Publications by authors named "Selda Murat"

14 Publications

  • Page 1 of 1

The impact of hydroxychloroquine and azithromycin on the corrected qt interval in patients with the novel Coronavirus disease 2019.

Rev Assoc Med Bras (1992) 2021 Jul;67(7):979-984

Eskisehir Osmangazi University, Medical Faculty Department of Cardiology - Eskisehir, Turkey.

Objective: With the coronavirus disease 2019 (COVID-19) continuing to spread all over the world, although there is no specific treatment until now, hydroxychloroquine and azithromycin have been reported to be effective in recent studies. Although long-term use of hydroxychloroquine and azithromycin has been reported to cause QT prolongation and malign arrhythmia, there is not enough data about the effect of short-term use on arrhythmia. Therefore, this study aims to assess the effect of hydroxychloroquine alone and hydroxychloroquine + azithromycin on corrected QT (QTc).

Methods: A baseline electrocardiogram and on-treatment baseline electrocardiogram were retrospectively collected in COVID-19 patients who received hydroxychloroquine and/or azithromycin. The QTc interval was calculated, and the baseline and peak QTc intervals were compared. In addition, the peak QTc intervals of monotherapy and combination therapy were compared.

Results: Of the 155 patients included, 102 (65.8%) patients were using hydroxychloroquine, and 53 (34.2%) patients were using hydroxychloroquine + azithromycin combination. The use of both hydroxychloroquine alone and hydroxychloroquine + azithromycin combined therapy significantly prolonged the QTc, and the QTc interval was significantly longer in patients receiving combination therapy. QTc prolongation caused early termination in both groups, 5 (4.9%) patients in the monotherapy group and 6 (11.3%) patients in the combination therapy group.

Conclusion: In this study, patients who received hydroxychloroquine for the treatment of COVID-19 were at high risk of QTc prolongation, and concurrent treatment with azithromycin was associated with greater changes in QTc.
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http://dx.doi.org/10.1590/1806-9282.20210380DOI Listing
July 2021

Prognostic value of D-dimer/fibrinogen ratio on in-hospital outcomes of patients with heart failure and COVID-19.

Biomark Med 2021 Nov 20;15(16):1519-1528. Epub 2021 Oct 20.

Medical Faculty Department of Cardiology, Eskisehir Osmangazi University, Eskisehir, 26040, Turkey.

In the present study, the relationship between D-dimer/fibrinogen ratio (DFR) and in-hospital outcomes was evaluated in patients with COVID-19 and a diagnosis of heart failure (HF). In-hospital outcomes were compared in patients with high and low DFR values. With regard to in-hospital outcomes, patients in the third tertile of DFR had a higher rate of mechanical ventilation, cardiogenic shock and death (p < 0.001). The length of ICU stay was longer in the third tertile group (p < 0.001). When evaluated together with infection markers, DFR was found to be an independent predictor of outcomes. DFR can be used as a prognostic marker in patients with COVID-19 with a diagnosis of HF, and perhaps more valuable than other infection markers.
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http://dx.doi.org/10.2217/bmm-2021-0341DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8547277PMC
November 2021

Wild type transthyretin cardiac amiloidozis as a rare and overlooked underlying etiology in a patient with heart failure with preserved ejection fraction and left ventricular hypertrophy.

Turk Kardiyol Dern Ars 2021 Oct;49(7):579-584

Eskişehir Osmangazi University, Faculty of Medicine, Department of Nuclear Medicine, Eskişehir.

Cardiac amyloidosis (CA) is a rare, progressive, infiltrative and restrictive cardiomyopathy characterized by extracellular deposition of insoluble amyloid fibrils in the form of misfolded endogenous proteins in the heart. The most common types of CA are transthyretin (TTR) and immunoglobulin light chain (AL) amyloidosis. TTR-CA is further subdivided into wild-type (wtTTR-CA) and mutant (mTTR-CA) forms. CA has long been thought to be a rare disease. However, in clinical practice, it is frequently overlooked, but increasingly recognized as the cause of heart failure with preserved ejection fraction (HFpEF). Patients with CA show poor prognosis. Early diagnosis and novel therapeutic options have been shown to significantly improve prognosis. Novel diagnostic modalities such as nuclear scintigraphy allow the earlier diagnosis of TTR-CA without a biopsy. In this report, we present a case of wtTTR-CA as a rare and overlooked underlying etiology of HFpEF and left ventricular hypertrophy.
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http://dx.doi.org/10.5543/tkda.2021.09310DOI Listing
October 2021

Gender differences in clinical characteristics and in-hospital and one-year outcomes of young patients with ST-segment elevation myocardial infarction under the age of 40.

J Cardiovasc Thorac Res 2021 8;13(2):116-124. Epub 2021 Feb 8.

Eskisehir Osmangazi University, Medical Faculty Department of Cardiology, Eskisehir, Turkey.

Although the incidence of acute ST-segment elevation myocardial infarction (STEMI) in the elderly population has decreased in recent years, this is not the case for young people. At the same time, no reduction in hospitalization rate after STEMI was shown in young people. Clinical characteristics, risk factors, angiographic findings, in-hospital and one-year outcomes of patients under the age of 40 and their gender differences were investigated. This study has been performed retrospectively in two centers. Between January 2015 and April 2019, 212 patients aged 18-40 years with STEMI and who underwent reperfusion therapy were included. The gender differences were compared. The median age of (male 176; 83.0% and female 36; 17.0%) patients included in the study was 36 (33-38) for men and 36 (34-38) for women. Chest pain was the most common complaint for both genders (96.0% vs. 94.4%; = 0.651). While men presented more often with Killip class 1,women presented more often with Killip class 2. The anterior myocardial infarction (MI) was the most common MI type and it was higher in women than in man ( = 0.027). At one year of follow-up, the prevalence of all-cause hospitalization was 24%, MI 3.8%, coronary angiography 15.1%, cardiovascular death 1.4%, and all-cause death 0.47%, there was no gender difference. Anterior MI was the most common type of MI and it was more common in women than in men. Left anterior descending artery was the most common involved coronary artery. The most common risk factor is smoking. In terms of in-hospital outcome, left ventricular ejection fraction was significantly lower in women. There was no significant difference in one-year outcomes between both genders.
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http://dx.doi.org/10.34172/jcvtr.2021.17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8302902PMC
February 2021

Clinical characteristics and in-hospital outcomes of COVID-19 patients with history of heart failure: a propensity score-matched study.

Acta Cardiol 2021 Jul 5:1-8. Epub 2021 Jul 5.

Medical Faculty Department of Cardiology, Eskisehir Osmangazi University, Eskisehir, Turkey.

Background: Data on the clinical course and outcomes of COVID-19 disease among patients with a history of heart failure (HF) are scarce. Therefore, the aim of this study was to assess the clinical characteristics, prognostic biomarkers and in-hospital outcomes of patients with a history of HF hospitalised with confirmed COVID-19.

Methods: A total of 8321 consecutive patients hospitalised with suspected COVID-19 disease were screened. Furthermore, 3849 patients with laboratory-confirmed SARS-CoV-2 infection were included in the study. Two hundred and forty COVID-19 patients with a history of HF and 240 without HF paired with PSM were evaluated.

Results: Mean age was 72.7 ± 9.90 years, and 64.6% were men. Oxygen saturation, systolic and diastolic blood pressure at admission were significantly lower and heart rate was significantly higher in patients with a history of HF compared to those without. Patients with HF, compared to those without, had significantly higher leukocyte count, D-dimer, CRP, procalcitonin, hsTnI, lactate and lower albumin and lymphocyte. Compared with patients without HF, those with previous HF had a longer length of stay at ICU (6.22 d vs. 3.71 d;  < 0.001), increased risk of mechanical ventilation (42.1% vs. 15.4%;  < 0.001), in-hospital death (39.2% vs. 15.4%;  < 0.001) and composite outcomes (52.9% vs. 17.1%;  < 0.001).

Conclusion: History of HF is associated with a higher risk of mechanical ventilation, cardiogenic shock, mortality and longer ICU stay in patients hospitalised for COVID-19, therefore the diagnosis of HF alone is important for predicting clinical outcomes.
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http://dx.doi.org/10.1080/00015385.2021.1945765DOI Listing
July 2021

Impact of COVID-19 outbreak on patients with ST-segment elevation myocardial ınfarction (STEMI) in Turkey: results from TURSER study (TURKISH St-segment elevation myocardial ınfarction registry).

J Thromb Thrombolysis 2021 May 29. Epub 2021 May 29.

Department of Cardiology, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey.

Objective: We aimed to investigate both the impact of COVID-19 pandemic on ST-segment elevation myocardial infarction (STEMI) admission, and demographic, angiographic, procedural characteristics, and in-hospital clinical outcomes of patients with COVID-19 positive STEMI in Turkey.

Methods: This was a multi-center and cross-sectional observational study. The study population included 1788 STEMI patients from 15 centers in Turkey. The patients were divided into two groups: COVID-19 era (March 11st-May 15st, 2020; n = 733) or pre- COVID-19 era group (March 11st-May 15st, 2019; n = 1055). Also, the patients in COVID-19 era were grouped as COVID-19 positive (n = 65) or negative (n = 668).

Results: There was a 30.5% drop in STEMI admission during COVID-19 era in comparison to pre-COVID-19 era. The patients admitted to the medical centers during COVID-19 era had a longer symptom-to-first medical contact time [120 (75-240) vs. 100 (60-180) minutes, p < 0.001]. COVID-19 positive STEMI patients had higher thrombus grade and lower left ventricular ejection fraction compared to COVID-19 negative patients. COVID-19 positive patients had higher mortality (28% vs. 6%, p < 0.001) and cardiogenic shock (20% vs. 7%, p < 0.001) rates compared with those without COVID-19. Matching based on propensity scores showed higher mortality and high thrombus grade in STEMI patients who were infected by SARS-COV-2 (each p < 0.05).

Conclusions: We detected significantly lower STEMI hospitalization rates and significant delay in duration of symptom onset to first medical contact in the context of Turkey during the COVID-19 outbreak. Moreover, high thrombus grade and mortality were more common in COVID-19 positive STEMI patients.
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http://dx.doi.org/10.1007/s11239-021-02487-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8164077PMC
May 2021

Assessment of fragmented QRS formation and its relationship with left ventricular hypertrophy in nonhypertensive acromegaly patients

Turk J Med Sci 2021 10 21;51(5):2437-2444. Epub 2021 Oct 21.

Department of Endocrinology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey

Background/aim: It is known that the presence of fragmented QRS (fQRS) on electrocardiography (ECG) is associated with cardiovascular events. The aim of this study was the evaluation of fQRS formation and its relationship with the left ventricular hypertrophy (LVH) parameters in acromegaly patients.

Materials And Methods: In total, 47 previously diagnosed with non-hypertensive acromegaly patients and 48 control subjects were included in the study. ECG and transthoracic echocardiography (TTE) were performed for each participant. Acromegaly patients were divided into two groups according to the fQRS formation on the ECG. Left ventricular wall thicknesses, and left atrial diameter (LAD), left ventricular mass (LVM), left ventricular mass index (LVMi), and relative wall thickness (RWT) were obtained.

Results: In control group 5 (10.4%) and in acromegaly group 17 (36.2%) patients had fQRS on ECG (p = 0.003). LAD [36.0 (34.0–38.0) vs. 38.0 (35.0–41.0) mm, p < 0.001], LVM [155.27 ± 27.00 vs. 173.0 (153.0–235.0) g, p < 0.001], LVMi [83.12 ± 13.19 vs. 92.0 (83.0–118.0) g/m², p < 0.001] and RWT [0.39 ± 0.03 vs. 0.43 (0.41–0.45), p = 0.001] were significantly higher in patients with acromegaly. Disease duration was significantly higher (11.59 ± 1.3 vs. 8.2 ± 1.8 years, p < 0.001) in the fQRS (+) group. LAD [41.0 (39.0–42.5) vs. 37.0 (34.7–38.0) mm, p < 0.001], LVM [219.0 (160.5–254.5) vs. 164.0 (153.0–188.0) g, p = 0.017], LVMi [117.0 (92.5–128.5) vs. 86.0 (82.0–100.2) g/m², p = 0.013] and RWT [0.44 (0.42–0.49) vs. 0.43 (0.40–0.44), p = 0.037] were significantly higher in fQSR (+) acromegaly patients. In multivariate logistic regression analysis, disease duration (odds ratio: 10.05, 95% CI: 1.099–92.012, p = 0.041) and LAD (odds ratio: 2.19, 95% CI: 1.030–4.660, p = 0.042) were found to be the independent predictors of fQRS formation.

Conclusion: The results of our study revealed that fQRS (+) acromegaly patients had increased LVH parameters compared to fQRS (-) patients.
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http://dx.doi.org/10.3906/sag-2101-229DOI Listing
October 2021

Hyperkalemia in chronic heart failure with renal dysfunction or diabetes mellitus: Results from the TREAT HF study.

Turk Kardiyol Dern Ars 2021 04;49(3):198-205

Dokuz Eylül Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, İzmir, Türkiye.

Objective: Chronic kidney disease (CKD) and diabetes mellitus (DM) are common comorbidities in heart failure (HF). Patients with HF are at a high risk of hyperkalemia, and are therefore undertreated with respect to disease-modifying therapies. The Turkish Research Team-Heart Failure (TREAT HF) data were analyzed for the evaluation of hyperkalemia in real-life clinical practice in HF patients with CKD or DM.

Methods: The TREAT HF is a multicenter, national, observational registry. In this study, potassium levels of 1028 patients with HF were analyzed. Hyperkalemia is defined as blood potassium levels >5 mEq/L and evaluated based on the CKD, DM, HF medications, and New York Heart Association (NYHA) classes.

Results: Overall, 14.3% of patients (n=147) were found to have hyperkalemia. Hyperkalemia was more prevalent in patients with estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 than those with eGFR ≥60 mL/min/1.73 m2 (17.7% and 12%, respectively, p=0.010). Hyperkalemia was present in 10.9% (n=23) of patients with stage 1, 12.6% (n=50) with stage 2, 17.0% (n=52) with stage 3, and 19.5% (n=22) with stage 4-5 CKD. Hyperkalemia was higher in patients with DM (20.5% vs 12.3%, p=0.001). Furthermore, hyperkalemia was much higher in patients with DM with eGFR <60 mL/min/1.73 m2 (25.2%). The rate of hyperkalemia increased across NYHA categories (NYHA-I: 9.8%, NYHA-II: 12.8%, NYHA-III: 14.4%, and NYHA-IV: 23.4%, p=0.030). In patients with stage 4-5 CKD who were receiving renin-angiotensin-aldosterone system (RAAS) inhibitor therapy, more patients had hyperkalemia than those not receiving RAAS inhibitor therapy (23.4% and 12.5%, respectively).

Conclusion: In clinical practice, 14.3% of all patients with HF, 17.7% of all patients with CKD, and 20.5% of all patients with DM have hyperkalemia. The risk of hyperkalemia increases with advanced stages of CKD or NYHA and the risk is higher in patients receiving RAAS inhibitor therapy.
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http://dx.doi.org/10.5543/tkda.2021.58675DOI Listing
April 2021

Comments on the value of ECG changes in risk stratification of COVID-19 patients.

Ann Noninvasive Electrocardiol 2021 05 19;26(3):e12841. Epub 2021 Mar 19.

Department of Cardiology, Eskisehir Osmangazi University, Eskisehir, Turkey.

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http://dx.doi.org/10.1111/anec.12841DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8164154PMC
May 2021

Assesment of Cerebral Blood Flow Velocities with Transcranial Doppler Ultrasonography in Heart Failure Patients with Reduced Ejection Fraction.

J Stroke Cerebrovasc Dis 2021 May 6;30(5):105706. Epub 2021 Mar 6.

Eskisehir Osmangazi University, Faculty of Medicine, Department of Cardiology, Eskisehir 26480, Turkey.

Background: Heart and brain interaction is a well-known entity in heart failure (HF) and left ventricular systolic dysfunction poses an increased risk for stroke and cognitive impairment. Transcranial Doppler (TCD) provides valuable information on cerebral blood flow velocities (CBFV). However, less is known about CBFV in HF patients with reduced EF. So, we aimed to evaluate CBFV by means of TCD in patients with HF and reduced ejection fraction (HFrEF).

Methods: This study included 46 HFrEF patients (mean age 65.2±11 years, mean EF 20.1±3.8%) who underwent to TCD examination. In addition, 26 healthy individuals with sinus rhythm and EF >50% were included in the study as a control group. Peak systolic, mean and end diastolic flow velocities of the both right and left middle cerebral artery (RMCA and LMCA) were analyzed. In subgroup analysis, HFrEF patients compared according to rhythm. Correlation analyses was performed in HFrEF group between EF and TCD velocities.

Results: The average of RMCA and LMCA peak systolic and mean flow velocities were significantly lower in HF patients than those in control group (76,06±23,7 cm/s and 48,49±16,4 cm/s in HF group vs 87,84±14,5 cm/s and 56,41±10,7 cm/s in control group, p=0,025 and p=0,016, respectively, for RMCA and 75,1±22,3 cm/s and 47,57±14.8 cm/s in HF group vs 88,73±17,7 cm/s and 57,15±12,4 cm/s in control group, p=0,009 and p=0,007, respectively, for LMCA). The average mean flow velocity of RMCA and LMCA was significantly lower in HFrEF patients with AF than HFrEF patients with sinus rhythm. (P=0.04 and P= 0.03, respectively) In correlation analysis, EF was significantly positively correlated with both LMCA and RMCA flow velocities in HFrEF group.

Conclusion: This study showed that HFrEF patients have lower CBFV as compared to healthy controls and HFrEF patients with AF rhythm have lower CBFV compared to HFrEF with sinus rhythm which might be one of the explanations of the adverse interaction between heart and brain in HFrEF.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2021.105706DOI Listing
May 2021

Comments on efficacy and safety of non-vitamin K antagonist oral anticoagulants versus warfarin in patients with atrial fibrillation and diabetes mellitus.

Acta Cardiol 2021 Feb 26. Epub 2021 Feb 26.

Medical Faculty, Department of Cardiology, Eskisehir Osmangazi University, Eskisehir, Turkey.

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http://dx.doi.org/10.1080/00015385.2021.1883905DOI Listing
February 2021

Comments on development and validation of home delivery for ambulatory ECG monitoring.

J Electrocardiol 2021 Mar-Apr;65:121. Epub 2021 Feb 8.

Eskisehir Osmangazi University, Medical Faculty Department of Cardiology, Eskisehir 26070, Turkey. Electronic address:

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http://dx.doi.org/10.1016/j.jelectrocard.2021.01.014DOI Listing
July 2021

The association of exaggerated hypertensive response to exercise and beta-blockers use in hypertensives.

Clin Exp Hypertens 2020 Nov 16;42(8):707-713. Epub 2020 Jun 16.

Faculty of Medicine, Department of Cardiology, Eskişehir Osmangazi University , Eskişehir, Turkey.

Purpose: An elevation in blood pressure (BP) during exercise is the normal physiological response, however an abnormally exaggerated rise in BP, in terms of hypertensive response to exercise (HRE), is seen as a prognostic factor for end-organ damage and mortality. HRE is more common in hypertensive (HT) patients and data are lacking on the effect of antihypertensive medication on HRE. In this study, we evaluated patients who underwent treadmill exercise testing (TET) to reveal the effect of antihypertensive medication on HRE.

Materials And Methods: A cohort of 2970 individuals underwent TET and data were evaluated for HRE development. HRE has been defined as a systolic BP>210 mmHg in males and >190 mmHg in females throughout the TET. To reveal the effects of antihypertensive medication on HRE, 992 HT patients were analyzed.

Results: HRE was observed in 11.4% ( = 113) of HT patients and 5.9% ( = 107) of non-HT individuals( < .001). HRE was observed significantly more in males (57.6% vs. 67.3%; = .033), and in patients with higher body mass index BMI (29.1 ± 4.5 vs. 30.3 ± 5.2;0.033). There was no significant association between medication and HRE development apart from beta-blockers. Also, gender (odds ratio:1.787; 95%CI:1.160-2.751; = .008), BMI (odds ratio:1.070;95%CI:1.025-1.116; = .002) and being under beta-blocker treatment (odds ratio:0.637;95%CI:0.428-0.949; = .026) were found to be independent predictors of HRE in multivariate logistic regression analysis.

Conclusion: HRE was associated with gender, BMI and beta-blocker use in hypertensive with male gender and higher BMI associated with higher HRE, while beta-blocker-based treatment, either mono- or combination therapy, associated with lower HRE.
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http://dx.doi.org/10.1080/10641963.2020.1779284DOI Listing
November 2020

Effect of hypochloride on microbial ecology of bulking and foaming activated sludge treatment for tannery wastewater.

J Environ Sci Health A Tox Hazard Subst Environ Eng 2006 ;41(10):2163-74

Istanbul Technical University, Faculty of Civil Engineering, Department of Environmental Engineering, Maslak, Istanbul, Turkey.

This study investigates the effect of hypochloride application for controlling bulking and foaming on the microbial ecology of an activated sludge system treating tannery wastewater. Detailed characterization of the wastewater treatment influent and effluent is also reported for the study period. During the study, bulking and foaming are first monitored with a sudden burst in the sludge volume index over 250 mL g(-1), creating a significant deterioration of the effluent quality. The corresponding upset in the microbial ecology is the combined excessive proliferation of M. parvicella, N. limicola II and Gordona (Nocardia) spp., but mainly triggered by Gordona contamination of the floc structure and the rapid outward growth of this filamentous microorganism extending to adjacent flocs. Chlorine application at an average rate of 3 g Cl(-1)(kg MLSS.day)(-1) for 12 days provide an effective solution for bulking and foaming, restoring the effluent quality. It destroys filamentous texture between the flocs, leaving only a lot of loose and chopped filament fragments and, totally removes the Gordona spp. from solution which retrieves back into the flocs. Therefore, chlorine remediation of bulking and foaming, although temporarily effective, is only superficial as the Gordona seeding inside the floc remains intact and potentially available for excessive growth in the next favorable conditions.
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http://dx.doi.org/10.1080/10934520600867813DOI Listing
January 2007
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