Publications by authors named "Fatih Oksuz"

45 Publications

Severe cardiovascular involvement in a patient with rheumatoid arthritis.

Kardiol Pol 2021 ;79(5):577-578

Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey.

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http://dx.doi.org/10.33963/KP.15879DOI Listing
June 2021

Diagnosis of Heterotaxy Syndrome in a Patient With Multiple Congenital Cardiac Malformations Using Magnetic Resonance Imaging.

Circ Cardiovasc Imaging 2020 09;13(9):e010307

Department of Cardiology (S.N.M., D.Y., M.Y., U.B., I.E.C., F.O., M.D.), Ankara Education and Research Hospital, Ankara, Turkey.

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http://dx.doi.org/10.1161/CIRCIMAGING.119.010307DOI Listing
September 2020

Relationship between mild renal dysfunction and coronary artery disease in young patients with stable angina pectoris.

Biomark Med 2020 04 9;14(6):433-440. Epub 2020 Apr 9.

Department of Cardiology, Faculty of Hamidiye Medicine, University of Health Science Turkey, Ankara Research & Education Hospital, Ankara, Turkey.

We investigated the relationship between mild renal dysfunction (MRD) and the presence of coronary artery disease (CAD) in people under 60 years of age.  A total of 634 (317 patients with vessel stenosis ≥50% and 317 with normal angiography) individuals diagnosed with stable angina pectoris and estimated glomerular filtration rate (eGFR) ≥60 ml/min/1.73 m were included in the present study. The mean eGFR was lower (95.3 ± 23.7 vs 109.7 ± 22.3, respectively, p = 0.002) and the number of patients with MRD was higher in patients with CAD (137, 43.2%) than in the control group (52, 16.4%, p < 0.001). The multivariate analysis showed that lower eGFR is an independent risk factor for presence of CAD in people under 60 years of age with stable angina pectoris. According to our retrospective study, the risk of developing CAD appears to be slightly increased in individuals under 60 years of age with MRD.
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http://dx.doi.org/10.2217/bmm-2019-0319DOI Listing
April 2020

Mitral annular calcification and its severity predict high risk for cardio-embolic stroke in elderly patients with first diagnosed atrial fibrillation.

Acta Cardiol 2021 Feb 19;76(1):56-62. Epub 2019 Nov 19.

Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey.

Background: Atrial fibrillation (AF) is the most common arrhythmia worldwide and a large proportion of patients with AF are older than 75 years of age. Mitral annular calcification (MAC), which is usually observed in advanced age, is associated with increased risk of AF and cardio-embolic stroke in the general population.

Objectives: This study was performed to assess whether presence of MAC and its severity predict cardio-embolic stroke in elderly patients with first diagnosed AF.

Methods: In this cross-sectional study, 72 elderly patients suffering from acute cardio-embolic stroke with first diagnosed AF and 79 elderly control group patients with first diagnosed AF and without stroke were investigated. A parasternal short-axis view at the level of the mitral annulus was used for MAC measurements. The severity of MAC was measured from the anterior to posterior edge at its greatest width.

Results: MAC thicknesses were significantly higher in the stroke group. ROC curve analysis showed that a cut point of 2.5 mm for the value of MAC thickness exhibited 68.1% sensitivity and 77.2% specificity for detecting cardio-embolic stroke in elderly patients with AF. In multivariate logistic regression analysis, MAC thickness (OR = 1.173, 95% CI 1.083-1.270;  < 0.001) was found to be independent predictor of cardio-embolic stroke in elderly patients with AF.

Conclusion: MAC thickness may provide useful information for the relevant risk evaluation of elderly patients with AF. Pre-stroke MAC presence and its severity appear to have better clinical value for predicting cardio-embolic stroke in elderly patients with AF, independent from traditional risk factors for stroke.
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http://dx.doi.org/10.1080/00015385.2019.1690260DOI Listing
February 2021

CHA2DS2-Vasc score and saphenous vein graft disease in patients with coronary artery bypass graft surgery.

Coron Artery Dis 2020 05;31(3):243-247

Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey.

Background: Saphenous vein grafts (SVGs) are still frequently used in coronary artery bypass graft surgery (CABG). However, the patency rate of SVGs is lower than arterial grafts. CHA2DS2-VASc score gives important information about the prognosis of various cardiovascular diseases. In this study, we aimed to investigate the association between CHA2DS2-VASc score and saphenous vein graft disease (SVGD) in patients with history of CABG surgery.

Methods: A total of 241 patients who had undergone CABG surgery and who underwent coronary angiography due to stable angina pectoris symptoms were reviewed retrospectively. SVGD was defined as ≥50% stenosis in at least one SVG. Patients were divided into two groups according to the presence or absence of SVGD.

Results: It was found that CHA2DS2-VASc scores were significantly higher in SVGD group. In multivariate logistic regression analysis, time interval after CABG [odds ratio (OR) = 1.077, 95% confidence interval (CI) 1.004-1.155; P = 0.037], and CHA2DS2-VASc score ≥ 4 (OR = 10.10, 95% CI 4.739-21.276; P < 0.001) were found to be independent predictors of SVGD.

Conclusion: For the first time, our results have suggested that CHA2DS2-VASc score, which is commonly used in daily clinical practice and easy to calculate, can provide useful information for the risk assessment of patients with SVGs.
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http://dx.doi.org/10.1097/MCA.0000000000000809DOI Listing
May 2020

Risk factors for coronary artery disease in young patients with stable angina pectoris

Turk J Med Sci 2019 08 8;49(4):993-998. Epub 2019 Aug 8.

Department of Cardiology, Ankara Research and Education Hospital, Ankara, Turkey

Background/aim: We aimed to investigate the relationship between risk factors and the presence of coronary artery disease (CAD) in a young population with stable angina pectoris (SAP).

Materials And Methods: A total of571 individuals younger than 60 years old, admitted to the outpatient clinic with chest pain and referred for coronary angiography between January 2015 and December 2017, were included in the study. All clinical and biochemical parameters were documented in the hospital records. Coronary angiography of patients was monitored from records. The individuals were divided into two groups. The patient group consisted of 363 individuals with at least one-vessel stenosis of ≥70%, and the control group consisted of 208 individuals with normal coronary angiography. We compared the traditional and nontraditional risk factors of these two groups in terms of the presence of CAD.

Results: Prevalence of male sex and smoking were higher in the patient group, and the prevalence of hypertension and diabetes were similar in the two groups. In the patient group, mean age, blood cholesterols, serum gamma-glutamyltransferase, hemoglobin, and white blood cell and lymphocyte levels were higher, while estimated glomerular filtration rate (eGFR), high-density lipoprotein cholesterol (HDL-C), platelets, and neutrophil/lymphocyte and platelet/lymphocyte ratios were lower. Low eGFR and HDL-C levels, older age, male sex, smoking, and high levels of low-density lipoprotein cholesterol and lymphocytes were independent risk factors for the presence of CAD in young patients.

Conclusion: Contrary to studies performed in the elderly, traditional and nontraditional risk factors could not exactly predict the presence of CAD in a young population with SAP.
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http://dx.doi.org/10.3906/sag-1905-56DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7018258PMC
August 2019

Possible Effect of Alcohol Consumption on Aortic Dilatation by Inducing Renin-Angiotensin-Aldosterone System.

Angiology 2019 11 19;70(10):978-979. Epub 2019 Jun 19.

1 Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey.

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http://dx.doi.org/10.1177/0003319719857381DOI Listing
November 2019

The relationship between lymphocyte-to-monocyte ratio and saphenous vein graft patency in patients with coronary artery bypass graft.

Biomark Med 2017 Oct 4;11(10):867-876. Epub 2017 Oct 4.

Ankara Education & Research Hospital, Department of Cardiology, Ankara, Turkey.

Aim: A lower lymphocyte count and a high monocyte count give important clues about the prognosis of various cardiovascular diseases. We hypothesized that lymphocyte-to-monocyte ratio (LMR) was associated with the saphenous vein graft disease (SVGD) in patients with coronary artery bypass graft (CABG).

Patients & Methods: A total of 218 patients with previous history of CABG surgery, who underwent coronary angiography due to stable angina symptoms, were investigated, retrospectively.

Results: LMR levels were significantly lower in the SVGD group. Multiple logistic regression analyses showed that LMR levels were independent predictors of SVGD (OR: 0.648; 95% CI: 0.469-0.894; p = 0.008).

Conclusion: Our results suggested that LMR levels may provide useful information for the relevant risk evaluation of SVGD in CABG patients.
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http://dx.doi.org/10.2217/bmm-2017-0079DOI Listing
October 2017

Response to the letter concerning the article: "Atrial electromechanical delay analysed by tissue Doppler echocardiography…".

Kardiol Pol 2017 ;75(6):633-634

Ankara Education and Research Hospital, Cardiology Clinic, Ankara, Turkey, Turkey.

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http://dx.doi.org/10.5603/KP.2017.0113DOI Listing
November 2017

Impact of free thyroxine levels and other clinical factors on bare metal stent restenosis.

Arch Endocrinol Metab 2017 Mar-Apr;61(2):130-136. Epub 2016 Aug 25.

Türkiye Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey.

Objective: Thyroid hormones have both direct and indirect effects on thermogenesis such as modulating vascular smooth muscle cell proliferation. However, the influence of more subtle changes in thyroid hormones on coronary atherosclerosis remains a matter of speculation. Smooth muscle cells play a crucial role in the pathogenesis of in-stent restenosis (ISR). However, the relationship between free thyroxine (fT4) and ISR has not been studied. In the present study, we aimed to assess the role of preprocedural serum fT4 level on the development of ISR in patients undergoing coronary bare metal stent (BMS) implantation.

Materials And Methods: We enrolled and analyzed clinical, biochemical, and angiographic data from 705 consecutive patients without a history of primary thyroid disease [mean age 60.3 ± 9.3 years, 505 (72%) male]; all patients had undergone BMS implantation and further control coronary angiography owing to stable or unstable angina pectoris. Patients were divided into 3 tertiles based on preprocedural serum fT4 levels.

Results: ISR was observed in 53 (23%) patients in the lowest tertile, 82 (35%) patients in the second tertile, and 107 (46%) patients in the highest fT4 tertile (p < 0.001). Using multiple logistic regression analysis, five characteristics emerged as independent predictors of ISR: diabetes mellitus, smoking, HDL-cholesterol, stent length, and preprocedural serum fT4 level. In receiver operating characteristics curve analysis, fT4 level > 1.23 mg/dL had 70% sensitivity and 73% specificity (AUC: 0.75, p < 0.001) in predicting ISR.

Conclusion: Higher preprocedural serum fT4 is a powerful and independent predictor of BMS restenosis in patients with stable and unstable angina pectoris.
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http://dx.doi.org/10.1590/2359-3997000000197DOI Listing
September 2017

Atrial electromechanical delay analysed by tissue Doppler echocardiography is prolonged in patients with generalised anxiety disorders.

Kardiol Pol 2017 10;75(6):581-588. Epub 2017 Mar 10.

Ankara Education and Research Hospital, Ankara, Turkey, Turkey.

Background: It has been shown that psychological status is associated with the likelihood of atrial fibrillation (AF). Prolongation of the duration of atrial electromechanical delay (AEMD) is known to be a precursor for AF development.

Aim: Therefore, we aimed to evaluate AEMD in patients with anxiety disorder.

Methods: In this prospective study, a total of 82 anxiety disorder and 80 healthy subjects were enrolled. Symptoms of anxiety were evaluated by using the Hamilton Anxiety Rating Scale (HAM-A). P-wave dispersion (PWD) was measured on a 12-lead electrocardiogram. Both intra- and inter-AEMD were measured with tissue Doppler imaging.

Results: Basal characteristics were similar between the two groups. PWD, inter- and right intra-AEMD were significantly prolonged in patients with anxiety disorders, compared to the control group (p < 0.05). In the correlation analysis, HAM-A was significantly and moderately correlated with right intra- and inter-AEMD, and PWD.

Conclusions: Patients suffering from anxiety disorders are characterised by prolonged AEMD, which can provide significant contributions to evaluate the risk for AF development in this group.
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http://dx.doi.org/10.5603/KP.a2017.0038DOI Listing
July 2017

Dynamic Systolic Compression of the Left Anterior Descending Coronary Artery by a Postinfarction Dyskinetic Left Ventricular Aneurysm.

Int J Angiol 2016 Dec 28;25(5):e14-e15. Epub 2015 Jan 28.

Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.

Dynamic systolic compression of the coronary arteries is almost always due to the existence of myocardial bridging that is most commonly localized in the middle segment of the left anterior descending coronary artery. However, it has rarely been reported in patients with pericardial adhesions, tumor, foreign body, or pseudoaneurysms. Only rare case reports exist regarding dynamic coronary compression by a dyskinetic left ventricular aneurysm. We present a patient with a myocardial bridge-like systolic compression of the distal left anterior descending caused by postinfarction dyskinetic left ventricular aneurysm.
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http://dx.doi.org/10.1055/s-0034-1396790DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5186298PMC
December 2016

Severity of coronary artery disease is an independent risk factor for decline in kidney function.

Eur J Intern Med 2016 Sep 9;33:93-7. Epub 2016 Jul 9.

Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey. Electronic address:

Background And Aim: Chronic kidney disease (CKD) and cardiovascular disease are closely interrelated and the presence of one condition synergistically affects the prognosis of the other, in a negative manner. There are surprisingly very few data on the relationship between baseline coronary artery disease (CAD) severity and subsequent decline in kidney function. We aimed to evaluate for the first time whether baseline coronary artery lesion severity predicts the decline in kidney function.

Materials And Methods: The study population was derived from a series of consecutive patients presenting with stable angina pectoris or angina equivalents, who underwent coronary angiography. SYNTAX score for each patient was calculated to define severity of CAD. Change in kidney function was defined by calculating the rates of change in eGFR.

Results: Among the 823 patients included in our study, the mean age was 59.2±10.7years, 78.4% were males, and 32% had diabetes. The mean baseline eGFR was 87.3±24.9ml/min/1.73m(2) and the median Syntax score was 14 (IQR=10-20). The median length of follow-up was 2.75years (IQR=2.42-3.50). The mean yearly change for eGFR in the entire study population was 4.06 (95% CI: 3.59-4.51)ml/min/1.73m(2). A higher Syntax score was associated with a significantly faster decline in eGFR in all (unadjusted and adjusted) models. During the follow-up, 103 patients developed CKD. A higher Syntax score, analyzed both as continuous and categorical variable, was associated with incident CKD in all models.

Conclusion: We have demonstrated for the first time that severity of CAD is an independent risk factor for the decline in kidney function. Studies are needed to highlight the potential mechanisms regarding the association between severity of CAD and decline in kidney function.
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http://dx.doi.org/10.1016/j.ejim.2016.06.031DOI Listing
September 2016

The effect of statin treatment on the prevention of stent mediated flow limited edge dissections during PCI in patients with stable angina.

Int J Cardiol 2016 Oct 27;220:365-70. Epub 2016 Jun 27.

Turkiye Yuksek Ihtisas Education and Research Hospital, Department of Cardiology, Ankara, Turkey.

Objectives: The effect of statin therapy before PCI with direct stenting may reduce the development of flow limited edge dissections (ED) in patients with stable angina.

Background: Flow limited ED after PCI is associated with an increased risk of major adverse cardiovascular events. Statin therapy induces important changes in the plaque composition which have been previously identified as strong predictors of ED.

Material And Methods: 100 patients complicated with flow limited ED and 100 control patients with successful procedure were enrolled into the study. EDs were described as the 5-mm regions that were immediately adjacent to the stent borders, both distally and proximally on the coronary angiography.

Results: Rate of statin use and duration of statin use were significantly higher in patients with non-ED group (63%) versus ED group (25%) (p<0.001). In addition, patients in ED group had significantly higher levels of C-reactive protein (CRP) at admission (9.9mg/dL (5.89-16.45) vs. 4.40mg/dL (3.5-7.09), respectively, p=0.014).

Conclusions: Our findings suggested that maintenance statin treatment before PCI with direct stenting may reduce the development of flow limited ED in patients with stable angina.
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http://dx.doi.org/10.1016/j.ijcard.2016.06.214DOI Listing
October 2016

Heart Failure Functional Class Associated with Depression Severity But Not Anxiety Severity.

Acta Cardiol Sin 2016 Jan;32(1):55-61

Department of Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital;

Background: Depression and anxiety are common in heart failure (HF) patients and associated with adverse clinical outcomes. However, there are little or no published data that focuses on the relationship between these commonly observed situations and HF classes. The aim of this study was to evaluate the relationship between these psychiatric co-morbidities and HF symptom classes. As a second objective of our study, the associations between patient characteristics and depression severity were also assessed.

Methods: Our study enrolled a total of 420 HF study participants. The severity of depressive and anxiety symptoms was evaluated by Beck's depression and anxiety. The measured total scores were used to grade depression severity and anxiety as minimal/mild and moderate/severe.

Results: According to NYHA Functional Classification, 228 patients (51%) had class I symptoms, 101 (23%) had class II symptoms, 31 (7%) had class III symptoms, and class IV symptoms were noted in the remaining 60 patients (19%). The mean Beck's depression and anxiety scores were 12.4 ± 11.1 and 13.4 ± 9.0, respectively. While no association between HF symptom classes and anxiety severity was observed, a significant positive relation between HF symptom class and depression score was found.

Conclusions: The results of our study suggested that HF symptom class was positively associated with severity of depression. On the other hand, there was no association between HF symptom class and anxiety score in a wide population of heart failure patients.

Key Words: Anxiety; Depression; Heart failure.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4804941PMC
http://dx.doi.org/10.6515/acs20150509aDOI Listing
January 2016

Uric Acid is a Useful Tool to Predict Contrast-Induced Nephropathy.

Angiology 2017 Aug 22;68(7):627-632. Epub 2016 Mar 22.

4 Department of Medicine, Division of Nephrology, Koç University School of Medicine, Istanbul, Turkey.

Developing contrast-induced nephropathy (CIN) after primary percutaneous coronary intervention (pPCI) has a negative impact on survival and morbidity. We assessed the predictive value of serum uric acid (SUA) for the development of CIN in patients with ST-segment elevation myocardial infarction (STEMI) who underwent pPCI. Contrast-induced nephropathy was defined an increase of ≥25% or ≥0.5 mg/dL in creatinine concentrations within 72 hours after pPCI. Patients were divided into 2 groups according to admission median SUA level. Serum uric acid level was <5.4 mg/dL (group 1; n = 222) and ≥5.4 mg/dL (group 2; n = 228). Compared to group 1, development of CIN (12% vs 20%, P < .001) was significantly greater in group 2. Using a cut point of >5.45 mg/dL, the SUA level predicted development of CIN with a sensitivity of 70% and specificity of 67%. In multiple logistic regression analysis, SUA level, diabetes mellitus, left ventricular ejection fraction <50%, contrast volume, estimated glomerular filtration rate, and C-reactive protein level emerged as independent predictors of CIN. In conclusion, elevated SUA is an independent risk factor for the development of CIN after pPCI in patients with STEMI.
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http://dx.doi.org/10.1177/0003319716639187DOI Listing
August 2017

The association between platelet-to-lymphocyte ratio and inflammatory markers with the severity of aortic stenosis.

Biomark Med 2016 14;10(4):367-73. Epub 2016 Mar 14.

Türkiye Yüksek Ihtisas Training & Research Hospital, Cardiology Clinic, Ankara, Turkey.

Aim: Platelet-to-lymphocyte ratio (PLR) was proposed as a novel indirect marker of inflammation. We aimed to evaluate the relationship between PLR and aortic stenosis (AS).

Patients & Methods: The study population included 453 patients of which 98 patients with severe AS, 206 patients with mild-to-moderate AS and 149 patients as control.

Results: PLR was significantly increased in parallel to the severity of AS (p < 0.001). There was significant positive correlation between PLR and maximum, and mean systolic transaortic gradient (all p < 0.001). Also, PLR was correlated with C-reactive protein and neutrophil-to-lymphocyte ratio (all p < 0.001) and PLR was independently associated with the presence of AS (p < 0.001).

Conclusion: We found a significant relationship between PLR and AS.
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http://dx.doi.org/10.2217/bmm-2015-0016DOI Listing
December 2016

The Relationship Between Lymphocyte-to-Monocyte Ratio and Bare-Metal Stent In-Stent Restenosis in Patients With Stable Coronary Artery Disease.

Clin Appl Thromb Hemost 2017 Apr 9;23(3):235-240. Epub 2016 Jul 9.

1 Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey.

In-stent restenosis (ISR) is a common clinical problem in patients with coronary artery disease treated with percutaneous coronary intervention. Inflammatory process plays a pivotal role in the development of ISR. Both lymphocytes and monocytes are associated with inflammatory status. Recently, it has been shown that the lymphocyte-to-monocyte ratio (LMR) is a novel inflammatory marker. We aimed to investigate the association of serum LMR levels and ISR in patients undergoing bare-metal stent (BMS) implantation. The study included 273 patients (aged 61 ± 11 years, 66.5% men) with a history of BMS implantation and a further control coronary angiography due to stable angina pectoris. Patients were divided into 2 groups: patients with and without ISR. The LMR levels were significantly lower in patients with ISR than in those without ISR (2.50 ± 0.95 vs 3.87 ± 1.51, respectively, P < .001). On multivariate logistic regression analysis, the LMR was independently associated with ISR (odds ratio [OR]: 0.310, 95% confidence interval: 0.166-0.579, P < .001) together with high-sensitivity C-reactive protein (OR: 1.244, P = .008), reason for stent implantation (OR: 6.566, P = .003), stent diameter (OR: 0.015, P < .001), and stent length (OR: 1.137, P = .007). In conclusion, LMR levels are inversely related to ISR in patients treated with BMS implantation.
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http://dx.doi.org/10.1177/1076029615627340DOI Listing
April 2017

The Role of Plasma Triglyceride/High-Density Lipoprotein Cholesterol Ratio to Predict New Cardiovascular Events in Essential Hypertensive Patients.

J Clin Hypertens (Greenwich) 2016 08 22;18(8):772-7. Epub 2015 Dec 22.

Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey.

Triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio (TG/HDL-C) has been suggested as a simple method to identify unfavorable cardiovascular outcomes in the general population. The effect of the TG/HDL-C ratio on essential hypertensive patients is unclear. About 900 consecutive essential hypertensive patients (mean age 52.9±12.6 years, 54.2% male) who visited our outpatient hypertension clinic were analyzed. Participants were divided into quartiles based on baseline TG/HDL-C ratio and medical records were obtained periodically for the occurrence of fatal events and composite major adverse cardiovascular events (MACEs) including transient ischemic attack, stroke, aortic dissection, acute coronary syndrome, and death. Participants were followed for a median of 40 months (interquartile range, 35-44 months). Overall, a higher quartile of TG/HDL-C ratio at baseline was significantly linked with higher incidence of fatal and nonfatal cardiovascular events. Using multivariate Cox regression analysis, plasma TG/HDL-C ratio was independently associated with increased risk of fatal events (hazard ratio [HR], 1.25; 95% confidence interval [CI], 1.13-1.37; P≤.001] and MACEs (HR, 1.13; 95% CI, 1.06-1.21; P≤.001). Increased plasma TG/HDL-C ratio was associated with more fatal events and MACEs in essential hypertensive patients.
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http://dx.doi.org/10.1111/jch.12758DOI Listing
August 2016

Morning Blood Pressure Surge as a Predictor of Development of Chronic Kidney Disease.

J Clin Hypertens (Greenwich) 2016 05 4;18(5):444-8. Epub 2015 Nov 4.

Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey.

Blood pressure (BP) usually increases upon awakening--a physiological mechanism called morning BP surge (MBPS). BP values above the MBPS threshold are associated with target organ damage, including left ventricular hypertrophy and proteinuria. Despite these data, there have been no studies that have investigated the association between elevated MBPS and the development of incident chronic kidney disease (CKD). In this study, patients with essential hypertension were included and underwent ambulatory BP measurements and MBPS. Patients were followed for a median of 3.33 years. In total, 622 patients were enrolled. The mean age of patients was 57.6±12.4 years, 54.0% were men, 16.7% had diabetes, and 10.6% had prevalent cardiovascular disease. During follow-up, 32 patients developed CKD. Higher MBPS, analyzed both as continuous and categorical variables, was associated with incident CKD in all models. Elevated MBPS is associated with kidney function deterioration and the development of CKD. Studies are needed to further examine underlying mechanisms regarding MBPS and these renal outcomes.
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http://dx.doi.org/10.1111/jch.12707DOI Listing
May 2016

'Action potential-like' ST elevation following pseudo-Wellens' electrocardiogram.

Indian Heart J 2015 Sep-Oct;67(5):472-5. Epub 2015 Aug 4.

Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey.

Coronary artery vasospasm is an important cause of chest pain syndromes that can lead to myocardial infarction, ventricular arrhythmias, and sudden death. In 1959, Prinzmetal et al described a syndrome of nonexertional chest pain with ST-segment elevation on electrocardiography. Persistent angina is challenging, and repeated coronary angioplasty may be required in this syndrome. Calcium antagonists are extremely effective in treating and preventing coronary spasm, and may provide long-lasting relief for the patient. Whereas the Wellens' syndrome is characterized by symmetrically inverted T-waves with preserved R waves in the precordial leads suggestive of impending myocardial infarction due to a critical proximal left anterior descending stenosis, the pseudo-Wellens' syndrome caused by coronary artery spasm has also rarely been reported in literature. We present a pseudo-Wellens syndrome as a cause of vasospastic angina, and a diffuse ST segment elavation on electrocardiogram resembling the Greek letter lambda, called also 'action potential-like' ECG in a patient with vasospastic-type Printzmetal angina.
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http://dx.doi.org/10.1016/j.ihj.2015.05.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4593797PMC
December 2016

The association of plasma fibrinogen with the extent and complexity of coronary lesions in patients with acute coronary syndrome.

Kardiol Pol 2016 28;74(4):338-45. Epub 2015 Sep 28.

Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey.

Background: High Syntax score (SXscore) is associated with more serious disease and worse prognosis in patients with acute coronary syndrome (ACS). Plasma fibrinogen levels are associated with poor cardiovascular outcomes.

Aim: To investigate the relation of admission fibrinogen levels with intermediate-high SXscore in patients with ACS.

Methods: A total of 752 patients (61.6 ± 12.8 years, 67.3% men) with ACS, who underwent urgent coronary angiography (CAG) were enrolled. Laboratory data including fibrinogen and high sensitivity C-reactive protein were obtained before CAG. Syntax scores of all patients were calculated from baseline CAG. The patients were divided into two groups: low SXscore (≤ 22) and intermediate-high SXscore (≥ 23).

Results: Admission fibrinogen levels were significantly higher in the SXscore ≥ 23 group when compared with the SXscore ≤ 22 group (median 492 mg/dL, interquartile range 428-581 mg/dL vs. median 370 mg/dL, interquartile range 309-428 mg/dL, respectively; p < 0.001). In multivariate analysis, the independent predictors of intermediate-high SXscore were fibrinogen (OR 1.008, 95% CI 1.005-1.010, p < 0.001), left ventricular ejection fraction (OR 0.935, p < 0.001), and age (OR 1.029, p = 0.041). A level of fibrinogen > 417 mg/dL had an 80.0% sensitivity and 71.3% specificity in predicting intermediate-high SXscore.

Conclusions: Increased fibrinogen levels are independently associated with intermediate-high SXscore in patients with ACS.
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http://dx.doi.org/10.5603/KP.a2015.0196DOI Listing
July 2017

Association of lymphocyte-to-monocyte ratio with the no-reflow phenomenon in patients who underwent a primary percutaneous coronary intervention for ST-elevation myocardial infarction.

Coron Artery Dis 2015 Dec;26(8):706-12

Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey.

Background: Recently, it has been shown that the lymphocyte-to-monocyte ratio (LMR) is a novel inflammatory marker. A decreased LMR is associated significantly with a high risk for vascular endpoints in patients with peripheral arterial disease. We aimed to investigate whether LMR on admission is associated with no-reflow after a primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI).

Patients And Methods: A total of 857 patients (mean age 58.9±13.1 years, 75.6% men), who were admitted to our hospital for STEMI and undergoing primary PCI within 12 h of onset of symptoms, were recruited. LMR was calculated by dividing the lymphocyte count by the monocyte count. The patients were divided into two groups according to the postprocedural thrombolysis in myocardial infarction (TIMI) flows: no-reflow and normal-reflow. No-reflow was defined as a final TIMI flow of 2 or less or final TIMI flow of 3 with a myocardial blush grade of less than 2.

Results: Admission LMR levels were significantly lower in patients with no-reflow than in patients with normal-reflow (1.85±1.01 vs. 3.64±1.74, P<0.001). A receiver-operating characteristic analysis indicated that an LMR value of less than 2.292 and had a 76.3% sensitivity and a 72.5% specificity in predicting no-reflow. Multivariate analysis showed that LMR less than 2.292 [odds ratio (OR) 2.657, P=0.030], Killip class at least 2 at admission (OR 3.442, P=0.039), baseline infarct artery patency (OR 0.260, P=0.004), neutrophil count (OR 1.213, P=0.002), and total stent length (OR 1.059, P=0.001) were independent factors for predicting no-reflow.

Conclusion: Our results suggested that LMR could be a simple and useful marker to predict high risk of patients for no-reflow in patients with STEMI who underwent primary PCI.
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http://dx.doi.org/10.1097/MCA.0000000000000301DOI Listing
December 2015

The classical "R-on-T" phenomenon.

Indian Heart J 2015 Jul-Aug;67(4):392-4. Epub 2015 Apr 27.

Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey.

The polymorphic ventricular tachycardia (PVT) is uncommon arrhythmia with multiple causes and has been classified according to whether they are associated with long QT interval or normal QT. Whereas "Torsade de pointes (TdP)" is an uncommon and distinctive form of PVT occurring in a setting of prolonged QT interval, which may be congenital or acquired (congenital or acquired), "PVT with normal QT" is associated with myocardial ischemia, electrolyte abnormalities (hypokalemia), mutations of the cardiac sodium channel (Brugada syndrome), and the ryanodine receptor (catecholaminergic PVT). This distinction is crucial because of the differing etiologies and management of these arrhythmias. Moreover, the PVT in the setting of acute MI generally occurs during the hyperacute phase, is related to ischemia ("ischemic PVT") and is not associated with QT prolongation. It is triggered by ventricular extrasystoles with very short coupling interval (the "R-on-T" phenomenon) and is not pause-dependent. However, recently there has been described a new PVT during the "healing phase" of MI in patients with no evidence of ongoing ischemia and following excessive QT prolongation, the electrophysiologic abnormality being a "pause-dependent infarct-related TdP" due to a LQTS in healing MI patients. Therefore, "ischemic PVT" differs from "infarct-related TdP" in terms of pathophysiology and ECG manifestations.
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http://dx.doi.org/10.1016/j.ihj.2015.02.030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4561790PMC
December 2016

Elevated serum fibrinogen levels and risk of contrast-induced acute kidney injury in patients undergoing a percutaneous coronary intervention for the treatment of acute coronary syndrome.

Coron Artery Dis 2016 Jan;27(1):13-8

Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey.

Objectives: Contrast-induced acute kidney injury (CI-AKI) is a common complication of diagnostic and therapeutic catheterizations, especially in the setting of acute coronary syndrome (ACS). Fibrinogen is a well-known cardiovascular risk factor. We evaluated whether serum fibrinogen level is associated independently with CI-AKI in patients with ACS who underwent a percutaneous coronary intervention (PCI).

Methods: Patients (n=710, aged 61 ± 13, 69% men) were classified into two groups: CI-AKI and non-CI-AKI. CI-AKI was defined as an increase of at least 0.5 mg/dl or at least 25% in the serum creatinine level within 72 h following PCI.

Results: CI-AKI occurred in 75 (10.6%) patients. We found significantly higher serum fibrinogen levels in patients who developed CI-AKI than in those who did not (498 ± 152 vs. 386 ± 96 mg/dl, P<0.001). Multivariate logistic regression analysis showed that serum fibrinogen level (odds ratio 1.006, 95% confidence interval 1.003-1.009, P<0.001), age, glomerular filtration rate, female sex, and white blood cell count were correlated with the development of CI-AKI.

Conclusion: Serum fibrinogen level is associated independently with a higher risk of CI-AKI in patients with ACS undergoing PCI.
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http://dx.doi.org/10.1097/MCA.0000000000000295DOI Listing
January 2016

Association of total serum antioxidant capacity with the Tei index in echocardiography in patients with microvascular angina.

Coron Artery Dis 2015 Nov;26(7):620-5

aDepartment of Cardiology, Ankara Education and Research Hospital bDepartment of Cardiology cDepartment of Biochemistry, Ufuk University School of Medicine, Ankara, Turkey.

Objectives: Cardiac syndrome X (CSX) is a condition characterized by exercise-induced chest pain that occurs considering a normal coronary angiogram. We aimed to investigate the total serum antioxidant capacity (TAC) and biventricular global functions using echocardiography in patients with CSX.

Patients And Methods: The study population included 55 patients with typical anginal symptoms and a positive exercise stress test, or ischemia in myocardial perfusion scintigraphy and normal coronary arteries detected angiographically, and 49 healthy volunteers with atypical chest pain and a negative stress test. TAC was assessed from blood samples. Transthoracic echocardiography was performed for the entire study population. The Tei index was calculated using the formula IVCT+IVRT/ET.

Results: TAC was found to be significantly lower in the CSX group compared with the control group (0.70±0.37 vs. 1.5±0.30, respectively, P<0.001). The Tei index was significantly higher in patients with CSX than the control group (0.60±0.18 vs. 0.42±0.12, respectively, P<0.001).There was a significant and inverse relationship between TAC and the Tei index (r=-0.41, P<0.001). When we divided the study population according to the normal range of TAC into the decreased TAC group (<1.30 mmol/l), the normal TAC group (1.30-1.77 mmol/l), and the increased TAC group (>1.77 mmol/l), it was found that the Tei index was higher in the decreased TAC group compared with the other groups (0.66±0.18 vs. 0.49±0.10 and 0.46±0.13 mmol/l, P<0.001, respectively).

Conclusion: Our study suggested that TAC was significantly decreased in CSX patients and decreased antioxidant levels were related to impaired Tei index in echocardiography in patients with microvascular angina.
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http://dx.doi.org/10.1097/MCA.0000000000000293DOI Listing
November 2015

Association of Serum Uric Acid Level With Blood Pressure Variability in Newly Diagnosed Essential Hypertension.

J Clin Hypertens (Greenwich) 2015 Dec 7;17(12):929-35. Epub 2015 Aug 7.

Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey.

Serum uric acid (UA) is independently associated with hypertension and blood pressure (BP) variability (BPV) is associated with cardiovascular events and mortality in hypertensive patients. The aim of the present study was to assess the association of serum UA with BPV in 300 untreated essential hypertension patients (mean age 57.3±13.6 years). BPV was quantified as the standard deviation (SD) of the 24-hour, daytime, and nighttime mean values obtained by using ambulatory BP monitoring. In correlation analysis, log UA values were found to be positively correlated with 24-hour systolic BPV and nighttime systolic and diastolic BPV (Pearson coefficients of 0.246, 0.280, and 0.353, respectively; P<.001 for all). In multivariate analysis, log UA had an independent association with 24-hour systolic BPV and nighttime systolic and diastolic BPV. This study show for the first time that increased serum UA is independently associated with BPV in untreated essential hypertension patients.
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http://dx.doi.org/10.1111/jch.12641DOI Listing
December 2015

Preprocedural Albumin Levels and Risk of In-Stent Restenosis After Coronary Stenting With Bare-Metal Stent.

Angiology 2016 May 3;67(5):478-83. Epub 2015 Aug 3.

Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey.

In-stent restenosis (ISR) remains a significant clinical problem in patients with coronary artery disease treated with percutaneous coronary intervention. Decreased serum albumin (SA) level is related to an increased risk of cardiovascular events. The aim of the present study was to assess whether SA levels at admission are an independent predictor of ISR in patients undergoing bare-metal stent (BMS) implantation. A total of 341 patients (aged 61 ± 11, 65.4% men) with a history of BMS implantation and a further control coronary angiography due to stable angina pectoris (SAP) were included. The study population was classified into 2 groups: patients with and without ISR. The ISR was observed in 140 (41.1%) patients. We found significantly lower SA levels in patients who developed ISR than in those who did not (3.69 ± 0.41 vs 4.07 ± 0.35 mg/dL,P< .001). Multivariate analysis revealed that SA level (odds ratio 0.109, 95% confidence interval 0.017-0.700,P= .020), stent diameter, reason for stent implantation, and body mass index were independent risk factors for the development of ISR. The SA level at admission is inversely associated with ISR in patients with SAP.
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http://dx.doi.org/10.1177/0003319715598084DOI Listing
May 2016

Predictive Value of Gamma-Glutamyl Transferase Levels for Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention.

Am J Cardiol 2015 Sep 4;116(5):711-6. Epub 2015 Jun 4.

Department of Cardiology, Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey.

Contrast-induced nephropathy (CIN) after primary percutaneous coronary intervention (PPCI) is associated with adverse short- and long-term outcomes. The aim of this study was to evaluate the predictive value of gamma-glutamyl transferase (GGT) for risk of CIN in patients with ST-segment elevation myocardial infarction who underwent PPCI. A total of 473 patients were enrolled in the study. A relative increase in serum creatinine ≥25%, or an absolute increase ≥0.5 mg/dl, from the baseline within 72 hours of contrast exposure was defined as CIN. Patients were divided into 3 groups according to GGT tertiles (tertile 1, GGT <19 U/L; tertile 2, GGT 19 to 33 U/L; and tertile 3, GGT >33 U/L) on admission. Demographics, clinical risk factors, laboratory parameters, CIN incidence, and other inhospital clinical outcomes were compared among GGT tertiles. CIN incidence was significantly higher in tertile 3 (29%) compared with tertiles 1 (11%) and 2 (11%, p <0.001). Inhospital death incidence was significantly increased across tertiles (from tertile 1 to tertiles 2 and 3, 1%, 4%, and 5%, respectively, p <0.05). In receiver operating characteristic analysis, a threshold value of GGT >26.5 U/L had 70% sensitivity and 60% specificity for CIN. After including variables found significant in univariate analysis, the presence of diabetes mellitus (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.22 to 2.31, p <0.001), C-reactive protein (for each 1 mg/L increase; OR 1.01, 95% CI 1.00 to 1.02, p = 0.007), contrast volume (for each 1-ml increase; OR 1.01, 95% CI 1.00 to 1.02, p = 0.012), and GGT >26.5 U/L (OR 2.59, 95% CI 1.48 to 4.53, p <0.001) were found as independent associates of CIN in multivariate regression analysis. Each 1 U/L increase in GGT was also associated with CIN risk (OR 1.04, 95% CI 1.03 to 1.06, p <0.001). In conclusion, GGT on admission was a significant and independent predictor of CIN after PPCI in patients with ST-segment elevation myocardial infarction.
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http://dx.doi.org/10.1016/j.amjcard.2015.05.042DOI Listing
September 2015

Association of mean platelet volume level with in-hospital major adverse events in infective endocarditis.

Wien Klin Wochenschr 2015 Mar 17;127(5-6):197-202. Epub 2015 Mar 17.

Department of Infectious Diseases, Turkish Armed Forces Health Command Health and Veterinary Services, Ankara, Turkey.

We hypothesised that increased on-admission and follow-up mean platelet volume (MPV) levels would correlate with adverse outcomes in patients with infective endocarditis (IE). A total of 108 consecutive patients were grouped into two according to median MPV level (≤ 8.6 and > 8.6 fL). Patients with MPV level of > 8.6 fL had a significantly higher rate of end-stage renal disease, Staphylococcus aureus infection, higher CRP levels, embolic events and in-hospital mortality compared to patients with MPV levels ≤ 8.6 fL. In multivariable Cox regression analysis, previous history of IE, S. aureus infection, end-stage renal disease, depressed LVEF, early surgical intervention, vegetation size ≥ 10 mm, presence of perivalvular abscess, higher on-admission platelet count, CRP and MPV levels emerged as independent predictors of in-hospital unfavourable outcomes. Patients with embolic events and in-hospital mortality revealed an incremental trend for MPV levels compared to patients without any adverse events. Our study results suggest that both on-admission and follow-up MPV levels may be a simple and available biomarker for risk stratification of IE patients.
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http://dx.doi.org/10.1007/s00508-015-0746-2DOI Listing
March 2015
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