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    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, Bayram
    Background: 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.
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    The effect of nutritional scores on mortality in COVID-19 patients
    (Assoc Medica Brasileira, 2022) Aktan, Adem; Guzel, Tuncay; Demir, Muhammed; Ozbek, Mehmet
    OBJECTIVES: While studies on the treatment for the coronavirus disease 2019 (COVID-19) pandemic continue all over the world, factors that increase the risk of severe disease have also been the subject of research. Malnutrition has been considered an independent risk factor. Therefore, we aimed to investigate the clinical effect of dietary habits and evaluate the prognostic value of the Controlling Nutritional Status score in the COVID-19 patients we followed up.METHODS: A total of 2760 patients hospitalized for COVID-19 were examined. Patients were retrospectively screened from three different centers between September 1 and November 30, 2020. A total of 1488 (53.9%) patients who met the criteria were included in the study. Risk classifications were made according to the calculation methods of prognostic nutritional index and Controlling Nutritional Status scores and total scores. The primary outcome of the study was in-hospital mortality.RESULTS: The groups with severe Controlling Nutritional Status and prognostic nutritional index scores had a significantly higher mortality rate than those with mild scores. In the multivariable regression analysis performed to determine in-hospital mortality, the parameters, such as age (OR 1.04; 95%CI 1.02-1.06, p<0.001), admission oxygen saturation value (SaO2) (OR 0.85; 95%CI 0.83-0.87, p<0.001), and Controlling Nutritional Status score (OR 1.34; 95%CI 1.23-1.45, p<0.001), were independent predictors. The patient groups with a low Controlling Nutritional Status score had a higher rate of discharge with recovery (p<0.001).CONCLUSIONS: Higher Controlling Nutritional Status scores may be effective in determining in-hospital mortality in patients with COVID-19. Nutrition scores can be used as a useful and effective parameter to determine prognosis in patients with COVID-19.
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    Is plasma atherogenic index or LDL/HDL ratio more predictive of peripheral arterial disease complexity?
    (Sage Publications Ltd, 2024) Evsen, Ali; Aktan, Adem; Altunova, Mehmet; Ozbek, Mehmet
    Introduction: The most basic and well-known cause of peripheral arterial disease (PAD) is atherosclerosis. One of the main factors causing atherosclerosis is dyslipidemia. We will evaluate whether specific ratios of dyslipidemia, such as the atherogenic plasma index (AIP) and LDL/HDL ratio, which have recently been used in practice, can help us to predict the complexity of PAD in the clinic. Methods: A total of 305 patients with PAD admitted to our clinic were retrospectively included in this study. After evaluation according to angiography images using TASC-II classification, patients were divided into TASC A-B and TASC C-D. AIP was evaluated with the following formula: Log (TG/HDL). Cut-off values for AIP and LDL/HDL were determined on the ROC (receiver operating characteristic) curve. Logistic regression analysis were conducted to predict peripheral arterial disease complexity. Results: The mean ages of Group 1 (n:180, 68.3% male) and Group 2 (n:125, 77.6% male) patients were 64.10 +/- 12.39 and 64.94 +/- 11.12 years, respectively. The prevalence of diabetes mellitus (DM, p < 0.016) and coronary artery disease (CAD, p < 0.001) was higher in group 2. Group 2 had higher TG (p = 0.045), LDL-C (p = 0.004), AIP (p = 0.010), LDL/HDL (p < 0.001), and lower HDL-C (p = 0.015). In multivariate logistic regression analysis evaluating parameters in predicting PAD complexity, DM (OR: 1.66 Cl 95%: 1.01-2.73 p = 0.045), CAD (OR: 2.86 Cl 95%: 1.75-4.69 p < 0.001) and LDL/HDL (OR: 1.47 Cl 95%: 1.10-1.96 p = 0.008) were independent variables. Conclusion: In our study, we compared LDL/HDL ratio and AIP in PAD for the first time in the literature and showed that LDL/HDL ratio is a more valuable ratio and an independent predictor of PAD complexity.
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    Left ventricular global longitudinal strain can detect subclinical left ventricular systolic dysfunction in adult patients with primary nephrotic syndrome
    (Springer, 2023) Cap, Nese Kanbal; Aydin, Emre; Kadiroglu, Ali Kemal; Ozbek, Mehmet; Yildirim, Yasar; Yilmaz, Zulfikar; Aydin, Fatma Yilmaz
    It has been shown that there is an increased risk of cardiovascular events such as heart failure and death in nephrotic syndrome. Left ventricle global longitudinal strain (LVGLS) is a more sensitive measure of assessing myocardial dysfunction and is more reproducible than left ventricle ejection fraction (LVEF%). LVGLS can detectsubclinical deterioration in the left ventricle early. In this study, we aimed to investigate LVGLS in Primary Nephrotic Syndrome (PNS) patients with normal LVEF%. Patients with histopathologically confirmed PNS were evaluated for this prospective single-center study. Patients with similar age and gender characteristics without nephrotic syndrome were included as the control group. LVGLS measurements were performed by 2D speckle tracking echocardiography. A total of 171 patients, 57 with PNS and 114 in the control group, were included in the study. The mean age was 38 +/- 12 years in the study population, and 95(56%) of the patients were women. LVEF% was 60.2 +/- 4.2 in the PNS group and 61.1 +/- 3.2 in the control group, and there was no significant difference between the two groups (p=0.111). LVGLS was found to be significantly lower in the PNS group (-19.3 +/- 2.3% vs.-20.8 +/- 1.5 %, p<0.001). A significant relationship was observed between PNS and LVGLS in the multivariable linear regression analysis (beta= 4.428, CI 95% =0.57?1.48, p<0.001). A significant relationship was observed between PNS and LVGLS, and LVGLS was found to be lower in PNS patients. In patients with PNS, subclinical left ventricular systolic dysfunction may be detected in the early period by measuring LVGLS.
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    Monocyte to high-density lipoprotein cholesterol and lymphocyte to monocyte ratios are predictors of in-hospital and long-term mortality in patients with acute coronary syndrome
    (Wiley, 2021) Oylumlu, Muhammed; Oylumlu, Mustafa; Arik, Baran; Demir, Muhammed; Ozbek, Mehmet; Arslan, Bayram; Acun, Baris
    Objective We aimed to determine the relationship between LMR and MHR and in-hospital and long-term mortality in patients with ACS. Methods We retrospectively collected patients with ACS undergoing coronary angiography between January 2012 and December 2013. Results In total, 825 patients with a mean age of 62.4 +/- 12.9 years (71.3% male) were enrolled in the study. Patients were divided into three tertiles based on MHR levels and LMR levels. In-hospital mortality of the patients was significantly higher amongst patients in the upper MHR tertile when compared with the lower and middle MHR tertile groups [30 (10.9%) vs 8 (2.9%) and 14 (5.1%); P < .001, P = .009, respectively]. Five-year mortality of the patients was significantly higher amongst patients in the upper MHR tertile when compared with the lower and middle MHR tertile groups [84 (30.5%) vs 48 (17.5%) and 57 (20.7%); P < .001, P = .005, respectively]. In-hospital mortality of the patients was significantly higher amongst patients in the lower LMR tertile when compared with the upper and middle LMR tertile groups [25 (9.1%) vs 10 (3.6%) and 17 (6.2%); P = .007, P = .130, respectively]. Five -year mortality of the patients was significantly higher amongst patients in the lower LMR tertile when compared with the upper and middle LMR tertile groups [77 (28.0%) vs 47 (17.1%) and 65 (23.6%); P = .001, P = .142, respectively]. Conclusion We have shown that high MHR and low LMR were significant and independent predictors of in-hospital and long-term mortality in patients with ACS.
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    Non-invasive Evaluation of Electromechanical Transmission in Patients with Hypertensive Response to Exercise Stress Test
    (Galenos Publ House, 2023) Kaya, Ahmet Ferhat; Ozdil, Mehmet Hasan; Yilmaz, Cemalettin; Kilic, Raif; Ozbek, Mehmet; Kaya, Hasan
    Objective: Excessive hypertensive response to exercise testing is associated with adverse cardiovascular events such as left ventricular hypertrophy and atrial fibrillation (AF). In this study, we examined the relationship between electromechanical delay and excessive hypertensive response to exercise testing.Methods: Twenty-five people who had a hypertensive response to the exercise stress test and 28 people who were similar in age and gender with a normal blood pressure response in the exercise stress test as the control group were included in the study.Results: There was no statistical difference between the study groups in blood pressure holter values, conventional echocardiography findings, and exercise stress test findings. Lateral PA-TDI time (the time from the beginning of the P wave measured by tissue Doppler imaging to the beginning of the A' wave), left atrial electromechanical delay, and interatrial electromechanical delay were observed to be significantly longer in the hypertensive response group to exercise stress test compared with the control group (74.0 +/- 6. 3 vs. 68.8 +/- 5.7, p=0.003; 24.7 +/- 7.0 vs. 19.6 +/- 7.1, p=0.013; 36.8 +/- 8.5 vs. 30.6 +/- 6.6, p=0.003, respectively).Conclusions: Early detection of electromechanical delay non-invasively may be useful in this patient group in predicting the development of new AF risk.
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    A novel predictor in patients with coronary chronic total occlusion: systemic immune-inflammation index: a single-center cross-sectional study
    (Assoc Medica Brasileira, 2022) Demir, Muhammed; Ozbek, Mehmet
    OBJECTIVE: Severe inflammation is reportedly associated with subsequent cardiovascular events, including in patients with coronary artery disease. This study aimed to examine the prognostic value of systemic immune-inflammation index and determine mortality and clinical outcomes in patients with chronic coronary total occlusion. METHODS: Our study evaluated 366 consecutive coronary total occlusion patients. The clinical end points were all-cause mortality and major adverse cardiovascular events, which include target vessel revascularization, myocardial infarction, and cerebrovascular events during 105 months follow-up. RESULTS: The study findings showed 59 (16.1%) all-cause death, 22 (6%) target vessel revascularization cases, 32 (8.7%) myocardial infarction cases, and 13 (3.6%) cerebrovascular events cases, with a median follow-up of 49 months (26-74). Multivariate logistic regression analysis showed that systemic immune-inflammation index was not associated with target vessel revascularization, myocardial infarction, and cerebrovascular events. Multivariate Cox regression analysis found systemic immune-inflammation index to be associated with all-cause death. Kaplan-Meier analysis showed a lower survival rate and myocardial infarction-free survival time in patients with higher systemic immune-inflammation index scores. CONCLUSION: Although systemic immune-inflammation index is a preferable tool for the detection of mortality, it failed to give adverse outcomes. Larger multicenter studies are thus warranted to investigate the effect of systemic immune-inflammation index on clinical outcomes.
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    Prognostic Significance of Serum Albumin in Patients With Acute Coronary Syndrome
    (Sage Publications Inc, 2020) Polat, Nihat; Oylumlu, Mustafa; Isik, Mehmet Ali; Arslan, Bayram; Ozbek, Mehmet; Demir, Muhammed; Kaya, Hasan
    In patients with unstable angina pectoris (UAP) or non-ST elevation myocardial infarction (NSTEMI), long-term mortality remains high despite improvements in the diagnosis and treatment. In this study, we investigated whether serum albumin level is a useful predictor of long-term mortality in patients with UAP/NSTEMI. Consecutive patients (n = 403) who were hospitalized with a diagnosis of UAP/NSTEMI were included in the study. Patients were divided into 2 groups based on the presence of hypoalbuminemia and the relationship between hypoalbuminemia and mortality was analyzed. Hypoalbuminemia was detected in 34% of the patients. The median follow-up period was 35 months (up to 45 months). Long-term mortality rate was 32% in the hypoalbuminemia group and 8.6% in the group with normal serum albumin levels (P< .001). On multivariate analysis, hypoalbuminemia, decreased left ventricular ejection fraction, and increased age were found to be independent predictors of mortality (P< .05). The cutoff value of 3.10 g/dL for serum albumin predicted mortality with a sensitivity of 74% and specificity of 67% (receiver-operating characteristic area under curve: 0.753, 95% CI: 0.685-0.822). All-cause long-term mortality rates were significantly increased in patients with hypoalbuminemia. On-admission albumin level was an independent predictor of mortality in patients with UAP/NSTEMI.
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    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, Burhan
    OBJECTIVE: 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.
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    Unusual response to His-refractory atrial premature complex: What is the mechanism?
    (Wiley, 2020) Kara, Meryem; Korkmaz, Ahmet; Karimli, Emin; Rencuzogullari, Ibrahim; Demir, Muhammed; Ozbek, Mehmet; Ozeke, Ozcan
    A 32-year-old woman underwent radiofrequency catheter ablation of narrow QRS tachycardia that was terminated with intravenous adenosine.