Publications by authors named "Yüksel Çavuşoğlu"

100 Publications

Resting heart rate and real-life treatment modalities in outpatients with left ventricular systolic dysfunction study: A multicenter, prospective, observational, and national registry.

Anatol J Cardiol 2021 May;25(5):304-312

Department of Cardiology, İstanbul University Cardiology Institute; İstanbul-Turkey.

Objective: Heart rate (HR) reduction is associated with improved outcomes in heart failure (HF). This multicenter, prospective, observational, and national registry aimed to evaluate resting HR and the impacts of HR-related medications in real-life clinical practice in patients with HF.

Methods: The Resting HR and Real-Life Treatment Modalities in Outpatients with Left Ventricular Systolic Dysfunction (REALITY HF) study enrolled 1054 patients with HF and left ventricular ejection fraction (LVEF) of <40% from 16 centers. Clinical characteristics, HR, and medications were noted (enrollment phase). A total of 487 patients with sinus rhythm and HR of ≥70 bpm were included in a further 4-month follow-up (FU) program (V0). Changes in HR and medications were reevaluated at 1-month (V1) and 4-month (V2) FU visits. The Kansas City Cardiomyopathy Questionnaire (KCCQ) was used to assess the quality of life (QoL) of 320 patients in a 4-month FU program.

Results: During enrollment, 794 patients (75.3%) were in sinus rhythm, in whom resting HR was 76.7±14 bpm, 69.1% had a resting HR of ≥70 bpm, 79.1% were receiving beta blocker (BB), and 6.1% were receiving ivabradine. Resting HR was lower in patients receiving BB (75.8±13 vs. 80.4±16 bpm; p=0.001); however, 65.8% of those still had a resting HR of ≥70 bpm. A significant association was found between elevated HR and worse New York Heart Association (NYHA) class, worse QoL, or lower LVEF. During the 4-month FU, adjustment of HR-lowering therapy was left to the physician's discretion. Resting HR significantly reduced from 83.6±12 (80) bpm at V0 to 78.6±13 (77) bpm at V1 (p=0.001) and further decreased to 73.0±11 (73) bpm at V2 (p=0.001). Patients achieving a resting HR of <70 bpm were 21.7% at V1 (p=0.001) and 39.9% at V2 (p=0.001). KCCQ significantly increased from 59.7±23 (62.7) at V0 to 73.1±18 (78.5) at V2 (p=0.001). In addition, patients with NYHA I increased from 22.2% at V0 to 29.2% at V1 and 39.4% at V2 (p=0.01).

Conclusion: In real-life clinical practice, elevated HR is highly prevalent in HF despite widely used BB therapy and is associated with worse clinical picture. Therapeutic interventions targeting HR significantly reduce HR, and HR lowering is associated with improved clinical outcomes.
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http://dx.doi.org/10.14744/AnatolJCardiol.2020.13247DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114622PMC
May 2021

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

Turk Kardiyol Dern Ars 2021 Apr;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

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

Marital status and outcomes in chronic heart failure: Does it make a difference of being married, widow or widower?

North Clin Istanb 2021 29;8(1):63-70. Epub 2021 Jan 29.

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

Objective: We aimed to compare the outcomes of chronic heart failure (HF) patients with reduced ejection fraction (CHFrEF) in the Turkish Research Team in HF (TREAT-HF) registry according to marital status with a specific focus on being the widowed (widow/widower) versus the married.

Methods: TREAT-HF is a network, enrolling CHFrEF with a follow up for HF-related hospitalization (HFrH) and all-cause mortality (ACM). In this cohort, the widowed patients were compared with patients who were married before and after propensity score (PS) matching analysis.

Results: There were 723 cHFrEF patients with a complete dataset, including reported marital status at baseline for this analysis. Out of 723 patients with HF, 37 "never-married" and "divorced" patients were excluded from the analysis. Then, out of 686 remaining patients with HF, who had at least one reported marriage in the database, widowed patients with HF (n=124) were compared with married patients (n=562). The mean follow up period was 21±12 months up to 48 months. The widowed patients had a higher risk of HFrH (p=0.047), although ACM remained similar compared to married patients (p=0.054). After PS matching, HFrH remained more frequent among the widowed compared with the married (p=0.039) although ACM yielded similar rates. Of note, it was shown that being a widower (p=0.419) was not linked to increased risk of HFrH during follow up contrary to being a widow (p=0.037) despite similar age, ejection fraction, creatinine, NYHA functional class distribution and a similar rate of life-saving medications.

Conclusion: PS matching analysis yielded that the widowed had increased the risk for HFrH. Of note, widowers did not seem to have an increased risk for HFrH, contrary to widows.
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http://dx.doi.org/10.14744/nci.2020.88003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7881434PMC
January 2021

[Fabry disease in cardiology: Diagnosis and therapeutic approaches].

Turk Kardiyol Dern Ars 2020 Dec;48(Suppl 2):1-42

Fabry disease is a rare, progressive, X-linked inherited storage disorder due to absent or deficient of lysosomal alfa galactosidase A activity. Deficient activity of alfa-galactosidase A results in progressive accumulation of globotriaosylceramide in a variety of tissues and organs including myocardium, kidney and nerve system. This disorder predominantly affects males; however, female heterozygotes may also be affected with a less severe clinical picture. Classic Fabry disease is usually diagnosed in early age of childhood because of multiorgan involvement whereas cardiac and renal variants of Fabry are manifested in 30-50 years of age because of late onset of clinical picture in which other organs involvement are uncommon. Although Fabry is known as a very rare disease, its prevalence is reported to be higher in patients with ventricular hypertrophy, chronic kidney disease and cryptogenic stroke. From the cardiology point of view, the most important key finding of the disease is unexplained ventricular hypertrophy. However, in clinical practice, ventricular hypertrophy is usually thought to be due to hypertrophic cardiomyopathy in the absence of hypertension or aortic stenosis and Fabry disease is often undiagnosed or overlooked. Early diagnosis and enzyme replacement therapy have been shown to significantly improve prognosis. The aim of this paper is to provide a comprehensive review including epidemiology, prognosis, clinical presentation, diagnosis and therapeutic approaches of cardiac variant of Fabry based on the available data in the literature.
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http://dx.doi.org/10.5543/tkda.2020.38262DOI Listing
December 2020

Heart Failure Association of the European Society of Cardiology update on sodium-glucose co-transporter 2 inhibitors in heart failure.

Eur J Heart Fail 2020 11 27;22(11):1984-1986. Epub 2020 Oct 27.

Centre for Heart Diseases, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland.

The Heart Failure Association (HFA) of the European Society of Cardiology (ESC) has recently issued a position paper on the role of sodium-glucose co-transporter 2 (SGLT2) inhibitors in heart failure (HF). The present document provides an update of the position paper, based of new clinical trial evidence. Accordingly, the following recommendations are given: • Canagliflozin, dapagliflozin empagliflozin, or ertugliflozin are recommended for the prevention of HF hospitalization in patients with type 2 diabetes mellitus and established cardiovascular disease or at high cardiovascular risk. • Dapagliflozin or empagliflozin are recommended to reduce the combined risk of HF hospitalization and cardiovascular death in symptomatic patients with HF and reduced ejection fraction already receiving guideline-directed medical therapy regardless of the presence of type 2 diabetes mellitus.
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http://dx.doi.org/10.1002/ejhf.2026DOI Listing
November 2020

Increased frequency of occurrence of bendopnea is associated with poor outcomes in heart failure outpatients.

Acta Cardiol 2020 Aug 19:1-9. Epub 2020 Aug 19.

Department of Cardiology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey.

Background: Relationship between the frequency of occurrence of bendopnea during the daily life of heart failure (HF) outpatients and clinical outcomes has never been evaluated before.

Methods: Turkish Research Team-Heart Failure (TREAT-HF) is a network between HF centres, which undertakes multicentric observational studies in HF. Herein, the data including stable 573 HF patients with reduced ejection fraction out of seven HF centres were presented. A questionnaire was filled by the patients, with the question 'Do you experience shortness of breath while tying your shoelace?', assessing the presence and frequency of bendopnea.

Results: To the question related to bendopnea, 48% of the patients answered 'yes, every time', 31% answered 'yes, sometimes', and 21% answered 'No'. Patients were followed for an average of 24 ± 14 months, and the patients who answered 'yes, every time' and 'yes, sometimes' to the bendopnea question were found having increased risk for both HF-related hospitalisations (HR:3.2,  < .001- HR:2.8,  = .005) and composite outcome consisting of 'HF-related hospitalisations and all-cause death in the multi-variate analysis (HR:3.1,  < .001- HR:3.0,  < .001). Kaplan Meier analysis for HF-related hospitalisation, all-cause death, and the composite of these were provided for these three groups, yielding significant and graded divergence curves with the best prognosis in 'no' group, with the moderate prognosis in 'sometimes' group, and with the worst prognosis in the 'every time' group.

Conclusion: For the first time in the literature, our study shows that the increased frequency of bendopnea occurrence in daily life is associated with poor outcomes in HF outpatients.
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http://dx.doi.org/10.1080/00015385.2020.1797303DOI Listing
August 2020

[Cardiac scintigraphy-centered diagnostic process in transthyretin cardiac amyloidosis].

Turk Kardiyol Dern Ars 2020 07;48(5):514-521

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

Cardiac amyloidosis (CA) is a progressive infiltrative cardiomyopathy. Amyloid fibrils in the form of misfolded endogenous proteins accumulate in the heart, as well as the kidneys, liver, and gastrointestinal tract. The most common forms of CA are transthyretin (TTR) and immunoglobulin light chain amyloidosis (AL). CA has long been thought to be a rare disease. However, recent reports have suggested that 13% of heart failure patients with a preserved ejection fraction and 16% of advanced-age patients with severe aortic stenosis have TTR-CA. Patients with TTR-CA have a poor prognosis, with a median survival of 2-4 years; however, early diagnosis and novel therapeutic options have been shown to significantly improve the prognosis. Scintigraphy using bone isotopes is considered a highly reliable and easy-to-use method in the diagnosis of TTR-CA. This is a review of the role of scintigraphic imaging with technetium-99m- labeled bisphosphonates in the diagnostic work-up process of TTR-CA and the applicable protocols.
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http://dx.doi.org/10.5543/tkda.2020.90914DOI Listing
July 2020

Sodium-glucose co-transporter 2 inhibitors in heart failure: beyond glycaemic control. A position paper of the Heart Failure Association of the European Society of Cardiology.

Eur J Heart Fail 2020 09 5;22(9):1495-1503. Epub 2020 Aug 5.

Department of Internal Medicine, and Department of Research and Education, General Hospital Murska Sobota, Murska Sobota, Slovenia.

Heart failure (HF) is common and associated with a poor prognosis, despite advances in treatment. Over the last decade cardiovascular outcome trials with sodium-glucose co-transporter 2 (SGLT2) inhibitors in patients with type 2 diabetes mellitus have demonstrated beneficial effects for three SGLT2 inhibitors (empagliflozin, canagliflozin and dapagliflozin) in reducing hospitalisations for HF. More recently, dapagliflozin reduced the risk of worsening HF or death from cardiovascular causes in patients with chronic HF with reduced left ventricular ejection fraction, with or without type 2 diabetes mellitus. A number of additional trials in HF patients with reduced and/or preserved left ventricular ejection fraction are ongoing and/or about to be reported. The present position paper summarises recent clinical trial evidence and discusses the role of SGLT2 inhibitors in the treatment of HF, pending the results of ongoing trials in different populations of patients with HF.
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http://dx.doi.org/10.1002/ejhf.1954DOI Listing
September 2020

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

[Turkish Cardiology Association Consensus Report: COVID-19 Pandemic and Cardiovascular Diseases (May 13, 2020)].

Turk Kardiyol Dern Ars 2020 05;48(Suppl 1):1-87

Cardiology Clinic, Baskent University Istanbul Hospital, Health Practice and Research Center, İstanbul.

In December 2019, in the city of Wuhan, in the Hubei province of China, treatment-resistant cases of pneumonia emerged and spread rapidly for reasons unknown. A new strain of coronavirus (severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2]) was identified and caused the first pandemic of the 21st century. The virus was officially detected in our country on March 11, 2020, and the number of cases increased rapidly; the virus was isolated in 670 patients within 10 days. The rapid increase in the number of patients has required our physicians to learn to protect both the public and themselves when treating patients with this highly infectious disease. The group most affected by the outbreak and with the highest mortality rate is elderly patients with known cardiovascular disease. Therefore, it is necessary for cardiology specialists to take an active role in combating the epidemic. The aim of this article is to make a brief assessment of current information regarding the management of cardiovascular patients affected by COVID-19 and to provide practical suggestions to cardiology specialists about problems and questions they have frequently encountered.
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http://dx.doi.org/10.5543/tkda.2020.36713DOI Listing
May 2020

[Consensus Report from Turkish Society of Cardiology: COVID-19 and Cardiovascular Diseases. What cardiologists should know. (25th March 2020)].

Turk Kardiyol Dern Ars 2020 03;48(Suppl 1):1-48

Department of Cardiology, Ege University Medical Faculty Hospital, İzmir.

In December 2019, in the city of Wuhan, in the Hubei province of China, treatment-resistant cases of pneumonia emerged and spread rapidly for reasons unknown. A new strain of coronavirus (severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2]) was identified and caused the first pandemic of the 21st century. The virus was officially detected in our country on March 11, 2020, and the number of cases increased rapidly; the virus was isolated in 670 patients within 10 days. The rapid increase in the number of patients has required our physicians to learn to protect both the public and themselves when treating patients with this highly infectious disease. The group most affected by the outbreak and with the highest mortality rate is elderly patients with known cardiovascular disease. Therefore, it is necessary for cardiology specialists to take an active role in combating the epidemic. The aim of this article is to make a brief assessment of current information regarding the management of cardiovascular patients affected by COVID-19 and to provide practical suggestions to cardiology specialists about problems and questions they have frequently encountered.
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http://dx.doi.org/10.5543/tkda.2020.97198DOI Listing
March 2020

Snapshot evaluation of acute and chronic heart failure in real-life in Turkey: A follow-up data for mortality.

Anatol J Cardiol 2020 Feb;23(3):160-168

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

Objective: Heart failure (HF) is a progressive clinical syndrome. SELFIE-TR is a registry illustrating the overall HF patient profile of Turkey. Herein, all-cause mortality (ACM) data during follow-up were provided.

Methods: This is a prospective outcome analysis of SELFIE-TR. Patients were classified as acute HF (AHF) versus chronic HF (CHF) and HF with reduced ejection fraction (HFrEF), HF with mid-range ejection fraction, and HF with preserved ejection fraction and were followed up for ACM.

Results: There were 1054 patients with a mean age of 63.3±13.3 years and with a median follow-up period of 16 (7-17) months. Survival data within 1 year were available in 1022 patients. Crude ACM was 19.9% for 1 year in the whole group. ACM within 1 year was 13.7% versus 32.6% in patients with CHF and AHF, respectively (p<0.001). Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta blocker, and mineralocorticoid receptor antagonist were present in 70.6%, 88.2%, and 50.7%, respectively. In the whole cohort, survival curves were graded according to guideline-directed medical therapy (GDMT) scores ≤1 versus 2 versus 3 as 28% versus 20.2% versus 12.2%, respectively (p<0.001). Multivariate analysis of the whole cohort yielded age (p=0.009) and AHF (p=0.028) as independent predictors of mortality in 1 year.

Conclusion: One-year mortality is high in Turkish patients with HF compared with contemporary cohorts with AHF and CHF. Of note, GDMT score is influential on 1-year mortality being the most striking one on chronic HFrEF. On the other hand, in the whole cohort, age and AHF were the only independent predictors of death in 1 year.
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http://dx.doi.org/10.14744/AnatolJCardiol.2019.87894DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7222636PMC
February 2020

Arginine vasopressin and difficult triangle of heart failure, atrial fibrillation, and hyponatremia.

Hellenic J Cardiol 2020 Jul - Aug;61(4):296. Epub 2019 Nov 15.

Departments of Cardiology, Osmangazi University Medical School, Eskisehir, Turkey.

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http://dx.doi.org/10.1016/j.hjc.2019.10.001DOI Listing
December 2020

Cardiac amyloidosis: Recent advances in the diagnosis and therapy.

Turk Kardiyol Dern Ars 2019 06;47(Suppl 2):1-34

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

Cardiac amyloidosis (CA) is a progressive cardiomyopathy in which misfolded endogenous proteins form amyloid fibrils that deposit in the heart as well as kidneys, liver, gastrointestinal tract and soft tissues. The most common forms of CA include immunoglobulin light chain (AL) amyloidosis and transthyretin (TTR) amyloidosis. Although cardiac amyloidosis is thought to be a very rare disease, emerging data suggested that 13% of heart failure patients with preserved ejection fraction and 16-26% of advanced aged patients with severe aortic stenosis may have TTR-CA. Amyloidosis with cardiac involvement shows poor prognosis with a median survival of 6 months in AL-CA and 26-43 months in TTR-CA. Early diagnosis and novel therapeutic options have been shown to significantly improve prognosis. Recent diagnostic techniques such as cardiac MR or nuclear scintigraphy using bone isotopes as well as increasingly wide use of echocardiography, genetic testing, biopsy and histopathological analysis allow the clinicians to make early diagnosis of CA. The aim of this paper is to provide a comprehensive review including etiology, clinical presentation, diagnosis and management of CA and to address recent important advances in noninvasive cardiac imaging techniques and novel therapeutic approaches based on the available data in the literature.
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http://dx.doi.org/10.5543/tkda.2019.28035DOI Listing
June 2019

Initiation of sacubitril/valsartan in haemodynamically stabilised heart failure patients in hospital or early after discharge: primary results of the randomised TRANSITION study.

Eur J Heart Fail 2019 08 27;21(8):998-1007. Epub 2019 May 27.

Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain.

Aims: To assess tolerability and optimal time point for initiation of sacubitril/valsartan in patients stabilised after acute heart failure (AHF).

Methods And Results: TRANSITION was a randomised, multicentre, open-label study comparing two treatment initiation modalities of sacubitril/valsartan. Patients aged ≥ 18 years, hospitalised for AHF were stratified according to pre-admission use of renin-angiotensin-aldosterone system inhibitors and randomised (n = 1002) after stabilisation to initiate sacubitril/valsartan either ≥ 12-h pre-discharge or between Days 1-14 post-discharge. Starting dose (as per label) was 24/26 mg or 49/51 mg bid with up- or down-titration based on tolerability. The primary endpoint was the proportion of patients attaining 97/103 mg bid target dose after 10 weeks. Median time of first dose of sacubitril/valsartan from the day of discharge was Day -1 and Day +1 in the pre-discharge group and the post-discharge group, respectively. Comparable proportions of patients in the pre- and post-discharge initiation groups met the primary endpoint [45.4% vs. 50.7%; risk ratio (RR) 0.90; 95% confidence interval (CI) 0.79-1.02]. The proportion of patients who achieved and maintained for ≥ 2 weeks leading to Week 10, either 49/51 or 97/103 mg bid was 62.1% vs. 68.5% (RR 0.91; 95% CI 0.83-0.99); or any dose was 86.0% vs. 89.6% (RR 0.96; 95% CI 0.92-1.01). Discontinuation due to adverse events occurred in 7.3% vs. 4.9% of patients (RR 1.49; 95% CI 0.90-2.46).

Conclusions: Initiation of sacubitril/valsartan in a wide range of heart failure with reduced ejection fraction patients stabilised after an AHF event, either in hospital or shortly after discharge, is feasible with about half of the patients achieving target dose within 10 weeks.

Clinical Trial Registration: ClinicalTrials.gov ID: NCT02661217.
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http://dx.doi.org/10.1002/ejhf.1498DOI Listing
August 2019

[Snapshot evaluation of heart failure in Turkey: Baseline characteristics of SELFIE-TR].

Turk Kardiyol Dern Ars 2019 Apr;47(3):198-206

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

Objective: Heart failure (HF) is an important health issue of the 21st century and the prevalence in Turkey has been reported as 2.9%. A national profile, frequency data, characteristics of different phenotypes, and risk factors have not yet been well established. The Snapshot Evaluation of Heart Failure Patients in Turkey (SELFIE-TR) was an analysis of a representative sample of HF patients from Turkey.

Methods: A total of 23 centers with at least 2 cardiologists from the 12 NUTS-1 regions of Turkey were invited to participate in the research. The contributing centers shared the data of a consecutive enrollment of HF patients, as confirmed by an investigator, on a pre-selected day of each week for the month of October or November of 2015.

Results: The mean age of the entire cohort was 63.3+-13.3 years (male/female ratio: 751/303, 71.3%/28.7%). There were 712 acute HF patients and 342 chronic HF patients. The total number of HF patients with reduced ejection fraction (HFrEF), heart failure with mid-range ejection fraction, and heart failure with preserved ejection fraction was 801 (75%), 176 (16.7%), and 77 (7.3%), respectively. The patients with chronic HF were younger than those with acute HF (61.1+-13.3 years vs 67.9+-12.1 years; p<0.001). Among the whole cohort, hypertension was observed in 46%, diabetes mellitus was present in 27.5%, chronic obstructive pulmonary disease was present in 12.8%, and previous myocardial infarction was noted in 45.2%. In patients with HFrEF, the use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, a beta blocker, or a mineralocorticoid receptor antagonist was noted in 74.7%, 89.7%, and 60.9%, respectively.

Conclusion: The SELFIE-TR findings provide important insight, since it is the first study to make a snapshot of HF patients in our country. These data may help to create standardized prevention and treatment strategies.
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http://dx.doi.org/10.5543/tkda.2019.66877DOI Listing
April 2019

Natriuretic Peptides in Clinical Practice.

Anatol J Cardiol 2019 Mar;21(Suppl 1):1-40

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

Natriuretic peptides have long been introduced into clinical practice. These biomarkers have certainly been shown to provide useful information in the diagnosis, prognosis and risk stratification in heart failure and also may have a role in the guidance of heart failure therapy. Although, there are some limitations in using of these markers such as lack of specificity, aging, renal dysfunction or obesity, among the huge number of candidates for heart failure biomarkers, only natriuretic peptides are currently widely used in daily clinical practice in heart failure. Recent heart failure guidelines recognize natriuretic peptides as an essential tool in the new diagnostic and therapeutic algorithms. Furthermore, natriuretic peptides are not only used in the diagnosis or prognosis of heart failure, but also these biomarkers are referred to have some potential role in primary prevention, cardio-oncology, advanced heart failure, assessment of response to cardiac resynchronization therapy, pulmonary arterial hypertension, acute coronary syndromes, atrial fibrillation and valvular heart disease. In this article, natriuretic peptides have been reviewed for their updated information and new recommendations in heart failure and also potential role of these biomarkers in the management of various clinical conditions have been addressed in the form of expert opinion based on the available data in the literature.
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http://dx.doi.org/10.14744/AnatolJCardiol.2019.55623DOI Listing
March 2019

Editorial.

Anatol J Cardiol 2019 Mar;21(Suppl 1)

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

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http://dx.doi.org/10.14744/AnatolJCardiol.2019.54789DOI Listing
March 2019

Vaccination of adults with heart failure and chronic heart conditions: Expert opinion.

Turk Kardiyol Dern Ars 2018 12;46(8):723-734

Department of Cardiology, Mersin University Faculty of Medicine, Mersin, Turkey.

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http://dx.doi.org/10.5543/tkda.2018.10.5543/tkda.2018.37048DOI Listing
December 2018

Facts and details: Ivabradine in acute decompensated heart failure.

Int J Cardiol 2018 11;271:210

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

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http://dx.doi.org/10.1016/j.ijcard.2018.05.123DOI Listing
November 2018

Hyponatremia is associated with occurrence of atrial fibrillation in outpatients with heart failure and reduced ejection fraction.

Hellenic J Cardiol 2019 Mar - Apr;60(2):117-121. Epub 2018 Apr 3.

Cumhuriyet University Medical School, Department of Cardiology, Sivas, Turkey.

Objectives: Hyponatremia and atrial fibrillation (AF) have been established as strong predictors for worse clinical outcomes in patients with heart failure (HF). However, little is known about hyponatremia in relation to the occurrence of AF. This study aims to investigate the possible relationship between hyponatremia and AF in patients with chronic HF and reduced ejection fraction (HFrEF).

Methods: Turkish research team-HF (TREAT-HF) is a network that has been undertaking multicenter, observational cohort studies on HF. A total of 880 patients who had plasma sodium measurement in TREAT-HF data set were included in this study. Hyponatremia was defined as a plasma sodium level of ≤135 mmol/L. The patients were classified into hyponatremia (n=213) or normonatremia (n=667) based on the sodium level.

Results: The rate of AF was found to be 33.3% in patients with hyponatremia and 18.8% in patients with normonatremia (p<0.001). Univariate analysis demonstrated an association between hyponatremia and AF. Furthermore, in multivariate logistic regression model, hyponatremia was also found to be significantly and independently associated with the occurrence of AF (odds ratio [OR]=2.457, 95% confidence interval [CI]=1.586-3.806, p<0.001) in addition to other well-known risk factors for AF.

Conclusion: The results of this study showed that AF was more prevalent in outpatients with HFrEF and hyponatremia than in those with HFrEF and normonatremia. These results also suggest that hyponatremia is independently associated with the occurrence of AF.
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http://dx.doi.org/10.1016/j.hjc.2018.03.006DOI Listing
February 2020

Influences of cardiac resynchronization therapy on cardiac biomarkers in patients with chronic heart failure.

Turk Kardiyol Dern Ars 2018 03;46(2):81-83

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

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http://dx.doi.org/10.5543/tkda.2018.48280DOI Listing
March 2018

Fracture of the distal part of an implantable cardioverter-defibrillator lead two months after implantation.

Kardiol Pol 2018 ;76(2):472

Cardiology Department, Eskisehir Osmangazi University, Büyükdere Mahallesi, Eskisehir, Turkey.

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http://dx.doi.org/10.5603/KP.2018.0043DOI Listing
December 2018

Heart and brain interaction in patients with heart failure: overview and proposal for a taxonomy. A position paper from the Study Group on Heart and Brain Interaction of the Heart Failure Association.

Eur J Heart Fail 2018 02 27;20(2):199-215. Epub 2017 Dec 27.

University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.

Heart failure (HF) is a complex clinical syndrome with multiple interactions between the failing myocardium and cerebral (dys-)functions. Bi-directional feedback interactions between the heart and the brain are inherent in the pathophysiology of HF: (i) the impaired cardiac function affects cerebral structure and functional capacity, and (ii) neuronal signals impact on the cardiovascular continuum. These interactions contribute to the symptomatic presentation of HF patients and affect many co-morbidities of HF. Moreover, neuro-cardiac feedback signals significantly promote aggravation and further progression of HF and are causal in the poor prognosis of HF. The diversity and complexity of heart and brain interactions make it difficult to develop a comprehensive overview. In this paper a systematic approach is proposed to develop a comprehensive atlas of related conditions, signals and disease mechanisms of the interactions between the heart and the brain in HF. The proposed taxonomy is based on pathophysiological principles. Impaired perfusion of the brain may represent one major category, with acute (cardio-embolic) or chronic (haemodynamic failure) low perfusion being sub-categories with mostly different consequences (i.e. ischaemic stroke or cognitive impairment, respectively). Further categories include impairment of higher cortical function (mood, cognition), of brain stem function (sympathetic over-activation, neuro-cardiac reflexes). Treatment-related interactions could be categorized as medical, interventional and device-related interactions. Also interactions due to specific diseases are categorized. A methodical approach to categorize the interdependency of heart and brain may help to integrate individual research areas into an overall picture.
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http://dx.doi.org/10.1002/ejhf.1100DOI Listing
February 2018

Use of tolvaptan in patients hospitalized for worsening chronic heart failure with severe hyponatremia: The initial experience at a single-center in Turkey.

Turk Kardiyol Dern Ars 2017 Jul;45(5):415-425

Department of Cardiology, Uludağ University Faculty of Medicine, Bursa, Turkey.

Objective: The aim of the present study was to assess the efficacy and safety of tolvaptan for severe hyponatremia (SH) in hypervolemic heart failure (HF) patients within daily clinical practice.

Methods: We restrospectively reviewed our database on tolvaptan as an add-on treatment in hypervolemic patients admitted to our clinic due to deterioration of HF and having hyponatremia resistant to standard therapy. Severe hyponatremia was defined as serum sodium concentration ≤125 mEq/L. The database included demographic, clinical, laboratory, and echocardiographic findings on admission, and numerous outcome measures for oral tolvaptan treatment were used to assess its efficacy and safety.

Results: The study group consisted of 56 hypervolemic HF patients with severe hyponatremia (25 female and 31 male) with mean age of 66 years. All patients received a single dose of tolvaptan 15 mg daily for an average of 3.2 days due to severe hyponatremia. Sodium and potassium concentrations, fluid intake, and urine volume increased (p<0.0001, p=0.037, p<0.0001, and p<0.0001, respectively), whereas furosemide dosage, body weight, heart rate, systolic and diastolic blood pressure, and New York Heart Association class decreased significantly in response to tolvaptan treatment, without a rise in serum creatinine or urea concentrations (p<0.0001, p<0.0001, p=0.001, p<0.049, p<0.009 ve p=0.001, respectively).

Conclusion: In this retrospective, single-centered study conducted in a small group of Turkish patients, short-term treatment with low-dose tolvaptan added to standard therapy of hypervolemic HF patients with severe hyponatremia was well tolerated with a low rate of major side effects and was effective in correcting severe hyponatremia.
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http://dx.doi.org/10.5543/tkda.2017.80026DOI Listing
July 2017

Effects of ivabradine and beta-blocker therapy on dobutamine-induced ventricular arrhythmias.

Kardiol Pol 2017 25;75(8):786-793. Epub 2017 May 25.

Department of Cardiology, Eskisehir Yunus Emre State Hospital, Eskisehir, Turkey, Turkey.

Background: Indirect evidences suggest that the If blocker ivabradine may exert an antiarrhythmic effect in ventricular myocardium in heart failure (HF) patients by inhibiting spontaneous depolarisations, but the clinical relevance of this mechanism is not known. Dobutamine (DOB) has been known to increase heart rate and the incidence of cardiac arrhythmias.

Aim: In this study, we evaluated the effects of ivabradine on DOB-induced ventricular arrhythmias and compared them with those of beta-blocker (BB) therapy.

Methods: Patients with decompensated HF requiring inotropic support, left ventricular ejection fraction < 35%, and in sinus rhythm were included in the study (ivabradine group - 29 patients, control group - 29 patients, BB group - 15 patients). All patients underwent Holter recording for 6 h before the initiation of DOB infusion. Following baseline recording, DOB was administered at incremental doses of 5, 10, and 15 μg/kg/min, with 6-h steps. Holter monitoring was continued during 18 h of DOB infusion and analysed for the median number of ventricular premature contractions (VPC), ventricular couplets, episodes of non-sustained ventricular tachycardia, and total ventricular arrhythmias in each step of the study protocol.

Results: The positive chronotropic effect of incremental DOB doses was blunted by beta-blockade and was totally abolished by ivabradine. The median number of VPCs, ventricular couplets, and total ventricular arrhythmias significantly increased with incremental doses of DOB in the control group (p = 0.018) and, to a lesser extent, in the ivabradine group (p = 0.015). In the BB group the absolute VPCs numbers were smaller than in the control or the ivabradine group, with the on-ivabradine VPCs numbers falling between those seen in control and BB groups. A numeric increase in VPCs with incremental DOB doses occurred in the BB group but did not reach statistical significance (p > 0.05), consistent with a protective effect of beta-blockade. Ivabradine reduced VPCs by 43% at 5 μg/kg/min DOB and by 38% at 10 μg/kg/min DOB against the control group (VPCs median 256 vs. 147 and 251 vs. 158) in the absence of significant differences at 15 μg/kg/min DOB between the control and ivabradine groups (overall p > 0.05). Thus, ivabradine administered without background beta-blockade attenuated the arrhythmogenic effect of increasing doses of DOB in the low and moderate DOB dose but not in the high DOB dose.

Conclusions: In patients with decompensated HF, ivabradine appears to reduce the incidence of VPCs in response to low and medium DOB dose. Whether the anti-arrhythmic effect of ivabradine is additive to the anti-arrhythmic effect of beta-blockade requires further investigation; this should also determine the clinical significance of ventricular arrhythmia attenuation with ivabradine.
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http://dx.doi.org/10.5603/KP.a2017.0094DOI Listing
December 2017

Iron deficiency and anemia in heart failure.

Turk Kardiyol Dern Ars 2017 Mar;45(Suppl 2):1-38

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

Heart failure is an important community health problem. Prevalence and incidence of heart failure have continued to rise over the years. Despite recent advances in heart failure therapy, prognosis is still poor, rehospitalization rate is very high, and quality of life is worse. Co-morbidities in heart failure have negative impact on clinical course of the disease, further impair prognosis, and add difficulties to treatment of clinical picture. Therefore, successful management of co-morbidities is strongly recommended in addition to conventional therapy for heart failure. One of the most common co-morbidities in heart failure is presence of iron deficiency and anemia. Current evidence suggests that iron deficiency and anemia are more prevalent in patients with heart failure and reduced ejection fraction, as well as those with heart failure and preserved ejection fraction. Moreover, iron deficiency and anemia are referred to as independent predictors for poor prognosis in heart failure. There is strong relationship between iron deficiency or anemia and severity of clinical status of heart failure. Over the last two decades, many clinical investigations have been conducted on clinical effectiveness of treatment of iron deficiency or anemia with oral iron, intravenous iron, and erythropoietin therapies. Studies with oral iron and erythropoietin therapies did not provide any clinical benefit and, in fact, these therapies have been shown to be associated with increase in adverse clinical outcomes. However, clinical trials in patients with iron deficiency in the presence or absence of anemia have demonstrated considerable clinical benefits of intravenous iron therapy, and based on these positive outcomes, iron deficiency has become target of therapy in management of heart failure. The present report assesses current approaches to iron deficiency and anemia in heart failure in light of recent evidence.
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http://dx.doi.org/10.5543/tkda.2017.79584DOI Listing
March 2017