Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item The Safety and Tolerability of Nebivolol in Hypertensive Patients with Coronary Artery Disease and Left Ventricular Ejection Fraction >= 40%: A Population-Based Cohort Study (Nebivolol-TR Study)(2022) Altin, Cihan; Okyay, Kaan; Kocaba, Umut; Coner, Ali; https://orcid.org/0000-0001-6134-8826; https://orcid.org/0000-0002-5711-8873; 36317659; AAK-7355-2020; ABD-7321-2021Background: This study aimed to assess the safety and tolerability of nebivolol in hypertensive patients with coronary artery disease and left ventricular ejection fraction >= 40% in a Turkish cohort. Methods: A total of 1015 hypertensive patients and coronary artery disease with left ventricular ejection fraction >= 40% were analyzed from 29 different centers in Turkey. Primary outcomes were the mean change in blood pressure and heart rate. Secondary outcomes were to assess the rate of reaching targeted blood pressure (<130/80 mmHg) and heart rate (<60 bpm) and the changes in the clinical symptoms (angina and dyspnea). Adverse clinical events and clinical outcomes including cardiovascular mortality, cardiovascular hospital admissions, or acute cardiac event were recorded. Results: The mean age of the study population was 60.3 +/- 11.5 years (male: 54.2%). During a mean follow-up of 6 months, the mean change in blood pressure was -11.2 +/- 23.5/-5.1 +/- 13.5 mmHg, and the resting heart rate was -12.1 +/- 3.5 bpm. Target blood pressure and heart rate were achieved in 76.5% and 37.7% of patients. Angina and functional classifications were improved by at least 1 or more categories in 31% and 23.2% of patients. No serious adverse events related to nebivolol were reported. The most common cardiovascular side effect was symptomatic hypotension (4.2%). The discontinuation rate was 1.7%. Cardiovascular hospital admission rate was 5% and hospitalization due to heart failure was 1.9% during 6 months' follow-up. Cardiovascular mortality rate was 0.1%. Conclusion: Nebivolol was well tolerated and safe for achieving blood pressure and heart rate control in hypertensive patients with coronary artery disease and heart failure with preserved or mildly reduced ejection fraction.Item Management of Sacubitril/Valsartan Combination in an End-stage Heart Failure Patient Hospitalized for COVID-19 Pneumonia: Should we Withdraw Temporarily or Continue?(2021) Coner, Ali; Altin, CihanBackground: Many factors were blamed for the worse prognosis in COVID-19. Heart failure patients are thought to be under increased risk because of either immune-compromised basal status or possible interaction of viral infection with on-going medications, such as the Renin-Angiotensin-Aldosterone system (RAAS) blockers. Sacubitril is a neprilysin inhibitor and its' combination with valsartan is recommended as a novel medication for heart failure. Case Report: A 71 years of age female with end-stage heart failure was hospitalized for COVID-19 pneumonia. She was under sacubitril/valsartan combination for the heart failure, and at the end of the first week of hospitalization, clinical and laboratory parameters recovered uneventfully. Sacubitril/valsartan therapy was continued without complications during the in-hospital course. Conclusion: Specific therapies for heart failure should not be withdrawn in COVID-19. To our knowledge, this is the first case report documenting the clinical progress of a COVID-19 pneumonia patient who was already under sacubitril/valsartan treatment.Item 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-5564-2021Objective: 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.Item 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; 32352420Objective: 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.Item 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-4284-2021Purpose: 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.Item Subclinical myocardial dysfunction in liver transplant candidates determined using speckle-tracking imaging(2019) Inci, Saadet Demirtas; Sade, Leyla Elif; Altin, Cihan; Pirat, Bahar; Pamukcu, Hilal Erken; Yilmaz, Sabriye; Muderrisoglu, Haldun; 31802775Objective: There are various cardiovascular abnormalities in end-stage liver disease (ESLD). In these patients, left ventricular (LV) systolic function is normal at rest but deteriorates during stress. This deterioration may be due to subclinical myocardial dysfunction. This study evaluated global LV and right ventricular (RV) functions using 2-dimensional (2D) speckle tracking in patients with ESLD. Methods: Forty liver transplant candidates with ESLD and 26 healthy individuals were included in the study. All of the patients underwent conventional echocardiographic measurement. Longitudinal, circumferential, and radial strain measurements, as well as apical and parasternal short-axis image recordings were obtained. All 2D strain measurements were measured with offline analysis using velocity vector imaging (VVI) software. Results: In the apical 4- and 2-chamber measurements, the LV mean longitudinal strain was significantly lower in the patient group compared with that of the control group (-16.0 +/- 3.2% versus -17.6 +/- 2.2%, -16.7 +/- 3.3% versus -18.7 +/- 2.1 +/- 2.1 %; p=0.002, respectively). The LV mean circumferential strain did not differ between groups. The LV mean radial strain and RV longitudinal strain were significantly lower in the patient group (45.4 +/- 10.7 vs. 52.7 +/- 10.8%; p=0.01 and -19.2 +/- 3.5% versus -21.5 +/- 3.6%; p=0.03, respectively). Conclusions: Subclinical impairment of global LV and RV systolic functions was determined in liver transplantation candidates using VVI. This deterioration was detected in longitudinal and radial deformation rather than circumferential deformation mechanics, which is consistent with early-stage LV myocardial dysfunction.Item A rare cause of circulatory shock(2014) Altin, Cihan; İzmir, Arzu; Osmanoglu, Sevda; Gezmis, Esin; Sagduyu, Afsin; 25233504Item A clinical dilemma about a new oral anticoagulant treatment(2014) Altin, Cihan; Ozturkeri, Ovgu Anil; Gezmis, Esin; Muderrisoglu, Haldun; 25341482Item A novel oral anticoagulant, dabigatran, in acute renal infarction(2015) Altin, Cihan; Sakallioglu, Onur; Gezmis, Esin; Muderrisoglu, Haldun; 25625445Item Possible renoprotective effects of dabigatran Reply(2015) Altin, Cihan; Sakallioglu, Onur; Gezmis, Esin; Muderrisoglu, Haldun; 26258187