Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item 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-7583-2021Objective: 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.Item The Effect of Renal Transplantation on Cardiac Functions(2020) Yilmaz, Kerem Can; Akgun, Arzu Neslihan; Keskin, Suzan; Ciftci, Orcun; Moray, Gokhan; Muderrisoglu, Haldun; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0001-8926-9142; 33229768; AAJ-8097-2021; W-5233-2018; AAJ-1331-2021Chronic renal failure is a well-known risk factor for cardiovascular poor outcome. Despite advances in dialysis and renal transplantation, these patients still have high cardiovascular morbidity and mortality. The aim of our study was to evaluate the changes in blood parameters and echocardiographic parameters of patients undergoing renal transplantation in our center. One hundred and eighty-three patients who underwent renal transplantation between September 2012 and January 2016 were included in the study. Pre- and postoperative hemoglobin values, lipid profiles, ejection fractions, presence of left ventricular hypertrophy, presence of diastolic dysfunction, and valve pathologies were retrospectively scanned. Data were obtained from all patients in terms of blood parameters, but we compared 92 patients' echocardiographic data because of lack of both pre- and postoperative echocardiography records. In our study, 124 patients (67.8%) were male, and the mean age was 42.6 +/- 14.4 years. Hemoglobin levels (11.2 +/- 1.98, 12.7 +/- 2.2 mg/dL, P <0.001) and high-density lipoprotein (HDL) values (37.6 +/- 10.5, 46.6 +/- 13.6 mg/dL, P <0.001) were found to be different significantly. In echocardiographic evaluation, there was no difference between pre- and postoperative ejection fractions in 92 patients. However, patients with preoperative ejection fraction <50% had a significant increase in postoperative ejection fraction (40.1 +/- 6.2, 48.4% +/- 9.4%, P = 0.012). Renal transplantation can improve left ventricle ejection fraction in patients with basal ejection fraction less than 50% and also provide a significant increase in hemoglobin and HDL levels in all patients. This suggests that renal transplantation may reverse the process for dilated cardiomyopathy and may improve cardiac function in patients with low ejection fraction. However, transplantation should be performed as early as possible in these patients.Item The Role of Selvester Score on 12-Lead ECG in Determination of Left Ventricular Systolic Dysfunction Among Patients Receiving Trastuzumab Therapy(2019) Ciftci, Orcun; Yilmaz, Kerem Can; Karacaglar, Emir; Akgun, Arzu Neslihan; Yilmaz, Mustafa; Oguz, Arzu; Muderrisoglu, Ibrahim Haldun; 0000-0001-8926-9142; 0000-0001-6512-6534; W-5233-2018; W-8004-2019; ABI-6723-2020Objective: Breast cancer is the most common cancer in women. Trastuzumab is an effective breast cancer agent. The most significant side effect of trastuzumab is left ventricular systolic dysfunction. Selvester score calculated from 12-lead electrocardiography (ECG) has a proven accuracy in predicting left ventricular infarct area and scar volume. We aimed to determine its role in detection of left ventricular systolic dysfunction among trastuzumab-treated breast cancer patients. Methods: A total of 60 trastuzumab-treated patients were retrospectively included. The patients were grouped into two groups with trastuzumab-induced left ventricular systolic dysfunction (left ventricular ejection fraction (LVEF) <55%) (Group 1) and without (Group 2). The left ventricular systolic dysfunction group was divided into two subgroups: LVEF <50% and (Group 1a) and LVEF 50-54% (Group 1b). The Selvester score was compared between Group 1 and Group 2, and between Group 1a, Group 1b, and Group 2. The predictive role of Selvester score in trastuzumab-induced left ventricular systolic dysfunction was determined with univariate and multivariate analysis. Results: The mean age of the patients was 56.7 +/- 13.7 years. Twenty (21.1%) patients had trastuzumab-induced left ventricular systolic dysfunction. The Selvester score was similar between Group 1 and Group 2. Group 1a had a significantly greater Selvester score compared to Group 1b and Group 2 (p<0.05); however, Group 1b and Group 2 had similar Selvester scores (p>0.05). The Selvester score was significantly correlated with left ventricular systolic dysfunction in univariate analysis (r=0.189, p<0.05) but not in multivariate analysis. Conclusion: Selvester score may be useful especially for detecting severe trastuzumab-induced left ventricular systolic dysfunction.Item 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; 31258358Objective: 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.Item MELD-XI Score in Hospitalized Heart Failure Patients with Cardiac Electronic Devices(2019) Ciftci, Orcun; Celik, Casit Olgun; Yilmaz, Kerem Can; Karacaglar, Emir; Sezenoz, Burak; Ozin, Bulent; Muderrisoglu, I. HaldunObjective: MELD-XI (Model for End-Stage Liver Disease Excluding INR) score predicts mortality in patients with heart failure. Herein, we assessed the role of MELD- XI score in predicting in-hospital mortality among heart failure patients having intracardiac cardioverter defibrillator (ICD) or cardiac resynchronization therapy with defibrillator backup (CRT-D) who presented with appropriate device shock or acute decompensated heart failure. Methods: We reviewed the medical records of patients with implantable cardioverter defibrillator or cardiac resynchronization therapy with defibrillator backup admitted to coronary care unit with acute decompensated heart failure or appropriate implantable device shocks between 01 January 2013 and 01 November 2018. MELD-XI score was compared between the deceased and surviving patients. The correlation of MELD-XI score with in-hospital mortality was sought. Results: There were 106 coronary care unit admissions of 67 patients (52 (77.6%) males and 15 (22.4%) females), who had a mean age of 64.8 (range 19-93) years. Eighty-eight (83.0%) admissions were for acute decompensated heart failure and 18 (17.0%) for appropriate device shock and/or electrical storm. A total of 16 (15.1%) patients died at hospital. The median MELD-XI score of the patients who died at hospital was significantly greater than that of the survivors (11.80 (0.59-28.98) vs 15.24 (9.11-24.64); p<0.05). A binary logistic regression analysis showed that MELD-XI score was a significant independent predictor of in-hospital mortality (X-2=1.229 (%95 CI 1.06-1.43); p<0.05). Conclusion: MELD-XI score successfully predicts in-hospital mortality among patients with ICD or CRT-D admitted with acute decompensated heart failure or appropriate implantable electronic device shocks.Item Preoperative Cardiac Risk Assessment in Renal Transplant Recipients: A Single-Center Experience(2019) Yilmaz, Kerem Can; Akgun, Arzu Neslihan; Ciftci, Orcun; Muderrisoglu, Haldun; Sezer, Siren; Moray, Gokhan; Haberal, Mehmet; 0000-0002-9635-6313; 29025386; AAG-8233-2020Objectives: Cardiovascular disease is the major cause of morbidity and mortality in patients on renal replacement therapy and in kidney transplant recipients. There are no specific recommendations for preoperative cardiac risk assessment before renal transplant. The aim of our study was to analyze preoperative cardiac test frequencies, test results, patient characteristics, and relations between cardiac stress test results and severe coronary artery disease. Materials and Methods: We retrospectively examined patients who underwent renal transplant between December 2011 and December 2016 in our hospital (Ankara, Turkey). Our study group included 216 patients. All patients had preoperative echocardiography. We recorded results of exercise stress tests, myocardial perfusion scintigraphy, and coronary angiography. For all patients, preoperative complete blood cell count, creatinine, high-density lipoprotein, triglycerides, low-density lipoprotein, and red cell distribution width values were obtained and recorded. Results: We classified patient groups according to presence or absence of severe coronary artery disease. Fourteen of 66 patients had severe coronary artery disease. In univariate analyses, age, having a history of familial coronary artery disease, diabetes mellitus, presence of coronary artery disease, and triglyceride levels were risk factors for severe coronary artery disease. In multivariate analysis, diabetes mellitus, presence of coronary artery disease, and having a history of familial coronary artery disease were statistically significant. Conclusions: Renal transplant recipients are a special patient population, and there must be specific suggestions for this population. If patients present with more than 1 risk factor, a stress test should be performed to evaluate cardiovascular risk. In some patients, especially those whose risk factors include prior cardiovascular disease or diabetes mellitus, stress tests should be skipped and patients should directly undergo coronary angiography to look for severe coronary artery disease.