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Öğe 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, TuncayObjective: 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.Öğe 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, MuhammedBACKGROUND: 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.Öğe The effect of atherogenic plasma index on collateral development in patients with chronic coronary total occlusion(2021) Güzel, Tuncay; Bilik, Mehmet Zihni; Arslan, Bayram; Kılıç, Raif; Aktan, AdemAim: To demonstrate the correlation between coronary collateral circulation (CCC) and atherogenic plasma index (AIP), one of the factors associated with the formation of collateral vessels. Methods: Hospital records of patients with chronic total occlusion (100% stenosis) in at least one coronary artery were evaluated. Triglycerides, HDL level, triglyceride/HDL ratio and atherogenic plasma index before coronary angiography were assessed for the 451 patients who met the study criteria. Results: Comparison of the two groups in terms of laboratory findings showed that triglyceride/HDL ratio (5.04±3.13 vs 3.56±2.12, p<0.001) and AIP (0.63±0.25 vs 0.48±0.25, p<0.001) were higher with statistical significance in the weak collateral group. The ROC analysis revealed an association between weak collateral formation and atherogenic plasma index with 64.7% sensitivity and 66.2% specificity using a cut-off value of 0.58 for AIP. Accordingly, low AIP was found to be an independent predictor of good collateral artery formation. Conclusion: This study suggests that a high atherogenic plasma index may be an independent factor associated with poor collateral formation.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 Evaluation of parameters predicting in-hospital mortality and septic embolisms in patients with infective endocarditis(Termedia Publishing House Ltd., 2024) Kış, Tuba Tatlı; Kış, Mehmet; Güzel, Tuncay; Mermutluoğlu, ÇiğdemIntroduction: Infective endocarditis (IE) is the infection of the cardiac endothelium and heart valves. The incidence of IE has recently increased due to the widespread use of cardiac device therapies and prosthetic heart valves. Despite modern medical and surgical treatment methods, morbidity and mortality are still high, and it leads to serious complications. Evaluation of predictive factors leading to septic embolism, which is one of the most important complications in terms of mortality and morbidity, is important for improving outcomes in infective endocarditis. Aim: In this study, we aimed to determine the predictive parameters of in-hospital mortality and septic embolism in patients with IE. Material and methods: This was a retrospective cohort study. The patients were divided into two groups: group 1 (septic embolism or mortality +, 21 patients) and group 2 (septic embolism or mortality –, 43 patients). ROC analysis was performed to determine the cut-off value of the predictive parameters. Univariable and multivariable regression analysis was performed to identify parameters significantly associated with in-hospital mortality/septic embolism in infective endocarditis. Results: A total of 64 patients diagnosed with IE were included in the study. In the multivariable regression analysis, the parameters vegetation size (OR = 1.227; 95% CI: 1.019–1.477, p = 0.031), aortic valve vegetation (OR = 0.088; 95% CI: 0.009–0.820, p = 0.033), mitral valve vegetation (OR = 0.082; 95% CI: 0.009–0.760, p = 0.028), albumin (OR = 0.185; 95% CI: 0.039–0.889, p = 0.035) and D-dimer (OR = 1.004; 95% CI: 1.000–1.009, p = 0.045) were found to be independent predictors for septic embolism and mortality in IE patients. Conclusions: Vegetation size, high D-dimer and low serum albumin levels are predictors of in-hospital mortality and septic embolism in patients with IE. © 2024 Termedia Publishing House Ltd.. All rights reserved.Öğe Hemoglobin A1c is a predictor of poor collateral development in non-diabetic patients with coronary chronic total occlusion: Retrospective clinical trial(Türkiye Klinikleri Yayınevi, 2022) Kış, Mehmet; Güzel, TuncayObjective: Collateral circulation plays an important role for the nutrition of the myocardium in the region of chronic total occlusion (CTO), and affects clinical prognosis. It has been accepted that increased hemoglobin A1c (HbA1c) is a risk factor for cardiovascular events and subclinical atherosclerosis in individuals without diabetes mellitus. In this study, we aimed to reveal the effect of HbA1c level on coronary collateral development in the non-diabetic adult population with CTO. Material and Methods: The study included 208 non-diabetic patients out of 487 patients diagnosed with CTO on coronary angiography between March 2014 and January 2019. The patients were classified into two groups based on the Rentrop classification. Group 1 (Rentrop 0-1) (poor collateral) (90 patients) and Group 2 (Rentrop 2-3) (good collateral) (118 patients). This is a retrospective analysis. Results: The two groups were similar in terms of male gender, age, hypertension and previous history of myocardial infarction (78.9% vs. 75.4%, p=0.557; 58.9±9.9 vs. 60.8±11.2, p=0.194; 26.7% vs. 33.0%, p=0.321; and 18.9% vs. 12.7%, p=0.221; respectively). HbA1c value was statistically higher in Group 1 (5.85±0.45) than in Group 2 (5.22±0.84) (p<0.001). The ideal HbA1c cut-off value was 5.65 that was calculated by the Youden index had 77% sensitivity, and 75% specificity (Receiver operating characteristic area under curve: 0.780, 95% confidence interval: 0.717-0.844, p<0.001) for poor collateral development of CTO. Conclusion: HbA1c is a parameter that affects coronary collateral development even in non-diabetic patients. In non-diabetic patients with CTO, high HbA1c levels correlate with poor collateral development.Öğe Impact of COVID-19 outbreak on patients with ST-segment elevation myocardial infarction (STEMI) in Turkey: results from TURSER study (TURKISH St-segment elevation myocardial infarction registry)(Springer, 2021) Kiris, Tuncay; Avcı, Eyüp; Ekin, Tuba; Akgün, Didar Elif; Tiryaki, Mücahit; Yidirim, Arafat; Hazır, Kutluhan; Murat, Bektaş; Yeni, Mehtap; Altındağ, Rojhad; Gül, Sefa; Arık, Baran; Güzel, Tuncay; Murat, Selda; Öz, Ahmet; Karabacak, Mustafa; Aktaş, Zihni; Yıldırım, Tarık; Kılıçaslan, Barış; Ergene, Asim OktayObjective We aimed to investigate both the impact of COVID-19 pandemic on ST-segment elevation myocardial infarction (STEMI) admission, and demographic, angiographic, procedural characteristics, and in-hospital clinical outcomes of patients with COVID-19 positive STEMI in Turkey. Methods This was a multi-center and cross-sectional observational study. The study population included 1788 STEMI patients from 15 centers in Turkey. The patients were divided into two groups: COVID-19 era (March 11st–May 15st, 2020; n=733) or pre- COVID-19 era group (March 11st–May 15st, 2019; n=1055). Also, the patients in COVID-19 era were grouped as COVID-19 positive (n=65) or negative (n=668). Results There was a 30.5% drop in STEMI admission during COVID-19 era in comparison to pre-COVID-19 era. The patients admitted to the medical centers during COVID-19 era had a longer symptom-to-frst medical contact time [120 (75–240) vs. 100 (60–180) minutes, p<0.001]. COVID-19 positive STEMI patients had higher thrombus grade and lower left ventricular ejection fraction compared to COVID-19 negative patients. COVID-19 positive patients had higher mortality (28% vs. 6%, p<0.001) and cardiogenic shock (20% vs. 7%, p<0.001) rates compared with those without COVID-19. Matching based on propensity scores showed higher mortality and high thrombus grade in STEMI patients who were infected by SARS-COV-2 (each p<0.05). Conclusions We detected signifcantly lower STEMI hospitalization rates and signifcant delay in duration of symptom onset to frst medical contact in the context of Turkey during the COVID-19 outbreak. Moreover, high thrombus grade and mortality were more common in COVID-19 positive STEMI patients.Öğe Koroner kronik total oklüzyon saptanan hastalarda aterojenik indeksin kollateral gelişimi üzerine olan etkisi(Dicle Üniversitesi, Tıp Fakültesi, 2019) Güzel, Tuncay; Bilik, Mehmet ZihniGiriş ve Amaç: Koroner arterlerin kronik total oklüzyonu (KTO), damar lümeninin en az 3 ay boyunca tamamen tıkanması olarak tanımlanır. Koroner kollateral dolaşım (KKD) normal kalpte bulunan ve kan akımını bozan kritik bir darlık veya total tıkanma oluştuğunda, lezyonun distalinde kalan miyokart dokusunun perfüzyonunu ve canlılığını korumak için iskemik miyokart dokusuna kan akışını sağlamak amacı ile, aynı koroner arterin bölümleri arasında veya farklı koroner arterler arasında kronik, uyum sağlayıcı bir cevap olarak oluşan vasküler yapılar olarak tanımlanabilir. Birtakım kardiyovasküler risk faktörlerinin koroner kollateral dolaşımının gelişiminde olumsuz rol oynadığı gösterilmiş olsa da, yeterli bir kollateral ağı oluşması açısından, hastalar arasında neden farklılıklar olduğu konusu halen netlik kazanmamıştır. Bu çalışmamızda kollateral gelişimi üzerine etkili faktörlerden biri olan aterojenik plazma indeksi (AİP) ile koroner kollateral dolaşım (KKD) gelişimi arasındaki iliskiyi göstermeyi hedefledik. Gereç ve Yöntem: Dicle Üniversitesi Tıp Fakültesi Kalp Hastanesi kardiyoloji kliniğinde 03/2014-11/2018 tarihleri arasında gerçekleştirilen koroner anjiografi serisinde, hastaların verileri retrospektif olarak tarandı. En az bir koroner arterinde kronik total oklüzyon (%100 darlık olması) saptanan hastaların hastane kayıtları incelendi. Çalışma kriterlerine uyan 451 hastanın koroner anjiyografi öncesi; trigliserid düzeyleri, HDL düzeyleri, trigliserid / HDL oranları ve aterojenik plazma indekslerine bakıldı. Kollateral dolaşım ise Rentrop kollateral sınıflamasına göre değerlendirildi. Rentrop grade 0 ve 1 olanlar zayıf kollateral, grade 2 ve 3 olanlar iyi kollateral şeklinde gruplandırıldı. Hastaların rutin bakılan kan tetkikleri, klinik risk faktörleri, koroner kollateral dolaşım sınıfı ve aterojenik plazma indeksleri ile birlikte dökümante edildi. Bulgular: Kollateral sınıflamasına göre hastaların demografik ve klinik özellikleri ile yapılan analizde; zayıf kollateral grubunda, diyabetes mellitus (p<0,001) ve sigara öyküsü (p<0,001) ortalamaları istatistiksel olarak anlamlı derecede daha fazla saptanırken, hipertansiyon (p=0,123) ve aile öyküsü (p=0,059) ortalamaları ise istatistiksel olarak anlamlı olmasa da daha fazla saptandı. Anjiyografik bulgular ile yapılan analizde; her üç koroner arter kıyaslandığında genel olarak RCA'da daha fazla kronik total oklüzyon (KTO) saptanmıştır. RCA'daki KTO lezyonlarına karşı, istatistiksel olarak anlamlı saptanmasa da iyi kollateral gelişimi daha fazla saptandı (p=0,133). LAD (p=0,397) ve CX'teki (p=0,724) KTO lezyonlarına karşı ise, istatistiksel olarak anlamlı saptanmasa da zayıf kollateral gelişimi daha fazla saptandı. Laboratuvar ve ekokardiyografi bulguları açısından iki grup karşılaştırıldığında ise; zayıf kollateral grubunda, açlık glukoz değeri (158,5±75,60'e karşı 132,3±55,23, p<0,001), trigliserid değeri (186,7±86,75'e karşı 143,9±69,16, p<0,001), total kolesterol değeri (183,9±47,95'e karşı 173,4±46,63, p=0,019), trigliserid / HDL oranı (5,04±3,13'e karşı 3,56±2,12, p<0,001) ve aterojenik plazma indeksi (AİP) (0,63±0,25'e karşı 0,48±0,25, p<0,001) açısından istatistiksel olarak anlamlı oranda daha yüksek saptandı. Kollateral gelişimi ile aterojenik plazma indeksi (AİP) arasında korelasyon analizi yapıldıg?ında, zayıf derecede negatif korelasyon olup istatistiksel olarak anlamlı bulundu (rs= -0,299, p<0.001). Aterojenik plazma indeksi (AİP) ile kollateral gelişimi arasındaki ilişkiyi incelemek için yapılan multivariate logistik regresyon analizinde, diğer faktörlerden bağımsız olarak (OR: 0,083, %95 CI: 0,035-0,196, p=0,000) istatistiksel olarak anlamlı saptandı. Buna göre aterojenik plazma indeksindeki (AİP) düşüklük, iyi kollateral arter gelis?iminin bag?ımsız o?ngo?rdürücüsü oldug?u saptandı. Yapılan ROC analizinde; aterojenik plazma indeksi için 0,58 cut-off deg?eri alındığında, %64,7 sensitivite, %66,2 spesifite ile zayıf kollateral varlığı ile ilişkili olduğunu tespit ettik. Sonuç: Kardiyovasküler hastalıklar açısından riskli bireylerin tespit edilmesinde, özellikle aile bireylerinde koroner kalp hastalıkları öyküsü bulunan kişilerde, basit, non-invaziv, hızlı sonuç alınabilen, ekonomik ve aynı zamanda önemli bir değere sahip olan aterojenik plazma indeksi dikkatlice değerlendirilmelidir. Bu çalışma ile aterojenik plazma indeksindeki yüksekliğin zayıf kollateral gelişimiyle ilişkili bağımsız bir faktör olduğunu ortaya koyduk. Bu nedenle aterojenik plazma indeksini oluşturan parametrelerin sıkı takibi ve bu değerin düşürülmesine yönelik yaklaşımlarla, kardiyovasküler hastalıkların gelişmesi azaltılabilir. Ayrıca hastalık gelişenlerde, kollateral gelişimi üzerindeki olumsuz etkilerini azaltmak açısından oldukça önem taşımaktadır.Öğe A Novel Predictor of Vegetation Size in Infective Endocarditis: MAPH Score(Yuzuncu Yil Universitesi Tip Fakultesi, 2024) Mermutluoğlu, Çiğdem; Güzel, Tuncay; Kış, Tuba TatlıThe aim of this study is to evaluate the predictive value of the MAPH score in patients with, a novel score that includes blood viscosity biomarkers such as hematocrit, mean platelet volume (MPV), age, and total protein, on the extent of vegetation in infective endocarditis. This study was retrospective. Fifty-four patients older than 18 years who were diagnosed with infective endocarditis (IE) between June 2017 and June 2023 were inclu ded. The study included patients from three different tertiary healthcare centers. Hematocrit, C-reactive Protein (CRP), MPV, total protein, serum albumin, kidney and liver function tests were analyzed on the first day of hospitalization. The Youden Inde x was used to determine the cut points for predicting age and MPV, hematocrit and total protein values for vegetation size. The MAPH score has been calculated as a total of 0 or 1 point with the cutoff in each ratio, and values above the cut-off were considered 1 point. Thirty-eight patients were found to have large vegetations (>10 mm). The mean age of the patients was 54.78 ± 17.32 years. The other clinical characteristics and demographic data were similar to each other. total protein level, MPV, and MAPH score were significantly higher in the vegetation size >10 mm group than in the vegetation size ≤ 10 mm group when analyzing the clinical laboratory characteristics of the study. The results of our study were that the MAPH score can be used as an estima te of the extent of vegetation cover. © 2024, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.Öğe Predictive value of C-reactive protein to albumin ratio in ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention(Sage Publications INC., 2021) Acet, Halit; Güzel, Tuncay; Aslan, Bayram; Işık, Mehmet Ali; Ertaş, Faruk; Çatalkaya, SibelThe present study aimed to examine the association of C-reactive protein to albumin ratio (CAR) with short-term major adverse cardiac events (MACEs) in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). We included 539 STEMI patient treated with pPCI in this study. Patients were divided into 2 groups according to MACE development. Patients with MACE had higher CAR than those without (1.18 [0.29-1.99] vs 0.21 [0.09-0.49], P < .001). Multivariate analysis showed that The Global Record for Acute Coronary Events score, Percutaneous Coronary Intervention with TAXus and cardiac surgery (SYNTAX) score, glucose and CAR (odds ratio:1.326, 95% CI: 1.212-1452, P < .001) were independent predictors of MACE. The CAR may be proven useful for risk stratification in STEMI patients undergoing pPCIÖğe Predictive value of nutritional scores in non-valvular atrial fibrillation patients: Insights from the AFTER-2 study(Elsevier B.V., 2025) Söner, Serdar; Güzel, Tuncay; Aktan, Adem; Kılıç, Raif; Arslan, Bayram; Demir, Muhammed; Güzel, HamdullahBackground and aim: Many scoring systems are used to evaluate malnutrition, but there is no consensus on which scoring system would be more appropriate. We aimed to investigate the effect of malnutrition in patients with non-valvular atrial fibrillation (NVAF) and to compare three scoring systems. Methods and results: A total of 2592 patients with non-valvular AF from 35 different centers in Turkey were included in this prospective study. All participants were divided into two groups: 761 patients who died and 1831 patients who were alive. The malnutrition status of all participants was evaluated with three scoring systems. The primary outcome was all-cause mortality. The mean age of the population was 68.7 ± 11.1 years, and 55.5 % were female. According to Cox regression analysis, the geriatric nutritional risk index (GNRI) (HR = 0.989, 95 % CI: 0.982–0.997, p = 0.007), controlling nutritional status (CONUT) score (HR = 1.121, 95 % CI: 1.060–1.185, p < 0.001), and prognostic nutritional index (PNI) (HR = 0.980, 95 % CI: 0.962–0.999, p = 0.036) were found to be significant mortality predictors. ROC curve analysis indicated GNRI (AUC = 0.568), CONUT (AUC = 0.572), and PNI (AUC = 0.547) had moderate predictive values. Kaplan-Meier analysis showed that increasing the risk class based on GNRI (p < 0.001) and CONUT (p < 0.001) was associated with decreased survival, while PNI staging had no statistically significant effect (p = 0.266). Conclusions: Malnutrition, determined by three scoring systems, was found to be an independent predictor of all-cause mortality in NVAF patients. Nutritional examination may provide useful information for prognosis and risk stratification in patients with NVAF. © 2024 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II UniversityÖğe 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 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.Öğe The relationship between good collateral development and magnesium/phosphate ratios in chronic total occlusion(Kocaeli Üniversitesi Tıp Fakültesi, 2022) Kış, Mehmet; Şenöz, Oktay; Güzel, TuncayObjective: Coronary collateral formation can be triggered by many acquired factors such as ischemia and growth factors, which ultimately manifests as differences in the quality of the coronary collateral circulation (CCC) in patients. Low magnesium (Mg) levels can increase endothelial cell dysfunction and potentially increase the risk of thrombosis and atherosclerosis. However, it has been reported that high serum phosphate (P) levels are correlated with the development of atherosclerosis and mortality. In this article, we aimed to reveal the relationship between CCC quality and Mg/P ratio in chronic total occlusion (CTO). Methods: A total of 269 patients with detected CTO in coronary angiography between March 2014 and June 2018 were included in the study. The patients were divided into two groups as group I (127 patients) and group II (142 patients) according to the Rentrop classification. The study is a retrospective, observational study. Results: In the multivariable regression analysis; smoking (p=0.004), triglyceride (p<0.001) and Mg/P ratio (p<0.001) parameters were independent predictors affecting CCC in CTO. Mg/P value was statistically lower in the group I (0.49±0.17) than group II (0.62±0.12) (p<0.001). The ideal Mg/P cut-off value was 0.56 that calculated by the Youden index had 69% sensitivity, and 64% specificity for collateral development of CTO. Conclusion: Mg/P is a parameter that affects coronary collateral development. High Mg/P ratio level is associated with good collateral development in patients who had CTO.Öğe Reply to letter to the editor: “Anticoagulation in real-life patients with atrial fibrillation: Impact of renal disease"(Kare Yayıncılık, 2023) Güzel, Tuncay; Aktan, Adem; Kılıç, Raif; Arslan, Bayram; Demir, Muhammed; Özbek, Mehmet; Ertaş, FarukWe would like to thank the esteemed author Anetta Undas for reading our manuscript with interest and for her contributions. We would like to contribute to the author’s valuable comments and answer her questions.Öğe Unusual case report of malignant pheochromocytoma presenting with STEMI(Oxford University Press, 2023) Demir, Muhammed; Özbek, Mehmet; Güzel, Tuncay; Aktan, AdemBackground: Pheochromocytomas (PHEOs) are a group of tumours that leads to multiple symptoms and can induce hypercoagulability and promote thrombosis. Pheochromocytomas may also present without elevated serum and urinary markers. We aimed to provide tips and tricks for the diagnostic and therapeutic management of an unusual case of PHEOs. Case summary: Thirty-four-year-old woman with the unremarkable medical history presented with epigastric pain and dyspnoea. Electrocardiogram showed ST-segment elevation in the inferior limb leads. She underwent an emergency coronary angiogram, which showed a high thrombus burden in the distal right coronary artery. A subsequent echocardiogram demonstrated a 31 × 33mm right atrial mass adhering to the inferior vena cava and abdominal computed tomography (CT) scan revealed a 113 × 85mm necrotic mass in the left adrenal bed, with tumour thrombus extending proximally to the confluence of hepatic veins immediately inferior to the right atrium and distally to iliac vein bifurcation. Blood parameters, thrombophilia panel, vanillylmandelic acid, 5 hydroxy indole acetic acid, and homovanillic acid levels were normal. Tissue sampling confirmed the diagnosis of PHEOs. The surgical procedure was not planned due to the presence of metastatic foci on imaging, including positron emission tomography (PET)-CT. Anticoagulation with rivaroxaban and treatment with 177Lu-DOTATATE-based peptide receptor radionuclide therapy (PRRT) was initiated. Discussion: The coexistence of arterial and venous thrombosis is extremely rare in patients with PHEOs. Multidisciplinary approaches are required for the care of such patients. Catecholamines likely contributed to the development of thrombosis in our patient. Early recognition of PHEOs is the key point to ameliorate clinical outcomes.
