Publications by authors named "Osman Turak"

73 Publications

Development and Validation of a Scale to Measure Fear of Activity in Patients With Coronary Artery Disease (Fact-CAD).

Arch Phys Med Rehabil 2020 03 25;101(3):479-486. Epub 2019 Sep 25.

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

Objective: To develop and validate a scale to measure fear of activity in patients with coronary artery disease.

Design: Psychometric study.

Setting: Outpatient cardiology clinics.

Participants: The scale was applied to patients who had myocardial infarction, coronary artery bypass grafting, or percutaneous coronary intervention within the last 12 months (N=250).

Interventions: A scale for fear of activity in patients with coronary artery disease (Fact-CAD) was created through semistructured focus group interviews with patients. Face and content validity of Fact-CAD was verified.

Main Outcome Measures: Psychometric analysis included model fit, unidimensionality, reliability, local dependency, differential item functioning, and external construct validity. Analyses were performed using the Rasch Analysis Model.

Results: Fact-CAD scale was a reliable (high Person Separation Index of 0.89) and valid (unidimensional, no misfit, local independency supported, no residual correlations) measure of fear of activity. Three items showed differential item functioning according to employment status, marital status, and angina pectoris, which were not assigned as real item bias by experts and remained in the model.

Conclusion: Fact-CAD was supported by Rasch analysis as a psychometrically valid scale to evaluate fear of activity in patients with coronary artery disease.
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http://dx.doi.org/10.1016/j.apmr.2019.09.001DOI Listing
March 2020

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

Tp-e interval and Tp-e/QT ratio before and after catheter ablation in patients with premature ventricular complexes.

Biomark Med 2017 Apr 14;11(4):339-346. Epub 2017 Mar 14.

Department of Cardiology, Türkiye Yüksek İhtisas Education & Research Hospital, Ankara, Turkey.

Aim: Tp-e/QT ratio is a novel marker of ventricular repolarization. The aim of the study is to evaluate the Tp-e interval and Tp-e/QT ratio before and after radiofrequency ablation (RFA) for patients with frequent premature ventricular complexes (PVCs).

Patients & Methods: The study included 151 consecutive patients who underwent RFA for treatment of symptomatic frequent PVCs.

Results: Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio (all p < 0.001) were significantly different before and after RFA. After the procedure, mean left ventricular ejection fraction of the population were significantly increased than before RFA (p < 0.001). There was a significant correlation between preprocedural Tp-e/QTc ratio and PVC burden in patients (p = 0.023).

Conclusion: Our study shows that PVCs may have a negative effect on ventricular repolarization.
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http://dx.doi.org/10.2217/bmm-2016-0263DOI Listing
April 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

A Novel Marker of Impaired Aortic Elasticity in Never Treated Hypertensive Patients: Monocyte/High-Density Lipoprotein Cholesterol Ratio.

Acta Cardiol Sin 2017 Jan;33(1):41-49

Department of Cardiology, Türkiye Yüksek İhtisas Education and Research Hospital.

Background: Monocyte to high density lipoprotein cholesterol ratio (MHR) is generally understood to be a candidate marker of inflammation and oxidative stress. Therefore, we aimed to assess the association between MHR and aortic elastic properties in hypertensive patients.

Methods: A total of 114 newly-diagnosed untreated patients with hypertension and 71 healthy subjects were enrolled. Aortic stiffness index, aortic strain and aortic distensibility were measured by using echocardiography.

Results: Patients with hypertension had a significantly higher MHR compared to the control group (p < 0.001). Also, aortic stiffness index (p < 0.001) was significantly higher and aortic distensibility (p < 0.001) was lower in the hypertensive group. There was a positive correlation of MHR with aortic stiffness index (r = 0.294, p < 0.001) and negative correlation with aortic distensibility (r = -0.281, p < 0.001). In addition, MHR and high sensitivity C-reactive protein have a positive correlation (r = 0.30, p < 0.001). Furthermore, MHR was found to be an independent predictor of aortic distensibility and aortic stiffness index.

Conclusions: In patients with newly-diagnosed untreated essential hypertension, higher MHR was significantly associated with impaired aortic elastic properties.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241435PMC
http://dx.doi.org/10.6515/acs20160427aDOI Listing
January 2017

3D echocardiographic imaging of a septal myocardial cleft in hypertrophic cardiomyopathy.

Echocardiography 2016 Dec 22;33(12):1929-1930. Epub 2016 Sep 22.

Department of Cardiology, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey.

Myocardial clefts are defined as narrow, deep blood-filled invaginations within the left ventricular myocardium. They occur in hypertrophic cardiomyopathy patients with different frequency and represent a distinctive morphological expression of hypertrophic cardiomyopathy. Although two-dimensional transthoracic echocardiography is able to detect myocardial clefts in some cases, cardiovascular magnetic resonance imaging with its high spatial resolution can detect myocardial clefts not visualized with echocardiography. In this report, we represent multimodality imaging of a septal myocardial cleft in a hypertrophic cardiomyopathy patient.
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http://dx.doi.org/10.1111/echo.13343DOI Listing
December 2016

Monocyte count-to-high-density lipoprotein-cholesterol ratio is associated with abdominal aortic aneurysm size.

Biomark Med 2016 Oct 14;10(10):1039-1047. Epub 2016 Sep 14.

Turkiye Yuksek Ihtisas Training & Research Hospital, Department of Cardiovascular Surgery, Ankara, Turkey.

Aim: To determine the association of monocyte count-to-high-density lipoprotein (HDL)-cholesterol ratio, a recently emerged inflammatory marker, with abdominal aortic aneurysm (AAA) size.

Patients & Methods: A total of 120 asymptomatic AAA subjects (99 male, mean age: 67.1 ± 10.2 years) were enrolled into the study. All data were compared between patients with low and high admission monocyte/HDL ratio. Multivariate linear regression analysis was performed to study the relationship between different variables and AAA size.

Results: Compared to patients with below-median monocyte/HDL ratio, aneurysm diameter was significantly higher in above-median monocyte/HDL ratio group (54.3 ± 10.6 mm vs 62.0 ± 12.4 mm, p < 0.001, respectively). Hypertension, coronary artery disease, monocyte/HDL ratio and C-reactive protein were independently associated with AAA diameter.

Conclusion: Monocyte/HDL ratio is independently associated with AAA size.
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http://dx.doi.org/10.2217/bmm-2016-0157DOI Listing
October 2016

Novel White Blood Cell Subtypes and Ratios in Patients With Essential Hypertension.

J Clin Hypertens (Greenwich) 2017 01 22;19(1):104. Epub 2016 Aug 22.

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

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http://dx.doi.org/10.1111/jch.12906DOI Listing
January 2017

Monocyte to HDL ratio in prediction of BMS restenosis in subjects with stable and unstable angina pectoris.

Biomark Med 2016 Aug 14;10(8):853-60. Epub 2016 Jul 14.

Department of Cardiology, Türkiye Yüksek İhtisas Education & Research Hospital, Ankara, Turkey.

Aim: This study aims to assess the predictive role of the preprocedural circulating monocyte to high-density lipoprotein (HDL) cholesterol ratio (MHR) on the occurrence of stent restenosis (SR) in patients with stable and unstable angina pectoris undergoing successful bare-metal stenting (BMS).

Patients & Methods: Between February 2008 and June 2014, a total of 831 patients with stable and unstable angina pectoris who underwent successful BMS were retrospectively analyzed. Demographic and clinical characteristics of the patients were recorded. Left ventricular ejection fraction and laboratory data were also noted.

Results: In the receiver operating characteristics curve analysis, MHR >14 had 71% sensitivity and 69% specificity in predicting SR.

Conclusion: Our study results show that preprocedural MHR is an independent predictor of SR in this patient population.
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http://dx.doi.org/10.2217/bmm-2016-0071DOI Listing
August 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

A novel marker of inflammation in patients with slow coronary flow: lymphocyte-to-monocyte ratio.

Biomark Med 2016 05 18;10(5):485-93. Epub 2016 Apr 18.

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

Aim: Recently, lymphocyte-to-monocyte ratio (LMR) has emerged as a new indirect marker of inflammation which is associated with adverse outcomes in oncology and cardiovascular diseases. The aim of the study was to evaluate the relationship between LMR and slow coronary flow (SCF).

Patients & Methods: A total of 100 consecutive patients with SCF and 100 consecutive patients with normal coronary flow were enrolled in this study.

Results: LMR was significantly lower in patients with SCF than in patients with normal coronary flow (p < 0.001). Also, LMR was negatively correlated with neutrophil-to-lymphocyte ratio and CRP levels (p < 0.001 and p = 0.005). LMR was found to be significantly and independently associated with SCF (p = 0.033).

Conclusion: LMR was negatively correlated with serum C-reactive protein and neutrophil-to-lymphocyte ratio levels.
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http://dx.doi.org/10.2217/bmm-2016-0022DOI Listing
May 2016

Author`s Reply.

Anatol J Cardiol 2016 Mar;16(3):219

Department of Cardiology, Yüksek İhtisas Training and Research Hospital; Ankara-Turkey.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5336815PMC
March 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

Reply to: The Triglyceride to High-Density Lipoprotein Cholesterol Ratio Is a Useful Marker to Predict Unfavorable Cardiovascular Outcomes, But Other Confounding Factors Should Be Considered.

J Clin Hypertens (Greenwich) 2016 09 14;18(9):952. Epub 2016 Mar 14.

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

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http://dx.doi.org/10.1111/jch.12805DOI Listing
September 2016

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

Catheter ablation of drug refractory electrical storm in patients with ischemic cardiomyopathy: A single center experience.

Anatol J Cardiol 2016 Mar 24;16(3):159-64. Epub 2015 Apr 24.

Department of Cardiology, Yüksek İhtisas Training and Research Hospital; Ankara-Turkey.

Objective: Electrical storm (ES) is a life-threatening pathology that requires immediate and effective treatment due to increased morbidity and mortality. Catheter ablation (CA) is an effective therapeutic option, particularly in patients with drug resistant ventricular arrhythmia episodes. These procedures should only be performed in highly specialized and experienced centers. Here we aimed to assess safety and efficacy of CA in a relatively large cohort with ES in our tertiary center hospital.

Methods: A total of 44 patients (90.9% male; mean age: 59.7 ± 10.3 years) with ischemic cardiomyopathy undergoing CA for drug-refractory ES were prospectively evaluated. Procedures were performed using non-contact and electro-anatomic mapping systems. Long-term follow-up analysis addressed the predictors of ES recurrence and cardiac mortality.

Results: Acute success rates for clinical and non-clinical VTs were 90.8% and 55.5%, respectively. A mean follow-up at 28 ± 11 months revealed cardiac mortality in 8 (18%) patients, 39 (88.6%) patients were free from the ES, and 24 (55%) patients remained free from both ES and paroxysmal VT episodes. In multivariate regression analysis, recurrence of ES (OR=3.11, 95% CI: 1.65-4.62, p=0.001), LVEF, and serum creatinine were found as independent predictors of cardiac mortality. In addition, substrate based ablation, implantation of ICD for secondary prophylaxis, LVEF, and serum creatinine were good predictors of ES recurrence.

Conclusion: Catheter ablation for ventricular arrhythmias in the course of ES in patients with ischemic cardiomyopathy is safe with an acceptable success rate.
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http://dx.doi.org/10.5152/akd.2015.6095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5336800PMC
March 2016

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

Evaluation of Tp-E Interval and Tp-E/QT Ratio in Patients with Aortic Stenosis.

Ann Noninvasive Electrocardiol 2016 May 5;21(3):287-93. Epub 2015 Aug 5.

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

Background: The risk of syncope and sudden cardiac death due to ventricular arrhythmias increased in patients with aortic stenosis (AS). Recently, it was shown that Tp-e interval, Tp-e/QT, and Tp-e/QTc ratio can be novel indicators for prediction of ventricular arrhythmias and mortality. We aimed to investigate the association between AS and ventricular repolarization using Tp-e interval and Tp-e/QT ratio.

Methods: Totally, 105 patients with AS and 60 control subjects were enrolled to this study. The severity of AS was defined by transthoracic echocardiographic examination. Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were measured from the 12-lead electrocardiogram.

Results: Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were significantly increased in parallel to the severity of AS (P < 0.001, P = 0.001, and P = 0.001, respectively). Also, it was shown that Tp-e/QTc ratio had significant positive correlation with mean aortic gradient (r = 0.192, P = 0.049). In multivariate logistic regression analysis, Tp-e/QTc ratio and left ventricular mass were found to be independent predictors of severe AS (P = 0.03 and P = 0.04, respectively).

Conclusions: Our study showed that Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were increased in patients with severe AS. Tp-e/QTc ratio and left ventricular mass were found as independent predictors of severe AS.
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http://dx.doi.org/10.1111/anec.12298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6931434PMC
May 2016

Platelet to lymphocyte ratio as a novel indicator of inflammation is correlated with the severity of metabolic syndrome: A single center large-scale study.

Platelets 2016 21;27(2):178-83. Epub 2015 Jul 21.

a Turkiye Yuksek Ihtisas Training and Research Hospital, Cardiology Clinic , Ankara , Turkey and.

Metabolic syndrome (MetS) as a cluster of several cardio-metabolic components is rapidly growing public-health problem worldwide and significantly associated with poor cardiovascular outcomes. Increased visceral adiposity activates the important pathways connecting low-grade chronic inflammation, oxidative stress and blood coagulation. Recently, platelet to lymphocyte ratio (PLR) has been evidenced as a novel indirect inflammatory marker. Therefore, for the first time, we aimed to investigate the association of PLR with both the presence and severity of MetS. In this cross-sectional study, a total of 1146 participants were enrolled (n = 539 with MetS and n = 607 without MetS). MetS was defined according to NCEP-ATP III criteria. MetS (+) group revealed significantly higher PLR and C-reactive protein (CRP) levels as compared to MetS (-) group (p < 0.05). There was a graded relationship between increasing number of MetS components and PLR (p < 0.05). Also, PLR was positively correlated with CRP level (r = 0.163, p < 0.001). In multivariate regression analysis, PLR [1.121 (1.113-1.135), p < 0.001], CRP [1.044 (1.029-1.060), p < 0.001], and age [1.030 (1.017-1.043), p < 0.001] were remained as independent predictors for the presence of MetS. In conclusion, our findings showed that increased PLR was significantly associated with both the presence and severity of MetS which was linked to systemic inflammation based on the correlation between PLR and CRP. As PLR is an easily available, simple and cheap indirect indicator of inflammation, it can be used in clinical practice as a predictor of MetS.
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http://dx.doi.org/10.3109/09537104.2015.1064518DOI Listing
November 2016

Association of Monocyte-to-HDL Cholesterol Ratio with Slow Coronary Flow is Linked to Systemic Inflammation.

Clin Appl Thromb Hemost 2016 Jul 1;22(5):476-82. Epub 2015 Jul 1.

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

Background: Previous studies proposed that both inflammation, oxidative stress, and impaired endothelial dysfunction have a significant role in occurrence of slow coronary flow (SCF). monocyte-to-high density lipoprotein cholesterol ratio (MHR) is a recently emerged indicator of inflammation and oxidative stress, which have been studied only in patients with chronic kidney disease.

Hypothesis: We aimed to assess the relationship between MHR and SCF.

Methods: Patients who had angiographically normal coronary arteries were enrolled in this retrospective study (n = 253 as SCF group and n = 176 as control group). Patients who had corrected thrombolysis in myocardial infarction frame counts (cTFCs) above the normal cutoffs were defined as with SCF.

Results: The MHR and high-sensitivity C-reactive protein (hsCRP) were significantly higher in the SCF group. In correlation analysis, MHR has a significantly positive correlation with cTFC and serum hsCRP levels (P < .001). In multivariate logistic regression analysis, MHR was found as independently associated with the presence of SCF (odds ratio: 1.24, P < .001).

Conclusion: Higher MHR which indicates an enhanced inflammation and oxidative stress was significantly and independently associated with the presence of SCF. Besides, MHR was positively correlated with serum hsCRP level as a conventional marker for systemic inflammation.
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http://dx.doi.org/10.1177/1076029615594002DOI Listing
July 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

How to interpret liver function tests in heart failure patients?

Turk J Gastroenterol 2015 May;26(3):197-203

Department of Cardiology, Türkiye Yüksek İhtisas Hospital, Ankara, Turkey.

Cardiac hepatopathy has generally been used to describe any liver damage caused by cardiac disorders in the absence of other possible causes of liver damage. Although there is no consensus on the terminology used, cardiac hepatopathy can be examined as congestive hepatopathy (CH) and acute cardiogenic liver injury (ACLI). CH is caused by passive venous congestion of the liver that generally occurs in the setting of chronic cardiac conditions such as chronic HF, constrictive pericarditis, tricuspid regurgitation, or right-sided heart failure (HF) of any cause, and ACLI is most commonly associated with acute cardiocirculatory failure resulting from acute myocardial infarction, acute decompensated HF, or myocarditis. Histologically, CH is characterized by sinusoidal dilation, replacement of hepatocytes with red blood cells extravasating from the sinusoids, and necrosis/apoptosis of zone 3 of the Rappaport acinus, and it could progress to cirrhosis in advanced cases. In ACLI, however, massive necrosis of zone 3 is the main histological finding. Primary laboratory findings of CH are elevated serum cholestasis markers including bilirubin, alkaline phosphatase, and γ-glutamyl-transpeptidase levels, whereas those of ACLI are a striking elevation in transaminase and lactate dehydrogenase levels. Both CH and ACLI have a prognostic value for identifying cardiovascular events and mortality and have some special implications in the management of patients undergoing ventricular assist device implantation or cardiac transplantation. There is no specific treatment for CH or ACLI other than treatment of the underlying cardiac disorder.
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http://dx.doi.org/10.5152/tjg.2015.0086DOI Listing
May 2015

Association Between Platelet to Lymphocyte Ratio and Saphenous Vein Graft Disease.

Angiology 2016 Feb 29;67(2):133-8. Epub 2015 Mar 29.

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

Atherosclerosis plays an important role in saphenous vein graft disease (SVGD). Previous trials showed that inflammatory blood cells play a role in this process. The platelet to lymphocyte ratio (PLR) has been proposed as a novel predictor for cardiovascular risk and indicator of atherosclerosis. The aim of this study was to assess the relationship between SVGD and PLR. A total of 220 patients with SVG were enrolled (n = 87 with SVGD and n = 133 with patent SVG). A ≥ 50% stenosis within the SVG was defined as clinically significant. Median PLR (P < .001) and mean platelet volume (MPV; P = .043) were significantly higher in patients with SVGD. Also, PLR showed significantly positive correlation with age of SVG (P < .05). Median age of SVGs was also higher in the SVGD group (P = .025). In multivariate logistic regression analyses, the PLR and MPV were independent predictors of SVGD. Using a cutoff level of 106.3, the PLR predicted SVGD with a sensitivity of 87.4% and a specificity of 80.3%. To the best of our knowledge, this study showed, for the first time, that PLR was independently associated with SVGD. Both PLR and MPV might predict SVGD.
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http://dx.doi.org/10.1177/0003319715578258DOI Listing
February 2016

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

Effect of Vitamin D Replacement on Atrial Electromechanical Delay in Subjects with Vitamin D Deficiency.

J Cardiovasc Electrophysiol 2015 Jun 18;26(6):649-55. Epub 2015 Apr 18.

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

Objectives: Limited data are available regarding cardiac arrhythmias in vitamin D (VitD) deficiency. Therefore, we aimed to assess whether atrial electromechanical delay (AEMD) measured by tissue Doppler imaging (TDI), which is an indicator for atrial fibrillation (AF) development, is prolonged in patients with VitD deficiency as compared to the control group. The effect of vitD replacement on AEMD was also evaluated.

Methods: In this prospective study a total of 28 VitD-deficient and 56 age-, gender-, and BMI-matched VitD-sufficient healthy participants were enrolled. P-wave dispersion (PWd) was calculated on the 12-lead electrocardiogram. Both intra- and inter-AEMD were calculated by TDI. Measurements were performed at baseline in both groups and were repeated after 6-month replacement therapy in subjects with vitD deficiency.

Results: PWd and inter- and left intra-AEMD were significantly prolonged in patients with VitD deficiency compared to the control group (P < 0.001). While serum 25(OH)D levels were significantly and negatively correlated with left intra-AEMD (r = -0.657, P < 0.001), there was a positive correlation between serum 25(OH)D level and PWd (r = 0.523, P < 0.001). The serum 25(OH)D level was found as the independent predictor of the both left intra- and inter-AEMD in the multivariate linear regression analysis (β:-0.552, P < 0.001 and β:-0.555, P < 0.001, respectively). The serum 25(OH)D level was significantly increased after replacement therapy. While inter-AEMD was significantly decreased (P = 0.013), there was no change in PWD and left and right intra-AEMD (P > 0.05) following replacement therapy.

Conclusion: PWd and left intra- and inter-AEMD are increased in patients with VitD deficiency. The serum 25(OH)D level was found as an independent predictor for AEMD in patients with VitD deficiency. Also a significant decrement was observed in inter-AEMD following vitD replacement therapy. Studies with longer follow-up are needed to investigate whether vitD-deficient patients with prolonged AEMD develop clinical arrhythmia and vitD replacement reduces the risk of atrial arrhythmias.
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http://dx.doi.org/10.1111/jce.12656DOI Listing
June 2015

Relationship of admission neutrophil-to-lymphocyte ratio with in-hospital mortality in patients with acute type I aortic dissection.

Turk J Med Sci 2014 ;44(2):186-92

Aim: Acute aortic dissection is a life-threatening cardiovascular emergency. Neutrophil-to-lymphocyte ratio is proposed as a prognostic marker and found to be related to worse clinical outcomes in various cardiovascular diseases. The aim of the present study was to evaluate the relationship between admission neutrophil-to-lymphocyte ratio and in-hospital mortality in acute type I aortic dissection.

Materials And Methods: We retrospectively evaluated 123 consecutive patients who had undergone emergent surgery for acute type I aortic dissection. Patients were divided into 2 groups as patients dying in the hospital (Group 1) and those discharged alive (Group 2). All parameters, including neutrophil-to-lymphocyte ratio, were compared between the 2 groups and predictors of mortality was estimated by using multivariate analysis.

Results: A total of 104 patients (79 males, mean age: 55.2 + 14 years) were included in the final analysis. In multivariate analyses, cross- clamp time, cardiopulmonary bypass time, intensive care-unit duration, platelet count, and neutrophil-to-lymphocyte ratio were found to be independent predictors of mortality. Patients with higher neutrophil-to-lymphocyte ratios had a significantly higher mortality rate (hazard ratio: 1.05; 95% CI: 1.01-1.10; P = 0.033). Receiver operating characteristic analysis revealed that using a cut-off point of 8, neutrophil-to-lymphocyte ratio predicts mortality with a sensitivity of 70% and specificity of 53%.

Conclusion: This study suggests that admission neutrophil-to-lymphocyte ratio is a potential predictive parameter for determining the in-hospital mortality of acute type I aortic dissection.
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January 2015

Impaired cardiac autonomic functions in apparently healthy subjects with vitamin D deficiency.

Ann Noninvasive Electrocardiol 2015 Jul 2;20(4):378-85. Epub 2014 Nov 2.

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

Objectives: Vitamin D (VitD) deficiency affects the cardiovascular system via endocrine, paracrine, and autocrine pathways. Limited data are available regarding cardiac autonomic dysfunction in VitD deficiency. The aim of this study was to assess the cardiac autonomic functions by using heart rate recovery index (HRRI) and heart rate variability (HRV) in apparently healthy subjects with VitD deficiency.

Methods: A total of 24 VitD deficient and 50 age-, gender-, and body mass index-matched VitD sufficient healthy participants who admitted to outpatient clinics at a tertiary centre were enrolled. All study participants underwent Treadmill exercise test and 24-hour Holter recording to assess cardiac autonomic functions. HRRIs were calculated by subtracting first, second, and third minute heart rates during recovery period from maximal heart rate.

Results: Mean HRR1 (28.0 ± 8.3 vs 42.8 ± 6.4, P < 0.001), HRR2 (41.1 ± 11.2 vs 60.8 ± 10.4, P < 0.001), and HRR3 (44.9 ± 13.3 vs 65.9 ± 9.8, P < 0.001) were significantly higher in VitD sufficient group compared to VitD deficient group. HRV parameters as, SDNN (P = 0.040), SDANN (P < 0.001), RMSSD (P < 0.001), PNN50 (P < 0.001), and HF (P < 0.001) were significantly decreased in patients with VitD deficiency; but LF (P < 0.001) and LF/HF (P = 0.003) were significantly higher in VitD deficient group. Serum 25(OH)D level was positively correlated with HRRIs (P < 0.001), PNN50, RMSSD, SDANN, and HFnu; negatively correlated with LFnu and LF/HF (P < 0.05). Also, multivariate linear regression analysis showed that serum 25(OH)D level was significantly associated with HRRIs and HRV parameters (P < 0.001).

Conclusion: Our study results suggest that cardiac autonomic functions are impaired in patients with VitD deficiency despite the absence of overt cardiac involvement and symptoms. Further studies are needed to elucidate the prognostic significance and clinical implications of impaired autonomic functions in patients with VitD deficiency.
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http://dx.doi.org/10.1111/anec.12233DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6931811PMC
July 2015

D-dimer level predicts in-hospital mortality in patients with infective endocarditis: a prospective single-centre study.

Thromb Res 2014 Sep 21;134(3):587-92. Epub 2014 Jun 21.

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

Background: Increased circulating D-dimer levels have been correlated with adverse outcomes in various clinical conditions. To our knowledge, the association of on-admission D-dimer and in-hospital mortality in infective endocarditis (IE) has not been investigated. We hypothesized that increased on-admission D-dimer levels would correlate with adverse outcomes when prospectively studied in patients with IE.

Methods: In this prospective study, a total of 157 consecutive patients with the definite IE diagnosis met the inclusion criteria and underwent testing for on-admission D-dimer and CRP assays. The outcome measure was in-hospital death from any cause.

Results: In-hospital mortality occurred in 40 (26%) patients. Increased levels of plasma D-dimer (5.1 ± 1.7 vs 1.9 ± 0.8, p<0.001), CRP [45(13-98) vs 12(5-28), p<0.001] were found in dead patients compared with those survived. In addition to S. aureus infection, increased leukocyte count, end-stage renal disease, LVEF<50%, vegetation size of >10mm, perivalvular abscess, on-admission D-dimer (HR: 1.32; 95% CI: 1.24-1.40; p<0.001) and CRP (HR: 1.18; 95% CI: 1.09-1.36; p=0.001) levels were significantly associated with in-hospital mortality. Furthermore, the sensitivity and specificity of D-dimer ≥ 4.2mg/L in predicting in-hospital death in IE were 86% and 85%, respectively. Moreover, the sensitivity and specificity of CRP levels ≥ 13.6 mg/L were 72% and 69%, respectively.

Conclusion: Our findings suggest that on-admission D-dimer level may be a simple, available and valuable biomarker that allows us to identify high-risk IE patients for in-hospital mortality. D-dimer ≥ 4.2mg/L, CRP ≥ 13.6 mg/L were independently associated with IE related in-hospital death.
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http://dx.doi.org/10.1016/j.thromres.2014.06.015DOI Listing
September 2014
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