Publications by authors named "Cihangir Kaymaz"

105 Publications

Unicuspid aortic valve with false aortic dissection appearance: A case report.

Turk Kardiyol Dern Ars 2021 Apr;49(3):242-244

Department of Cardiology, Koşuyolu High Specialization Training and Research Hospital, İstanbul, Turkey.

Summary- Unicuspid aortic valve (UAV) is a rare congenital anomaly that usually presents with aortic stenosis or mixed stenosis and regurgitation early in life. Ascending aortic aneurysm and aortic dissection are important complications of UAVs. A 27-year-old man presented to the emergency department with a complaint of acute chest pain. Bedside transthoracic echocardiography (TTE) showed dilatation of ascending aorta (47 mm) and mild aortic regurgitation; computed tomography (CT) angiography revealed a suspicious dissection flap within ascending aorta. A cardiovascular surgeon, a radiologist, and a cardiologist were immediately consulted. TTE performed by the cardiologist revealed a unicuspid unicommissural aortic valve and dilated ascending aorta with no signs of dissection. Aortic dissection image on CT angiogram was interpreted by an experienced radiologist and the cardiovascular surgeon as superior pericardial recess and considered as a false-positive dissection image. Given the patient was pain-free, the CT image was considered false positive and as TTE clearly visualized the ascending aorta, the heart team decided that no further imaging is required. After excluding acute aortic syndrome, acute coronary syndrome, and other causes of acute chest pain, the patient was discharged with close follow-up. Diagnosis of aortic dissection is based on noninvasive imaging modalities, and CT is the first-line imaging choice in most emergency departments. Depending on a single imaging modality may cause false interpretations and lead to unnecessary surgical explorations.
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http://dx.doi.org/10.5543/tkda.2021.27793DOI Listing
April 2021

A Novel Risk Assessment Model Using Urinary System Contrast Blush Grading to Predict Contrast-Induced Acute Kidney Injury in Low-Risk Profile Patients.

Angiology 2021 Mar 26:33197211005206. Epub 2021 Mar 26.

Department of Cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey.

Contrast-induced acute kidney injury (CI-AKI) can occur after coronary interventions despite protective measures. We evaluated the effect of urinary system contrast blush grading for predicting post-procedure CI-AKI in 486 patients with chronic coronary artery disease. Patient characteristics and blood samples were collected. Urinary system contrast blush grade was recorded during the coronary angiography and interventions. Post-procedure third to fourth day blood samples were collected for diagnosis of CI-AKI. The median age of the patients was 61 years (53-70, interquartile range), and 194 (39.9%) participants were female. Contrast-induced acute kidney injury occurred in 78 (16%) patients. By comparing full and reduced models with the likelihood ratio test, it was observed that in the reduced model, factors such as age, diabetes mellitus, body weight-adapted contrast media (CM), hemoglobin, and urinary system blush were associated with CI-AKI presence. The probability of CI-AKI presence increased slightly from grade 0 to 1 blush, but it increased sharply grade from 1 to 2 blush. According to our results, an increase in body weight-adapted CM and urinary blush grading were the main predictors of CI-AKI. These findings suggest that when body weight-adapted CM ratio exceeds 3.5 mL/kg and urinary contrast blush reaches grade 2, the patients should be followed up more carefully for the development of CI-AKI.
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http://dx.doi.org/10.1177/00033197211005206DOI Listing
March 2021

Temporal association of contamination obsession on the prehospital delay of STEMI during COVID-19 pandemic.

Am J Emerg Med 2021 Jan 31;43:134-141. Epub 2021 Jan 31.

University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Istanbul, Turkey.

Background: One of the modifiable risk factors for ST elevation myocardial infarction is prehospital delay. The purpose of our study was to look at the effect of contamination contamination obsession on prehospital delay compared with other measurements during the Covid-19 pandemic.

Method: A total of 139 patients with acute STEMI admitted to our heart center from 20 March 2020 to 20 June 2020 were included in this study. If the time interval between the estimated onset of symptoms and admission to the emergency room was >120 min, it was considered as a prehospital delay. The Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and Padua Inventory-Washington State University Revision (PI-WSUR) test were used to assess Contamination-Obbsessive compulsive disorder (C-OCD).

Result: The same period STEMI count compared to the previous year decreased 25%. The duration of symptoms onset to hospital admission was longer in the first month compared to second and third months (180 (120-360), 120 (60-180), and 105 (60-180), respectively; P = 0.012). Multivariable logistic regression (model-2) was used to examine the association between 7 candidate predictors (age, gender, diabetes mellitus (DM), hypertension, smoking, pain-onset time, and coronary artery disease (CAD) history), PI-WSUR C-OCD, and admission month with prehospital delay. Among variables, PI-WSUR C-OCD and admission month were independently associated with prehospital delay (OR 5.36 (2.11-13.61) (P = 0.01); 0.26 (0.09-0.87) p < 0.001] respectively].

Conclusion: Our study confirmed that contamination obsession was associated with prehospital delay of STEMI patients, however anxiety and depression level was not associated during the pandemic.
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http://dx.doi.org/10.1016/j.ajem.2021.01.083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7847738PMC
January 2021

Development and validation of clinical prediction model to estimate the probability of death in hospitalized patients with COVID-19: Insights from a nationwide database.

J Med Virol 2021 May 10;93(5):3015-3022. Epub 2021 Feb 10.

Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.

In the current study, we aimed to develop and validate a model, based on our nationwide centralized coronavirus disease 2019 (COVID-19) database for predicting death. We conducted an observational study (CORONATION-TR registry). All patients hospitalized with COVID-19 in Turkey between March 11 and June 22, 2020 were included. We developed the model and validated both temporal and geographical models. Model performances were assessed by area under the curve-receiver operating characteristic (AUC-ROC or c-index), R , and calibration plots. The study population comprised a total of 60,980 hospitalized COVID-19 patients. Of these patients, 7688 (13%) were transferred to intensive care unit, 4867 patients (8.0%) required mechanical ventilation, and 2682 patients (4.0%) died. Advanced age, increased levels of lactate dehydrogenase, C-reactive protein, neutrophil-lymphocyte ratio, creatinine, albumine, and D-dimer levels, and pneumonia on computed tomography, diabetes mellitus, and heart failure status at admission were found to be the strongest predictors of death at 30 days in the multivariable logistic regression model (area under the curve-receiver operating characteristic = 0.942; 95% confidence interval: 0.939-0.945; R  = .457). There were also favorable temporal and geographic validations. We developed and validated the prediction model to identify in-hospital deaths in all hospitalized COVID-19 patients. Our model achieved reasonable performances in both temporal and geographic validations.
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http://dx.doi.org/10.1002/jmv.26844DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014660PMC
May 2021

Prognostic value of main pulmonary artery diameter to ascending aorta diameter ratio in patients with advanced heart failure.

Acta Cardiol 2021 Jan 27:1-9. Epub 2021 Jan 27.

Department of Cardiology, University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey.

Objectives And Background: In this study we assessed the prognostic value of main pulmonary artery diameter and its ratio to ascending aorta diameter (P/Ao ratio) in advanced heart failure patients.

Methods: Patients with advanced heart failure who were candidates for heart transplantation were retrospectively evaluated. The clinical information, cardiac catheterisation results, and computed tomography images were gathered from institutional database system. The observed and predicted probabilities for survival were analysed in a nomogram.

Results: The P/Ao ratio was found to be a strong predictor for MACE both in traditional multivariable Cox proportional hazard regression modelling (increase in P/Ao ratio per 2 SD, HR:2.72, 95% CI 1.14-6.48,  = 0.024) and ridge regression analysis (increase in P/Ao ratio per 2SD, HR:3.45, 95% CI 1.53-7.74,  = 0.003). Prediction model showed statistically significant correlation between the observed and predicted probabilities for 1-year survival.

Conclusion: In patients with advanced heart failure, computed tomography derived P/Ao ratio might be a prognostic predictor during follow up.
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http://dx.doi.org/10.1080/00015385.2021.1872186DOI Listing
January 2021

Incidence of symptomatic venous thromboembolism following hospitalization for coronavirus disease 2019: Prospective results from a multi-center study.

Thromb Res 2021 02 11;198:135-138. Epub 2020 Dec 11.

Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Background: Thrombosis and pulmonary embolism appear to be major causes of mortality in hospitalized coronavirus disease 2019 (COVID-19) patients. However, few studies have focused on the incidence of venous thromboembolism (VTE) after hospitalization for COVID-19.

Methods: In this multi-center study, we followed 1529 COVID-19 patients for at least 45 days after hospital discharge, who underwent routine telephone follow-up. In case of signs or symptoms of pulmonary embolism (PE) or deep vein thrombosis (DVT), they were invited for an in-hospital visit with a pulmonologist. The primary outcome was symptomatic VTE within 45 days of hospital discharge.

Results: Of 1529 COVID-19 patients discharged from hospital, a total of 228 (14.9%) reported potential signs or symptoms of PE or DVT and were seen for an in-hospital visit. Of these, 13 and 12 received Doppler ultrasounds or pulmonary CT angiography, respectively, of whom only one patient was diagnosed with symptomatic PE. Of 51 (3.3%) patients who died after discharge, two deaths were attributed to VTE corresponding to a 45-day cumulative rate of symptomatic VTE of 0.2% (95%CI 0.1%-0.6%; n = 3). There was no evidence of acute respiratory distress syndrome (ARDS) in these patients. Other deaths after hospital discharge included myocardial infarction (n = 13), heart failure (n = 9), and stroke (n = 9).

Conclusions: We did not observe a high rate of symptomatic VTE in COVID-19 patients after hospital discharge. Routine extended thromboprophylaxis after hospitalization for COVID-19 may not have a net clinical benefit. Randomized trials may be warranted.
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http://dx.doi.org/10.1016/j.thromres.2020.12.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836837PMC
February 2021

Impact of the updated hemodynamic definitions on diagnosis rates of pulmonary hypertension.

Pulm Circ 2020 Jul-Sep;10(3):2045894020931299. Epub 2020 Aug 28.

University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey.

We evaluated whether updated pulmonary hypertension definitive criteria proposed in sixth World Symposium on Pulmonary Hypertension had an impact on diagnosis of overall pulmonary hypertension and pre-capillary and combined pre- and post-capillary phenotypes as compared to those in European Society of Cardiology/European Respiratory Society 2015 pulmonary hypertension Guidelines. Study group comprised the retrospectively evaluated 1300 patients (age 53.1 ± 18.8 years, female 807, 62.1%) who underwent right heart catheterization with different indications between 2006 and 2018. Mean pulmonary arterial pressure ≥25 mmHg (European Society of Cardiology) and PAMP (mean pulmonary arterial pressure) >20 mmHg (World Symposium on Pulmonary Hypertension) right heart catheterization definitions criteria were used, respectively. For pre-capillary pulmonary hypertension, pulmonary artery wedge pressure ≤15 mmHg and pulmonary vascular resistance ≥3 Wood units criteria were included in the both definitions. Normal mean pulmonary arterial pressure (<21 mmHg), borderline mean pulmonary arterial pressure elevation (21-24 mmHg), and overt pulmonary hypertension (≥25 mmHg) were documented in 21.1, 9.8, and 69.1% of the patients, respectively. The pre-capillary and combined pre- and post-capillary pulmonary hypertension were noted in 2.9 and 1.1%, 8.7 and 2.5%, and 34.6 and 36.6% of the patients with normal mean pulmonary arterial pressure, borderline, and overt pulmonary hypertension subgroups, respectively. The World Symposium on Pulmonary Hypertension versus European Society of Cardiology/European Respiratory Society definitions resulted in a net 9.8% increase in the diagnosis of overall pulmonary hypertension whereas increases in the pre-capillary pulmonary hypertension and combined pre- and post-capillary pulmonary hypertension diagnosis were only 0.8 and 0.3%, respectively. The re-definition of mean pulmonary arterial pressure threshold seems to increase the frequency of the overall pulmonary hypertension diagnosis. However, this increase was mainly originated from those in post-capillary pulmonary hypertension subgroup whereas its impact on pre-capillary and combined pre- and post-capillary pulmonary hypertension was negligible. Moreover, criteria of pre-capillary pulmonary vascular disease and combined pre- and post-capillary phenotypes were still detectable even in the presence of normal mean pulmonary arterial pressure. The obligatory criteria of pulmonary vascular resistance ≥3 Wood units seems to keep specificity for discrimination between pre-capillary versus post-C pulmonary hypertension after lowering the definitive mean pulmonary arterial pressure threshold to 20 mmHg.
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http://dx.doi.org/10.1177/2045894020931299DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457658PMC
August 2020

The association of left ventricular end-diastolic pressure with global longitudinal strain and scintigraphic infarct size in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.

Int J Cardiovasc Imaging 2021 Jan 6;37(1):359-366. Epub 2020 Aug 6.

Department of Cardiology, SBU Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey.

Left ventricular end-diastolic pressure (LVEDP) is an independent predictor for prognosis in ST-elevation myocardial infarction (STEMI) patients. We aimed to investigate the relationship of admission LVEDP measured after a successful primary percutaneous coronary intervention (pPCI) with scintigraphic infarct size (IS) and global longitudinal strain (GLS), a strong predictor of IS, in STEMI patients. A total of 62 consecutive patients with STEMI were enrolled in the study. LVEDP measurements were performed after pPCI in patients who had TIMI-3 flow. Echocardiography was performed 24 h after pPCI and repeated 3 months later. GLS was calculated as an average peak strain from the 3 apical projections. IS was evaluated at the third month by technetium 99m sestamibi. The mean age was 56 ± 8 years in the study population. The mean LVEDP was found 19.4 ± 4.4 mmHg. Median IS was 4% (0-11.7 IQR).The mean GLS at the 24th hour and the third month were found to be - 15.4 ± 2.8 and - 16.7 ± 2.5 respectively. There was a moderate negative correlation between LVEDP and GLS (24th-hour p < 0.001 r = - 0.485 and third-month p < 0.001 r = - 0.489). LVEDP had a moderate positive correlation with scintigraphic IS (p < 0.001 r = 0.545). In the multivariable model, we found that LVEDP was significantly associated with scintigraphic IS (β coefficient = 0.570, p = 0.008) but was not associated with the 24th hour (β coefficient = 0.092, p = 0.171) and third month GLS (β coefficient = 0.037, p = 0.531). This study demonstrated that there was a statistically significant relationship between LVEDP and scintigraphic IS, and IS was increased with high LVEDP values. However, there was not a relationship between LVEDP and GLS.
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http://dx.doi.org/10.1007/s10554-020-01945-yDOI Listing
January 2021

Outcomes of Pulmonary Endarterectomy Operation Concomitant with Cardiac Procedures.

Thorac Cardiovasc Surg 2021 Apr 1;69(3):279-283. Epub 2020 Aug 1.

Department of Thoracic Surgery, Marmara University School of Medicine, İstanbul, Turkey.

Background:  The aim of this study was to analyze the results of pulmonary endarterectomy (PEA) performed simultaneously with additional cardiac procedures in a single tertiary-level center.

Methods:  Data of patients who underwent PEA with additional cardiac procedures for chronic thromboembolic pulmonary hypertension (CTEPH) in our clinic were retrospectively reviewed using patient records.

Results:  Between March 2011 and April 2019, 56 patients underwent PEA with additional cardiac surgery. The most common additional procedure was coronary artery bypass grafting (21 patients; 38%). The median intensive care unit and hospital stays were 4 (3-6) days and 10 (8-14) days. Mortality was recorded in six patients (11%). In multivariate analysis, only preoperative pulmonary vascular resistance (PVR) ( = 0.02; odds ratio [OR]: 1.003) and cardiopulmonary bypass duration ( = 0.02; OR: 1.028) were associated with mortality. When the cutoff value of 1000 dyn.s.cm was taken in the receiver operating characteristic curve analysis, preoperative PVR predicted mortality with 83% sensitivity and 94% specificity (area under curve = 0.89;  < 0.01).

Conclusion:  PEA for CTEPH may be performed safely with other cardiac operations. This type of surgery is a complex procedure that should be performed only in expert centers. Patients with high preoperative PVR are at increased risk of perioperative complications.
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http://dx.doi.org/10.1055/s-0040-1710580DOI Listing
April 2021

Development of acute severe right heart failure after transcatheter aortic valve implantation in patient with left ventricle assist device-acquired aortic regurgitation.

Turk Kardiyol Dern Ars 2020 Jul;48(5):545-551

Department of Cardiology, Kartal Koşuyolu High Speciality Training and Research Hospital, İstanbul, Turkey.

A 58-year-old man with a left ventricular assist device (LVAD), which had been implanted 1 year earlier, presented with rest dyspnea. Moderate to severe aortic regurgitation (AR), pre-postcapillary pulmonary hypertension, modarete right ventricular (RV) failure, and low cardiac output were observed at presentation. Transcatheter aortic valve implantation (TAVI) was performed to treat the AR and a self-expandable aortic valve was implanted. Within minutes, hypotension, RV and inferior vena cava dilatation, and left atrial (LA) and left ventricular (LV) collapse occurred and persisted despite LVAD speed reduction. It was observed that severe RV failure had developed and venoarterial extracorporeal membrane oxygenation (VA-ECMO) was applied. Following VA-ECMO treatment, the RV dimensions decreased, and the LA and LV dimensions began to increase, as well as the LVAD flow. Weaning from VA-ECMO was unsuccessful and exitus occurred on the fifth day after TAVI secondary to RV failure. It was surmised that the decrease in blood circulation from the aorta to the LV after treatment of severe AR with TAVI caused an acute increase in the cardiac output and the RV preload. The acute increase in the RV preload led to acute severe right heart failure. It is necessary to prepare the RV to compete with an acute increase in preload before TAVI even when there is only modarete RV failure.
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http://dx.doi.org/10.5543/tkda.2020.39132DOI Listing
July 2020

The effect of P wave indices on new onset atrial fibrillation after trans-catheter aortic valve replacement.

J Electrocardiol 2020 Jul - Aug;61:71-76. Epub 2020 Jun 5.

Kartal Kosuyolu Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.

Objectives: Data is scarce regarding the relation between P wave indices and new onset atrial fibrillation (NOAF) after trans-catheter aortic valve replacement (TAVR).

Aims: The present study aimed to find out certain characteristics of P wave that may predict NOAF after TAVR procedure.

Method: Patients with severe calcific aortic stenosis who had undergone TAVR procedure between 2013 and 2019 in two centers were investigated. P wave abnormalities that have been resumed to reflect impaired atrial conduction; partial and advanced inter atrial block (IAB), P-wave terminal force in lead V1, P wave dispersion, reduced amplitude of P- wave in lead I, P wave peak time in D2 and V1 were evaluated on pre- procedural 12 derivation surface electrocardiography (ECG). The relationship between these parameters and incidence of NOAF during index hospitalization was evaluated.

Results: A total of 227 consecutive patients (median age 79 [74-83]; 134 [59%] female) were included in the study. NOAF occurred in 46 (20.3%) patients. P wave duration, P wave dispersion, number of patients with partial and advanced IAB, left atrium diameter, STS score were higher in NOAF patients. Use of general anesthesia and history of prior open heart surgery were also more frequent in NOAF group. In multivariable logistic regression analysis; advanced IAB (OR 6.413 [2.555-16.095] p < 0.01), P wave dispersion (OR 3.544 [1.431-8.780] p = 0.006) and use of general anesthesia (OR 2.736 [1.225-6.109] p = 0.014) were independent predictors of NOAF.

Conclusion: Among P wave abnormalities evaluated on pre-procedural 12-derivation surface ECG, advanced IAB and P wave dispersion may predict NOAF after TAVR procedure.
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http://dx.doi.org/10.1016/j.jelectrocard.2020.06.001DOI Listing
June 2020

Relationship between histopathological features of aspirated thrombi and long-term left ventricular function in patients with ST-segment elevation myocardial infarction.

Turk Kardiyol Dern Ars 2020 Mar;48(2):116-126

Department of Cardiology, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, İstanbul, Turkey.

Objective: This study was an investigation of the severity of inflammation (SOI) in aspirated material and thrombus age to examine any association with pre-discharge and long-term left ventricular (LV) function after ST-elevation myocardial infarction (STEMI).

Methods: The study group comprised 25 patients with STEMI from whom an occlusive thrombus was aspirated from the infarct-related artery with a 7-F catheter. The SOI in the aspirate was determined according to the mean leukocyte count in 5 high-power magnification fields and graded as mild in the presence of ≤100 leukocytes per field or significant if there were >100 leukocytes per field. The thrombi were categorized as fresh or lytic/organized (L/O) using predefined criteria. Echocardiographic assessment was performed prior to discharge and at 1 year. Adverse left ventricular remodeling (LVR) was defined as a 20% increase in LV end-diastolic volume in comparison with baseline values.

Results: LVR was observed in 8 patients. The mean leukocyte count of the aspirate (127.5±86.0 vs 227.2±120.7; p=0.026) and frequency of significant inflammation (35% vs 75% p=0.046) were significantly higher in the group with LVR. The serum high-sensitivity C-reactive protein (hsCRP) level was significantly correlated with the leukocyte count of the aspirate (r=0.532; p=0.006). An L/O thrombus was related to better pre-discharge and long-term LV volumes and ejection fraction values compared with a fresh thrombus.

Conclusion: A significant increase in the leukocyte count in the aspirate and a fresh thrombus might predict long-term LV functional deterioration irrespective of the clinical and procedure-related characteristics. In addition, serum markers of inflammation, like hsCRP, might also reflect the intensity of the local inflammatory response at the site of occlusion.
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http://dx.doi.org/10.5543/tkda.2019.62121DOI Listing
March 2020

The TAPSE/PASP ratio and MELD score in patients with advanced heart failure.

Herz 2021 Apr 21;46(Suppl 1):75-81. Epub 2020 Jan 21.

Cardiology Department, Kartal Kosuyolu Education and Research Hospital, Denizer caddesi Cevizli Kavşağı No: 2, Kartal, İstanbul, Turkey.

Introduction: The aim of this study was to explore the relationship between the tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure (TAPSE/PASP) ratio and model for end-stage liver disease (MELD) score in patients with advanced heart failure.

Methods: A total of 103 patients with advanced heart failure evaluated for candidacy for heart transplantation were included in this study. TAPSE was measured by M‑mode echocardiography and cardiac catheterization was performed. TAPSE/ PASP ratio and MELD score were calculated.

Results: The median age of patients was 49 (40.5-54) years and the majority were male (92%). The percentage of patients with ischemic cardiomyopathy was 40%. The mean value of the group's MELD score was 10 ± 3.3 and the median value of TAPSE/PASP 0.24 (0.18-0.34). There was a moderate negative correlation between TAPSE/PASP and MELD score (r: -0.38, p < 0.001). Right atrial pressure (RAP) and left ventricular end-diastolic pressure (LVEDP) were also negatively correlated with TAPSE/PASP (correlation coefficients were r: -0.562 and r: -0.575, respectively). In patients with a lower TAPSE/PASP ratio, MELD score, LVEDP and RAP were higher and tricuspid regurgitation was more severe, but there were no significant differences between cardiac output (CO) and mean aortic pressure (mean BP). The presence of ischemia was found to be an independent predictor for lower values of TAPSE/PASP.

Conclusion: The lower TAPSE/PASP obtained on echocardiography may be a sign of the multi-organ failure defined as a high MELD score in patients with advanced heart failure.
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http://dx.doi.org/10.1007/s00059-019-04879-xDOI Listing
April 2021

Comparison of automated quantification and semiquantitative visual analysis findings of IQ SPECT MPI with conventional coronary angiography in patients with stable angina.

Turk Kardiyol Dern Ars 2019 Jul;47(5):357-364

Department of Cardiology, Kartal Koşuyolu High Speciality Training and Research Hospital, İstanbul, Turkey.

Objective: The aim of this study was to assess the validity of automated quantitative and semiquantitative visual analysis of total perfusion deficit (TPD) using the IQ SPECT gamma camera system compared to conventional coronary angiographically detected significant coronary artery disease (CAD).

Methods: The study included patients with suspected CAD who underwent myocardial perfusion single photon emission computed tomography and conventional coronary angiography. The summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) (semiquantitative visual analysis results) were assessed using a 5-point scale in a standard 17-segment model, and TPD (stress, rest, and ischemic TPD) was quantified using automated software.

Results: In all, 84 patients (Group 1, those who underwent revascularization) had significant coronary artery lesions, and 81 (Group 2) had non-significant lesions. The median interquartile range values were: stress-TPD (sTPD): 16 (3.5- 33.5) vs 9.2 (2-17.9), rest-TPD: 9.4 (2.2-18.8) vs 4 (1-11), and 6.9 (1.9-14.1) vs 3.4 (1-6.1) for ischemic-TPD (iTPD) in Group 1 and Group 2, respectively. To detect ischemia, the optimal cut-off points were 9.5 (sensitivity: 75%, specificity; 60%) for sTPD, and 4.5 (sensitivity: 56%, specificity: 73%) for iTPD. There were significant correlations between quantitative and semi-quantitative methods in detection of significant coronary artery disease (sTPD-SSS: r=0.954, sTPD-SDS: r=0.746, iTPD-SSS: r=0.654, iTPD-SDS: r=0.759; p<0.05 for all).

Conclusion: The quantitative analysis and summed stress scores produced by the IQ SPECT system appear to be a useful and valid method to detect significant CAD.
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http://dx.doi.org/10.5543/tkda.2019.03367DOI Listing
July 2019

Increased exercise-related platelet activation assessed by impedance aggregometry in diabetic patients despite aspirin therapy.

J Thromb Thrombolysis 2019 Apr;47(3):396-402

Department of Cardiology, Bursa Yuksek İhtisas Training and Research Hospital, Health Sciences University, Bursa, Turkey.

Aspirin is widely used for the prevention of thromboembolic diseases, but inhibition of platelet aggregation (PA) is not uniform. Additionally, aspirin has been shown to be ineffective in blunting PA in response to exercise in patients with coronary artery disease (CAD). Limited data exists about platelet function following acute exercise in diabetics taking aspirin. In our study, we aimed to investigate PA before and after exercise stress test in type-2 diabetic patients taking aspirin. Forty-three patients with type-2 diabetes mellitus (DM) and 36 subjects (age- and sex-matched) as control group were included prospectively. All participants were under aspirin (100 mg/day) therapy for at least 1 week. The measures of PA were assessed by impedance aggregometry using arachidonic acid as an agonist (ASPI test). Blood samplings were undertaken before and immediately after treadmill exercise test. At rest, diabetic and control groups had comparable pre-exercise PA (22.97 ± 14.57 versus 22.11 ± 12.71 AU min, p = NS, respectively). After treadmill exercise, both groups showed significantly higher absolute increase (9.02 ± 13.08 and 3.66 ± 5.87 AU min, p < 0.01, p < 0.01, respectively) and percent (%) increase (45.67 ± 49.34 and 24.04 ± 46.59 AU min, p < 0.01, p = 0.01, respectively) in PA. Both absolute increase (p < 0.05) and % increase (p < 0.05) in PA were significantly higher in DM group compared to the control group. Multiple regression analysis revealed that high-sensitive C-reactive protein (p = 0.014) was independent predictor of absolute increase PA. Our study showed that aspirin has limited effect in inhibiting exercise-induced PA, even in the absence of documented CAD. The increase in PA following exercise was significantly greater in patients with DM compared with controls.
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http://dx.doi.org/10.1007/s11239-019-01825-wDOI Listing
April 2019

Comparison of 30-Day MACE between Immediate versus Staged Complete Revascularization in Acute Myocardial Infarction with Multivessel Disease, and the Effect of Coronary Lesion Complexity.

Medicina (Kaunas) 2019 Feb 15;55(2). Epub 2019 Feb 15.

Department of Cardiology, Kosuyolu Heart Education and Research Hospital, University of Health Sciences, 34844 Istanbul, Turkey.

In patients with acute myocardial infarction and multivessel disease, the timing of intervention to non-culprit lesions is still a matter of debate, especially in patients without shock. This study aimed to compare the effect of multivessel intervention, performed at index percutaneous coronary intervention (PCI) (MVI-I) or index hospitalization (MVI-S), on the 30-day results of acute myocardial infarction (AMI), and to investigate the effect of coronary lesion complexity assessed by the Syntax (Sx) score on the timing of multivessel intervention. We enrolled 180 patients with MVI-I, and 425 patients with MVI-S. The major adverse cardiovascular events (MACE) for this study were identified as mortality, nonfatal myocardial infarction, nonfatal stroke, acute heart failure, ischemia driven revascularization, major bleeding, and acute renal failure developed within 30 days. The unadjusted MACE rates at 30 days were 11.2% and 5% among those who underwent MVI-I and MVI-S, respectively (OR 3.02; 95% confidence interval (CI) 1.51⁻6.02; =0.002). Associations were statistically significant after adjusting for covariates in the penalized multivariable model (adjusted OR 2.06; 95%CI 1.02⁻4.18; =0.043), propensity score adjusted multivariable model (adjusted OR 2.46; 95%CI 1.19⁻5.07; =0.015), and IPW (adjusted OR 2.11; 95%CI 1.28⁻3.47; =0.041). We found that the Syntax score of lesions did not affect the results. Conclusion: MVI-S was associated with a lower incidence of major adverse cardiovascular events within 30 days after discharge.
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http://dx.doi.org/10.3390/medicina55020051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6410006PMC
February 2019

Is there a gender gap in secondary prevention of coronary artery disease in Turkey?

Turk Kardiyol Dern Ars 2018 12;46(8):683-691

Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Objective: It has been reported that women receive fewer preventive recommendations regarding pharmacological treatment, lifestyle modifications, and cardiac rehabilitation compared with men who have a similar risk profile. This study was an investigation of the impact of gender on cardiovascular risk profile and secondary prevention measures for coronary artery disease (CAD) in the Turkish population.

Methods: Statistical analyses were based on the European Action on Secondary and Primary Prevention through Intervention to Reduce Events (EUROASPIRE)-IV cross-sectional survey data obtained from 17 centers in Turkey. Male and female patients, aged 18 to 80 years, who were hospitalized for a first or recurrent coronary event (coronary artery bypass graft, percutaneous coronary intervention, acute myocardial infarction, or acute myocardial ischemia) were eligible.

Results: A total of 88 (19.7%) females and 358 males (80.3%) were included. At the time of the index event, the females were significantly older (p=0.003) and had received less formal education (p<0.001). Non-smoking status (p<0.001) and higher levels of depression and anxiety (both p<0.001) were more common in the female patients. At the time of the interview, conducted between 6 and 36 months after the index event, central obesity (p<0.001) and obesity (p=0.004) were significantly more common in females. LDL-C, HDL-C or HbA1c levels did not differ significantly between genders. The fasting blood glucose level was significantly higher (p=0.003) and hypertension was more common in females (p=0.001). There was no significant difference in an increase in physical activity or weight loss after the index event between genders, and there was no significant difference between genders regarding continuity of antiplatelet, statin, beta blocker or ACEi/ARB II receptor blocker usage (p>0.05).

Conclusion: Achievement of ideal body weight, fasting blood glucose and blood pressure targets was lower in women despite similar reported medication use. This highlights the importance of the implementation of lifestyle measures and adherence to medications in women.
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http://dx.doi.org/10.5543/tkda.2018.10.5543/tkda.2018.45392DOI Listing
December 2018

A five-year, single-centre experience on ultrasound-assisted, catheter-directed thrombolysis in patients with pulmonary embolism at high risk and intermediate to high risk.

EuroIntervention 2018 Nov;14(10):1136-1143

University of Health Sciences, Kosuyolu Heart Education and research Hospital, Department of Cardiology, Istanbul, Turkey.

Aims: In this single-centre study, we aimed to evaluate the short- and long-term efficacy and safety outcomes of ultrasound-assisted thrombolysis (USAT) performed in patients with acute pulmonary embolism (PE) at intermediate to high risk and high risk (IHR, HR).

Methods And Results: The study group comprised 141 retrospectively evaluated patients with PE who underwent USAT. Tissue-type plasminogen activator (t-PA) dosage was 36.1±15.3 mg, and infusion duration was 24.5±8.1 hours. USAT was associated with improvements in echocardiographic measures of right ventricle systolic function, pulmonary arterial (PA) obstruction score, right to left ventricle diameter ratio (RV/LV), right to left atrial diameter ratio and PA pressures, irrespective of the risk (p<0.0001 for all). In-hospital mortality, major and minor bleeding rates were 5.7%, 7.8% and 11.3%, respectively. Follow-up data (median 752 days) were available in all patients. Absolute and % changes in RV/LV and % changes in PA mean pressure were significantly higher in patients younger than 65 years compared with older patients, whereas bleeding, 30-day and long-term mortality were not related to age, t-PA dosage or infusion duration. HR versus IHR increased 30-day mortality.

Conclusions: USAT was associated with improvements in thrombolysis and stabilisation of haemodynamics along with relatively low rates of complications in patients with PE, regardless of the risk status. However, HR still confers a higher short-term mortality. Increasing the t-PA dosage and prolongation of infusion may not offer benefit in USAT treatments.
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http://dx.doi.org/10.4244/EIJ-D-18-00371DOI Listing
November 2018

Percutaneous treatment of high-output right heart failure with pulmonary hypertension due to a large iliac arteriovenous fistula using a patent ductus arteriosus occluder.

Turk Kardiyol Dern Ars 2018 06;46(4):301-305

Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey.

Presently described is the case of a 41-yearold male patient with signs of high-output right heart failure (HF) due to a possibly iatrogenic arteriovenous fistula (AVF) between the left common iliac artery and the left common iliac vein. Invasively evaluated hemodynamic measurements were consistent with severe shunting, which resulted in precapillary pulmonary hypertension (PH). The AVF was successfully closed with a non-dedicated, 16-mm Amplatzer patent ductus arteriosus occluder (St. Jude Medical, Inc., St. Paul, MN, USA). Although his signs and symptoms were documented to be dramatically improved after closure, because mild PH persisted, adjuvant pulmonary arterial hypertension-targeted treatment with bosentan was initiated to prevent late pulmonary vascular disease.
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http://dx.doi.org/10.5543/tkda.2018.63847DOI Listing
June 2018

Dart to the target: an alternative bull's eye parametric display for European Society of Cardiology / European Respiratory Society goal-orientated risk reduction strategy in pulmonary arterial hypertension.

Pulm Circ 2018 Jul-Sep;8(3):2045894018780522. Epub 2018 May 16.

University of Health Sciences, Kosuyolu Heart Education and Research Hospital Cevizli Mah., İstanbul, Turkey.

Despite the significant mortality and mobidity benefits being obtained with the targeted therapies in patients with pulmonary arterial hypertension (PAH), mid- to long-term survival of patients with this disease has remained unsatisfactory. For earlier and reliable risk stratification in PAH and tailoring the dynamic management strategies, various risk assessment models have been developed. Currently available risk reduction strategy recommended by the European Society of Cardiology (ESC)/European Respiratory Society (ERS) 2015 Pulmonary Hypertension Guidelines has been utilized in three recent registries. In this review, we evaluated the risk prediction models and management algorithms in this setting and propose an alternative parametric display, a bull's eye, dart table scheme for ESC/ERS goal-orientated risk reduction strategy in patients with PAH.
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http://dx.doi.org/10.1177/2045894018780522DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055270PMC
May 2018

Pulmonary endarterectomy for patients with chronic thromboembolic disease.

Anatol J Cardiol 2018 Apr;19(4):273-278

Department of Thoracic Surgery, Faculty of Medicine, Marmara University; İstanbul-Turkey.

Objective: Chronic thromboembolic disease (CTED) is characterized by persistent pulmonary thromboembolic occlusions without pulmonary hypertension. Early surgical treatment by performing pulmonary endarterectomy (PEA) may improve symptoms. The goal of the study was to review our experience and early outcome of PEA in patients with CTED.

Methods: Data were prospectively collected on all patients who underwent PEA between 2011 and 2015. Patients with CTED and a mean pulmonary artery pressure (mPAP) of <25 mm Hg were identified. All patients were in New York Heart Association (NYHA) functional class II or III. Measured outcomes were in-hospital complications, improvement in cardiac function and exercise capacity, and survival after PEA. Patients were reassessed at 6 months following surgery.

Results: A total of 23 patients underwent surgery. There was no in-hospital mortality, but complications occurred in six patients (26%). At 6 months following surgery, 93% of the patients remained alive. Following PEA, the mPAP fell significantly from 21.0±2.7 mm Hg to 18.2±5.5 mm Hg (p<.001). Pulmonary vascular resistance also significantly decreased from 2.2±0.7 wood to 1.5±0.5 wood (p<.001). The 6-min walking distance significantly increased from 322.6±80.4 m to 379.9±68.2 m (p<.001). There was a significant symptomatic improvement in all survivors in NYHA functional classes I or II at 6 months following surgery (p=.001).

Conclusion: PEA in selected patients with CTED resulted in significant improvement in symptoms. The selection of patients for undergoing PEA in the absence of pulmonary hypertension must be made based on patients' expectations and their acceptance of the perioperative risk.
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http://dx.doi.org/10.14744/AnatolJCardiol.2018.37929DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5998853PMC
April 2018

Reappraisal of the reliability of Doppler echocardiographic estimations for mean pulmonary artery pressure in patients with pulmonary hypertension: a study from a tertiary centre comparing four formulae.

Pulm Circ 2018 Apr-Jun;8(2):2045894018762270. Epub 2018 Feb 26.

1 Department of Cardiology, University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey.

Different Doppler echocardiography (DE) models have been proposed for estimation of mean pulmonary arterial pressures (PAMP) from tricuspid regurgitation (TR) jet velocity. We aimed to compare four TR-derived DE models in predicting the PAMP measured by right heart catheterization (RHC) in different groups of precapillary pulmonary hypertension (PH). A total of 287 patients with hemodynamically pre-capillary PH were enrolled (mean age = 51 ± 17.4 years, 59.9% female). All patients underwent DE before RHC (< 3 h) and four formulae (F) were used for TR-derived PAMP estimation (PAMP-DE). These were as follows: F1 = Chemla (0.61 × systolic pulmonary artery pressure [PASP] + 2); F2 = Friedberg (0.69 × PASP - 0.22), F3 = Aduen (0.70 × PASP); and F4 = Bech-Hanssen (0.65 × PASP - 1.2). The PASP and PAMP (mmHg) measured by RHC were 89.1 ± 30.4 and 55.8 ± 20.8, respectively. In the overall PH group, DE estimates for PASP (r = 0.59, P = 0.001) and PAMP (r = 0.56, P = 0.001 for all) showed significant correlations with corresponding RHC measures. Concordance was noted between Chemla and Bech-Hanssen, and Aduen and Bech-Hanssen. The Bland-Altman plot showed that Chemla and Bech-Hanssen overestimated and Friedberg and Aduen underestimated PAMP-RHC measures. Paired-t test showed significant systematic biases for Aduen and Bech-Hanssen while Passing-Bablok non-parametric analysis revealed significant systematic biases all four PAMP-DE estimates. There was poor agreement between PAMP-RHC measures and PAMP-DE deciles (Kappa values were 0.112, 0.097, 0.095, and 0.121, respectively). This study showed a poor agreement between PAMP-DE estimates by four TR-derived formulae and PAMP-RHC in patients with PH, regardless of the etiology. However, these results can not be fully extrapolated to a normal population and did not address the reliability of DE estimates for PH screening procedures.
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http://dx.doi.org/10.1177/2045894018762270DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5865458PMC
February 2018

Extrinsic compression of left main coronary artery by aneurysmal pulmonary artery in severe pulmonary hypertension: its correlates, clinical impact, and management strategies.

Eur Heart J Cardiovasc Imaging 2018 11;19(11):1302-1308

University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Denizer Street, No. 2, Cevizli / Kartal, Istanbul, Turkey.

Aims: Although left main coronary artery (LMCA) compression (Co) by pulmonary artery (PA) aneurysm (A) has been reported in some pulmonary hypertension (PH) series, clinical importance and management of this complication remain to be determined. In this single-centre prospective study, we evaluated correlates, clinical impact, and management strategies of LMCA-Co in patients with PH.

Methods And Results: Our study group comprised 269 (female 166, age 52.9 ± 17.3 years) out of 498 patients with confirmed PH who underwent coronary angiography (CA) because of the PAA on echocardiography, angina or incidentally detected LMCA-Co during diagnostic evaluation with multidetector computed tomography. The LMCA-Co ≥ 50% was documented in 22 patients (8.2%) who underwent CA, and stenosis were between 70% and 90% in 14 of these. Univariate comparisons revealed that a younger age, a D-shaped septum, a higher PA systolic, diastolic, and mean pressures and pulmonary vascular resistance, a larger PA diameter, a smaller aortic diameter and pulmonary arterial hypertension associated with patent-ductus arteriosus, atrial or ventricular septal defects were significantly associated with LMCA-Co. Bare-metal stents were implanted in 12 patients and 1 patient underwent PAA and atrial septal defect surgery and another one declined LMCA stenting procedure.

Conclusion: Our study demonstrates that LMCA-Co is one of the most important and potentially lethal complications of severe PH, and alertness for this risk seems to be necessary in specific circumstances related with PAA. However, long-term benefit from stenting in this setting remains as a controversy.
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http://dx.doi.org/10.1093/ehjci/jex303DOI Listing
November 2018

Preliminary results from a nationwide adult cardiology perspective for pulmonary hypertension: RegiStry on clInical outcoMe and sUrvival in pulmonaRy hypertension Groups (SIMURG).

Anatol J Cardiol 2017 Oct;18(4):242-250

Department of Cardiology, Faculty of Medicine, Marmara University; İstanbul-Turkey.

Objective: The present study was designed to evaluate the characteristics of pulmonary hypertension (PH) and adult cardiology practice patterns for PH in our country.

Methods: We evaluated preliminary survey data of 1501 patients with PH (females, 69%; age, 44.8±5.45) from 20 adult cardiology centers (AdCCs).

Results: The average experience of AdCCs in diagnosing and treating patients with PH was 8.5±3.7 years. Pulmonary arterial hypertension (PAH) was the most frequent group (69%) followed by group 4 PH (19%), group 3 PH (8%), and combined pre- and post-capillary PH (4%). PAH associated with congenital heart disease (APAH-CHD) was the most frequent subgroup (47%) of PAH. Most of the patients' functional class (FC) at the time of diagnosis was III. The right heart catheterization (RHC) rate was 11.9±11.6 per month. Most frequently used vasoreactivity agent was intravenous adenosine (60%). All patients under targeted treatments were periodically for FC, six-minute walking test, and echo measures at 3-month intervals. AdCCs repeated RHC in case of clinical worsening (CW). The annual rate of hospitalization was 14.9±19.5. In-hospital use of intravenous iloprost reported from 16 AdCCs in CWs. Bosentan and ambrisentan, as monotreatment or combination treatment (CT), were noted in 845 and 28 patients, respectively, and inhaled iloprost, subcutaneous treprostinil, and intravenous epoprostenol were noted in 283, 30, and four patients, respectively. Bosentan was the first agent used for CT in all AdCCs and iloprost was the second. Routine use of antiaggregant, anticoagulant, and pneumococcal and influenza prophylaxis were restricted in only two AdCCs.

Conclusion: Our nationwide data illustrate the current status of PH regarding clinical characteristics and practice patterns.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5731519PMC
http://dx.doi.org/10.14744/AnatolJCardiol.2017.7549DOI Listing
October 2017

[EINSTEIN CHOICE: Comparison of rivaroxaban treatment and prophylactic doses with aspirin in the extended treatment of patients with venous thromboembolism].

Authors:
Cihangir Kaymaz

Turk Kardiyol Dern Ars 2017 Sep;45(Suppl 4):1-7

Department of Cardiology, Koşuyolu Yüksek İhtisas Training and Research Hospital, İstanbul, Turkey.

Although many patients with venous thromboembolism (VTE) may need extended treatment, efficacy and safety issues of full- or lower-intensity anticoagulation over acetyl salicylic acid (ASA) treatment have remained to be determined. EINSTEIN CHOICE is a randomized, double-blind and phase 3 study, and compared either once-daily rivaroxaban (at doses of 20 mg or 10 mg) and 100 mg of ASA in patients with VTE who were in equipoise regarding the need for extended anticoagulation. Study drugs were administered for up to 12 months. The primary efficacy outcome was symptomatic recurrent fatal or nonfatal VTE and the principal safety outcome was major bleeding. A total of 3365 patients were included in the intentionto-treat analyses (median treatment duration, 351 days). The primary efficacy outcome occurred in 1.5% of patients receiving 20 mg of rivaroxaban and in 1.2% of patients receiving 10 mg of rivaroxaban, in comparison to 4.4% of those receiving aspirin (hazard ratio for 20 mg of rivaroxaban vs. ASA, 0.34; 95% confidence interval [CI] 0.20 to 0.59; hazard ratio for 10 mg of rivaroxaban vs. ASA, 0.26; 95% CI 0.14 to 0.47; P<0.001 for both comparisons). Rates of major bleeding and adverse events were comparable among three treatment groups. In conclusion, in patients with VTE in equipoise for extended anticoagulation, either a treatment dose (20 mg) or a prophylactic dose (10 mg) of rivaroxaban compared with ASA significantly reduced the risk of VTE recurrence without a significant increase in bleeding risk.
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http://dx.doi.org/10.5543/tkda.2017.02646DOI Listing
September 2017

A successful cesarean delivery without fetal or maternal morbidity in an Eisenmenger patient with cor triatriatum sinistrum, double-orifice mitral valve, large ventricular septal defect, and single ventricle who was under long-term bosentan treatment.

Turk Kardiyol Dern Ars 2017 Mar;45(2):184-188

Department of Cardiology, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey.

Presently described is successful cesarean delivery in a pregnancy superimposed on long-term bosentan treatment in an Eisenmenger syndrome patient with cor triatriatum sinistrum, double-orifice mitral valve, and large ventricular septal defect resulting in single functioning ventricle with double outlets. Cesarean delivery was performed at 27th week of gestation without maternal or fetal morbidity. The infant had no congenital cardiovascular abnormality or any probable teratogenic effect of bosentan treatment during pregnancy.
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http://dx.doi.org/10.5543/tkda.2016.17747DOI Listing
March 2017

[EUROASPIRE-IV: European Society of Cardiology study of lifestyle, risk factors, and treatment approaches in patients with coronary artery disease: Data from Turkey].

Turk Kardiyol Dern Ars 2017 Mar;45(2):134-144

Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Objective: Data from EUROASPIRE-IV Turkey report investigating risk factors and adherence to guidelines in patients hospitalized for coronary artery disease are presented and results are compared with those of EUROASPIRE-III Turkey and EUROASPIRE-IV Europe.

Methods: Study was performed in 24 European countries, including Turkey (17 centers). Patients (18-80 years old) hospitalized for coronary (index) event during preceding 3 years were identified from hospital records and interviewed ≥6 months later. Patient information regarding index event was acquired from hospital records. Anamnesis was obtained during the interview, and physical examination and laboratory analyses were performed.

Results: Median age at the index coronary event was 58.8 years, and it was significantly decreased compared with last EUROASPIRE-III study (60.5 years), which was conducted at the same centers 6 years earlier (p=0.017). Of all patients, 19.3% were under 50 years of age and mean age was lower than that of EUROASPIRE-IV Europe (62.5 years). Comparing EUROASPIRE-IV Turkey with EUROASPIRE-III Turkey, rate of smokers increased to 25.5% from 23.1% (p=0.499), obesity increased to 40.7% from 35.5% (p=0.211), total cholesterol level increased to 49.6% from 48.3% (p=0.767), and diabetes rate increased to 39.7% from 33.6% (p=0.139), however none of the differences reached a level of statistical significance. Only 11.7% of the smokers quit after coronary event. Rates for these factors were lower in EUROASPIRE-IV Europe (16% for smoking, 37.6% for obesity, and 26.8% for diabetes).

Conclusion: EUROASPIRE-IV Turkey data revealed that secondary prevention was unsatisfactory and had progressed unfavorably compared with last EUROASPIRE study, some risk factors were more uncontrolled than overall European average, and coronary artery events at young age remain an important problem.
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http://dx.doi.org/10.5543/tkda.2016.82352DOI Listing
March 2017

Ultrasound-Assisted Catheter-Directed Thrombolysis in High-Risk and Intermediate-High-Risk Pulmonary Embolism: A Meta-Analysis.

Curr Vasc Pharmacol 2018 01;16(2):179-189

Department of Cardiology, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.

Background: Catheter-directed Ultrasound-Assisted Thrombolysis (USAT) is a novel technology providing a high efficacy with a reduced bleeding risk in patients with pulmonary embolism (PE).

Methods: We performed a meta-analysis based on presented or published PE series in which USAT was utilized. We searched the MEDLINE, EMBASE and the Cochrane Library for trials published up to December 2015.

Results: The primary outcomes were mean pulmonary artery pressure (PAMP), right to left ventricle diameter ratio (RV/LV ratio) and computed tomography (CT) obstruction score. The secondary outcomes were all-cause and cardiovascular mortality, major and minor bleeding episodes and recurrent PE. The 11 trials (n=553) and 15 trials (n=655) met eligibility criteria of primary and secondary outcomes, respectively. USAT was found to significantly reduce PAMP, RV/LV ratio and CT obstruction scores. After adjusting for baseline covariates in meta-regression analysis, male sex and number of high-risk patients were found to be associated with PAMP and RV/LV ratio while only male sex was associated with CT obstruction scores. The pooled incidence of all-cause and cardiovascular mortality were 3.2% and 2.2%, and the incidence of major and minor bleeding episodes were 5.5% and 6.9%, respectively. In the pooled analysis of the remaining trials, the incidence of recurrent PE was 1.7%. USAT compared with three randomized thrombolytic trials showed a similar death rate with a lower rate of major bleeding.

Conclusion: This meta-analysis confirmed that USAT significantly reduced PAMP, RV/LV ratio and CT obstruction scores with similar death rates and a lower risk of major bleeding compared with patients with PE undergoing systemic thrombolytic treatment.
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http://dx.doi.org/10.2174/1570161115666170404122535DOI Listing
January 2018