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  • Küçük Resim
    Öğe
    Meme kanseri nedeni ile kemoterapi almış olan hastalarda elektrokardiyografideki repolarizasyon belirteçlerinin kardiyotoksisite nedenli kardiyak etkilenmeyi öngördürücülüğü: Retropsektif gözlemsel çalışma
    (Ege Üniversitesi, Tıp Fakültesi, 2018) Özbay, Benay; Yavuzgil, Oğuz
    Giriş: Meme kanseri kadınlarda en sık rastlanan malignitedir, kanser nedeni ile tedavi almış hastalarda kemoterapötiklere bağlı en sık yan etki kardiyovasküler sistem üzerinedir. Meme kanseri tedavisinde antrasiklinler sıklıkla tercih edilmekte olup geri dönüşümsüz kardiyotoksisiteye neden olabilmektedirler. Tedaviye başlamadan ve tedavi sonrası erken dönemde kardiyotoksisite gelişimi açısından riskli hastaları belirlemek için henüz kanıtlanmış bir algoritma bulunmamaktadır. Güncel kılavuzlarda strain EKO takibi önerilmekte ancak mekanik disfonksiyon gelişimine dek geçen sürede daha erken fikir verecek bir yöntem bulunmamıştır. Bu çalışma ile EKG kayıtlarında repolarizasyon değerlendirme parametreleri olan QT ve QTc dispersiyonu, Tp-Te intervali ve Tp-Te/QT değerlendirilerek, güncel kılavuzlarda önerilen strain EKO’dan daha erken subklinik kardiyotoksisitenin saptanması ve elektromekanik disfonksiyonun birlikte değerlendirilmesi amaçlanmıştır. Yöntem: Retrospektif olarak meme kanseri nedeni ile kemoterapi almış 35 hastanın (35 kadın, yaş ortalaması 48,9±11,8, ortalama doksorubisin kümülatif dozu 415± 32 mg/m2) antrasiklin öncesi, ilk antrasiklin dozu sonrası ve 3.ay EKG’leri ile tedavi öncesi ve 3.ay 2 boyutlu strain EKO’ları karşılaştırıldı. EKG kayıtlarında QTve QTc, QT ve QTc dispersiyonu, QT, QTc ve QT/√RR’ye göre Tp-Te ölçümleri yapıldı. EKO kayıtlarında GLS, sirkumferansiyel strain, radial strain ve torsiyon değerendirildi. Bulgular: Tedavi sonrası akut döenmde QT, QT dispersiyonu ve Tp-Te parametrelerinde uzamanın meydana geldiği ve bu uzamanın azalmakla birlikte 3.ayda da devam ettiği izlendi. (istatistiksel olarak anlamlılığa ulaşılmıştır). Tedavi öncesi ve 3.ayda yapılmış olan EKO’larda GLS değerlerinde anlamlı değişiklik izlenmedi. (GLS avg: -0,21±7,19 p=0,863; GLS LAX avg: -1,32±5,34 p=0,153; GLS A4C avg: -0,47±5,26 p=0,603; GLS A2C avg: -1,71±5,47 p=0,072) Ancak sirkumferansiyel strain, radial strain ve torsiyonda anlamlı düşüş izlenmiştir. (Sirkumferansiyel strain -17,2±3,53’den -13± 2,84 p<0,001, Radial strain %45,1±8,32’den %35,6±10 p<0,001, torsiyon 12,1±3,54’ten 7,7±2,17 p<0,001) Sonuç: Doksorubisine bağlı repolarizasyon bozulmaktadır ve heterojenite gelişmektedir. Bu elektriksel disfonksiyona eşlik eden, strain EKO’da sirkumferansiyel, radial strain ve torsiyonda da bozulma ile disfonksiyonun mekanik olarak devam ettiği görülmüştür. Kardiyotoksisite elektriksel ve mekanik olarak birlikte değerlendirilmelidir.
  • Küçük Resim Yok
    Öğe
    Prevalence of inappropriate sinus tachycardia and the comparison of the heart rate variability characteristics with propensity score-matched controls
    (2020) Şimşek, Evrim; Özbay, Benay; Mutlu, İnan; Gürses, Ecem; Kemal, Hatice S.; Yağmur, Burcu; Can, Levent Hürkan
    Objective: Inappropriate sinus tachycardia (IST) is a syndrome characterized by an elevated resting heart rate with distressing symptoms and no secondary cause of sinus tachycardia. This study was conducted to evaluate both the prevalence of IST among symptomatic patients and heart rate variability (HRV) characteristics. Methods: The records of all consecutive symptomatic patients who had undergone 24-hour Holter monitoring between September 2015 and November 2016 at a single center were retrospectively evaluated. IST was defined as a 24-hour mean heart rate (HR) of ?90 beats/minute and a resting HR of ?100 beats/minute in the absence of any secondary cause of sinus tachycardia. All of the study data related to clinical characteristics, symptoms, concomitant diseases, and Holter electrocardiogram parameters were obtained from the electronic hospital records. A propensity age- and sex-matched control group was selected from a non-IST patient cohort. Results: A total of 1865 consecutive patients were evaluated and 32% were excluded due to an inadequate Holter recording period or insufficient quality, atrial fibrillation episodes, atrioventricular block, or >1% atrial or ventricular extrasystoles. Among 1265 patients with sinus rhythm, 4.98% (n=63) had IST. The IST patients were younger (39.6±17.4 vs. 50.2±17.2 years; p<0.001), and female gender was more prominent (60.3% vs. 43.8%; p=0.009). All of the time and frequency domain parameters of HRV except the low frequency/high frequency ratio were significantly reduced in the IST group compared with the propensity-matched controls. Conclusion: The IST prevalence among symptomatic patients in sinus rhythm was 4.98%. IST was primarily seen in younger women, and they had diminished time and frequency domain HRV parameters.
  • Küçük Resim Yok
    Öğe
    Prevalence of inappropriate sinus tachycardia and the comparison of the heart rate variability characteristics with propensity score-matched controls
    (2020) Şimşek, Evrim; Özbay, Benay; Mutlu, İnan; Gürses, Ecem; Kemal, Hatice S.; Yağmur, Burcu; Can, Levent Hürkan
    Objective: Inappropriate sinus tachycardia (IST) is a syndrome characterized by an elevated resting heart rate with distressing symptoms and no secondary cause of sinus tachycardia. This study was conducted to evaluate both the prevalence of IST among symptomatic patients and heart rate variability (HRV) characteristics. Methods: the records of all consecutive symptomatic patients who had undergone 24-hour Holter monitoring between September 2015 and November 2016 at a single center were retrospectively evaluated. IST was defined as a 24-hour mean heart rate (HR) of ?90 beats/minute and a resting HR of ?100 beats/minute in the absence of any secondary cause of sinus tachycardia. All of the study data related to clinical characteristics, symptoms, concomitant diseases, and Holter electrocardiogram parameters were obtained from the electronic hospital records. A propensity age- and sex-matched control group was selected from a non-IST patient cohort. Results: A total of 1865 consecutive patients were evaluated and 32% were excluded due to an inadequate Holter recording period or insufficient quality, atrial fibrillation episodes, atrioventricular block, or >1% atrial or ventricular extrasystoles. Among 1265 patients with sinus rhythm, 4.98% (n=63) had IST. the IST patients were younger (39.6±17.4 vs. 50.2±17.2 years; p<0.001), and female gender was more prominent (60.3% vs. 43.8%; p=0.009). All of the time and frequency domain parameters of HRV except the low frequency/high frequency ratio were significantly reduced in the IST group compared with the propensity-matched controls. Conclusion: the IST prevalence among symptomatic patients in sinus rhythm was 4.98%. IST was primarily seen in younger women, and they had diminished time and frequency domain HRV parameters.
  • Küçük Resim Yok
    Öğe
    The real-life data of hospitalized patients with heart failure: on behalf of the Journey HF-TR study investigators
    (2019) Sinan, Ümit Yaşar; Ekmekçi, Ahmet; Özbay, Benay; Akyıldız, Filiz Akçay; Bekar, Lütfü; Koza, Yavuzer; Kocabaş, Umut
    Objective: Acute heart failure (AHF) is a life-threatening clinical syndrome characterized by rapid onset of heart failure (HF) symptoms and signs and requires urgent therapy. the aim of the present study was to evaluate the overall clinical characteristics, management, and in-hospital outcomes of hospitalized patients with AHF in a large sample of Turkish population. Methods: the Journey HF-TR study is a cross-sectional, multicenter, non-invasive and observational trial. Patients who were hospitalized with a diagnosis of AHF in the intensive care unit (ICU)/coronary care unit and cardiology wards between September 2015 and September 2016 were included in our study. Results: A total of 1606 (male: 57.2%, mean age: 67.8±13 years) patients who were diagnosed with AHF were enrolled in the study. Seventeen percent of the patients were admitted to the hospital with a diagnosis of new onset AHF. Hypertension (67%) and coronary artery disease (CAD) (59.6%) were the most frequent underlying diseases. Acute coronary syndrome accompanying HF (14.7%), infection (29.3%), arrhythmia (25.1%), renal dysfunction (23%), and non-compliance with medication (23.8%) were the precipitating factors. the median length of stay in the ICU was 3 days (interquartile range, IQR 1–72) and 7 days (IQR 1–72) for in-hospital journey. the guideline recommended medications were less likely used in our patient population (<73%) before admission and were similar to European and US registers at discharge. the in-hospital mortality rate was 7.6%. Hypertension and CAD were the most frequent underlying diseases in our population similar to other European surveys. Although our study population was younger than other registers, in-hospital mortality was high. Conclusion: Analyses of such real-world data will help to prepare a national database and distinctive diagnosis and treatment algorithms and to provide observing compliance with the current European Society of Cardiology guidelines for more effective management of HF. (Anatol J Cardiol 2019; 21: 25-30)
  • Küçük Resim Yok
    Öğe
    The real-life data of hospitalized patients with heart failure: On behalf of the Journey HF-TR study investigators
    (2019) Sinan, Ümit Yaşar; Ekmekçi, Ahmet; Özbay, Benay; Akyıldız, Filiz Akçay; Bekar, Lütfü; Koza, Yavuzer; Zoghi, Mehdi
    Objective: Acute heart failure (AHF) is a life-threatening clinical syndrome characterized by rapid onset of heart failure (HF) symptoms and signs and requires urgent therapy. The aim of the present study was to evaluate the overall clinical characteristics, management, and in-hospital outcomes of hospitalized patients with AHF in a large sample of Turkish population. Methods: The Journey HF-TR study is a cross-sectional, multicenter, non-invasive and observational trial. Patients who were hospitalized with a diagnosis of AHF in the intensive care unit (ICU)/coronary care unit and cardiology wards between September 2015 and September 2016 were included in our study. Results: A total of 1606 (male: 57.2%, mean age: 67.8±13 years) patients who were diagnosed with AHF were enrolled in the study. Seventeen percent of the patients were admitted to the hospital with a diagnosis of new onset AHF. Hypertension (67%) and coronary artery disease (CAD) (59.6%) were the most frequent underlying diseases. Acute coronary syndrome accompanying HF (14.7%), infection (29.3%), arrhythmia (25.1%), renal dysfunction (23%), and non-compliance with medication (23.8%) were the precipitating factors. The median length of stay in the ICU was 3 days (interquartile range, IQR 1–72) and 7 days (IQR 1–72) for in-hospital journey. The guideline recommended medications were less likely used in our patient population (<73%) before admission and were similar to European and US registers at discharge. The in-hospital mortality rate was 7.6%. Hypertension and CAD were the most frequent underlying diseases in our population similar to other European surveys. Although our study population was younger than other registers, in-hospital mortality was high. Conclusion: Analyses of such real-world data will help to prepare a national database and distinctive diagnosis and treatment algorithms and to provide observing compliance with the current European Society of Cardiology guidelines for more effective management of HF. (Anatol J Cardiol 2019; 21: 25-30)
  • Küçük Resim Yok
    Öğe
    Takotsubo syndrome after treatment with non-cardiotoxic chemotherapy agents
    (2021) Şimşek, Evrim; Kültürsay, Hakan; Kemal, Hatice; Gürses, Ecem; Özbay, Benay
    Summary– Takotsubo syndrome (TTS), acute stress-induced cardiomyopathy, is known to have a dramatic clinical presentation mimicking acute myocardial infarction. Recently developed chemotherapeutic drugs have resulted in improvements in morbidity and mortality in many forms of cancer. However, some chemotherapeutic drugs are cardiotoxic and may cause heart failure. Gemcitabine and vinorelbine are commonly used drugs for various solid organ neoplasms. While neither of these chemotherapeutic drugs has been directly associated with cardiotoxicity, there are a few case reports in the literature related to gemcitabine treatment-induced cardiomyopathy. This case report describes a case of TTS developing within hours of gemcitabine and vinorelbine chemotherapy.