without an LAA thrombus and did not predict an LAA thrombus in patients presenting with AF.
MELD-XI score predicts in-hospital mortality independent of simplified pulmonary embolism severity index among patients with intermediate-to-high risk acute pulmonary thromboembolism
(2019) Ciftci, Orcun; Celik, Casit Olgun; Uzar, Guldeniz; Kupeli, Elif; Muderrisoglu, Ibrahim Haldun; 31709948
Introduction: Acute pulmonary thromboembolism (PTE) is a highly morbid and fatal condition. Although several risk stratification models exist for prediction of mortality risk in PTE, no study has yet focused on the effect of impaired vital organ function, such as renal or hepatic impairment, on mortality in PTE. MELD-XI (Model for end-stage liver disease excluding INR) score predicts mortality among patients with end-stage hepatic and cardiovascular disorders. Herein, we aimed to test MELD-XI score for predicting in-hospital prognosis of patients with intermediate-to-high risk acute PTE. Materials and Methods: We reviewed the medical records patients older than 18 years hospitalized with intermediate-to-high risk PTE between 01.06.2011 and 01.01.2019. Simplified pulmonary embolism severity index (sPESI) score and MELD-XI score were calculated, and in-hospital mortality determined. MELD-XI score was compared between patients with and without in-hospital mortality and was correlated to sPESI score. The predictive power of MELD-XI score for in-hospital mortality was sought and an in-hospital survival analysis with Kaplan Meier curve and log-rank test was done for MELD-XI score. Results: A total of 104 patients [mean age of 70.8 +/- 15.9 years; 68 (65.4%) females]. Fourteen (13.5%) patients died at hospital. MELD-XI and sPESI scores were significantly correlated to each other and were higher in deceased patients than the survivors [17.3 (IQR 14.3) vs. 10.12 (IQR 2.99); p < 0.05 and 2 (IQR 1) vs. 1 (IQR 1); p < 0.05, respectively]. MELD-XI score and sPESI score were significant predictor of in-hospital mortality in multivariate analysis. A MELD-XI score >= 10.25 had a sensitivity of 78.6% and a specificity of 70.0% for in-hospital mortality. A survival analysis revealed that a high MELD-XI category (MELD-XI score >= 10.2) significantly worsened in-hospital survival (p < 0.01; log rank test). Conclusion: MELD-XI score performs well for mortality prediction among patients with intermediate-to-high risk PTE. This subject needs to be further studied by large, randomized controlled studies.
Neutrophil to Lymphocyte Ratio As A Predictor of Severe Coronary Artery Disease and Left Ventricular Systolic Dysfunction of Any Degree in Geriatric Patients Presenting to Emergency Department with Acute Coronary Syndrome
(2017) Ciftci, Orcun; Kayipmaz, Afsin Emre; Aydos, Tolga Resat; Muderrisoglu, Ibrahim Haldun; 0000-0002-1832-9336; 0000-0001-8926-9142; AAJ-7279-2020; AAC-2597-2020; W-5233-2018
Introduction: We examined the role of the neutrophil-to-lymphocyte ratio (NLR) for predicting severe coronary artery disease and left ventricular systolic dysfunction of any degree in geriatric patients presenting to emergency department with non-ST-elevation acute coronary syndrome. Materials and Method: We retrospectively reviewed data for patients aged >= 65 years with non-ST-elevation acute coronary syndrome who underwent coronary angiography between April 2011 and January 2016. Patients were divided into Group 1 (101 patients; severe [>50%] lesions in one or more epicardial artery or branch) and Group 2 (65 patients; no severe lesions). The key clinical parameters, including NLR were compared among the groups and the power of NLR as a predictor of severe coronary artery disease and left ventricular systolic dysfunction of any degree was determined. Results: Group 1 included more patients who were male, older, or smoked; these had higher troponin I, mass CK-MB, NLR, but a lower left-ventricular ejection fraction. NLR was an independent predictor of severe coronary disease and left ventricular systolic dysfunction of any degree with good sensitivity and moderate specificity. Conclusion: Neutrophil-to-lymphocyte ratio is a simple, rapid, and cheap parameter that can predict severe coronary artery disease and left ventricular systolic dysfunction of any degree in geriatric patients with non-ST-elevation acute coronary syndrome.
Neutrophil/Lymphocyte Ratio in Coronary Bare Metal Stent Restenosis
(2017) Yilmaz, Kerem Can; Ciftci, Orcun; Karacaglar, Emir; Bal, Ugur Abbas; Okyay, Kaan; Aydinalp, Alp; Yildirir, Aylin; Muderrisoglu, Ibrahim Haldun; 0000-0002-9446-2518; 0000-0002-2538-1642; 0000-0002-3761-8782; 0000-0001-8926-9142; 0000-0001-8750-5287; 0000-0001-6134-8826; 0000-0003-3320-9508; AAK-4322-2021; ABI-6723-2020; AAJ-1331-2021; AAD-5841-2021; W-5233-2018; A-4947-2018; AAK-7355-2020
A New Chest Radiography Clue to Predict Saphenous Vein Graft Failure
(2022) Akbay, Ertan; Coner, Ali; Akinci, Sinan; Adar, Adem; Demir, Ali Riza; Uygur, Begum; Saba, Tonguc; Budak, Ali Baran; Muderrisoglu, Ibrahim Haldun
Objective: Saphenous vein graft failure (VGF) is a measure of the short-and long-term success of coronary artery bypass graft surgery (CABG). Aortic arch calcification (AAC) is a long-term finding of atherosclerosis in large vessels. The aim of this study was to evaluate the relationship between AAC and VGF.Materials and Methods: Patients who underwent CABG surgery and subsequent coronary angiography in a single hospital between January 2010 and January 2021 were included in the study. The presence and stage of AAC was evaluated using preoperative chest X-rays. VGF was defined as >= 75% stenosis and/or total occlusion in the saphenous vein graft. In addition, the effect of AAC on VGF was evaluated based on the time elapsed since the CABG procedure. Results: Of the 594 patients who underwent CABG during the study period, 91 patients (mean age 63.6 +/- 10.0; 71 [78.0%] male) were included in the study. VGF was observed in 49 (53.8%) patients. AAC was found to be an independent predictor of VGF (odds ratio [OR]: 2.788, 95% confidence interval [CI]: 1.068-7.278). The results indicated no association between AAC and VGF in patients whose coronaries were screened within 1 year (OR: 1.143, 95% CI: 0.279-4.683), while there was a strong association between AAC and VGF in patients who were screened 1 year after the surgery (OR: 5.355, 95% CI: 1.618-17.720).Conclusion: AAC evaluation may be a valuable diagnostic method to predict VGF after CABG, and particularly late VGF.
The Novel CHA(2)DS(2)-VASC-FSH Score is Predictive of Severe Coronary Artery Disease on Coronary Angiography in Patients with Atrial Fibrillation and Unstable Symptoms
(2019) Ciftci, Orcun; Yilmaz, Kerem Can; Karacaglar, Emir; Yilmaz, Mustafa; Ozin, Bulent; Muderrisoglu, Ibrahim Haldun; 31258358
Objective: AF may create confusion about the presence of severe or unstable coronary artery disease in cases with unstable symptoms. Novel scores and markers are needed to determine severe coronary artery disease in such patients. We aimed to test the newly developed CHA(2)DS(2)-VASc-FSH score, developed by adding family history for coronary artery disease, hyperlipidemia, and smoking to the original CHA(2)DS(2)-VASc score, in the prediction of severe CAD in patients with AF and unstable symptoms. Materials and Methods: We retrospectively analyzed 72 patients presenting to Baskent Universtiy School of Medicine Hospital between April 2011 and January 2016. The CHA(2)DS(2)-VASc-FSH score was assessed for the prediction of severe CAD. Results: Seventy-two patients aged 65.7 +/- 11.2 years were enrolled. Thirty-five (48.6%) patients had severe CAD and 11 (15.3%) had unstable CAD. patients with severe coronary artery disease had a significantly greater CHA(2)DS(2)-VASC-FSH score (5 (1-8) vs 3(0-7); p< 0.05). The CHA(2)DS(2)-VASC-FSH score independently predicted severe CAD, with a CHA(2)DS(2)-VASc-FSH score of 3 or greater having a sensitivity of 77.1% and a specificity of 56.8% for severe CAD. Conclusion: Among patients with AF and unstable symptoms, the CHA(2)DS(2)-VASc-FSH score independently predicts severe CAD.