Scopus İndeksli Açık & Kapalı Erişimli Yayınlar
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Item Effects of Continuous-Flow Left Ventricular Assist Device Therapy on Peripheral Vascular Function(2022) Kaya, Ersin; Kocabas, Umut; Simsek, Evrim; Nalbantgil, Sanem; Kahraman, Umit; Engin, Cagatay; Yagdi, Tahir; Ozbaran, Mustafa; Akilli, Azem; 35089263; GXG-7709-2022The peripheral vascular effects of continuous-flow left ventricular assist device (CF-LVAD) implantation are still unclear. The aim of the current study was to determine peripheral vascular function before and after implantation of CF-LVAD in patients with end-stage heart failure (HF), and to compare this data to age- and sex-matched chronic heart failure with reduced ejection fraction (HFrEF) patients. Forty-three consecutive end-stage HF patients (New York Heart Association [NYHA] class III/IV; three women and 40 men; mean age 53 +/- 11 years) who planned to receive CF-LVAD implantation comprised the LVAD patient population, and their clinical characteristics, preoperative and third postoperative month peripheral vascular function assessment data including flow-mediated dilation (FMD) and pulsatility index (PI) assessed by ultrasound Doppler in brachial artery were compared to age- and sex-matched chronic, stable HFrEF patients (NYHA class II; five women and 30 men; mean age 51 +/- 10 years). After CF-LVAD implantation, median FMD decreased from 5.4 to 3.7% (p < 0.001), and median PI decreased from 6.9 to 1.4 (p < 0.001). In patients with end-stage HF before CF-LVAD implantation, FMD and PI were significantly lower compared to the chronic HFrEF patients (FMD: 5.4% +/- 0.9% vs. 7.6% +/- 1.1%; p < 0.001, respectively) and (PI: 6.9 +/- 1.3 vs. 7.4 +/- 1.2; p = 0.023, respectively). The current study revealed impaired peripheral vascular function in the end-stage HF patients compared to stable HFrEF patients, and documented the deterioration of peripheral vascular function after CF-LVAD implantation. These results suggest that impaired peripheral vascular function in the CF-LVAD patients compared to preoperative assessment is a consequence of the nonpulsatile blood flow due to the continuous-flow mechanical support.Item Resting Heart Rate and Real-Life Treatment Modalities in Outpatients with Left Ventricular Systolic Dysfunction Study: A Multicenter, Prospective, Observational, and National Registry(2021) Cavusoglu, Yuksel; Kozan, Omer; Temizhan, Ahmet; Kucukoglu, Mehmet Serdar; 33960305; ABC-9349-2021Objective: Heart rate (HR) reduction is associated with improved outcomes in heart failure (HF). This multicenter, prospective, observational, and national registry aimed to evaluate resting HR and the impacts of HR-related medications in real-life clinical practice in patients with HF. Methods: The Resting HR and Real-Life Treatment Modalities in Outpatients with Left Ventricular Systolic Dysfunction (REALITY HF) study enrolled 1054 patients with HF and left ventricular ejection fraction (LVEF) of <40% from 16 centers. Clinical characteristics, HR, and medications were noted (enrollment phase). A total of 487 patients with sinus rhythm and HR of >= 70 bpm were included in a further 4-month follow-up (FU) program (V0). Changes in HR and medications were reevaluated at 1-month (V1) and 4-month (V2) FU visits. The Kansas City Cardiomyopathy Questionnaire (KCCQ) was used to assess the quality of life (QoL) of 320 patients in a 4-month FU program. Results: During enrollment, 794 patients (75.3%) were in sinus rhythm, in whom resting HR was 76.7 +/- 14 bpm, 69.1% had a resting HR of >= 70 bpm, 79.1% were receiving beta blocker (BB), and 6.1% were receiving ivabradine. Resting HR was lower in patients receiving BB (75.8 +/- 13 vs. 80.4 +/- 16 bpm; p=0.001); however, 65.8% of those still had a resting HR of >= 70 bpm. A significant association was found between elevated HR and worse New York Heart Association (NYHA) class, worse QoL, or lower LVEF. During the 4-month FU, adjustment of HR-lowering therapy was left to the physician's discretion. Resting HR significantly reduced from 83.6 +/- 12 (80) bpm at V0 to 78.6 +/- 13 (77) bpm at V1 (p=0.001) and further decreased to 73.0 +/- 11 (73) bpm at V2 (p=0.001). Patients achieving a resting HR of >= 70 bpm were 21.7% at V1 (p=0.001) and 39.9% at V2 (p=0.001). KCCQ significantly increased from 59.7 +/- 23 (62.7) at V0 to 73.1 +/- 18 (78.5) at V2 (p=0.001). In addition, patients with NYHA I increased from 22.2% at V0 to 29.2% at V1 and 39.4% at V2 (p=0.01). Conclusion: In real-life clinical practice, elevated HR is highly prevalent in HF despite widely used BB therapy and is associated with worse clinical picture. Therapeutic interventions targeting HR significantly reduce HR, and HR lowering is associated with improved clinical outcomes.Item Consensus Statement of Endocrinology, Cardiology, and Nephrology(ENCARNE) Experts on Prevention, Diagnosis, and Management of Cardiovascular and Renal Complications of Diabetes(2021) Altay, HakanAn array of medical practitioners, including endocrinologists, family physicians, internal medicine specialists in nephrology and cardiology, unceasingly investigate, diagnose and treat over 8 million diabetic patients in Turkey. Apart from routine glycemic regulation, several frequent coexisting comorbidities such as obesity, hypertension, dyslipidemia, and their associated complications should also be promptly managed. Due to the concomitant occurrence of complications, the involvement of additional specialties in the precise management of such conditions becomes indispensable. Owing to the ever-expanding knowledge about the prevalence and clinical manifestations of diabetes, various international medical societies publish annual diabetes guidelines, which makes it too cumbersome as well as challenging for the practicing physicians to follow these comprehensive guidelines in clinical practice. There is an unmet need for an easyto-read and concise document for all physicians working for diabetes management for a standardized approach for better management of diabetes and improved patient care. This consensus report was prepared collectively by the Society of Endocrinology and Metabolism Turkey, Turkish Society of Cardiology, Turkish Society of Nephrology, Turkish Society of Hypertension and Renal Diseases to prevent cardiac and renal complications of diabetes, to timely detect these complications by using pertinent measures and to develop, implement and monitor strategies for managing them effectively.Item Snapshot evaluation of acute and chronic heart failure in real-life in Turkey: A follow-up data for mortality(2020) Yilmaz, Mehmet Birhan; Aksakal, Emrah; Aksu, Ugur; Altay, Hakan; Nesligul, Yildirim; Celik, Ahmet; Akil, Mehmet Ata; Bekar, Lutfu; Vural, Mustafa Gokhan; Guvenc, Rengin Cetin; Ozer, Savas; Ural, Dilek; Cavusoglu, Yuksel; Tokgozoglu, Lale; 32120368; AAE-1392-2021Objective: Heart failure (HF) is a progressive clinical syndrome. SELFIE-TR is a registry illustrating the overall HF patient profile of Turkey. Herein, all-cause mortality (ACM) data during follow-up were provided. Methods: This is a prospective outcome analysis of SELFIE-TR. Patients were classified as acute HF (AHF) versus chronic HF (CHF) and HF with reduced ejection fraction (HFrEF), HF with mid-range ejection fraction, and HF with preserved ejection fraction and were followed up for ACM. Results: There were 1054 patients with a mean age of 63.3 +/- 13.3 years and with a median follow-up period of 16 (7-17) months. Survival data within 1 year were available in 1022 patients. Crude ACM was 19.9% for 1 year in the whole group. ACM within 1 year was 13.7% versus 32.6% in patients with CHF and AHF, respectively (p<0.001). Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta blocker, and mineralocorticoid receptor antagonist were present in 70.6%, 88.2%, and 50.7%, respectively. In the whole cohort, survival curves were graded according to guideline-directed medical therapy (GDMT) scores <= 1 versus 2 versus 3 as 28% versus 20.2% versus 12.2%, respectively (p<0.001). Multivariate analysis of the whole cohort yielded age (p=0.009) and AHF (p=0.028) as independent predictors of mortality in 1 year. Conclusion: One-year mortality is high in Turkish patients with HF compared with contemporary cohorts with AHF and CHF. Of note, GDMT score is influential on 1-year mortality being the most striking one on chronic HFrEF. On the other hand, in the whole cohort, age and AHF were the only independent predictors of death in 1 year.Item Sodium glucose co-transporter 2 inhibitors in heart failure therapy(2020) Cavusoglu, Yuksel; Altay, Hakan; Cahn, Avivit; Celik, Ahmet; Demir, Serafettin; Kilicaslan, Baris; Nalbantgil, Sanem; Raz, Itamar; Temizhan, Ahmet; Yildirimturk, Ozlem; Yilmaz, Mehmet Birhan; AAE-1392-2021; 32281958Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) are a new class of drugs for patients with type 2 diabetes (T2DM) which inhibit urinary glucose reabsorption in the proximal tubule of the nephron and result in glucosuria, natriuresis and diuresis. In large, randomized clinical trials, SGLT-2i have been shown to reduce major cardiovascular (CV) events and heart failure (HF) hospitalizations in patients with T2DM who have atherosclerotic CV disease or CV risk factors. In these trials, SGLT-2i is have their greatest and most consistent effect on reducing the risk of HF hospitalization. The reduction in HF hospitalization was also observed in subgroups of patients with a HF diagnosis at baseline, which raised the possibility of a clinical benefit of SGLT-2i in HF patients, regardless of the presence or absence of T2DM. In very recently published DAPA-HF trial, a SGLT-2i, dapagliflozin treatment on top of standard HF therapy has been shown to have clear clinical benefits in terms of reducing HF hospitalization, CV mortality, all-cause mortality and improving quality of life in HF patients. This compelling evidence suggests that SGLT-2i have a potential to be an effective treatment option in HF, regardless of diabetes. This article provides a comprehensive overview focused on the role of SGLT-2i in the treatment of HF.Item Practical approaches for the treatment of chronic heart failure: Frequently asked questions, overlooked points and controversial issues in current clinical practice(2015) Cavusoglu, Yuksel; Altay, Hakan; Ekmekci, Ahmet; Eren, Mehmet; Kucukoglu, Mehmet Serdar; Nalbantgil, Sanem; San, Ibrahim; Selcuk, Timur; Temizhan, Ahmet; Ural, Dilek; 26574641Heart failure (HF) is a progressive disorder associated with impaired quality of life, high morbidity, mortality and frequent hospitalization and affects millions of people from all around the world. Despite further improvements in HF therapy, mortality and morbidity remains to be very high. The life-long treatment, frequent hospitalization, and sophisticated and very expensive device therapies for HF also leads a substantial economic burden on the health care system. Therefore, implementation of evidence-based guideline-recommended therapy is very important to overcome its worse clinical outcomes. However, HF therapy is a long process that has many drawbacks and sometimes HF guidelines cannot answers to every question which rises in everyday clinical practice. In this paper, commonly encountered questions, overlooked points, controversial issues, management strategies in grey zone and problems arising during follow up of a HF patient in real life clinical practice have been addressed in the form of expert opinions based on the available data in the literature.