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Öğe CHA2DS2-VASc score and modified CHA2DS2-VASc score can predict mortality and intensive care unit hospitalization in COVID-19 patients(Springer, 2021) Gunduz, Ramazan; Yildiz, Bekir Serhat; Ozdemir, Ibrahim Halil; Cetin, Nurullah; Ozen, Mehmet Burak; Bakir, Eren Ozan; Bayturan, OzgurIn this study, we investigated whether the CHA2DS2-VASc score could be used to estimate the need for hospitalization in the intensive care unit (ICU), the length of stay in the ICU, and mortality in patients with COVID-19. Patients admitted to Merkezefendi State Hospital because of COVID-19 diagnosis confirmed by RNA detection of virus by using polymerase chain reaction between March 24, 2020 and July 6, 2020, were screened retrospectively. The CHA2DS2-VASc and modified CHA2DS2-VASc score of all patients was calculated. Also, we received all patients' complete biochemical markers including D-dimer, Troponin I, and c-reactive protein on admission. We enrolled 1000 patients; 791 were admitted to the general medical service and 209 to the ICU; 82 of these 209 patients died. The ROC curves of the CHA2DS2-VASc and M-CHA2DS2-VASc scores were analyzed. The cut-off values of these scores for predicting mortality were >= 3 (2 or under and 3). The CHA2DS2-VASc and M-CHA2DS2-VASc scores had an area under the curve value of 0.89 on the ROC. The sensitivity and specificity of the CHA2DS2-VASc scores were 81.7% and 83.8%, respectively; the sensitivity and specificity of the M-CHA2DS2-VASc scores were 85.3% and 84.1%, respectively. Multivariate logistic regression analysis showed that CHA2DS2-VASc, Troponin I, D-Dimer, and CRP were independent predictors of mortality in COVID-19 patients. Using a simple and easily available scoring system, CHA2DS2-VASc and M-CHA2DS2-VASc scores can be assessed in patients diagnosed with COVID-19. These scores can predict mortality and the need for ICU hospitalization in these patients.Öğe Comparison of anti-factorXa assay and rotational thromboelastogram in evaluating the efficacy of enoxaparine treatment in patients with acute coronary syndrome without ST-segment elevation(Cukurova Univ, Fac Medicine, 2021) Gunduz, Ramazan; Yildiz, Bekir Serhat; Ozdemir, Ibrahim Halil; Ozen, Mehmet Burak; Cetin, Nurullah; Yavuzgil, OguzPurpose: The aim of this study was to compare anti-factor Xa assay and tromboelastogram in evaluation of efficacy of enoxaparin in patients with acute coronary syndrome without ST-segment elevation. Materials and Methods: Twenty-five patients with acute coronary syndrome were involved. Two blood samples were taken on admission and 4 hours after the subcutaneous injection of third dose of 1mg/kg enoxaparin to the patients. AntiFXa, tromboelastogram, activated coagulation time were calculated. Results: A non-significant increase in activated coagulation time was observed after the injection of enoxaparin. After injection enoxaparin thromboelastography parameters changed maximum amplitude(MA) increased (MA basal 65.4 +/- 11.9 after 63.4 +/- 7.8), R time increased (from 5 +/- 1.7 to 8.4 +/- 4.6,), K time increased (from 1.89 +/- 1.06 to 2.56 +/- 1.4), angle increased (from 66.34 +/- 5.6 to 57.9 +/- 11.4). AntiFXa increased. (from 0.122 +/- 0.06 to 0.501 +/- 0.359). Conclusion: Tromboelastography method can be used in assessment of efficacy of enoxaparin in patients with acute coronary syndrome without ST-Segment elevation.Öğe Dabigatran for stroke prevention in real life in a sample of population from Turkey: D-SPIRIT registry(Aves, 2021) Altin, Cihan; Topaloglu, Caner; Cetin, Nurullah; Dalgic, Onur; Yavuz, Veysel; Alioglu, Emin; Bilgin, NazileObjective: The D-SPIRIT registry is designed to investigate the safety and effectiveness of dabigatran etexilate in patients with atrial fibrillation in routine clinical practice. Methods: D-SPIRIT is the first national, multicenter, prospective, observational, postmarketing registry that investigates the usage of dabigatran in real life. A total of 326 noveloral anticoagulant-eligible patients with atrial fibrillation who have been taking dabigatran etexilate therapy for stroke prevention at least 6 months from 9 different centers were enrolled into the registry. Patients were followed up for 2 years to evaluate the effectiveness and safety of the treatment. All adverse clinical events including bleeding, thromboembolic events, stroke, systemic embolism, transient ischemic attack, myocardial infarction, and all-cause death were recorded. Results: The mean age was 71.1 +/- 9.6 years, and 57.4% of the study participants were female. The mean CHA(2)DS(2)-VASc (congestive heart failure, hypertension, age >= 75 years, diabetes mellitus, stroke or transient ischemic attack [TIA], vascular disease, age 65-74 years, sex category) score was 3.4 +/- 1.6. The cumulative adverse clinical events rate was 6.30% per year. The rate for embolic events including TIA, ischemic stroke, and peripheral embolism was 1.26% per year. The rate for major bleeding was 2.20% per year, and the mortality rate was 0.94% per year. Conclusion: This registry obtained an important overview of the current safety and effectiveness of the dabigatran etexilate in Turkey. Our results indicate similar rates of thromboembolic and bleeding events with pivotal phase 3 trial and other real-life registries. However, rate of undertreatment usage of dabigatran etexilate in real life was found to be considerable.Öğe Design and rationale of dabigatran's stroke prevention in real life in Turkey (D-SPIRIT)(Turkish Soc Cardiology, 2016) Turk, Ugur Onsel; Alioglu, Emin; Tuncer, Esref; Ozpelit, Mehmet Emre; Pekel, Nihat; Tengiz, Istemihan; Cetin, Nurullah; Dalgic, Onur; Topaloglu, Caner; Bilgin, Nazile; Altin, Cihan; Ozdemirkiran, Tolga; Tuluce, Kamil; Turkoglu, Ebru Ipek; Ozpelit, EbruObjective: The D-SPIRIT registry is designed to investigate the safety and efficacy of dabigatran etexilate in patients with nonvalvular atrial fibrillation (NVAF) and to collect data on outcomes in clinical practice. Methods: The D-SPIRIT is a national, prospective, observational, post-marketing registry involving patients with NVAF who have been taking dabigatran etexilate therapy for stroke prevention for a minimum of 6 months prior to enrollment. The registry will collect and analyze data from routine care, enrolling up to 600 patients in 9 centers. Patients will be followed up for 2 years to evaluate effectiveness and safety. A sample size of 600 subjects is proposed based on the following assumptions; Two-sided significance level of 0.05 (1-sided significance level of 0.025), ischemic stroke incidence rate of 0.768%-1.111%, hemorrhagic stroke incidence rate of 0.109%-0.130%, transient ischemic attack incidence rate of 0.722%-0.623%, therapy discontinuation incidence rate of 40% at day 730, and duration of enrollment period of 12 months with non-uniformed enrollment rate. Ethics approval was given by Dokuz Eyll University Ethics Committee of Clinical Research (2014/54) and approved by the Turkish Ministry of Health. Conclusion: Potential results of D-SPIRIT registry will add data from clinical practice to those from the RE-LY trial to expand knowledge of dabigatran etexilate treatment in patients with NVAF.Öğe Early Reverse Cardiac Remodeling Effect of Laparoscopic Sleeve Gastrectomy(Springer, 2017) Tuluce, Kamil; Kara, Cemal; Tuluce, Selcen Yakar; Cetin, Nurullah; Topaloglu, Caner; Bozkaya, Yasemin Turhan; Saklamaz, Ali; Cinar, Cahide Soydas; Ergene, OktayThis study evaluated the early postoperative benefits of laparoscopic sleeve gastrectomy (LSG) on the left ventricular (LV) function and left atrial (LA) structural, mechanical, and electrical functions in severely obese patients. Thirty-two patients with severe obesity who were consecutively scheduled for LSG and 30 healthy controls were included in the study. LV global longitudinal strain (LGS), peak atrial longitudinal strain (PALS), and strain rates (S-Sr, E-Sr, and A-Sr) of the lateral and septal LA walls, and intra- and interatrial dyssynchrony periods for all subjects were evaluated using strain echocardiography. The measurements were repeated in patients 1 month after surgery. LGS of the LV was significantly depressed in the patient group compared with the control group (p < 0.001). LA peak septal and lateral wall strain values were significantly lower in patients than in controls (both p values < 0.001). LA intra- and interatrial dyssynchrony periods were longer in patients than in controls (p = 0.012 and p = 0.004, respectively). LGS significantly improved after LSG (p < 0.001). Significant reductions were noted in the LA antero-posterior diameter (p < 0.001), LA volume index (LAVI, p = 0.001), and in the mitral velocity to the early diastolic velocity of the mitral annulus ratio (E/e' ratio, p = 0.046). The PALS of the septal and lateral LA walls significantly increased (p = 0.001 and p < 0.001, respectively). S-Sr, E-Sr, and A-Sr values of the septal LA wall (p = 0.049, p < 0.001, and p = 0.001, respectively) and the lateral LA wall (p = 0.009, p = 0.007, and p = 0.002, respectively) significantly improved postoperatively. Intra- and interatrial dyssynchrony significantly decreased (p = 0.001 and p < 0.001, respectively). Weight loss positively correlated with changes in LGS (R = 0.39, p = 0.039), LAVI (R = 0.39, p = 0.034), intra-atrial dyssynchrony (R = 0.45, p = 0.021), interatrial dyssynchrony (R = 0.42, p = 0.038), septal LA wall peak strain (R = 0.44, p = 0.027), lateral LA wall peak strain (R = 0.46, p = 0.017), septal LA wall A-Sr (R = 0.43, p = 0.028), and lateral LA wall A-Sr (R = 0.46, p = 0.019). The comparison of postoperative findings of the patients with controls revealed that the LA diameter, both LA volume and volume index (LAVI), E/e' ratio, S-Sr and E-Sr of both lateral and septal LA walls, intra- and interatrial LA dyssynchrony of the patient group became similar to the control group (all p value > 0.05). Postoperative A-Sr values of both LA walls (both p value < 0.001) were higher in patients than controls. The benefits of LSG on LV and LA function may be observed even in the early postoperative phase. The resulting weight loss correlates with LV and LA reverse remodeling in severely obese patients.Öğe Effect of Coronary Thrombus Aspiration in Non ST Elevation Acute Coronary Syndrome Patients on Three-Year Survival- Does it add any Benefit?(Sage Publications Inc, 2022) Yildiz, Bekir S.; Cetin, Nurullah; Gunduz, Ramazan; Bilge, Adnan; Ozgur, Su; Orman, Mehmet N.We assessed the effect of thrombus aspiration (TA) during percutaneous coronary intervention (PCI) on in-hospital and 3-year mortality in consecutive non-ST segment elevation myocardial infarction (n = 189) and unstable angina pectoris (n = 148) patients (n = 337) between 2011 and 2016. In total, 153 patients (45.4%) underwent TA. The number of patients with postoperative thrombolysis in terms of myocardial infarction grade 3 blood flow (P < .001) and myocardial blush grade 3 (P < .001) were significantly higher in all TA groups. At 6-, 12- and 24-month post-PCI, the mean left ventricular ejection fraction was significantly higher in the all TA groups versus the stand alone PCI group (P < .001). Thrombus aspiration was associated with a significant improvement both in epicardial flow, myocardial perfusion and left ventricular ejection fraction. Thrombus aspiration during PCI in all acute coronary syndrome (except ST segment elevation) patients was associated with better survival compared with stand alone PCI group at 3-year follow-up (P = .019).Öğe Effect of Coronary Thrombus Aspiration in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome on 3-Year Survival: Does It Add Any Benefit?(Elsevier Science Inc, 2021) Cetin, Nurullah; Orman, Mehmet; Yildiz, Bekir[No Abstract Available]Öğe Frontal QRS/T angle can predict mortality in COVID-19 patients(W B Saunders Co-Elsevier Inc, 2022) Gunduz, Ramazan; Yildiz, Bekir Serhat; Ozgur, Su; Ozen, Mehmet Burak; Bakir, Eren Ozan; Ozdemir, Ibrahim Halil; Cetin, NurullahAims: The frontal QRS-T (fQRS) angle has been investigated in the general population, including healthy people and patients with heart failure. The fQRS angle can predict mortality due to myocarditis, ischaemic and nonischaemic cardiomyopathies, idiopathic dilated cardiomyopathy, and chronic heart failure in the general population. Moreover, no studies to date have investigated fQRS angle in coronavirus disease 2019 (COVID-19) patients. Thus, the purpose of this retrospective multicentre study was to evaluate the fQRS angle of COVID-19 patients to predict in-hospital mortality and the need for mechanical ventilation.Methods and results: An electrocardiogram was performed for 327 COVID-19 patients during admission, and the fQRS angle was calculated. Mechanical ventilation was needed in 119 patients; of them, 110 died in the hospital. The patients were divided into two groups according to an fQRs angle >90 degrees versus an fQRS angle <_90 degrees. The percentages of mortality and the need for mechanical ventilation according to fQRS angle were 67.8% and 66.1%, respectively, in the fQRs >90 degrees group and 26.1% and 29.9% in the fQRS <_90 degrees group. Heart rate, oxygen saturation, fQRS angle, estimated glomerular filtration rate, and C-reactive protein level were predictors of mortality on the multivariable analysis. The mortality risk increased 2.9-fold on the univariate analysis and 1.6-fold on the multivariate analysis for the fQRS >90 degrees patient group versus the fQRS <_90 degrees group.Conclusion: In conclusion, a wide fQRS angle >90 degrees was a predictor of in-hospital mortality and associated with the need for mechanical ventilation among COVID-19 patients.(c) 2022 Elsevier Inc. All rights reserved.Öğe Multi-Center Experience of Coronary Artery Perforation During Percutaneous Coronary Intervention: Clinical and Angiographic Characteristics, Management, and Outcomes Between 2010 and 2020(Aves, 2022) Gunduz, Ramazan; Yildiz, Bekir Serhat; Cetin, Nurullah; Ozgur, Su; Cizgici, Ahmet Yasar; Tuluce, Kamil; Tuluce, Selcen YakarBackground: Coronary artery perforations are one of the most feared, rare, and catastrophic complication of percutaneous coronary intervention. Despite the remarkable increase in coronary angiography and percutaneous coronary intervention, there is no large database that collects coronary artery perforation for the Turkish population. Our study aimed to report our experience over a 10-year period for clinical and angiographic characteristics, management strategies, and outcomes of coronary artery perforation during the percutaneous coronary intervention at different cardiology departments in Turkey. Methods: The study data came from a retrospective analysis of 48 360 percutaneous coronary intervention procedures between January 2010 and June 2020. A total of 110 cases who had coronary artery perforation during the percutaneous coronary intervention were found by angiographic review. Analysis has been performed for the basic clinical, angiographic, procedural characteristics, the management of coronary artery perforation, and outcome of all patients. Results: The coronary artery perforation rate was 0.22%. Out of 110 patients with coronary artery perforation, 66 patients showed indications for percutaneous coronary intervention with acute coronary syndrome and 44 patients with stable angina pectoris. The most common lesion type and perforated artery were type C (34.5%) and left anterior descending (41.8%), respectively. The most observed coronary artery perforation according to Ellis classification was type III (37.2%). Almost 52.7% of patients have a covered stent implanted in the perforated artery. The all-cause mortality rate of coronary artery perforation patients in the hospital was 18.1%. Conclusion: The observed rate of coronary artery perforation in our study is consistent with the studies in this literature. However, the mortality rates related to coronary artery perforation are higher than in other studies in this literature. Especially, the in-hospital mortality rate was higher in type II and type III groups due to perforation and its complications. Nevertheless, percutaneous coronary intervention should be done in selected patients despite catastrophic complications.Öğe Safety of once-or twice-daily dosing of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with nonvalvular atrial fibrillation: A NOAC-TR study(Assoc Basic Medical Sci Federation Bosnia & Herzegovina Sarajevo, 2018) Emren, Sadik Volkan; Zoghi, Mehdi; Berilgen, Rida; Ozdemir, Ibrahim Halil; Celik, Oguzhan; Cetin, Nurullah; Enhos, Asim; Koseoglu, Cemal; Akyuz, Abdurrahman; Dogan, Volkan; Levent, Fatih; Dereli, Yuksel; Dogan, Tolga; Basaran, Ozcan; Karaca, Ilgin; Karaca, Ozkan; Otlu, Yilmaz Omur; Ozmen, Caglar; Cosar, Selvi; Sumerkan, Mutlu; Gursul, Erdal; Inci, Sinan; Onrat, Ersel; Ergene, OktayOnce-daily dosing of non-vitamin K antagonist oral anticoagulants (NOACs) may increase patient adherence to treatment but may also be associated with a higher risk of bleeding. In this study, we investigated the adherence to once-or twice-daily dosing of NOACs and the risk of bleeding in nonvalvular atrial fibrillation (NVAF) patients. This multicenter cross-sectional study, conducted between 1 September 2015 and 28 February 2016, included 2214 patients receiving NOACs for at least 3 months, due to NVAF. Patients receiving once-daily or twice-daily NOAC doses were 1: 1 propensity score matched for baseline demographic characteristics and the presence of other diseases. The medication adherence was assessed by the 8-item Morisky Medication Adherence Scale. Risk factors were investigated in relation to minor and major bleeding. The mean age of patients was 71 +/- 10 years, and 53% of the patients were women. The medication adherence was lower in patients receiving twice-daily NOAC doses compared to once-daily-dose group (47% versus 53%, p = 0.001), and there was no difference between the groups in terms of minor (15% versus 16%, p = 0.292) and major bleeding (3% versus 3%, p = 0.796). Independent risk factors for bleeding were non-adherence to medication (OR: 1.62, 95% CI: 1.23-2.14, p = 0.001), presence of 3 or more other diseases (OR: 10.3, 95% CI: 5.3-20.3, p < 0.001), and HAS-BLED (Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INR, Elderly, Drugs or alcohol) score (OR: 4.84, 95% CI: 4.04-5.8, p < 0.001). In summary, the once-daily dose of NOACs was associated with increased patient adherence to medication, while it was not associated with bleeding complications.
