PubMed İndeksli Yayınlar Koleksiyonu
Permanent URI for this collectionhttps://hdl.handle.net/11727/4810
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Item Management of Hyperkalemia in Heart Failure(2021) Altay, Hakan; Cavusoglu, Yuksel; Celik, Ahmet; Demir, Serafettin; Kilicarslan, Baris; Nalbantgil, Sanem; Temizhan, Ahmet; Tokgoz, Bulent; Ural, Dilek; Yesilbursa, Dilek; Yildirimturk, Ozlem; Yilmaz, Mehmet Birhan; 34738907Hyperkalemia is a common electrolyte abnormality in heart failure (HF) that can cause potentially life-threatening cardiac arrhythmias and sudden cardiac death. HF patients with diabetes, chronic kidney disease and older age are at higher risk of hyperkalemia. Moreover, hyperkalemia is also often associated with the use of renin-angiotensin-aldosterone system inhibitors (RAASi) including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists and sacubitril-valsartan. In clinical practice, the occurrence of hyperkalemia is a major concern among the clinicians and often limits RAASi use and/ or lead to dose reduction or discontinuation, thereby reducing their potential benefits for HF. Furthermore, recurrent hyperkalemia is frequent in the long-term and is associated with an increase in hyperkalemia-related hospitalizations. Therefore, management of hyperkalemia has a special importance in HF patients. However, treatment options in chronic management are currently limited. Dietary restriction of potassium is usually ineffective with variable adherence. Sodium polystyrene sulfonate is commonly used, but its effectiveness is uncertain and reported to be associated with intestinal toxicity. New therapeutic options such as potassium binders have been suggested as potentially beneficial agents in the management of hyperkalemia. This document discusses prevalence, predictors and management of hyperkalemia in HF, emphasizing the importance of careful patient selection for medical treatment, uptitration of the doses of RAASi, regular surveillance of potassium and treatment options of hyperkalemia.Item Importance of Systematic Right Ventricular Assessment in Cardiac Resynchronization Therapy Candidates: A Machine Learning Approach(2021) Galli, Elena; Le Rolle, Virginie; Smiseth, Otto A.; Duchenne, Jurgen; Aalen, John M.; Larsen, Camilla K.; Sade, Elif A.; Hubert, Arnaud; Anilkumar, Smitha; Penicka, Martin; Linde, Cecilia; Leclercq, Christophe; Hernandez, Alfredo; Voigt, Jens-Uwe; Donal, Erwan; 33422667Background: Despite all having systolic heart failure and broad QRS intervals, patients screened for cardiac resynchronization therapy (CRT) are highly heterogeneous, and it remains extremely challenging to predict the impact of CRT devices on left ventricular function and outcomes. The aim of this study was to evaluate the relative impact of clinical, electrocardiographic, and echocardiographic data on the left ventricular remodeling and prognosis of CRT candidates by the application of machine learning approaches. Methods: One hundred ninety-three patients with systolic heart failure receiving CRT according to current recommendations were prospectively included in this multicenter study. A combination of the Boruta algorithm and random forest methods was used to identify features predicting both CRT volumetric response and prognosis. Model performance was tested using the area under the receiver operating characteristic curve. The k-medoid method was also applied to identify clusters of phenotypically similar patients. Results: From 28 clinical, electrocardiographic, and echocardiographic variables, 16 features were predictive of CRT response, and 11 features were predictive of prognosis. Among the predictors of CRT response, eight variables (50%) pertained to right ventricular size or function. Tricuspid annular plane systolic excursion was the main feature associated with prognosis. The selected features were associated with particularly good prediction of both CRT response (area under the curve, 0.81; 95% CI, 0.74-0.87) and outcomes (area under the curve, 0.84; 95% CI, 0.75-0.93). An unsupervised machine learning approach allowed the identification of two phenogroups of patients who differed significantly in clinical variables and parameters of biventricular size and right ventricular function. The two phenogroups had significantly different prognosis (hazard ratio, 4.70; 95% CI, 2.1-10.0; P < .0001; log-rank P < .0001). Conclusions: Machine learning can reliably identify clinical and echocardiographic features associated with CRT response and prognosis. The evaluation of both right ventricular size and functional parameters has pivotal importance for the risk stratification of CRT candidates and should be systematically performed in patients undergoing CRT. (J Am Soc Echocardiogr 2021;34:494-502.)Item Sodium-glucose cotransporter-2 inhibitors in heart failure patients: an appraisal of recent cardiovascular outcome trials(2020) Kocyigit, Duygu; Kocyigit, Alime S.; Hussain, Muzna; 33059407Although initially introduced as a novel oral glucose-lowering agent class, cumulative evidence from randomized controlled trials (RCTs) have led sodium-glucose cotransporter-2 inhibitors (SGLT2i) to become a component of primary and secondary prevention from atherosclerotic cardiovascular disease in patients with type 2 diabetes mellitus (T2DM). Dapagliflozin, one of the agents of this class, was investigated in 2019 in patients with heart failure (HF) independent of being diagnosed with T2DM at baseline. Since then, many other studies are being undertaken in this class of drugs. Herein, we aimed to review the RCTs, their subgroup and post-hoc analyses that examined the effects of SGLT2i on cardiovascular outcomes (including HF-related outcomes) in patients diagnosed with HF that were published until June 2020. We also summarized the ongoing trials that aim to assess the impact of SGLT2i on cardiovascular outcomes in patients with HF and listed available guideline recommendations regarding the use of SGLT2i for cardiovascular disease management.Item Relation between serum sodium levels and clinical outcomes in Turkish patients hospitalized for heart failure: a multi-center retrospective observational study(2017) Muderrisoglu, Haldun; Avci, Burcak Kilickiran; Kucuk, Murathan; Eren, Mehmet; Kutlu, Merih; Yilmaz, Mehmet Birhan; Cavusoglu, Yuksel; Ongen, Zeki; 0000-0002-9635-6313; 27488755; AAG-8233-2020Objective: The purpose of the study was to analyze the prevalence of hyponatremia and related 1-year outcomes of patients hospitalized for decompensated heart failure with reduced ejection fraction (HFrEF) in Turkish patients. Methods: A total of 500 hospitalized patients with HFrEF were consecutively included in a retrospective study at 19 participating hospitals. Patients were categorized according to their serum sodium levels (sNa) on admission day as normonatremic (135-145 mEq/L) and hyponatremic (< 135 mEq/L). One-year all-cause mortality, re-hospitalization rates, and the impact of the changes in sNa at the time of discharge to clinical outcomes were examined. Results: Hyponatremia was observed in 29% of patients. Patients with hyponatremia had lower blood pressures, creatinine clearance, and left ventricular ejection fraction and higher serum creatinine and BUN levels on admission compared with those with normonatremia. Hyponatremia was associated with higher 1-year all-cause mortality (14% vs. 2.6%, p< 0.001) and re-hospitalization rates (46.9% vs. 33.7%, p=0.005). After adjustment for covariates, hyponatremia was independently associated with 1-year all-cause mortality (adjusted HR, 4.762; 95% CI, 1.941-11.764; p= 0.001). At discharge, only 50.8% of hyponatremic patients were corrected to normonatremia (>= 135 mEq/L). Those with persistent hyponatremia had the highest all-cause mortality (p< 0.001). Conclusion: In this study, it is demonstrated that hyponatremia is relatively common and is associated with increased 1-year all-cause mortality and re-hospitalization rates among Turkish patients hospitalized with HFrEF. Approximately 50% of the patients with initial low sNa had persistent hyponatremia at discharge, and these patients had the worst clinical outcomes.Item Iron deficiency and anemia in heart failure(2017) Altay, Hakan; Cavusoglu, Yuksel; Cetiner, Mustafa; Guvenc, Tolga Sinan; Temizhan, Ahmet; Ural, Dilek; Yesibursa, Dilek; Yildirim, Nesligul; Yilmaz, Mehmet Birhan; 28446734; AAE-1392-2021Heart failure is an important community health problem. Prevalence and incidence of heart failure have continued to rise over the years. Despite recent advances in heart failure therapy, prognosis is still poor, rehospitalization rate is very high, and quality of life is worse. Co-morbidities in heart failure have negative impact on clinical course of the disease, further impair prognosis, and add difficulties to treatment of clinical picture. Therefore, successful management of co-morbidities is strongly recommended in addition to conventional therapy for heart failure. One of the most common co-morbidities in heart failure is presence of iron deficiency and anemia. Current evidence suggests that iron deficiency and anemia are more prevalent in patients with heart failure and reduced ejection fraction, as well as those with heart failure and preserved ejection fraction. Moreover, iron deficiency and anemia are referred to as independent predictors for poor prognosis in heart failure. There is strong relationship between iron deficiency or anemia and severity of clinical status of heart failure. Over the last two decades, many clinical investigations have been conducted on clinical effectiveness of treatment of iron deficiency or anemia with oral iron, intravenous iron, and erythropoietin therapies. Studies with oral iron and erythropoietin therapies did not provide any clinical benefit and, in fact, these therapies have been shown to be associated with increase in adverse clinical outcomes. However, clinical trials in patients with iron deficiency in the presence or absence of anemia have demonstrated considerable clinical benefits of intravenous iron therapy, and based on these positive outcomes, iron deficiency has become target of therapy in management of heart failure. The present report assesses current approaches to iron deficiency and anemia in heart failure in light of recent evidence.Item Vaccination of adults with heart failure and chronic heart conditions: Expert opinion(2018) Celik, Ahmet; Altay, Hakan; Azap, Alpay; Cavusoglu, Yuksel; Nalbantgil, Sanem; Senol, Esin; Temizhan, Ahmet; Yilmaz, Mehmet Birhan; 30516533