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  • Küçük Resim
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    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.
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    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 Nuri
    Background: 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.
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    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, Bernas
    Introduction 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.
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    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, Erkan
    Hypertension 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.
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    Iloprost is a Useful Therapy for Adams-Oliver Syndrome with Eisenmenger Syndrome
    (2017) Altıntaş, Bernas; Baysal, Erkan; Bilge, Önder; Sevük, Utkan; Yaylak, Barış; Altındağ, Rojhat
    Adams-Oliver syndrome is characterized by scalp defects with terminal transverse limb anomalies. Most reports on this syndrome demonstrate autosomal dominant pedigrees. Cutis marmorata telangiectasia congenita accompanies the syndrome in many cases. Here, we describe a case of Adams-Oliver syndrome with cardiac malformation and Eisenmenger syndrome. Because this is a rare case, the detailed case and literature data are presented.
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    Koroner arter ektazi/anevrizması ile osteopontin seviyesi arasındaki ilişki
    (2015) Bilge, Önder
    Amaç: Koroner Arter Ektazisi (KAE) anjiyografik olarak, koroner arter lümen çapının komşu normal proksimal segment çapına oranla lokalize veya diffüz şekilde 1.5 - 2 kat arasındaki genişleme olarak tanımlanır. 2 kattan daha fazla genişleme ise koroner arter anevrizması olarak adlandırılmaktadır. KAE ve anevrizmaları koroner anomalilerin nadir formlarıdır. Konjenital veya edinsel orjinli olabilirler. Edinsel KAE ve koroner arter anevrizma gelişiminin etyolojisinde en sık ateroskleroz olmak üzere, sistemik inflamatuvar hastalıklar, konnektif doku hastalıkları ve perkütan koroner girişime sekonder gelişen vasküler hasar sorumludur. KAE’nin abdominal aorta ve perferik arterler gibi vasküler yapıların diğer kısımlarında anevrizma oluşumu ile birlikteliği gösterilmiştir. Osteopontin bir matrisellüler proteindir. Osteopontin inflamatuar süreçte rol alan tüm hücrelerde (makrofaj, endotel hücreleri, düz kas hücreleri ve fibroblast) sentezlenir. Henüz KAE ile osteopontin arasındaki ilişkiyi araştıran bir çalışma bulunmamaktadır. Bu çalışmada KAE ile osteopontin arasındaki ilişkiyi araştırmayı amaçladık. Metod : 07.05.2012 – 30.04.2013 tarihleri arasında anjinal yakınma şikayeti ile Dicle Üniversitesi Tıp Fakültesi Kardiyoloji Anabilim Dalı’na başvurup koroner anjiografi yapılan 88 hasta çalışmaya alındı. Hastalar KAE varlığına göre iki gruba ayrıldı. 45 KAE’li hastayı içeren ilk grubun yaş ortalaması 56.5 ± 8.3 ve 43 hastayı içeren koroner arter anatomisi normal olan ikinci grubun yaş ortalaması 53.7 ± 6.5 olarak tespit edildi.Toplanan kan örneklerinden hemogram, biyokimya, lipit profili ve ELISA yöntemiyle de osteopontin düzeyi çalışıldı. Tüm hastaların ekokardiyografik değerlendirilmesi yapıldı ve assendan aort çapının belirlenmesi için, sol ventrikül çıkım yolu (LVOT), sinüs valsalva ve sinotübüler bileşkeden ölçümler alındı. Bulgular: Çalışma grubunu oluşturan hastalar ile kontrol grubunu klinik ve demografik özellikleri karşılaştırıldığında,her iki grupta benzer bulundu. KAE grubunda osteopontin seviyesi normal koroner arter gruplarına göre daha yüksek saptandı (23.6 ng/ml ± 13.2 ng/ml ile 16.7 ng/ml ± 5.3 ng/ml, p=0.033). Her iki grubun Nötrofil/Lenfosit (N/L) oranı karşılaştırıldığında KAE grubunda anlamlı olarak daha yüksek bulundu (2.79 ± 2.6 ile 1.85 ± 0.6 p=0.024). Her iki grubun ortalama assendan aort çapı (3.4 cm ± 0.9 cm ile 3.0 cm ± 0.4 cm, p<0.001) ve diğer üç ölçüm bölgesinde de LVOT (2.4 cm ± 0.3 cm ile 2.2 cm ± 0.2cm, p <0.001), sinütübüler bileşke (3.0 cm ± 0.7 cm ile 2.7 cm ± 0.4 cm, p <0.001) ve sinüs valsalva ölçümleri (2.8 ± 0.4 cm ile 2.6 ± 0.3 cm, p <0.001) KAE grubunda anlamlı olarak daha geniş saptandı. Sonuç: Çalışmamızdan elde ettiğimiz bulgular inflamatuar sürecin bir parçası olan ve diğer vasküler yapılarda anevrizma oluşumu ile ilişkisi farklı çalışmalarla gösterilmiş olan osteopontinin, KAE oluşumunda da benzer şekilde rol oynadığını düşündürmektedir. Anahtar kelimeler:Koroner arter ektazisi, osteopontin