Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
Browse
23 results
Search Results
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 PrevAleNce and Associated Factors of InappropriaTe Dosing of Direct Oral AnticoaguLants in PAtients with Atrial Fibrillation: the ANATOLIA-AF Study(2022) Coner, Ali; https://orcid.org/0000-0002-5711-8873; 36527566; ABD-7321-2021Purpose Inappropriate dosing of direct oral anticoagulants is associated with an increased risk of stroke, systemic embolism, major bleeding, cardiovascular hospitalization, and death in patients with atrial fibrillation. The main goal of the study was to determine the prevalence and associated factors of inappropriate dosing of direct oral anticoagulants in real-life settings.Methods This study was a multicenter, cross-sectional, observational study that included 2004 patients with atrial fibrillation. The study population was recruited from 41 cardiology outpatient clinics between January and May 2021. The main criteria for inappropriate direct oral anticoagulant dosing were defined according to the recommendations of the European Heart Rhythm Association.Results The median age of the study population was 72 years and 58% were women. Nine-hundred and eighty-seven patients were prescribed rivaroxaban, 658 apixaban, 239 edoxaban, and 120 dabigatran. A total of 498 patients (24.9%) did not receive the appropriate dose of direct oral anticoagulants. In a logistic regression model, advanced age, presence of chronic kidney disease and permanent atrial fibrillation, prescription of reduced doses of direct oral anticoagulants or edoxaban treatment, concomitant use of amiodarone treatment, and non-use of statin treatment were significantly associated with potentially inappropriate dosing of direct oral anticoagulants.Conclusion The study demonstrated that the prevalence of inappropriate direct oral anticoagulant dosing according to the European Heart Rhythm Association recommendations was 24.9% in patients with atrial fibrillation. Several demographic and clinical factors were associated with the inappropriate prescription of direct oral anticoagulants.Item 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 HaldunObjective: 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.Item New Perspective On Fatigue In Hemodialysis Patients With Preserved Ejection Fraction: Diastolic Dysfunction Fatigue And Diastolic Dysfunction(2022) Akbay, Ertan; Akinci, Sinan; Coner, Ali; Adar, Adem; Genctoy, Gultekin; Demir, Ali Riza; https://orcid.org/0000-0002-9146-0621; https://orcid.org/0000-0001-5250-5404; AAD-5479-2021; AAD-5564-2021The relationship between diastolic dysfunction and fatigue in hemodialysis patients with preserved ejection fraction is unknown. In this context, the objective of this study is to assess fatigue using the relevant scales and to demonstrate its relationship with diastolic dysfunction. The patients who underwent hemodialysis were evaluated prospectively. Patients' fatigue was assessed using the Visual Analogue Scale to Evaluate Fatigue Severity (VAS-F). The echocardiographic works were performed as recommended in the American Society of Echocardiography guidelines. A total of 94 patients [mean age 64.7 +/- 13.5 years, 54 males (57.4%)] were included in the study. The median VAS-F score of these patients was 68.5 (33.25-91.25), and they were divided into two groups according to this value. Peak myocardial velocities during early diastole (e ') and tricuspid annular plane systolic excursion (TAPSE) values were found to be significantly lower in the group with high VAS-F scores, whereas the early diastolic flow velocities (E)/e ' ratio and pulmonary artery peak systolic pressures (PAP) were found to be significantly higher (p < 0.05, for all). E/e ' ratio (r 0.311, p 0.002) and PAP (r 0.281, p 0.006) values were found to be positively correlated with the VAS-F score, as opposed to the TAPSE (r - 0.257, p 0.012) and e ' (r - 0.303, p 0.003) values, which were found to be negatively correlated with the VAS-F score. High fatigue scores in hemodialysis patients may be associated with diastolic dysfunction. In addition, in our study, we determined the correlation of VAS-F score with E/e ' ratio, PAP and TAPSE.Item Evaluation of the relationship between para-aortic adipose tissue and ascending aortic diameter using a new method(2022) Adar, Adem; Onalan, Orhan; Cakan, Fahri; Keles, Hakan; Akbay, Ertan; Akinci, Sinan; Coner, Ali; Haberal, Cevahir; Muderrisoglu, Haldun; https://orcid.org/0000-0002-9146-0621; https://orcid.org/0000-0001-5250-5404; https://orcid.org/0000-0002-5711-8873; https://orcid.org/0000-0002-6496-5050; 36189879Background Para-aortic adipose tissue (PAT) is the local adipose tissue that externally surrounds the aorta. It contributes significantly to aortic atherosclerosis and enlargement. Studies conducted with computed tomography and magnetic resonance have shown that individuals with aortic aneurysm had more PAT than healthy individuals. In this study, we measured PAT using transthoracic echocardiography (TTE). The aim of this study is to investigate the possible relationship of TTE measured PAT with ascending aortic width. Methods PAT was defined as the hypoechoic space in front of ascending aortic 2 cm above the sinotubular junction at the end of the systole. Patients were divided into 2 groups according to the presence of dilatation in the ascending aorta using Roman's classification (aortic size index, ASI). ASI of less than 21 was considered no aortic dilation and an ASI of 21 mm/m2 or greater was considered to have aortic dilation. Results A total of 321 unselected patients were divided into the ascending aortic dilatation (AAD) group (n = 96) and the normal ascending aorta diameter group (n = 225 patients). PAT was significantly higher in the AAD group compared with the non-ADD group (0.9 (0.48) vs. 0.7 (0.91) mm, p < 0.0001). Univariate and multivariate logistic regression analysis revealed that PAT (OR: 3.005, 95%CI (1.445-6.251)) were significantly associated with AAD. Conclusions This is the first study which evaluated PAT measured by TTE. We found a significant association between PAT measured by TTE and ascending aorta width.Item Efficacy and Safety of Switching from Clopidogrel to Ticagrelor at the Time of Discharge in STEMI Patients Treated with a Pharmacoinvasive Approach(2021) Coner, Ali; Muderrisoglu, İbrahim Haldun; 0000-0002-5711-8873; ABD-7321-2021Objective: The aim of the study was to search for the efficacy and safety of switching from clopidogrel to ticagrelor at the time of discharge in ST-segment elevation myocardial infarction (STEMI) patients treated with a pharmacoinvasive approach. Materials and Methods: STEMI patients who were managed with pharmacoinvasive approach were involved in the study population. Patients were divided into two groups as clopidogrel and ticagrelor depending on the choice of P2Y12 inhibitor at the time of discharge. All-cause mortality, stent thrombosis, recurrent myocardial infarction, need for target lesion revascularization, and any major bleeding (BARC classification >= 2) were defined as composite clinical end points at the end of the 12th month follow-up. Results: A total of 194 patients (male: 156 patients, 80.4%; mean age 60.2 +/- 11.5 years) were involved in the study population (130 clopidogrel and 64 ticagrelor patients). The median time interval for switching time to ticagrelor was 48 (48-72) h. In a subgroup analysis for patients with a stented segment >= 30 mm, discharge with clopidogrel was related to 6.9 times increase in composite end points compared to patients discharged with ticagrelor (odds ratio: 6.955, confidence interval 95%: 1.512-30.980, p=0.012). Conclusion: Switching from clopidogrel to ticagrelor at the 48th h following fibrinolytic administration had similar safety end points in STEMI patients managed with pharmacoinvasive approach. In a subgroup of study patients with a total stent length of >= 30 mm, switching to ticagrelor was found to be superior to clopidogrel regarding composite clinical end points.Item Impact of the Novel Coronavirus Disease 2019 (COVID-19) Pandemic on Cardiac Emergencies and Future Perspectives in Turkey(2021) Coner, Ali; Kayipmaz, Afin Emre; Celikel, Elif; 0000-0002-5711-8873; ABD-7321-2021SARS-CoV-2-associated COVID-19 pandemic has affected the daily life of people across the world in 2020. Data about the course of viral involvement continues to be accumulated. COVID-19 is a multi-systemic disease, and the clinical presentations and possible complications may vary widely in different patient groups. The cardiovascular system is a primary target of COVID-19, and direct or indirect effects of viral involvement are observed. In addition to the direct effects of viral involvement on the cardiovascular system, decrement in acute cardiac emergencies has been experienced in many cardiology clinics in Turkey during the pandemic. Moreover, there may be a possible increase in out-of-hospital cardiac arrests in the near future. In this narrative review, we aimed to discuss the cardiac manifestations of COVID-19, the possible drug interactions related to the drugs used for COVID-19 management, and the effect of the pandemic on cardiac emergencies. We believe that understanding the natural mechanism of cardiac involvement of SARS-CoV-2 and emphasizing the data about out-of-hospital arrests will help clinicians effectively deal with the preventable cardiovascular causes of death in the forthcoming waves of COVID-19.Item In-Hospital Cardiac Complications in Legionnaires' disease: A Single Center Experience of 32 Patients(2021) Akinci, Sinan; Coner, Ali; 0000-0001-5250-5404; 0000-0002-5711-8873; AAD-5564-2021; ABD-7321-2021Introduction: Legionella species frequently causes Legionnaires' disease (LD), a community-acquired pneumonia (CAP). Although data on cardiac events during the course of CAP can be found in the literature, there has been little research on the same issue in LD patients specifically. This study aimed to investigate cardiac complications in the course of LD. Materials and Methods: A total of 32 patients hospitalized with CAP and who received a definitive diagnosis of Legionella infection were identified from the hospital database and included in the study population. The patients' electronic and written records were evaluated for possible cardiac complications. Results: Mean age was 65 +/- 13.5 years and 50% of the subjects were males. Seven patients died during hospitalization. Cardiovascular events were detected in 11 patients. New-onset atrial fibrillation was the most frequent event and was detected in 8 patients (25%), while two patients experienced a myocardial infarction, and one patient was diagnosed with myocarditis. The cardiovascular events were significantly related to the pneumonia severity index (PSI) score and need for intensive care unit. Conclusion: Although LD rarely involves the heart, it can often cause cardiac complications, and the frequency increases in parallel with the severity of the disease. This study indicates that patients with LD should be carefully followed for possible cardiac complications.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 Pheochromocytoma: An overlooked reversible cause of heart failure with reduced ejection fraction(2021) Coner, Ali; Ozyildiz, Ali Gokhan; 0000-0002-5711-8873; 34523598; ABD-7321-2021Pheochromocytoma is a rare, benign tumor of adrenal medulla, and its clinical symptoms are related to catecholamine production. Clinical presentation may vary in a broad spectrum. Dilated or hypertrophied cardiomyopathies are the possible clinical outcomes of pheochromocytoma. Pheochromocytoma should be kept in mind in the differential diagnosis where resistant hypertension, palpitations, headache, and sweating accompany cardiomyopathy. Excessive adrenergic stimulation causing catecholamine discharge can trigger hypertension crisis, pulmonary edema, and myocardial necrosis. Here in this report, we aimed to present the case of a patient with pheochromocytoma related cardiomyopathy who was totally recovered after surgical excision of the tumor.
- «
- 1 (current)
- 2
- 3
- »