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Öğe Ability of CHA2DS2-VASc/R2CHA2DS2-VASc Scores to Predict Complications Related to Cardiac Implantable Electronic Devices(John Wiley and Sons Inc, 2025) Söner, Serdar; Aktan, Adem; Kılıç, Raif; Güzel, Hamdullah; Taştan, Ercan; Okşul, Metin; Cömert, Adnan DuhaBackground: Globally, the number of cardiac implantable electronic devices (CIEDs) is increasing. In our study, we aimed to investigate whether CHA2DS2-VASc and R2CHA2DS2-VASc scores are predictive of CIED-related complications. Methods: Our investigation was carried out with a multicenter retrospective design. Patients who underwent CIED surgery at two cardiac centers in Turkey between January 2011 and May 2023, 1676, were evaluated. The patients were divided into two groups according to their R2CHA2DS2-VASc scores. Patients with R2CHA2DS2-VASc ≥ 5 were included in group 1 (380 patients), and patients with R2CHA2DS2-VASc < 5 (1296 patients) were included in group 2. The primary outcome was defined as the cumulative events. Each component of cumulative events, such as hematoma, pericardial effusion, pneumothorax, and infection, was also defined as a secondary outcome. Results: The study's patient population had an average age of 62.9 ± 14 years. Pneumothorax (1.8% vs. 1.3%, p = 0.444), pericardial effusion or tamponade (0.35% vs. 0.2%, p = 0.659), and clinically significant hematoma (1.1% vs. 0.6%, p = 0.376) were comparable between the groups. Infection-related devices and cumulative events classified as primary outcomes were higher in the R2CHA2DS2-VASc ≥ 5 group (6.1% vs. 1.2%, p < 0.001; 7.6% vs. 3.2%, p < 0.001, respectively). Modeling analyses showed that the CHA2DS2-VASc score and HT were also independent predictors of device-related infection and cumulative events. Conclusion: In the R2CHA2DS2-VASc ≥ 5 groups, infection related to the device system and cumulative events were higher. Patients with an R2CHA2DS2-VASc score of 5 or more and a high CHA2DS2-VASc score should be evaluated more carefully regarding infection and cumulative events before and after the operation. © 2025 Wiley Periodicals LLC.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 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 İskemik ve noniskemik kardiyomiyopatili hastalarda diürnal kan basıncı değişimi(2015) Taştan, ErcanAMAÇ: Kalp yetmezliği nöro-endokrin sistem maladaptasyonu ile karakterize kronik bir süreçtir. Bu süreçte sempatik aktivasyonda artma,baroreseptör duyarlılığında azalma ve periferik rezistansta artma izlenmektedir. Bu durumun kan basıncının diürnal ritmini değiştirebileceği düşünülmüştür. İlleri derecede sistolik kalp yetersizliği olan hastalarda kan basıncının sirkadiyen değişiminin kontrollerden farklı olmadığını gösteren çalışmalar olsa da,çalışmalar; çoğunlukla ileri derecede sistolik kalp yetersizliği olan hastalarda nondipper ve reverse dipper durumun ağırlıkta olduğunu göstermektedir.Kalp yetersizliğinin etyolojisinin bu durum üzerindeki etkilerini inceleyen herhangi bir çalışma bulunmamaktadır. Amacımız iskemik ve noniskemik kardiyomiyopatili hastalar arasında kan basıncının sirkadiyen ritmini araştırmaktır. MATERYAL VE METOD: Ejeksiyon fraksiyonu <%40 olan,sol kalbi geniş,sinüs ritminde,ciddi derecede kapak hastalığı olmayan, diyalize girmeyen ve biventriküler pace takılı olmayan, 22 iskemik kardiyomiyopati ve 22 noniskemik kardiyomiyopati ile 22’si kontrol grubundan oluşan toplam 66 hasta çalışmaya alındı. Çalışmaya alınan bütün hastaların hemogram ve rutin biyokimyaları çalışıldıktan sonra BMI ve GFR’leri hesaplandı. Bu hastaların ekokardiyografilerine bakılıp 24 saatlik ambulatuvar kan basıncı cihazi takılarak,hastalar çalışmaya alındı. BULGULAR: İKMP grubunda (21E, 1K), DKMP grubu (14E, 8K) ve Kontrol grubuna(13E, 9K) göre istatistiksel olarak anlamlı sayıda erkek hasta fazlalığı mevcuttu. Ayrıca, İskemik kardiyomiyopati grubunda, noniskemik kardiyomiyopati grubuna oranla istatistiksel olarak anlamlı statin kulanımı fazlalığı mevcuttu. Ejeksiyon fraksiyonları, yaş,DM,HT, GFR, BMI,hemogram, biyokimya parametreleri ve kullandığı ilaçlar bakımından iskemik kardiyomiyopati ve noniskemik kardiyomiyopati hastaları arasında istatistiksel olarak farklılık yoktu. Kontrol grubunda dipper, noniskemik kardiyomiyopati grubunda nondipper, iskemik kardiyomiyopati grubunda ise reverse dipper durum istatistiksel olarak anlamlı derecede fazlaydı. Gruplar arasında P< 0.001 idi. SONUÇ: İleri derecede sistolik kalp yetmezliği olan hastalarda kan basıncı diürnal ritmi değişmektedir. Çalışmamızda; DKMP grubunda %54 oranında non dipper, %27,3 oranında reverse dipper, İKMP grubunda ise %63,6 oranında reverse dipper,%27,3 oranında non dipper durum saptandı. Çalışmamızın verileri göz önünde bulundurulduğunda iskemik kardiyomiyopati grubunda reverse dipper durumun anlamlı oranda fazla olması nedeniyle ilerde olabilecek ölüm ve hastaneye başvurularında ve/veya yatışlarında noniskemik kardiyomiyopati grubuna oranla daha fazla olabileceği düşünülebilir. Her nekadar KKY hastalarında prognozu belirlemede AKBM ‘nın ve non dipper durumun yeri biliniyor olsa da bu hastalarda ilaç alma saatlerinin belirlenmesinde AKBM ‘ nın rolü göz önünde bulundurulmalıdır.
