Tıp Fakültesi / Faculty of Medicine

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    Imaging in Patients with Cardiovascular Implantable Electronic Devices: Part 1-Imaging Before and During Device Implantation. A Clinical Consensus Statement of the European Association of Cardiovascular Imaging (EACVI) and the European Heart Rhythm Association (EHRA) of the ESC
    (2023) Stankovic, Ivan; Voigt, Jens-Uwe; Burri, Haran; Muraru, Denisa; Sade, Leyla Elif; Haugaa, Kristina Hermann; Lumens, Joost; Biffi, Mauro; Dacher, Jean Nicolas; Marsan, Nina Ajmone; Bakelants, Elise; Manisty, Charlotte; Dweck, Marc R.; Smiseth, Otto A.; Donal, Erwan; 37861372
    More than 500 000 cardiovascular implantable electronic devices (CIEDs) are implanted in the European Society of Cardiology countries each year. The role of cardiovascular imaging in patients being considered for CIED is distinctly different from imaging in CIED recipients. In the former group, imaging can help identify specific or potentially reversible causes of heart block, the underlying tissue characteristics associated with malignant arrhythmias, and the mechanical consequences of conduction delays and can also aid challenging lead placements. On the other hand, cardiovascular imaging is required in CIED recipients for standard indications and to assess the response to device implantation, to diagnose immediate and delayed complications after implantation, and to guide device optimization. The present clinical consensus statement (Part 1) from the European Association of Cardiovascular Imaging, in collaboration with the European Heart Rhythm Association, provides comprehensive, up-to-date, and evidence-based guidance to cardiologists, cardiac imagers, and pacing specialists regarding the use of imaging in patients undergoing implantation of conventional pacemakers, cardioverter defibrillators, and resynchronization therapy devices. The document summarizes the existing evidence regarding the use of imaging in patient selection and during the implantation procedure and also underlines gaps in evidence in the field. The role of imaging after CIED implantation is discussed in the second document (Part 2).
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    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. Haldun
    Objective: 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.
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    Determinants of New-Onset Atrial Fibrillation in Patients Receiving CRT Mechanistic Insights From Speckle Tracking Imaging
    (2016) Sade, Leyla Elif; Atar, Ilyas; Ozin, Bulent; Yuce, Deniz; Muderrisoglu, Haldun; 26684972
    OBJECTIVES The aim of this study was to investigate the factors associated with the development of atrial fibrillation (AF) and to examine the impact of these factors for long-term outcome after cardiac resynchronization therapy (CRT). BACKGROUND The effect of CRT on the development of new AF is under debate. METHODS Clinical assessment, 12-lead electrocardiogram, echocardiography with speckle tracking strain imaging, and device interrogation before implantation and every 6 months thereafter were performed regularly over a 5-year follow-up. The primary endpoint was new-onset AF. Pre-specified outcome events were transplantation, assist device implantation, and death. RESULTS During follow-up, AF occurred in 29 of 106 patients. Parameters of left atrial (LA) mechanics including mitral annular (A') velocity, left atrial volume index (LAVI), LA ejection fraction, active emptying fraction, LA mean systolic strain (Ss) and late diastolic strain (Sa) improved at 6 months only in patients who remained free of AF. The change in LA Ss and Sa from baseline to 6 months after CRT had the highest accuracy to predict new-onset AF (area under the curve [AUC] = 0.793, 0.815, respectively, p < 0.0001 for both vs. left ventricular [LV] reverse remodeling AUC = 0.531; p < 0.01 for both). In addition, the change in LA Ss and Sa predicted outcome events independently from new-onset AF and LV volume response. CONCLUSIONS LA functional improvement is essential for AF-free survival after CRT and is an independent predictor of AF-free survival. The improvement in LA Ss and Sa as a means of LA mechanical reserve also predicts long-term event-free survival after CRT independently from LV volume response and new-onset AF. (C) 2016 by the American College of Cardiology Foundation.