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All-cause Mortality Can Be Predicted in Patients with Chronic Total Occlusion with CONUT and PNI Scores
(2023) Özbek, Mehmet; Demir, Muhammed; Aktan, Adem; Güzel, Tuncay
Objective: CTO is defined as 100% occlusion of a coronary artery for more than one month. Nutritional status has been shown to be a prognostic marker in many clinical situations. CONUT and PNI scores are objective indices that can be calculated based on simple blood parameters and can be used to evaluate the nutritional status of patients. The aim of this study was to examine the effect of nutritional status assessed by CONUT and PNI on all-cause mortality in patients with CTO. Material and Method: The retrospective study included 516 patients who had CTO on coronary angiography. The nutritional status of the patients was evaluated with PNI and CONUT scores, and categorical groups were formed according to these results and compared. Results: All-cause mortality occurred in 127 (24.6%) patients during median follow-up period of 48 months. At the end of the follow-up period, the patients were divided into two groups as survival and non-survival. In terms of all-cause mortality, mean PNI score (47,87±6,31 vs. 42,41±6,57) and median CONUT score (1(2) vs. 3(3)) differed significantly between the surviving and non-surviving groups (p <0.001). Kaplan-Meier analysis showed a significant difference in survival between the PNI and CONUT scores cathegorical groups (p <0.001). Conclusion: Higher CONUT scores and lower PNI scores were found to be associated with poor outcomes in CTO patients. Evaluation and monitoring of nutritional status in CTO patients by these nutritional scores may provide additional prognostic information.
Assessment of left atrial volumes and functions in patients with coronary slow flow
(Galenos Yayınevi, 2021) Aslan, Burhan; Peker, Tezcan; Tenekecioğlu, Erhan; Aktan, Adem; Özbek, Mehmet; Karadeniz, Muhammed; Çil, Habip
Objectives: Coronary slow flow phenomenon (CSFP) is the slow or late progression of the opaque material to the distal vascular structures during angiography in patients with normal or near-normal coronary arteries. This study aims to evaluate left atrial volumes and functions using conventional transthoracic and tissue Doppler echocardiographic parameters in patients with CSFP. Materials and Methods: According to criteria determined by Gibson, 50 patients with slow flow in at least one coronary artery were included as cases, and 40 subjects with normal coronary flow were included as controls. Results: In the transmitral and tissue Doppler analysis, mitral early velocity (E), mitral late velocity/mitral early velocity (E/A), and Em were significantly lower in the coronary slow flow (CSF) group. LA, Am, mitral early velocity/earlydiastolic velocity (E/Em), LAVmax, LAVmin, LAVpreA, index volumes, LAAEV, LATEV, and LAAEF were found to be higher in the CSF group. A significant positive correlation was observed between Frame LAD and LAAEF (r=0.66, p<0.001) and between Frame LAD and E/Em (r=0.34, p<0.001). A significant negative correlation was found between LAAEF and E/A ratio (r=-0.4, p=0.003). There was also a significant positive correlation between LAPEF and E/A (r=0.44, p<0.001) and between the mean frame and LAAEF (r=0.4, p=0.002). Conclusion: Impaired LV diastolic functions and significant changes in LA volumes were found in patients with CSFP.
Association Between ABO Blood Group, Peripheral Artery Disease Lesion Severity, and Coronary Artery Disease Coexistence
(Elsevier Inc., 2025) Evsen, Ali; Aktan, Adem; Kılıç, Raif; Özbek, Mehmet
Background: This study aims to investigate the relationship between ABO blood groups and the severity of peripheral artery disease (PAD) lesions, the coexistence of coronary artery disease (CAD) with PAD, and to identify which blood groups may be more predisposed to these conditions. Methods: This study, which has a single-center and retrospective design, includes 305 patients diagnosed with peripheral artery disease (PAD) between 2015 and 2021. The patients were selected from those with at least 50% stenosis detected by computed tomography (CT) angiography. The severity of PAD lesions was evaluated according to the TransAtlantic Inter-Society Consensus (TASC-II) classification, and the presence of CAD was determined by simultaneous conventional coronary angiography. Demographic data, comorbidities, and laboratory results were collected, and statistical analyses were performed using chi-square tests, logistic regression, and t-tests. All of these patients were divided into 2 groups based on their ABO blood types: O and non-O blood groups. Results: This study demonstrates a significant relationship between blood group classification and both the severity of PAD and the prevalence of CAD. Patients with non-O blood groups exhibited a higher likelihood of having severe PAD lesions (TASC-C and TASC-D) compared to those with O blood groups, who more frequently had milder lesions (TASC-A and TASC-B) (P < 0.001). The prevalence of CAD was also significantly higher among patients with non-O blood groups than those with the O blood group (54.4% vs. 36.4%; P = 0.003). In the logistic regression analysis, non-O blood groups, alongside age, hypertension (HT), and chronic kidney disease (CKD), emerged as independent predictors of severe PAD (P < 0.001 for non-O blood groups). Similarly, older age and non-O blood group status were identified as significant independent predictors of CAD (P = 0.004). These findings suggest that blood group classification, particularly non-O groups, may influence the severity and coexistence of PAD and CAD. Conclusion: Our study reveals a significant association between ABO blood groups and both the severity of PAD and the association of CAD, and shows that non-O blood groups are linked to more severe forms of these conditions. These findings highlight the potential role of ABO blood groups in cardiovascular risk stratification, suggesting a need for further research to confirm these associations and understand their clinical implications. © 2025 Elsevier Inc.
Can empagliflozin improve left ventricular strain parameters in patients with type-2 diabetes mellitus and normal ejection fraction?
(Dicle Üniversitesi Tıp Fakültesi, 2022) Işık, Ferhat; Aslan, Burhan; Bilge, Önder; İnci, Ümit; Taştan, Ercan; Akyüz, Abdurrahman; Demir, Muhammed; Özbek, Mehmet; Akın, Halil; Araç, Eşref
Objectives: Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are known to improve symptoms and reduce mortality in patients with heart failure (HF). Empagliflozin is an SGLT-2 inhibitor. Although empagliflozin is beneficial in patients with type-2 diabetes mellitus (DM) with or without HF, data on how empagliflozin affects echocardiographic parameters are limited. We aim to evaluate the changes in left ventricular myocardial strain parameters with 2-dimensional speckle-tracking echocardiography (2D-STE) in patients with type-2 DM and normal ejection fraction (EF) after empagliflozin treatment. Methods: A total of 92 participants were included in our study. Forty-eight of them had type-2 DM and 44 were the control group. The left ventricular ejection fraction (LVEF) of the type-2 DM patients was normal, and there were no HF symptoms and findings. Empagliflozin 10 mg once daily was given to the diabetic group. Initial and at the end of the 3rd month, the 2D-STE parameters of the diabetic group were compared. Results: The median age of the study population was 52.0 (46.0-58.0, IQR), and 48 (52.1%) were female. The left ventricle global longitudinal strain (LV-GLS), left ventricle global circumferential strain (LV-GCS), and left ventricular global radial strain (LV-GRS) were less in the diabetic group than in the control group (p value < 0.001, < 0.001, and < 0.001, respectively). There was a significant increase in the LV-GLS and LV-GCS compared to before empagliflozin treatment (-20.0 [-17.6;-20.9] vs -19.2 [-17.5;-20.2], p= 0.005 and -18.9 [-16.0;-20.8] vs -17.1 [-15.8;-18.7], p= 0.003, respectively). Although the LV-GRS increased compared to baseline, the change was not significant (37.0 [31.0-41.6] vs 36.3 [32.4-40.3], p= 0.776). Conclusion: In our study, after empagliflozin treatment left ventricular myocardial strain parameters such as LV-GLS and LV-GCS were improved in patients with type-2 DM and normal EF.
Catastrophic embolism of a suddenly ruptured isolated cardiac cyst hydatid: An unusual case report
(Bayçınar Tıbbi Yayıncılık, 2023) Özbek, Mehmet; Demir, Muhammed; Karaçalılar, Mehmet; Aktan, Adem
Hydatid cysts can be located in any organ or tissue system. Cardiac hydatid cyst is a rare, but fatal pathology. A 21-year-old male Syrian refugee patient with no previous known medical conditions was admitted to the hospital for chest pain and shortness of breath. He had increasing leg pain for 12 hours. Hydatid cyst rupture was detected on echocardiography. The peripheral artery thrombus and hydatid cyst membrane were removed with the embolectomy. The patient had renal and cranial infarctions. He underwent fasciotomy due to compartment syndrome. In conclusion, delayed diagnosis and treatment of cardiac hydatid cysts may result in a poor prognosis associated with the risk of rupture and is responsible for the spread of infection throughout the body as a result of the rupture. Even if there is an early diagnosis, surgical treatment supported by medical treatment is recommended very early.
Cell-specific expression pattern of toll-like receptors and their roles in animal reproduction
(Springer Science and Business Media Deutschland GmbH, 2022) Atlı, Mehmet Osman; Hitit, Mustafa; Özbek, Mehmet; Köse, Mehmet; Bozkaya, Faruk; 0000-0001-9853-5334; 0000-0001-5636-061X; 0000-0003-0070-8458
Toll-like receptors (TLRs), a part of the innate immune system, have critical roles in protection against infections and involve in basic pathology and physiology. Secreted molecules from the body or pathogens could be a ligand for induction of the TLR system. There are many immune and non-immune types of cells that express at a least single TLR on their surface or cytoplasm. Those cells may be a player in a defense system or in the physiological regulation mechanisms. Reproductive tract and organs contain different types of cells that have essential functions such as hormone production, providing an environment for embryo/fetus, germ cell production, etc. Although lower parts of reproductive organs are in a relationship with outsider contaminants (bacteria, viruses, etc.), upper parts should be sterile to provide a healthy pregnancy and germ cell production. In those areas, TLRs bear controller or regulator roles. In this chapter, we will provide current information about physiological functions of TLR in the cells of the reproductive organs and tract, and especially about their roles in follicle selection, maturation, follicular atresia, ovulation, corpus luteum (CL) formation and regression, establishment and maintenance of pregnancy, sperm production, maturation, capacitation as well as the relationship between TLR polymorphism and reproduction in domestic animals. We will also discuss pathogen-associated molecular patterns (PAMPs)-induced TLRs that involve in reproductive inflammation/pathology.
A comparison of postoperative complications following cardiac implantable electronic device procedures in patients treated with antithrombotic drugs
(Wiley, 2022) Demir, Muhammed; Özbek, Mehmet; Polat, Nihat; Aktan, Adem; Yıldırım, Bünyamin; Argun, Lokman; İldırımlı, Kamran; Toprak, Nizamettin
Background The incidence of postoperative complications following cardiac implantable electronic device (CIED) procedures in patients treated with antithrombotic drugs has not been studied sufficiently. Here we present a comparison of complications after CIED implantations. Methods Using an observational study design, the study included 1807 patients with a taking antiplatelet drugs (n: 1601), nonvitamin K anticoagulants (NOAC) (n: 136), and warfarin (n: 70) undergoing CIED surgery. Primary endpoint was accepted as cumulative events including composite of clinically significant hematoma (CSH), pericardial effusion or tamponade, pneumothorax, and infection related to device system. Secondary outcomes included each compenent of cumulative events. Multivariable analysis was performed to identify predictors of cumulative events. Results The overall cumulative event rate was 3.7% (67 of 1807). Cumulative events occured 3.1% (50 of 1601) in the antiplatelet, 5.1% (7 of 136) NOAC, and 14.3% (10 of 70) warfarin groups (p < 0.001). CSH occurred in 2 of 70 patients (2.9%) in the warfarin group, as compared with 5 of 1601 (0.3%) in the antiplatelet group (p: 0.032). However, no significant differences were found between NOAC and warfarin groups in terms of CSH (0.7% vs. 2.9% respectively, p: 0.267). Warfarin treatment was an independent predictor of cumulative events and increased 2.9-fold the risk of cumulative events. Major surgical complications were rare and did not differ significantly between the study groups. Conclusions The incidence and severity of complications may be lower in patients treated with periprocedurally antiplatelet or NOAC therapy when compared with warfarin therapy. Further randomized control studies are required to confirm our findings
COVID-19 ve kardiyovasküler hastalıklar
(Dicle Üniversitesi Tıp Fakültesi, 2021) Demir, Muhammed; Özbek, Mehmet; Şimşek, Hakkı
Koronavirüs hastalığı 2019 (COVID-19), şiddetli akut solunum sendromu koronavirüs 2 (Sars-CoV-2)’nin yol açtığı bir viral enfeksiyondur. İlk kez Aralık 2019'da Çin'in Wuhan şehrinde tespit edildi ve küresel bir sağlık krizine dönüştü. Bu derlemede COVID-19 ile kardiyovasküler hastalıkların ilişkisi, fizyopatolojisi, klinik seyri, prognozu ve tedavi yönetimi ele alındı. Pubmed, Google Scholar, Scopus, Science Direct veri tabanlarından COVID-19 ve kardiyovasküler hastalıklarla ilişkili bilimsel araştırmalar derlendi. Hastalığın epidemiyolojisi, fizyopatolojisi, kardiyovasküler hastalıklarla ilişkisi, klinik seyri ele alındı. COVID-19’un aritmilerden, kalp yetmezliğine kadar geniş spektrumda kalp hastalıklarıyla yakından ilişkili olduğu, aynı zamanda var olan kardiyovasküler hastalıkların COVID-19’un morbidite ve mortalitesini belirgin derecede artırdığı izlendi.
Dependence of clinical outcomes on time of hospital admission in patients with ST-segment elevation myocardial infarction
(King Faisal Specialist Hospital and Research Centre, 2023) Özbek, Mehmet; Ildirimli, Kamran; Arık, Baran; Aktan, Adem; Coşkun, Mehmet Sait; Evsen, Ali; Güzel, Tuncay; Acet, Halit; Demira, Muhammed
BACKGROUND: There are conflicting results in studies investigating the effects of percutaneous coronary intervention (PCI) on the prognosis of patients with ST-segment elevation myocardial infarction (STEMI) during or outside of usual hospital working hours. While some researchers have reported higher mortality rates in STEMI patients admitted outside of working hours, others did not find a statistically significant difference. OBJECTIVES: Investigate the short-term endpoints and long-term outcomes of STEMI patients by time of admission. DESIGN: Retrospective SETTING: Tertiary percutaneous coronary intervention center. PATIENTS AND METHODS: Patients were grouped by admission, which consisted of four intervals: 06:00 to <12:00, 12:00 to <18:00, 18:00 to <24:00, and 24:00 to <06:00. We analyzed demographic, clinical and mortality by admission time interval and mortality by multivariate analyses, including the time intervals. MAIN OUTCOME MEASURES: Clinical data and mortality SAMPLE SIZE: 735 patients; median (IQR) age 62 (22) years; 215 (29.3%) women. RESULTS: Patients admitted at night were 1.37 times more likely to experience pulmonary edema than patients whose symptoms started in the daytime (P=.012); 32.9% of the patients whose symptoms started at night presented with Killip class II-IV, while during the daytime, 21.4% presented with Killip class II-IV (P=.001). Among the patients, the most common was inferior STEMI (38.6%). However, no-reflow was significantly higher during the daytime compared to the nighttime (P=.12). The risk of the cardiac arrest on admission was 1.2 times higher in patients admitted at night (P=.034). Neither time interval of admission nor several other variables had an effect on clinical outcome or mortality. CONCLUSIONS: While patients admitted at night presented with pulmonary edema and cardiogenic shock more frequently, no reflow was observed during the day after the procedure. Although patients admitted at night with STEMI presented with worse clinical conditions, similar results were observed between the groups in clinical outcomes. LIMITATIONS: More “real world” results might have been obtained if the study had replicated more typical referral conditions for PCI. CONFLICT OF INTEREST: None.
The effect of COVID-19 pandemic on time in therapeutic range in patients using warfarin
(Wolters Kluwer Medknow Publications, 2022) Aktan, Adem; Güzel, Tuncay; Arslan, Bayram; Özbek, Mehmet; Demir, Muhammed; Aslan, Burhan
Introduction: Patients receiving anticoagulant therapy experience a serious problem at a time when the rates of outpatient visits for the international normalized ratio (INR) monitoring are gradually decreasing owing to the risk of virus transmission during the pandemic. The aim of this multicenter study was to investigate how the coronavirus disease 2019 pandemic affected the time in therapeutic range (TTR) value, which shows the use of effective doses of warfarin, and its monitoring in patients using warfarin. Materials and Methods: A total of 158 patients with 3 consecutive prepandemic INR levels and at least 3 postpandemic INR levels without time limitation were retrospectively evaluated. TTR values were calculated and the preepidemic and postepidemic values were compared. TTR was obtained using the conventional method. Results: The mean preepidemic and postepidemic TTR values were found to be 64.4 (61.8%-67.0%) and 34.9 (30.8%-39.0%), respectively. TTR rate was statistically significantly lower in the postpandemic period than in the prepandemic period (P < 0.001). While the prepandemic TTR of 68 (43%) patients was <60, the postpandemic TTR of 125 (79%) patients was <60. Discussion and Conclusion: Patients using warfarin were found to have lower TTR values during the pandemic. One of the most important reasons for this result is patients' delayed admission to the hospital due to fear of infection. The importance of regular follow-ups and alternative solutions should be emphasized for the effective treatment of these patients.
Factors associated with all-cause mortality in patients with coronary artery chronic total occlusions undergoing revascularization (percutaneous coronary intervention or surgery) or medical treatment
(Russian Heart Failure Soc., 2022) Aslan, Burhan; Özbek, Mehmet; Aktan, Adem; Boyraz, Bedrettin; Tenekecioğlu, Erhan
Aim Chronic total occlusion of a coronary artery (CTO) is a predictor of early and late cardiovascular mortality and poor cardiovascular outcomes in patients with coronary artery disease. The purpose of this study was to identify predictors of all-cause mortality in CTO patients that underwent invasive treatment. Material and methods Patients between 2012 and 2018 with CTO in at least one vessel, as demonstrated by coronary angiography, were included retrospectively in the study. The patients were divided into two groups, an intervention group (percutaneous and surgical revascularization) and a medical group. Results A total of 543 patients were studied, 152 females (28%) and 391 males (72%). The median follow-up period was 49 (26-72) mos. A total of 186 (34.2%) patients in the medical group and 357 (65.8%) patients in the invasive therapy group were followed. The 5-yr death rate was observed in 50 (26.9%) patients in the medical group and 53 (14.8%) patients in the intervention group, and it was found to be statistically higher in the medical group (p=0.001). In multivariable analysis, heart failure (odds ratio (OR): 1.92, 95% CI: 1.18-3.14; p=0.01), higher glucose levels (OR: 1.05, 95% CI: 1,02-1.08; p=0.04), lower albumin levels (OR: 0.49, 95% CI: 0.32-0.72; p=0.001), SYNTAX score (OR: 1.03, 95% CI: 1.01-1.05; p=0.001), and CTO (>= 2 occluded artery) (OR: 0.42, 95% CI: 0.22-0.72; p=0.01) were independent factors for all-cause mortality. Conclusion In comparison to the revascularized group, there was an increase in mortality among CTO patients treated medically. Heart failure, SYNTAX score, albumin, glucose, and CTO (>= 2 occluded arteries) were independent risk factors for all-cause mortality.
Fibrinogen to albumin ratio predicts burden of coronary artery disease in patients with NSTEMI
(Dicle Üniversitesi Tıp Fakültesi, 2021) Demir, Muhammed; Özbek, Mehmet; Aktan, Adem; Ertaş, Faruk
Objective: Fibrinogen plasma level rises in the event of inflammatory cases. It is known that there is a powerful intercourse between fibrinogen level and plasma viscosity. Albumin plasma level dropes during the inflammatory cases. The aim of this work determine significance of fibrinogen albumin ratio (FAR) as a indicator emphases the burden of atherosclerosis. Method: The study included 83 patients diagnosed with non-ST-segment elevation myocardial infarction (NSTEMI) between January and September 2015. The definition of NSTEMI was made according to “Definition of Third Universal Myocardial Infarction” guidelines published on 2013 by European Society of Cardiology. Burden of atherosclerosis was evaluated by Syntax score (SS) and Gensini Score. Patients were seperated two groups as medium-high SS (n=23) and low SS (n=60). FAR levels were compared. Results: FAR was 80.71 ± 30.3 in low SS group and 120 ± 49.72 in the mid-high SS group respectively (p <0.001). In correlation evaluation, FAR and SS showed a poor positive correlation (r = 0.496, p <0.001). In multivariate logistic regression assesment of elements impacting the SS, prominent variable was found to be FAR [p = 0.01, 95% CI (1005- 1042)]. In ROC evaluation FAR values of 85 and over demonstrated 83% sensitivity and 68% specificity in determining the burden of coronary artery disease (CAD). Conclusions: In moderate-high SS group FAR value is considerably higher than those with a low SS group. FAR value may be usefull indicator in clinical practice to determine the burden of coronary artery disease.
Global longitudinal strain score predicts all cause death in patients with chronic total occlusion with preserved ejection fraction
(Verduci Editore s.r.l, 2022) Özbek, Mehmet; Bilik, Mehmet Zihni; Demir, Muhammed; Arık, Baran; Şimşek, Hakkı; Ertaş, Faruk; Toprak, Nizamettin
OBJECTIVE: Change in LVEF is one of the most important indicators of prognosis in CTO cases. Studies in patients with CTO have shown improvement in LVEF approximately at 3 and 6 months after successful PCI. It has been shown that LV global longitudinal strain (GLS) starts to improve even 1 day after CTOPCI. We aimed at investigating the effect of subclinical echocardiographic involvement on allcause mortality in the group with CTO and preserved ejection fraction by evaluating the LV GLS score. PATIENTS AND METHODS: Patients with LVEF ≥ 50% were considered to have preserved ejection fraction and were included in the study. The endpoint of the study was all-cause death. For this retrospective study, 1,171 patients with coronary angiography who had had CTO in any of their vessels were screened. RESULTS: A total of 86 consecutive patients were reviewed in the study. The optimum GLS score cut-off value (≥ 14.18) for predicting mortality was determined using receiver operating characteristic (ROC) curve analysis (AUC: 0.897, sensitivity 87.5%, specificity 81.5% p<0.001). At a mean follow-up of 49 months, a significant difference was found between the two groups in all-cause mortality determined by the GLS score [2 (3.4%) vs. 14 (51.9%), p<0.001]. A significant difference in mortality was observed between the group with a low GLS score and the group with a high GLS score, according to Kaplan-Meier analysis. The effect of GLS score in predicting all-cause mortality was demonstrated in multivariate cox regression analysis (Low GLS score; OR: 6.36 95%CI (1.039-39.013), p=0.045). Cox regression multivariate analysis and the effect of GLS score in predicting mortality were observed [Low GLS score; OR: 6.368 95%CI (1.039-39.013), p=0.045]. CONCLUSIONS: As a predictor, GLS may be a valuable marker of cardiac subclinical dysfunction for all caused mortality in CTO patients.
Impact of nutritional assessment on long-term outcomes in patients with carotid artery stenting
(Wiley, 2021) Demir, Muhammed; Özbek, Mehmet
Background and Aims Malnutrition is associated with poor clinical outcomes in many diseases. The Controlling Nutritional Status (CONUT) is an objective index used for evaluating nutritional status of hospitalised patients. The aim of this study was to investigate the relationship between malnutrition assessed by CONUT score and the prognosis in patients undergoing carotid artery stenting (CAS). Methods and Results The study included 170 patients who underwent CAS because of symptomatic or asymptomatic severe carotid artery stenosis. Median follow-up period was 50 (interquartile range [IQR], 41-60) months. Patients were divided into two groups according to the CONUT score as normal CONUT (score <2) and mild-severe CONUT (score >= 2). Primary endpoint was accepted as MACE (major adverse cardiac events) including all-cause death and ischaemic stroke. The prevalence of MACE was significantly higher in the mild-severe CONUT score group (P = .001). Kaplan Meier analysis showed lower survival rates in the mild-severe CONUT score group (log rank = 9.36, P = .002; Figure 5). The Cox regression analysis showed that, the CONUT score was associated with increased risk of MACE for both unadjusted model and age- and gender- adjusted model, while in a full adjusted model the best predictor was age. Conclusion Higher CONUT scores were associated with adverse outcomes in patients with CAS. Malnutrition assessed by the CONUT score is preferable with regards to the detection of MACE in patients with CAS. Larger studies are warranted to investigate if our preliminary findings translate into clinical outcomes in patients with CAS.
Is There a Relationship between Anxiety-depression Level and SYNTAX Score in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention?
(2024) Kaya, Ahmet Ferhat; Yılmaz, Cemalettin; Özdil, Mehmet Hasan; Soner, Serdar; Özbek, Mehmet
Amaç: SYNTAX (PCI with TAXUS ve Cardiac Surgery arasındaki SYNergy) skoru, koroner arter hastalığı olan hastalarda hastalığın ciddiyetini ve yaygınlığını değerlendirmek için kullanılan kantitatif bir skorlama sistemidir. HADS (Hastane Anksiyete ve Depresyon Ölçeği), hastaların anksiyete ve depresyon düzeylerini ölçen bir ölçektir. Psikososyal stres ve ateroskleroz arasındaki ilişki iyi bilinmektedir. Bu çalışmada akut koroner sendrom (AKS) nedeniyle perkütan koroner girişim uygulanan hastalarda SYNTAX skoru ile HADS arasındaki ilişkiyi incelemeyi amaçladık. Gereç ve Yöntem: Çalışmamıza AKS'li toplam 130 hasta dahil edildi. İki bağımsız girişimsel kardiyolog tarafından hesaplanan SYNTAX skoru 0-22, düşük; 23-32, orta; 33 ve üstü, yüksek olarak üç gruba ayrıldı. Çalışmamızda, hastaların anksiyete ve depresyon düzeyleri AKS'den bir ay sonra HADS ile değerlendirildi. Bulgular: SYNTAX skoru 0-22, 23-32, >33 grubunda sırasıyla 68, 39 ve 23 hasta saptandı. Yüksek SYNTAX puanı ile HAD-depresyon ve anksiyete ölçeği arasında anlamlı bir ilişki gözlendi (sırasıyla p<0.001, p<0.001). Korelasyon analizinde SYNTAX puanı ile depresyon düzeyi arasında pozitif yönde orta düzeyde, SYNTAX puanı ile kaygı düzeyi arasında pozitif yönde zayıf bir ilişki bulundu (sırasıyla r=0.642, r=0.538). Sonuç: Çalışmamızda perkütan koroner girişim uygulanan AKS hastalarında HADS ve SYNTAX skorları arasında anlamlı korelasyon saptandı.
Multiple skleroz hastalarının sol ventrikül fonksiyonlarının strain ekokardiyografi ile değerlendirilmesi
(2017) Özbek, Mehmet; Akıl, Mehmet Ata
Multiple skleroz (MS), merkezi sinir sisteminde (MSS) beyaz madde ön planda olmak üzere fokal demiyelinize plaklarla karakterize kronik inflamatuar bir hastalıktır. Bu açıdan MS; kronik, otoimmün, inflamatuar, demiyelinizan ve nörodejeneratif bir hastalık olarak tanımlanır. Multiple sklerozun akciğer, üriner sistem ve gastrointestinal sistem benzeri farklı organlarda oluşturduğu anormallikler bilinmesine rağmen kardiyovasküler sistem üzerindeki etkileri iyi bilinmemektedir. Literatürde sağ ventrikül (SğV) ve sol ventrikül (SV) fonksiyonlarını inceleyen az sayıda çalışma vardır ve bu çalışmaların sonuçları çelişkili olarak görülmüştür. MS’de kardiyovasküler sistem disfonksiyonu sık rastlanan bir bulgudur. MS hastalarındaki kardiyovasküler sistem bozuklukları otonom sinir sistemi disfonksiyonu sebebiyle olabilir. Kardiyovasküler sempatik ve parasempatik testlerdeki anormallikler birçok yazar tarafından rapor edilmiştir. MS’deki kardiyak etkilenmenin, yeni ekokardiyografik yöntemler ile daha fazla araştırılmasına ihtiyaç vardır. Strain (S) ve strain rate (SR) ekokardiyografinin, MS’deki subklinik miyokardiyal fonksiyon bozukluğunu göstermede yararlı olabileceğinden hareketle böyle bir çalışma planladık. Çalışmamız, 2016 yılında, Nöroloji Anabilim Dalı polikliniğine başvuran ve MS tanısı alan 44 hastadan oluşan hasta ve 40 sağlıklı bireyi içeren kontrol grupları üzerinde yapıldı. Bireylerin ekokardiyografi ile kardiyak fonksiyonları incelendi. Doppler kayıtlarından S ve SR verileri elde edildi. Hasta ve kontrol gruplarının yaş ve cinsiyet gibi değişkenleri her iki grupta benzerdi. Grupları karşılaştırdığımızda, hasta grubunda diyastolik fonksiyon bozukluğunun daha fazla olduğunu bulduk. MS hastalarındaki mitral anüler hızları sağlıklı gruba göre anlamlı olarak daha düşük ölçtük. MS hastalarında kontrol grubuyla karşılaştırıldığında, bazal lateral, bazal anterior, mid inferior segmentlerdeki strain değerleri anlamlı olarak daha düşüktü. MS hastalarında SV ortalama S değerini anlamlı olarak daha düşük ölçtük (%-18,26±1,22 ve %-19,02±1,07, p=0,003). SR değerleri karşılaştırıldığında kontrol grubuna göre MS hastalarında apikal lateral, mid septal, apikal septal, apikal anterior, apikal inferior segmentlere ait strain rate değerleri anlamlı olarak daha düşüktü. MS hastalarında SV ortalama SR değerini anlamlı olarak daha düşük ölçtük (-1,32±0,14 s?¹ ve -1,40±0,15 s?¹, p=0,008). Sonuç olarak, MS’de S görüntüleme tekniği ile sol ventrikül fonksiyonlarının, subklinik düzeyde bozulduğunu saptadık. MS’deki subklinik miyokardiyal fonksiyon bozukluğunun, S görüntüleme tekniği gibi hassas ve yeni yöntemlerle araştırılmasının faydalı olacağını düşünüyoruz. Anahtar Kelimeler: Multiple skleroz, multiple skleroz ve kalp, sol ventrikül fonksiyonları, strain görüntüleme, subklinik miyokardiyal hasar
A novel predictor in endovascular treatment patients for cerebral perfusion and prognosis: CHA2DS2-VASC
(Churchill Livingstone, 2022) Özbek, Mehmet; Arık, Baran; Demir, Muhammed; Bilik, Mehmet Zihni; Akıl, Mehmet Ata; Demir, Fidel; Gültekin, Hamza; Akıl, Eşref
Objective: Thrombolysis in Cerebral Infarction(TICI) score is used to objectively evaluate cerebral perfusion after intervention in acute stroke with mechanical thrombectomy. In our study, we aimed to compare the results of patients with successful TICI perfusion score (TICI ≥ 2c) with the results of patients with poor TICI perfusion score (TICI < 2c) and to investigate the relationship of the CHA2DS2-VASc scoring system with the final TICI perfusion score and other endpoints. Methods: For this retrospective, single-center, cross-sectional study, 278 patients who underwent endovascular thrombectomy were screened consecutively by the interventional neurology department of hospital. The primary endpoint of the study was in-hospital and 1-year all-cause death. All patients underwent cranial imaging to evaluate hemorrhagic transformation after the procedure. Results: It was observed that CHA2DS2-VASc score was significantly higher in the poor cerebral perfusion group than in the succesful cerebral perfusion group (3.19 ± 1.8 vs 2.72 ± 1.73, p = 0.046). According to Kaplan Meier's analysis, a significant difference was observed in the group with a CHA2DS2-VASc score > 2.5 in terms of all-cause mortality at follow-up compared to the group with a low CHA2DS2-VASc score (p = 0.002). According to Kaplan Meier's analysis, a significant difference was observed in the group with a poor TICI score compared to the group with a succesful one in terms of all-cause mortality at follow-up (p < 0.001). Cox regression model showed that poor TICI score group, Age ≥ 75 years, lower glomerular filtariton rate (GFR), higher high-sensitive C-reactive protein (Hs-CRP), and higher admission NIHSS score were independent predictors of 1-year all-cause mortality. Conclusion: High CHA2DS2-VASc score has been shown to be a predictor of unsuccessful cerebral perfusion score and 1-year mortality after mechanical thrombectomy in stroke patients. As a result of our research, it has been shown that complete or nearly complete reperfusion has more positive results than partial reperfusion.
Predictive effect of nutritional scores assessment for 1-year mortality in patients with severe aortic stenosis treated with SAVR or TAVR
(Verduci Editore s.r.l, 2023) Karaçalılar, Mehmet; Özbek, Mehmet
OBJECTIVE: As treatment modalities of severe AS, interventional treatments such as SAVR or TAVR with the decision of the heart team have been performed recently. Controlling nutritional status (CONUT) score and prognostic nutritional index (PNI) have a very important place among the scores that provide a simple, effective, and objective evaluation of prognosis. In our study, we aimed to investigate the short-term prognostic results of severe AS patients who underwent TAVR or SAVR by comparing the CONUT and PNI results of the patients. PATIENTS AND METHODS: 258 patients who underwent percutaneous TAVR or SAVR in our clinic between December 2012 and December 2020 were included in the study in a randomized retrospective manner. The primary endpoint of the study was in-hospital and 1-year all-cause death. The results of all patient groups were compared by dividing them into 2 groups as all-cause death group (deceased group) and non-all-cause death group (survived group) within 1 year. RESULTS: All-cause mortality occurred in 57 (29%) patients within 1 year. As nutritional status scores, the PNI score (39.9±7.4 vs. 46.5±6.9, p<0.001) was lower in the deceased group and the median CONUT score [4(4) vs. 1(3) p<0.001] was found significantly higher. NLR score was also found to be significantly higher in the deceased group (p<0.001). They were divided into 3 tertiles containing an equal number of patients and compared according to the nutritional scores. Significantly higher 1-year mortality was observed in the high CONUT [10 (12%) deaths in T1, 12 (14%) in T2, and 35 (41%) deaths in T3, respectively, p<0.001] and low PNI [37 (43%) deaths in T1, 13 (15%) in T2, and 7 (8%) deaths in T3, respectively, p<0.001] groups, which can be considered as the worse nutritional group. CONCLUSIONS: In the surgical or transarterial treatment of symptomatic severe aortic stenosis, we found that a high CONUT score and a low PNI score were predictors of all-cause mortality at 1-year follow-up, regardless of the type of treatment. We think that checking patients with scores like the abovementioned procedure and making the necessary corrections will lead to positive results in terms of prognosis.
Prognostic importance of nutritional assessment in patients with acute ischemic stroke undergoing endovascular thrombectomy
(Verduci Editore s.r.l, 2023) Özbek, Mehmet; Akıl, Mehmet Ata; Demir, Muhammed; Arık, Baran; Demir, Fidel; Akıl, Eşref
OBJECTIVE: The prevalence of malnutrition in patients with acute ischemic stroke (AIS) can range from 8% to 34%. It has been shown that prognostic nutritional index (PNI) and control nutritional status (CONUT) scores can provide an opportunity to make prognostic predictions in some disease groups. Previous studies have shown a close relationship between malnutrition scores and stroke prognosis. We evaluated the effect of nutritional scores on in-hospital and long-term mortality in AIS patients undergoing endovascular therapy (EVT). PATIENTS AND METHODS: 219 patients who underwent EVT for the AIS were included in this retrospective design and cross-sectional study. The primary endpoint of the study was accepted as all-cause death including in-hospital death, 1-year death, and 3-years death. RESULTS: A total of 57 patients died in the hospital. In-hospital mortality rate was higher in the high CONUT group [36 (49.3%), 10 (13.7%), 11 (15.1%), p<0.001]. A total of 78 patients died within one year, and 1-year mortality was higher in the high CONUT group [43 (58.9%), 21 (28.8), 14 (19.2), p<0.001]. At the end of the 3-year follow-up, 90 patients had died, and the 3-year mortality rate was significantly higher in groups with a high CONUT score than in those with a low CONUT score (p<0.001). CONCLUSIONS: A higher CONUT score, calculated easily by simple scoring with parameters studied from peripheral blood before the EVT procedure, is an independent predictor of in-hospital, 1-year, and 3-years all-cause mortality.
Prognostic significance of monocyte to high-density lipoprotein ratio in patients with chronic coronary artery occlusion
(Dicle Üniversitesi Tıp Fakültesi, 2022) Demir, Muhammed; Özbek, Mehmet; Aktan, Adem; Güzel, Tuncay; Aslan, Burhan; Şimşek, Hakkı
Objective: Monocyte to high-density lipoprotein ratio (MHR) is a biomarker of inflammatory response. In this study, we investigated the relationship between MHR and mortality in patients with chronic coronary artery occlusion (CTO). Method: Retrospective observational study including 493 patients over a follow up period of 73 months. Blood samples were taken before cardiac catheterization for coronary angiography. Results: Median follow-up was 48 months(26-73) . Patients were seperated into two groups: (I) MHR <17.68 (n=278, 95 females) and (II) MHR ≥17.68 (n=215, 45 females). Mortality was considerably higher in MHR II than in MHR I (n=70 vs. n=43; p<0,001). MHR was an independent predictor of mortality (OR: 1.089, 95% [CI]: 1.055-1.124, p<0,001). Lower survival rates were found in MHR II on Kaplan-Meier analyses when compared to that of MHR I (75.223±2.670 vs. 89.220±2.102, p<0,001). Conclusions: As a simple, easy applicable and universal marker, MHR may be a parameter that predicts mortality risk and survival time in CTO patients.

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