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Öğe 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, HabipObjectives: 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.Öğe 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, EşrefObjectives: 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.Öğe Comparison of the real-life clinical outcomes of warfarin with effective time in therapeutic range and non-vitamin K antagonist oral anticoagulants: Insight from the AFTER-2 trial(Polish Cardiac Soc, 2023) Aktan, Adem; Guzel, Tuncay; Aslan, Burhan; Kilic, Raif; Gunlu, Serhat; Ozbek, Mehmet; Arslan, BayramBackground: It is unclear whether warfarin treatment with high time in therapeutic range (TTR) is as effective and safe as non-vitamin K antagonist oral anticoagulants (NOACs). It is crucial to compare warfarin with effective TTR and NOACs to predict long-term adverse events in patients with atrial fibrillation. Aims: We aimed to compare the long-term follow-up results of patients with atrial fibrillation (AF) who use vitamin K antagonists (VKAs) with effective TTR and NOACs. Methods: A total of 1140 patients were followed at 35 different centers for five years. During the follow-up period, the international normalized ratio (INR) values were studied at least 4 times a year, and the TTR values were calculated according to the Roosendaal method. The effective TTR level was accepted as >60% as recommended by the guidelines. There were 254 patients in the effective TTR group and 886 patients in the NOAC group. Ischemic cerebrovascular disease/transient ischemic attack (CVD/TIA), intracranial bleeding, and mortality were considered primary endpoints based on one-year and five-year follow-ups. Results: Ischemic CVD/TIA (3.9% vs. 6.2%; P = 0.17) and intracranial bleeding (0.4% vs. 0.5%; P = 0.69), the one-year mortality rate (7.1% vs. 8.1%; P = 0.59), the five-year mortality rate (24% vs. 26.3%; P = 0.46) were not different between the effective TTR and NOACs groups during the follow-up, respectively. The CHA2DS2-VASC score was similar between the warfarin with effective TTR group and the NOAC group (3 [2-4] vs. 3 [2-4]; P = 0.17, respectively). Additionally, survival free-time did not differ between the warfarin with effective TTR group and each NOAC in the Kaplan-Meier analysis (dabigatran; P = 0.59, rivaroxaban; P = 0.34, apixaban; P = 0.26, and edoxaban; P = 0.14). Conclusion: There was no significant difference in primary outcomes between the effective TTR and NOAC groups in AF patients.Öğe The Effect of Aortic Angulation on Clinical Outcomes of Patients Undergoing Transcatheter Aortic Valve Replacement(Soc Brasil Cirurgia Cardiovasc, 2024) Aktan, Adem; Demir, Muhammed; Guzel, Tuncay; Karahan, Mehmet Zulkuf; Aslan, Burhan; Kilic, Raif; Gunlu, SerhatIntroduction: The aim of this study was to assess the impact of aortic angulation (AA) on periprocedural and in -hospital complications as well as mortality of patients undergoing Evolut (TM) R valve implantation. Methods: A retrospective study was conducted on 264 patients who underwent transfemoral-approach transcatheter aortic valve replacement with self-expandable valve at our hospital between August 2015 and August 2022. These patients underwent multislice computer tomography scans to evaluate AA. Transcatheter aortic valve replacement endpoints, device success, and clinical events were assessed according to the definitions provided by the Valve Academic Research Consortium -3. Cumulative events included paravalvular leak, permanent pacemaker implantation, new-onset stroke, and in -hospital mortality. Patients were divided into two groups, AA <= 48(degrees) and AA > 48(degrees), based on the mean AA measurement (48.3 +/- 8.8) on multislice computer tomography. Results: Multivariable logistic regression analysis was performed to identify predictors of cumulative events, utilizing variables with a P-value < 0.2 obtained from univariable logistic regression analysis, including AA, age, hypertension, chronic renal failure, and heart failure. AA (odds ratio [OR]: 1.73, 95% confidence interval [CI]: 0.89-3.38, P=0.104), age (OR: 1.04, 95% CI: 0.99-1.10, P=0.099), hypertension (OR: 1.66, 95% CI: 0.82-3.33, P=0.155), chronic renal failure (OR: 1.82, 95% CI: 0.92-3.61, P=0.084), and heart failure (OR: 0.57, 95% CI: 0.27-1.21, P=0.145) were not found to be significantly associated with cumulative events in the multivariable logistic regression analysis. Conclusion: This study demonstrated that increased AA does not have a significant impact on intraprocedural and periprocedural complications of patients with new generation self-expandable valves implanted.Öğe The effect of chronic DOAC treatment on clinical outcomes of hospitalized patients with COVID-19(John Wiley and Sons Inc, 2021) Aslan, Burhan; Akyüz, Abdurrahman; Işık, Ferhat; Çap, Murat; İnci, Umit; Kaya, İlyas; Karahan, Mehmet Zülküf; Aktan, Adem; Bilge, Önder; Özbek, Mehmet NuriBackground: Recent findings indicate that thrombosis is one of the underlying pathophysiology and complication of COVID-19 infection. Therefore, the prognosis of the disease may be more favourable in people who were under oral anticoagulant treatment before the COVID-19 diagnosis. This study aims to evaluate the effects of chronic DOAC use on ICU admission and mortality in hospitalized patients due to COVID-19 infection. Method: Between 1 September and 30 November 2020, 2760 patients hospitalized in our hospital due to COVID-19 were screened. A total of 1710 patients who met the inclusion criteria were included in the study. The patients were divided into two groups as those who use DOAC due to any cardiovascular disease before the COVID-19 infection and those who do not. Results: Seventy-nine patients were enrolled in the DOAC group and 1631 patients in the non-DOAC group. Median age of all study patient was 62 (52-71 IQR) and 860 (50.5%) of them were female. The need for intensive care, in-hospital stay, and mechanical ventilation were observed at higher rates in the DOAC group. Mortality was observed in 23 patients (29%) in the DOAC group, and it was statistically higher in the DOAC group (P =.002). In the multivariable analysis, age (OR: 1.047, CI: 1.02-1.06, P <.001), male gender (OR: 1.8, CI: 1.3-2.7, P =.02), lymphocyte count (OR: 0.45, CI: 0.30-0.69, P <.001), procalcitonin (OR: 1.12, CI: 1.02-1.23, P =.015), SaO2 (OR: 0.8, CI: 0.77-0.82, P <.001) and creatinine (OR: 2.59, CI: 1.3-5.1, P =.006) were found to be associated with in-hospital mortality. DOAC treatment was not found to be associated with lower in-hospital mortality in multivariable analysis (OR:1.17, CI: 0.20-6.60, P =.850). Conclusion: Our study showed that the use of DOAC prior to hospitalization had no protective effect on in-hospital mortality and intensive care need in hospitalized COVID-19 patients.Öğe 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, BurhanIntroduction: 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.Öğe The effect of RAAS inhibitors on acute hypoxemic respiratory failure and in-hospital mortality in the hypertensive Covid-19 patients(Taylor & Francis, 2021) Akyüz, Abdurrahman; Işık, Ferhat; Aslan, Burhan; Çap, Murat; Kaya, İlyas; Atlı, Özgür; İnci, Ümit; Taştan, Ercan; Aktan, Adem; Bilge, Önder; Okşul, Metin; Aydın, Emre; Karahan, Zülküf; Altıntaş, Derya Deniz; Altındağ, Rojhat; Adıyaman, Mehmet Şahin; Altıntaş, BernasIntroduction We have aimed to investigate the relationship between use of angiotensin-converting-enzyme inhibitor (ACEI) or angiotensin-receptor-blocker (ARB) drugs and acute hypoxemic respiratory failure (AHRF) and in-hospital mortality in hypertensive Covid-19 patients. Material and method Consecutive 1345 patients diagnosed with Covid-19 between April and October 2020 who met inclusion criteria were divided into two groups based on presence and absence of AHRF and mortality. The groups were compared regarding epidemiological, clinical, radiological, laboratory findings and treatments methods. The patient groups ACEI, ARB and other antihypertensive drugs (non-ACEI/ARB) were compared regarding same parameters. Results Median age was 68 (60-76) years in the patient group including 805 (59.9.1%) females. Of the patients, 475 (35.3%), 644 (47.9%) and 226 (16.8%) were using ACEIs, ARBs and non-ACEI/ARB, respectively. AHRF and in-hospital mortality developed in 1053 (78.3%) and 290 (21.6%) patients, respectively. Age, gender, coronary artery disease, diabetes mellitus (DM), neutrophil, lymphocyte, creatinine, D-dimer, C-reactive protein (CRP), ACEI, beta blocker and aspartate transaminase (AST) found statistically significant in the univariable logistic regression performed to identify independent predictors of mortality were included multivariable logistic regression model. Age (OR: 1.066, 95%CI: 1.049-1.083; p < .001), DM (OR: 1.682, 95%CI: 1.238-2.286; p = .001), neutrophil (OR: 1.041, 95%CI: 1.007-1.077; p = .019), creatinine (OR: 1.178, 95%CI: 1.048-1.325; p = .006), CRP (OR: 1.008, 95%CI: 1.006-1.010; p < .001), ACEI (OR: 0.718, 95%CI: 0.521-0.988; p = .042), AST (OR: 1.005, 95%CI: 1.001-1.010; p = .010) were found associated with in-hospital mortality. Conclusion In our study, it was not detected clinically significant difference between three groups with regard to their relation with in-hospital mortality.Öğe The effect of resistant hypertension on in-hospital mortality in patients hospitalized with COVID-19(Springer Nature, 2021) Işık, Ferhat; Çap, Murat; Akyüz, Abdurrahman; Bilge, Önder; Aslan, Burhan; İnci, Ümit; Kaya, İlyas; Taştan, Ercan; Okşul, Metin; Çap, Neşe Kanbal; Karagöz, Ali; Baysal, ErkanHypertension is a major concomitant disease in hospitalized patients with COVID-19 (Coronavirus disease 2019) infection. The adverse effect of hypertension on prognosis in COVID-19 is known. Nevertheless, it is not known how COVID-19 progresses in resistant hypertensive patients. In this study, we aimed to examine the effect of resistant hypertension (ResHT) on in-hospital mortality in patients hospitalized with COVID-19. In our single-center retrospective study, included 1897 COVID-19 patients. The patients were divided into three groups according to the non-hypertensive (n = 1211), regulated HT (RegHT) (n = 574), and ResHT (n = 112). These three groups were compared according to demographic features, clinical signs, laboratory findings, and follow-up times. The median age of the study population was 62 (50–72 IQR) and 1000 (52.7%) of patients were male. The total mortality of the study population was 18.7% (n = 356). Mortality rates were similar in the hypertensive patient group (27.5% for the RegHT and 32.1% for ResHT, p = 0.321). In a multivariable analysis, ResHT was independently associated with a significantly increased risk of inhospital mortality of COVID-19, while no significant increased risk was observed with RegHT [respectively, Odds Ratio (OR) = 2.013, Confidence Interval (CI) 1.085–3.734, p = 0.026 and OR = 1.194, CI 0.795–1.794, p = 0.394]. Also, age, male gender, chronic renal failure, lymphocyte, procalcitonin, creatinine, and admission SpO2 levels were determined as independent predictors of in-hospital mortality. In our study, it was found that ResHT was an independent predictor of mortality in patients hospitalized with COVID-19; however, this situation was not found in RegHT.Öğe 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, ErhanAim 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.Öğe Koroner yavaş akım saptanan hastalarda sol atriyum fonksiyonlarının değerlendirilmesi(2015) Aslan, BurhanAmaç: Koroner yavaş akım fenomeni (KYAF), anjiyografik olarak koronerleri normal ya da normale yakın olanlarda anjiyografi sırasında distal vasküler yapılara opak madde ilerleyişinin yavaş ve geç olmasıdır. Patogenez tam olarak açıklanamamış olmakla birlikte daha çok vazodilatör reservin azalması sonucu gelişen mikrovasküler iskemi neden olarak gösterilmiştir. Biz de çalışmamızda KYAF olan hastalarda Sol atriyum fonsiyonlarını araştırmayı planladık. Gereç ve Yöntem: Ocak 2013-Kasım 2014 tarihlerinde miyokard iskemisini düşündüren anjinal yakınma ile hastanemize başvurup koroner anjiografi de epikardiyal koroner arterlerde darlık olmaksızın koroner yavaş akım saptanan 50 hasta ve koronerleri normal saptanan 40 hasta çalışmaya alındı. Her iki grubun klinik ve demografik özellikleri benzerdi. Tüm olgulara femoral yoldan standart Judkins tekniği ile selektif sol ve sağ koroner anjiyografi yapılmış olup, koroner yavaş akımın belirlenmesinde TIMI kare sayısı yöntemi kullanıldı. Sol atriyum fonksiyonları, ekokardiografi (GE VİVİD S6) cihazı kullanılarak apikal dört boşluktan modifiye Simpson metoduyla sol atriyum volümleri, nabız dalgalı Doppler ile E, A, E/A oranı, nabız dalgalı doku Doppler ile Em, Am ölçülerek değerlendirildi. Bulgular: E (0.09±0.19; 0.12±0.02, p<0.001), Em/Am (0.83±0.19; 1.2±0.29, p<0.001), E/A (0.99±0.2; 1.1±0.28, p<0.001) KYA grubunda kontrol grubuna göre düşük saptandı. E/Em KYA grubunda daha yüksek saptandı (7.1±2.1; 5.9±1.3, p=0.003). SAVImax (16.6±4.6, 11.3±2.1, p<0001), SAVImin (6.4±3.3, 5.0±1.3, P=0.001), SAVIpreA (12.8±2.8, 6.8±2.6 p<0.001) KYA grubunda yüksekti. SAPBV ve SAPEF KYA grubunda daha düşük, SAABV ve SAAEF kontrol grubuna göre daha yüksek saptandı. Diyastolik parametreler E/A ile SAAEF arasında istatiksel olarak anlamlı bir ilişki saptandı (r=-0.4, p=0.003). Frame LAD ile SAAEF, ortalama frame ile SAAEF arasında anlamlı bir ilişki saptandı (sırasıyla r=0.6, r=0.42, p<0.001, p=0.002). Sonuçlar: Çalışmamız, KYA ile sol atriyum hacmi ve SV diyastolik disfonksiyonu arasındaki ilişkiyi ortaya koymuştur. Sonuç olarak, KYA hastalarında sol atriyal volümlerde belirgin değişiklikler olmakta ve aktif atriyal boşalma volümü artmaktadır. Bu bulgulardan KYA hastalarında sinüs ritminin korunmasının daha da önemli hale geldiği görünmektedir. Bizim çalışmamız da bu açıdan KYAF'ın masum olmadığını, bu hastalarda sol ventrikül diyastolik fonksiyonlarının değerlendirilmesi gerektiğini ortaya koymuştur. Tedavi ve prognoz açısından daha geniş hasta popülasyonunu içeren prospektif çalışmalara ihtiyaç vardır. Anahtar kelimeler; Koroner yavaş akım , sol atriyum fonksiyonları, sol ventrikül diyastolik disfonsiyonÖğe 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, HakkıObjective: 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.Öğe Prognostic value of the leuko-glycemic index in coronary chronic total occlusion patients(Prusa Medikal Yayıncılık, 2023) Peker, Tezcan; Özbek, Mehmet; Boyraz, Bedrettin; Aslan, Selen Filiz; Demir, Muhammed; Aslan, BurhanObjectives: Inflammation parameters are related to the prevalence and mortality of coronary artery disease (CAD). We aimed to evaluate the prognostic value of the leuko-glycemic index (LGI) and determine mortality in patients with chronic coronary total occlusion (CTO). Methods: A total of 546 patients were evaluated in the study. All-cause death was the primary endpoint. The leuko-glycemic index was calculated from the blood samples at admission and patients were divided into 3 groups according to their LGI levels. Kaplan-Meier survival curves were performed and logistic regression analyses was used for all multivariable analysis. Results: The mean age of the study population was 63.1 ± 11.1 years and 70.3% were male. Median followup time 58.2 ± 22.4 months. The mortality rate was 33.6% in the high LGI group and significantly higher compared to the other group. In multivariable analysis, LGI (OR: 1.05, 95% CI: 1,0-1.2; p = 0.02) and age (OR: 1.07, 95% CI: 1.04-1.11; p = 0.001) were found as predictors of all-cause death. Conclusions: The study revealed that high LGI is associated with all-cause death in CTO patients and LGI was a predictor of all-cause death.Öğe Relationship between contrast-induced nephropathy and long-term mortality after percutaneous coronary intervention in patients with chronic coronary total occlusion(Assoc Medica Brasileira, 2022) Guzel, Tuncay; Aktan, Adem; Demir, Muhammed; Ozbek, Mehmet; Aslan, BurhanOBJECTIVE: Intervention in chronic total occlusion lesions involves long procedure time, a serious contrast load, and complex procedures. In this study, we aimed to investigate mortality rate of patients who had procedural coronary angiography done for chronic total occlusion lesions in coronary angiography series and who developed contrast-induced nephropathy. METHODS: A total of 218 patients with chronic total occlusion lesion in at least one coronary artery, from three different medical centers, who underwent procedural coronary angiography were recruited for the study. Patient population was divided into two groups: those who developed contrast -induced nephropathy and those who did not. Mortality due to all causes was investigated between both groups throughout a 100-month follow-up. RESULTS: Mean age of patients with incidence of contrast-induced nephropathy was 66.7 +/- 11.8, and 23.8% of them were comprised by female. We found a significantly higher mortality in long-term follow-up in the patient group with contrast-induced nephropathy (42.9 vs. 57.1%, p=<0.001). According to Kaplan-Meier analysis performed additionally, survival during follow-up was significantly shorter in this group and, in logistic regression analysis, it was an independent predictor of mortality (OR 11.78; 95%CI 3.38-40.9). CONCLUSION: We identified that the development of contrast-induced nephropathy is associated with long-term mortality. It might be possible to reduce adverse events with prophylactic approaches before the procedure and close follow-up of such patients after the procedure.Öğe The relationship between coronary collateral circulation and visceral fat(Galenos Yayıncılık, 2021) Aktan, Adem; Güzel, Tuncay; Özbek, Mehmet; Demir, Muhammed; Arslan, Bayram; Aslan, Burhan; Kılıç, RaifObjectives: Collateral circulation is assumed to prevent myocardial ischemia in healthy subjects and in patients with coronary artery disease. Visceral adipose tissue is an active component of total body fat, which holds some biochemical characteristics that have impact on several normal and pathological processes in the human body. In this study, we investigated the relationship between visceral fat ratio and coronary collateral circulation (CCC).Materials and Methods: Totally 148 patients with stable angina pectoris were recruited to the study and all patients’ heights and weights were recorded after the coronary angiography. The study subjects were divided into two groups as those between 1 and 9, and those >10 by classifying their visceral fat ratio with bioelectrical impedance analysis method. Patients were classified as poor CCC group (grade 0 and 1) and good CCC group (grade 2 and 3) based on the Rentrop’s classification of CCC.Results: In the analysis in accordance with collateral classification, visceral fat percentage (13.7±4.7 versus 10.1±4.0, p=0.01) and body mass index (28.2±2.4 versus 27.3±2.3, p=0.040) were found significantly higher in the poor collateral group. Diabetes mellitus was significantly higher in patient with high visceral fat ratio. In multivariate logistic regression analysis for collateral growth, visceral fat percentage [odds ratio (OR): 0.740, %95 confidence interval (CI): 0.602 0.909, p=0.040] and coronary stenosis percentage (OR: 1.220, %95 CI: 1.070-1.390, p=0.003) were found meaningful, independent from the other factors. In ROC analysis, increase in visceral fat level decreased collateral growth with 72.7% sensitivity and 58.5% specificity.Conclusion: The increase in visceral fat seems an independent factor for poor collateral development.
