TR-Dizin İndeksli Açık & Kapalı Erişimli Yayınlar
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Item Comparison of non-vitamin K antagonist oral anticoagulants and well-controlled warfarin in octogenarians with non-valvular atrial fibrillation: Real-world data from a single tertiary center(2021) Akgun, Arzu Neslihan; Karacaglar, Emir; Bal, Uğur Abbas; Ozin, Mehmet Bulent; 34236320Objective: Atrial fibrillation (AF) is the most common arrhythmia in clinical practice, and its prevalence increases with age. Nevertheless, data about the use of oral anticoagulants (OACs) among patients with >= 80 years remains limited. This study aimed to evaluate the efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin in octogenarians with non-valvular AF (NVAF). Methods: Medical records of 387 patients who were >= 80 years and diagnosed with NVAF in our hospital between January 2017 and December 2019 were evaluated retrospectively. Patients with NVAF were divided into 2 groups (NOACs and warfarin), and the incidence of stroke/systemic embolism and major bleeding were analyzed. Results: A total of 322 patients were included in the study. The median follow-up duration was 10.9 months for the NOACs group and 12.1 months for the warfarin group. The primary efficacy outcome was stroke/systemic embolism, and the primary safety outcome was major bleeding. A total of 220 patients were taking NOACs, and the most preferred NOACs were apixaban (53.6%), rivaroxaban (29.5%), dabigatran (13.2%), and edoxaban (3.6%) in this order. During a mean follow-up of 302.7 patient-years, the incidence of stroke or systemic embolic events was slightly higher among patients with warfarin but the difference was not statistically significant (p=0.862). The incidence rates of major bleeding events were similar between the treatment groups (p=0.824). Conclusion: Our study revealed that the safety and efficacy outcomes are similar between the 2 treatment groups in octogenarians with NVAF.Item Direct aortic transcatheter aortic valve implantation(2021) Karacaglar, Emir; Akgun, Arzu Neslihan; Aydinalp, Alp; Beyazpinar, Deniz Sarp; Sezgin, Atila; Muderrisoglu, Haldun; 34623302Transcatheter aortic valve implantation (TAVI) is a safe and effective alternative to surgical valve replacement in intermediate and even in low-risk patient cohorts. Direct aortic (DAo) route may be used in patients with severe peripheral vascular disease. Here, we present an 88-year old patient hospitalized with cardiogenic shock. Echocardiography revealed severe aortic valve stenosis with aortic valve area 0.5 cm(2), mean gradient of 55 mmHg, and peak gradient 92 mmHg. TAVI was considered by the Institutional Heart Team. Multislice computed tomography (MSCT) revealed severe peripheral vascular disease, decreased calibration of abdominal aorta, and multiple large vulnerable atherosclerotic plaques. The patient was scheduled for a DAo TAVI. A 26-mm Medtronic CoreValve Evolut R valve was implanted after predilatation with median sternotomy. The patient was discharged after 96 hours. Although transfemoral (TF) access is used as the default approach for TAVI, it was contraindicated in our patient owing to severe peripheral vascular disease and decreased calibration of the abdominal aorta at its narrowest point (4.5 mm) with multiple large vulnerable atherosclerotic plaques. Careful preprocedural MSCT evaluation is essential and directly affects the success of the procedure. MSCT is also mandatory to confirm the best cannulation zone that must be met for a successful DAo TAVI.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 Current clinician perspective on non-vitamin K antagonist oral anticoagulant use in challenging clinical cases(2020) Turk, Ugur Onsel; Acar, Rezzan Deniz; Akgun, Taylan; Emren, Volkan; Kanat, Selcuk; Karacaglar, Emir; Kepez, Alper; Kul, Seref; Ozel, Erdem; Simsek, Evrim; Tuluce, Selcen Yakar; Tuluce, Kamil; Camm, A. John; 0000-0002-2538-1642; 32281950; ABI-6723-2020Objective: The evolution of non-vitamin K antagonist anticoagulants (NOACs) has changed the horizon of stroke prevention in atrial fibrillation (SPAF). All 4 NOACs have been tested against dose-adjusted warfarin in well-designed, pivotal, phase III, randomized, controlled trials (RCTs) and were approved by regulatory authorities for an SPAF indication. However, as traditional RCTs, these trials have important weaknesses, largely related to their complex structure and patient participation, which was limited by strict inclusion and extensive exclusion criteria. In the real world, however, clinicians are often faced with complex, multimorbid patients who are underrepresented in these RCTs. This article is based on a meeting report authored by 12 scientists studying atrial fibrillation (AF) in diverse ways who discussed the management of challenging AF cases that are underrepresented in pivotal NOAC trials. Methods: An advisory board panel was convened to confer on management strategies for challenging AF cases. The article is derived from a summary of case presentations and the collaborative discussions at the meeting. Conclusion: This expert consensus of cardiologists aimed to define management strategies for challenging cases with patients who underrepresented in pivotal trials using case examples from their routine practice. Although strong evidence is lacking, exploratory subgroup analysis of phase III pivotal trials partially informs the management of these patients. Clinical trials with higher external validity are needed to clarify areas of uncertainty. The lack of clear evidence about complex AF cases has pushed clinicians to manage patients based on clinical experience, including rare situations of off-label prescriptions.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 Effects of right ventricular dysfunction on exercise capacity and quality of life and associations with serum NT-proBNP levels in COPD: an observational study(2014) Ozdemirel, Tugce Sahin; Ulasli, Sevinc Sarinc; Yetis, Begum; Karacaglar, Emir; Byraktar, Nilufer; Ulubay, GayeObjective: During the course of chronic obstructive pulmonary disease (COPD), pulmonary hypertension (PH) and right ventricular (RV) failure may develop due to elevated afterload of the RV. In those patients, exercise capacity is reduced due to pulmonary and cardiac limitations. We investigated relationships between serum N-terminal of proB-type natriuretic peptide (NT-proBNP) and RV functions with exercise capacity and quality of life in patients COPD. Methods: An observational case-control study was conducted. We enrolled 31 moderate and severe COPD patients, and 20 subjects without chronic diseases as control group. Parameters reflecting the right ventricular diastolic and systolic functions by echocardiography along with serum NT-proBNP levels were assessed. Cardiopulmonary exercise testing and Short Form-36 (SF-36) were applied. Results: Serum NT-proBNP levels were higher in COPD patients than control group (p=0.003). Serum NT-proBNP level was found to be related with pulmonary arterial pressure. Serum NT-proBNP levels were negatively correlated with anaerobic threshold oxygen uptake (AT VO2) and peak oxygen uptake (PVO2) values. Early ventricular filling velocity (Em) was lower in COPD patients. Em wave was significantly correlated with O-2 pulse. There was a positive relationship between tricuspid E/A ratio and VO2 value at AT. SF-36 domains of physical functioning, general health and role limitation due to physical disorder were significantly correlated with AT VO2, PVO2 and O-2 pulse. Conclusion: Exercise limitation may be predicted by assessment of right ventricule functions and NT-proBNP levels and exercise limitation impairs quality of life in COPD patients.Item Comparison of application of 2013 ACC/AHA guideline and 2011 European Society of Cardiology guideline for the management of dyslipidemias for primary prevention in a Turkish cohort(2017) Yilmaz, Mustafa; Atar, Ilyas; Hasirci, Senem; Akyol, Kadirhan; Tekin, Abdullah; Karacaglar, Emir; Ciftci, Orcun; Muderrisoglu, Haldun; 0000-0002-9635-6313; 0000-0002-2538-1642; 0000-0001-8926-9142; 0000-0002-8342-679X; 0000-0002-5658-870X; 0000-0002-2557-9579; 27684519; AAG-8233-2020; ABI-6723-2020; W-5233-2018; AAK-7805-2021; ABD-7304-2021; S-6973-2016OBJECTIVE: Atherosclerotic cardiovascular disease is a major global cause of death. The common approach in primary prevention of cardiovascular disease is to identify patients at high risk for cardiovascular disease. This article analyzes and compares the application of 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline and the 2011 European Society of Cardiology (ESC) guideline for the management of dyslipidemias for primary prevention in Turkish population. METHODS: The study included 833 patients (482 women and 351 men). Risk scores were calculated according to both guidelines and indications for statin treatment were determined according to sex and age group. Variables are presented as mean +/- SD or median with interquartile range for continuous data and as proportions for categorical data. Variables were analyzed by unpaired t-test, Mann-Whitney U test, chi-square or Fischer's exact test as appropriate. RESULTS: The ACC/AHA would suggest statin treatment in 415 patients out of 833 (49.5%), while ESC would recommend statin for 193 patients out of 833 (23.1%)(p<0.001). Statins would be recommended for 40.4% of women and 62.6% of men for primary prevention by the ACC/AHA, while this figure was 12% for women and 38.4% for men according to the ESC guideline (p<0.001 for both). CONCLUSION: When compared to the ESC guideline, the ACC/AHA guideline suggests augmented statin treatment for primary prevention in Turkish population