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Cagan Efe S, Buğrahan Cicek M, Unkun T, Yucel E, Karagöz A, Doğan C, Bayram Z, Tekatlı AF, Bozan B, Karaçam M, Halil GS, Karabağ T, Kaymaz C, Ozdemir N. Usability of myocardial work parameters to demonstrate subclinical myocardial involvement in normotensive individuals with exaggerated hypertensive response in treadmill exercise testing. J Clin Hypertens (Greenwich) 2024. [PMID: 38605567 DOI: 10.1111/jch.14814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/13/2024]
Abstract
Early determination of changes in myocardial functions is essential for the protection of cardiovascular diseases. This study aimed to evaluate myocardial work parameters in healthy individuals who developed an exaggerated hypertensive response during the treadmill exercise test procedure. The study included a total of 64 patients for whom an exercise electrocardiography test was planned for functional capacity evaluation. The study population was divided according to the presence of exaggerated hypertensive response to exercise (EBPRE) (SBP/DBP ≥210/105 mmHg in males ≥190/105 mmHg in females) and normal blood pressure response to exercise (NBPRE). Patients' echocardiographic evaluations were made at rest, and myocardial work parameters were calculated. There was no statistical difference between the groups (NBPRE vs. EBPRE, respectively) in terms of left ventricular 2,3 and 4 chamber strains and global longitudinal strain (GLS) values (-20.6 ± -2.3, -19.7 ± -1.9, p:.13; -21.3 ± -2.7, -21 ± -2.4, p:.68; -21.2 ± -2.2, -21.2 ± -2.3, p:.93; and -20.8 ± -1.5, -20.4 ± -1.5, p:.23, respectively). Global constrictive work (GCW), global waste work (GWW), and global work efficiency (GWE) were not statistically different between the two groups (2374 ± 210, 2465 ± 204, p:.10; 142 ± 64, 127 ± 42, p:.31; 94.3 ± 2.5, 95.1 ± 1.5, p:.18, respectively). In contrast, global work index (GWI) parameters were different between the two groups (2036 ± 149, 2147 ± 150, p < .001). The GWI was independently associated with EBPRE (odds ratio with 95% 3.32 (1.02-11.24), p = .03). The partial effect plots were used for GWI to predict EBPRE, according to the results, an increase in GWI predicts probability of exaggerated hypertensive response. In conclusion, Myocardial work analyses might be used to identify early signs of myocardial involvement in normotensive patients with EBPRE.
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Affiliation(s)
- Süleyman Cagan Efe
- Department of Cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Mahmut Buğrahan Cicek
- Department of Cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Tuba Unkun
- Department of Cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Enver Yucel
- Department of Cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Ali Karagöz
- Department of Cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Cem Doğan
- Department of Cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Zübeyde Bayram
- Department of Cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Ali Furkan Tekatlı
- Department of Cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Baver Bozan
- Department of Cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Murat Karaçam
- Department of Cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Gülümser Sevgin Halil
- Department of Cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Turgut Karabağ
- Department of Cardiology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Nihal Ozdemir
- Department of Cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
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Kaymaz C, Kültürsay B, Tokgöz HC, Hakgör A, Keskin B, Akbal ÖY, Tosun A, Tanyeri S, Sekban A, Buluş Ç, Külahçıoğlu Ş, Karagöz A, Tanboğa İH, Özdemir N. Is it Time to Reappraise for Black-Box Warning on AngioJet Rheolytic Thrombectomy in Patients with Pulmonary Embolism: A Systematic Review and Meta-analysis. Anatol J Cardiol 2024. [PMID: 38530216 DOI: 10.14744/anatoljcardiol.2024.4081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND AngioJet rheolytic thrombectomy (ART) system has been widely used as a catheter-directed treatment (CDT) method in acute pulmonary embolism (PE), however, there has been a controversy regarding the safety of its use. In this systematic review and meta-analysis, we evaluated the efficacy and safety outcomes of ART in patients with PE. METHODS Our meta-analysis have been based on search in the MEDLINE, EMBASE, and Cochrane Library for studies published up to August 2022. The primary outcomes were overall pooled rates of major bleeding (MB) and minor bleeding (mB), worsening renal function (WRF), bradycardia/conduction disturbance (BCD), and PE-related and all-cause mortality in patients who underwent ART. RESULTS Among the 233 studies documented at initial search, 24 studies were eligible for meta-analysis, and a total of 427 PE patients who underwent ART were evaluated. Overall pooled rates of MB and mB were 9.6% (95% CI 5.9%-15.2%) and 9.2% (95% CI 6.1%-13.6%), transient BCD and WRF were 18.2% (95% CI 12.4%-26%) and 15% (95% CI 10%-21.8%), and PE-related death and all-cause death were 12.7% (95% CI 9.1%-17.3%) and 15% (95% CI 11%-20%), respectively. However, significant heterogeneity and some evidence of funnel plot asymmetry and publication bias were noted for MB, BCD and WRF, but not for PE-related death and all-cause death. CONCLUSION Overall pooled rates of bleeding events, BCD and WRF episodes, PE-related death and all-cause death may be considered as encouraging results for efficacy and safety issues of ART utilization in specific scenarios of acute PE, and a reappraisal for black-box warning on ART seems to be necessary.
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Affiliation(s)
- Cihangir Kaymaz
- Department of Cardiology, Kartal Koşuyolu Training and Research Hospital, İstanbul, Türkiye
| | - Barkın Kültürsay
- Department of Cardiology, Kartal Koşuyolu Training and Research Hospital, İstanbul, Türkiye
| | - Hacer Ceren Tokgöz
- Department of Cardiology, Kartal Koşuyolu Training and Research Hospital, İstanbul, Türkiye
| | - Aykun Hakgör
- Department of Cardiology, Faculty of Medicine, Medipol University, İstanbul, Türkiye
| | - Berhan Keskin
- Department of Cardiology, Kocaeli City Hospital, Kocaeli, Türkiye
| | - Özgür Yaşar Akbal
- Department of Cardiology, Kartal Koşuyolu Training and Research Hospital, İstanbul, Türkiye
| | - Ayhan Tosun
- Department of Cardiology, Kartal Koşuyolu Training and Research Hospital, İstanbul, Türkiye
| | - Seda Tanyeri
- Department of Cardiology, Kartal Koşuyolu Training and Research Hospital, İstanbul, Türkiye
| | - Ahmet Sekban
- Department of Cardiology, Kartal Koşuyolu Training and Research Hospital, İstanbul, Türkiye
| | - Çağdaş Buluş
- Department of Cardiology, Kartal Koşuyolu Training and Research Hospital, İstanbul, Türkiye
| | - Şeyhmus Külahçıoğlu
- Department of Cardiology, Kartal Koşuyolu Training and Research Hospital, İstanbul, Türkiye
| | - Ali Karagöz
- Department of Cardiology, Kartal Koşuyolu Training and Research Hospital, İstanbul, Türkiye
| | - İbrahim Halil Tanboğa
- Department of Cardiology, Hisar Intercontinental Hospital, Nişantaşı University, İstanbul, Türkiye
| | - Nihal Özdemir
- Department of Cardiology, Kartal Koşuyolu Training and Research Hospital, İstanbul, Türkiye
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Kültürsay B, Tokgöz HC, Keskin B, Akbal ÖY, Kaymaz C. Complete Percutaneous Retrieval of Migrated VSD Occluder Device from the Pulmonary Artery: Management of a Catastrophic Complication. Turk Kardiyol Dern Ars 2024; 52:149-152. [PMID: 38465527 DOI: 10.5543/tkda.2023.93350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Transcatheter closure of muscular ventricular septal defects (VSD) remains a safe and effective method with low complication rates. However, device migration can pose a significant challenge to interventional cardiologists due to potential mortal consequences. A 21-year-old female presented to our clinic with exertional dyspnea and was diagnosed with a muscular VSD. The defect was percutaneously closed using an Amplatzer occluder device. On the first post-procedural day, the patient experienced repeated episodes of coughing and mild hemoptysis. Imaging revealed migration of the VSD occluder device to the right pulmonary artery (PA). Percutaneous retrieval of the device was then decided upon. The right PA was accessed using a hydrophilic guidewire and a pigtail catheter. This catheter was exchanged for an 8-Fr sheathless guide catheter, and a 6-Fr Judkins right catheter was advanced into the right PA through the sheathless guide catheter using the mother-and-child technique. Multiple attempts using a snare were made to retrieve the migrated device. Eventually, the proximal marker point, the hub of the device, was grasped and pulled back from the PA, then externalized through the sheath without the need for surgical cutdown. Our report represents a case of complete percutaneous retrieval of an embolized VSD occluder device from the PA.
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Affiliation(s)
- Barkın Kültürsay
- Department of Cardiology, Kartal Koşuyolu Education and Research Hospital, İstanbul, Türkiye
| | - Hacer Ceren Tokgöz
- Department of Cardiology, Kartal Koşuyolu Education and Research Hospital, İstanbul, Türkiye
| | - Berhan Keskin
- Department of Cardiology, Kartal Koşuyolu Education and Research Hospital, İstanbul, Türkiye
| | - Özgür Yaşar Akbal
- Department of Cardiology, Kartal Koşuyolu Education and Research Hospital, İstanbul, Türkiye
| | - Cihangir Kaymaz
- Department of Cardiology, Kartal Koşuyolu Education and Research Hospital, İstanbul, Türkiye
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Unkun T, Geçmen Ç, Çap M, İzci S, Erdoğan E, Önal Ç, Acar RD, Bakal RB, Kaymaz C, Özdemir N. Early Systolic Lengthening Is Associated with SYNTAX Score in Patients with Non-ST-Elevation Acute Coronary Syndrome. Anatol J Cardiol 2023:94-101. [PMID: 37961897 PMCID: PMC10837675 DOI: 10.14744/anatoljcardiol.2023.3064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Early systolic lengthening is a echocardiographic strain parameter previously used to determine the lesion severity in patients with stable coronary artery disease. In the present study, we aimed to evaluate the relationship between early systolic lengthening and anatomic SYNTAX score in troponin (-) and (+) groups among patients with non-ST-elevation acute coronary syndrome (ACS). METHODS A total of 95 patients diagnosed with non-ST-elevation ACS were included in the prospective, non-randomized, single-center study. The patients were categorized into 2 groups as troponin (+) and troponin (-). The patients were evaluated in terms of echocardiographic, clinical, and angiographic parameters. RESULTS The baseline characteristics, including age (58 ± 13 vs. 60 ± 10 respectively, P =.340), a history of hypertension (67.1% vs. 64%, respectively, P =.479), diabetes (28.6% vs. 32%, respectively, P =.467), global longitudinal strain (-14.37 ± 5.11 vs. -16.42 ± 3.93, respectively, P =.095), left ventricular ejection fraction (58.71 ± 8.73 vs. 57.20 ± 8.70, respectively, P =.263), and E/e' (8.44 ± 2.13 vs. 8.33 ± 1.99, respectively, P =.785), were similar between troponin (+) and troponin (-) groups. Left ventricle end-systolic diameter (3.2 ± 0.78; 3.50 ± 0.74 vs. 3.2 ± 0.78, respectively, P =.031), left ventricle end-systolic volume (55.57 ± 32.17 vs. 38.28 ± 13.63, respectively, P =.013), left ventricle end-diastolic volume (115.31 ± 49.54 vs. 91.23 ± 20.57, respectively, P =.042), the rate of early systolic lengthening (65.7% vs. 28%, respectively, P =.001), the duration of early systolic lengthening (24.02 ± 31 ms vs. 15.56 ± 30.19 ms, respectively, P =.009), and the SYNTAX score (16 ± 11 vs. 10 ± 10, respectively, P =.023) were higher in the troponin (+) group. Furthermore, a significant correlation was found between early systolic lengthening and SYNTAX score (r = 0.43, P <.001). CONCLUSION The rate and duration of early systolic lengthening were higher in patients in the troponin (+) group. Early systolic lengthening is related to SYNTAX score in patients with non-ST-elevation ACS.
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Affiliation(s)
- Tuba Unkun
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Çetin Geçmen
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Murat Çap
- Department of Cardiology, Dr. Gazi Yaşargil Training and Research Hospital, Diyarbakır, Türkiye
| | - Servet İzci
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Emrah Erdoğan
- Department of Cardiology, Faculty of Medicine, Van Yüzüncü Yıl University, Van, Türkiye
| | - Çağatay Önal
- Department of Cardiology, İstanbul Training and Research Hospital, İstanbul, Türkiye
| | - Rezzan Deniz Acar
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Ruken Bengi Bakal
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Cihangir Kaymaz
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Nihal Özdemir
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
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Ceren Tokgöz H, Erdem Öcal B, Cengiz Erkuş Y, Tanyeri Üzel S, Kültürsay B, Tosun A, Keskin B, Hakgör A, Sırma D, Buluş Ç, Karagöz A, Halil Tanboğa İ, Külahçıoğlu Ş, Bayram Z, Sekban A, Özdemir N, Kaymaz C. Remembering the Occam's Razor: Could Simple Electrocardiographic Findings Provide Relevant Predictions for Current Hemodynamic Criteria of Pulmonary Hypertension? Anatol J Cardiol 2023; 27:664-672. [PMID: 37842758 PMCID: PMC10621608 DOI: 10.14744/anatoljcardiol.2023.3181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 09/19/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND We evaluated the predictive value of electrocardiographic (ECG) findings for pulmonary hemodynamics assessed by right heart catheterization (RHC). METHODS Our study population comprised 562 retrospectively evaluated patients who underwent RHC between 2006 and 2022. Correlations between ECG measures and pulmonary arterial systolic and mean pressures (PASP and PAMP) and pulmonary vascular resistance (PVR) were investigated. Moreover, receiver operating characteristic (ROC) curve analysis assessed the predictive value of ECG for pulmonary hypertension (PH) and precapillary PH. RESULTS The P-wave amplitude (Pwa) and R/S ratio (r) in V1 and V2, Ra in augmented voltage right (aVR), right or indeterminate axis, but not P wave duration (Pwd) or right bundle branch block (RBBB) significantly correlated with PASP, PAMP, and PVR (P <.001 for all). The partial R2 analysis revealed that amplitude of R wave (Ra) in aVR, R/Sr in V1 and V2, QRS axis, and Pwa added to the base model provided significant contributions to variance for PASP, PAMP, and PVR, respectively. The Pwa > 0.16 mV, Ra in aVR > 0.05 mV, QRS axis > 100° and R/Sr in V1 > 0.9 showed the highest area under curve (AUC) values for PAMP > 20 mm Hg. Using the same cutoff value, Ra in aVR, Pwa, QRS axis, and R/Sr in V1 showed highest predictions for PVR > 2 Wood Units (WU). CONCLUSION In this study, Pwa, Ra in aVR, right or indeterminate axis deviations, and R/Sr in V1 and V2 showed statistically significant correlations with pulmonary hemodynamics, and Ra in aVR, R/Sr in V2 and V1, QRS axis, and Pwa contributed to variance for PASP, PAMP, and PVR, respectively. Moreover, Pwa, Ra in aVR, QRS axis, and R/Sr in V1 seem to provide relevant predictions for PH and precapillary PH.
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Affiliation(s)
- Hacer Ceren Tokgöz
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | | | - Yiğit Cengiz Erkuş
- Hamidiye Faculty of Medicine, University of Health Sciences, İstanbul, Türkiye
| | - Seda Tanyeri Üzel
- Department of Cardiology, University of Health Sciences, Derince Training and Research Hospital, Kocaeli, Türkiye
| | - Barkın Kültürsay
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Ayhan Tosun
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Berhan Keskin
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Aykun Hakgör
- Department of Cardiology, Faculty of Medicine, Medipol University, İstanbul, Türkiye
| | - Dicle Sırma
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Çağdaş Buluş
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Ali Karagöz
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - İbrahim Halil Tanboğa
- Department of Cardiology, Faculty of Medicine, Nişantaşı University, İstanbul, Türkiye
| | - Şeyhmus Külahçıoğlu
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Zübeyde Bayram
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Ahmet Sekban
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Nihal Özdemir
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Cihangir Kaymaz
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
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Tokgöz HC, Tanyeri S, Sekban A, Hakgör A, Kültürsay B, Keskin B, Karagöz A, Tosun A, Buluş Ç, Külahçıoğlu Ş, Tanboğa İH, Özdemir N, Kaymaz C. Hoarseness as a Predictor for Pulmonary Arterial Aneurysm and Extrinsic Left Main Coronary Artery Compression in Patients with Severe Pulmonary Hypertension. Turk Kardiyol Dern Ars 2023; 51:447-453. [PMID: 37861257 DOI: 10.5543/tkda.2023.63828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVE Pulmonary artery (PA) enlargement is a common finding in patients with severe pulmonary hypertension (PH) and may be associated with extrinsic compression of the left main coronary artery (LMCA-Co) and/or compression of the left recurrent laryngeal nerve resulting in hoarseness named as Ortner syndrome (OS). In this study, we evaluated the diagnostic impact of OS in predicting the PA aneurysm and significant LMCA-Co in patients with PH. METHODS Our study population comprised retrospectively evaluated 865 with PH confirmed with the right heart catheterization between 2006 and 2022. Patients underwent coronary angiography due to several indications, including the presence of a PA aneurysm on echocardiography, angina symptoms, or the incidental discovery of LMCA-Co on multidetector computed tomography. The LMCA-Co is defined as diameter stenosis ³ 50% in reference distal LMCA segment on two consecutive angiographic planes. RESULTS The LMCA-Co and hoarseness were documented in 3.8% and 4.3% of patients with PH, respectively. Increasing PA diameter was significantly associated with worse clinical, hemodynamic, laboratory, and echocardiographic parameters. The receiver operating curves revealed that the PA diameter >41 mm was cutoff for hoarseness (AUC: 0.834; sensitivity 69%, specificity 84%, and negative predictive value 98%), and PA diameter >35 mm was cutoff for LMCA-Co >50% (AUC: 0.794; sensitivity 89%, specificity 58 %, and negative predictive value 99%). An odds ratio of hoarseness for LMCA-Co was 83.3 (95% confidence interval; 36.5-190, P < 0.001) with 3.2% sensitivity, 98.7% specificity, and 59% positive and 98% negative predictive values. CONCLUSION In this study, a close relationship was found between the presence of hoarseness and the probability of extrinsic LMCA-Co by enlarged PA in patients with severe PH. Therefore, the risk of LMCA-Co should be taken into account in patients with PH suffering from hoarseness.
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Affiliation(s)
- Hacer Ceren Tokgöz
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Seda Tanyeri
- Department of Cardiology, Kocaeli City Hospital, Kocaeli, Türkiye
| | - Ahmet Sekban
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Aykun Hakgör
- Division of Cardiology, Medipol University, İstanbul, Türkiye
| | - Barkın Kültürsay
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Berhan Keskin
- Department of Cardiology, Kocaeli City Hospital, Kocaeli, Türkiye
| | - Ali Karagöz
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Ayhan Tosun
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Çağdaş Buluş
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Şeyhmus Külahçıoğlu
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | | | - Nihal Özdemir
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Cihangir Kaymaz
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
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7
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Sekban A, Kültürsay B, Tokgöz HC, Kılıçarslan MF, Kaymaz C. Intravascular Ultrasound-Guided Stent Implantation in the Left Main Coronary Artery Extrinsic Compression by Pulmonary Artery Aneurysm Due to Eisenmenger Syndrome. Turk Kardiyol Dern Ars 2023; 51:507-511. [PMID: 37861262 DOI: 10.5543/tkda.2023.56585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is a profoundly destructive condition marked by the gradual narrowing and restructuring of small pulmonary arteries, leading to a rise in pulmonary vascular resistance (PVR), causing right-sided heart failure and, ultimately, mortality. During more advanced stages of this disease, patients may present with rare manifestations of pulmonary artery aneurysm (PAA) which are exertional chest pain, and hoarseness. The left main coronary artery compression (LMCA-Co) has been an increasingly recognized and possibly life-threatening entity in patients with severe PAH. The lack of well-established decision-making strategies for the management of both PAA and LMCA-Co has been remained as an unsolved issue in this setting. In this report, we present a case of percutaneous intervention of LMCA-Co with the guidance of intracoronary imaging in a patient with patent ductus arteriosus-Eisenmenger syndrome. Percutaneous intervention with intravascular guidance appears to be a safe and effective option for relieving symptoms and achieving positive clinical outcomes in patients with LMCA-Co.
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Affiliation(s)
- Ahmet Sekban
- Department of Cardiology, Kartal Koşuyolu Education and Research Hospital, İstanbul, Türkiye
| | - Barkın Kültürsay
- Department of Cardiology, Kartal Koşuyolu Education and Research Hospital, İstanbul, Türkiye
| | - Hacer Ceren Tokgöz
- Department of Cardiology, Kartal Koşuyolu Education and Research Hospital, İstanbul, Türkiye
| | | | - Cihangir Kaymaz
- Department of Cardiology, Kartal Koşuyolu Education and Research Hospital, İstanbul, Türkiye
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8
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Kaymaz C, Ceren Tokgöz H, Kültürsay B, Hakgör A, Keskin B, Sekban A, Karagöz A. Current Insights for Catheter-Directed Therapies in Acute Pulmonary Embolism: Systematic Review and Our Single-Center Experience. Anatol J Cardiol 2023; 27:557-566. [PMID: 37599636 PMCID: PMC10541784 DOI: 10.14744/anatoljcardiol.2023.3639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/25/2023] [Indexed: 08/22/2023] Open
Abstract
In this review, the current status of the worldwide experience on different catheter-directed treatment systems utilized as alternative reperfusion methods in acute pulmonary-embolism was evaluated, and the risk stratification algorithms in which catheter-directed treatments may be implemented, source of evidence in this setting, adjudication of benefits and risks of available techniques, and innovative multidisciplinary frameworks for referral patterns and care delivery were discussed. Moreover, our perspectives on risk-based catheter-directed treatment utilization strategies in acute pulmonary embolism were summarized.
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Affiliation(s)
- Cihangir Kaymaz
- Department of Cardiology, Koşuyolu Training and Research Hospital, İstanbul, Türkiye
| | - Hacer Ceren Tokgöz
- Department of Cardiology, Koşuyolu Training and Research Hospital, İstanbul, Türkiye
| | - Barkın Kültürsay
- Department of Cardiology, Koşuyolu Training and Research Hospital, İstanbul, Türkiye
| | - Aykun Hakgör
- Department of Cardiology, Faculty of Medicine, Medipol University, İstanbul, Türkiye
| | - Berhan Keskin
- Department of Cardiology, Kocaeli City Hospital, Kocaeli, Türkiye
| | - Ahmet Sekban
- Department of Cardiology, Koşuyolu Training and Research Hospital, İstanbul, Türkiye
| | - Ali Karagöz
- Department of Cardiology, Koşuyolu Training and Research Hospital, İstanbul, Türkiye
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Hakgör A, Ceren Tokgöz Demircan H, Keskin B, Tanyeri S, Kültürsay B, Tosun A, Yaşar Akbal Ö, Külahçıoğlu Ş, Karagöz A, Türkday Derebey S, Bayram Z, Çağan Efe S, Doğan C, Halil Tanboğa İ, Özdemir N, Kaymaz C. A Novel Composed Index to Evaluate the Right Ventricle Free-Wall Adaptation Against Ventricular Wall Stress in Acute Pulmonary Embolism. Anatol J Cardiol 2023; 27:423-431. [PMID: 37288851 PMCID: PMC10339144 DOI: 10.14744/anatoljcardiol.2023.2677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/27/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Pulmonary embolism severity index and simplified pulmonary embolism severity index have been utilized in initial risk evaluation in patients with acute pulmonary embolism. However, these models do not include any imaging measure of right ventricle function. In this study, we proposed a novel index and aimed to evaluate the clinical impact. METHODS Our study population comprised retrospectively evaluated 502 patients with acute pulmonary embolism managed with different treatment modalities. Echocardiographic and computed tomographic pulmonary angiography evaluations were performed at admission to the emergency room within maximally 30 minutes. The formula of our index was as follows: (right ventricle diameter × systolic pulmonary arterial pressure-echo)/(right ventricle free-wall diameter × tricuspid annular plane systolic excursion). RESULTS This index value showed significant correlations to clinical and hemodynamic severity measures. Only pulmonary embolism severity index, but not our index value, independently predicted in-hospital mortality. However, an index value higher than 17.8 predicted the long-term mortality with a sensitivity of 70% and specificity of 40% (areas under the curve = 0.652, 95% CI, 0.557-0.747, P =.001). According to the adjusted variable plot, the risk of long-term mortality increased until an index level of 30 but remained unchanged thereafter. The cumulative hazard curve also showed a higher mortality with high-index value versus low-index value. CONCLUSIONS Our index composed from measures of computed tomographic pulmonary angiography and transthoracic echocardiography may provide important insights regarding the adaptation status of right ventricle against pressure/wall stress in acute pulmonary embolism, and a higher value seems to be associated with severity of the clinical and hemodynamic status and long-term mortality but not with in-hospital mortality. However, the pulmonary embolism severity index remained as the only independent predictor for in-hospital mortality.
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Affiliation(s)
- Aykun Hakgör
- Department of Cardiology, Medipol Mega University Hospital, İstanbul, Turkey
| | - Hacer Ceren Tokgöz Demircan
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Berhan Keskin
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Seda Tanyeri
- Department of Cardiology, University of Health Sciences Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Barkın Kültürsay
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Ayhan Tosun
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Özgür Yaşar Akbal
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Şeyhmus Külahçıoğlu
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Ali Karagöz
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Sevim Türkday Derebey
- Department of Cardiology, University of Health Sciences, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Zübeyde Bayram
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Süleyman Çağan Efe
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Cem Doğan
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | | | - Nihal Özdemir
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
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10
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Tanyeri S, Tokgöz HC, Karagöz A, Akbal ÖY, Keskin B, Kültürsay B, Hakgör A, Külahçıoglu Ş, Çeneli D, Tosun A, Efe S, Bayram Z, Tanboga IH, Özdemir N, Kaymaz C. Reappraisal of the Transthoracic Echocardiographic Algorithm in Predicting Pulmonary Hypertension Redefined by Updated Pulmonary Artery Mean Pressure Threshold. Anatol J Cardiol 2023; 27:348-359. [PMID: 37257005 DOI: 10.14744/anatoljcardiol.2023.2435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Although an adopted echocardiography algorithm based on tricuspid regurgitation jet peak velocity and suggestive findings for pulmonary hypertension has been utilized in the non-invasive prediction of pulmonary hypertension probability, the reliability of this approach for the updated hemodynamic definition of pulmonary hypertension remains to be determined. In this study, for the first time, we aimed to evaluate the tricuspid regurgitation jet peak velocity and suggestive findings in predicting the probability of pulmonary hypertension as defined by mean pulmonary arterial pressure > 20 mm Hg and > 25 mm Hg, respectively. METHODS Our study group was comprised of the retrospectively evaluated 1300 patients (age 53.1 ± 18.8 years, female 62.1%) who underwent right heart catheterization with different indications between 2006 and 2018. All echocardiographic and right heart catheterization assessments were performed in accordance with the European Society of Cardiology/European Respiratory Society 2015 Pulmonary Hypertension Guidelines. RESULTS Although tricuspid regurgitation jet peak velocity showed a significant relation with mean pulmonary arterial pressure in both definitions, suggestive findings offered a significant contribution only in predicting mean pulmonary arterial pressure ≥ 25 mm Hg but not for mean pulmonary arterial pressure > 20 mm Hg. In predicting the mean pulmonary arterial pressure > 20 mm Hg, tricuspid regurgitation jet peak velocity and suggestive findings showed an odds ratio of 2.57 (1.59-4.14, P <.001) and 1.25 (0.86-1.82, P =.16), respectively. In predicting the mean pulmonary arterial pressure ≥ 25 mm Hg, tricuspid regurgitation jet peak velocity, and suggestive findings showed an odds ratio of 2.33 (1.80-3.04, P <.001) and 1.54 (1.15-2.08, P <.001), respectively. The tricuspid regurgitation jet peak velocity > 2.8 m/s and tricuspid regurgitation jet peak velocity > 3.4 m/s were associated with 70% and 84% probability of mean pulmonary arterial pressure > 20 mm Hg and 60% and 76% probability of mean pulmonary arterial pressure ≥ 25 mm Hg, respectively. CONCLUSIONS In contrast to those in predicting the mean pulmonary arterial pressure ≥ 25 mm Hg, suggestive findings did not provide a significant contribution to the probability of mean pulmonary arterial pressure > 20 mm Hg predicted by tricuspid regurgitation jet peak velocity solely. The impact of the novel mean pulmonary arterial pressure threshold on the echocardiographic prediction of pulmonary hypertension remains to be clarified by future studies.
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Affiliation(s)
- Seda Tanyeri
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, Kocaeli, Türkiye
| | - Hacer Ceren Tokgöz
- Department of Cardiology, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Ali Karagöz
- Department of Cardiology, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Özgür Yasar Akbal
- Department of Cardiology, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Berhan Keskin
- Department of Cardiology, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Barkın Kültürsay
- Department of Cardiology, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Aykun Hakgör
- Department of Cardiology, İstanbul Medipol University, İstanbul, Türkiye
| | - Şeyhmus Külahçıoglu
- Department of Cardiology, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Doğancan Çeneli
- Department of Cardiology, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Ayhan Tosun
- Department of Cardiology, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Süleyman Efe
- Department of Cardiology, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Zübeyde Bayram
- Department of Cardiology, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Ibrahim Halil Tanboga
- Department of Cardiology, Nişantaşı University, Hisar Intercontinental Hospital, İstanbul, Türkiye
| | - Nihal Özdemir
- Department of Cardiology, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Cihangir Kaymaz
- Department of Cardiology, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
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11
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Türkday Derebey S, Tokgöz HC, Keskin B, Tosun A, Hakgör A, Karagöz A, Akbal ÖY, Bayram Z, Efe S, Doğan C, Tanboğa İH, Özdemir N, Kaymaz C. A New Index for the Prediction of In-Hospital Mortality in Patients with Acute Pulmonary Embolism: The Modified Shock Index. Anatol J Cardiol 2023; 27:282-289. [PMID: 37119189 PMCID: PMC10160840 DOI: 10.14744/anatoljcardiol.2023.2530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND Pulmonary embolism severity index, its simplified version, and shock index have been used for risk stratification in acute pulmonary embolism. In this study, we proposed a modification in severity index and evaluated the correlates and prognostic value of modification in severity index in this setting. METHODS The study group comprised retrospectively evaluated 181 patients with acute pulmonary embolism. Systematic workup including pulmonary embolism severity index, its simplified version, shock index, biomarkers, and echocardiographic and multidetector computed tomography assessments was performed in all patients. Moreover, we calculated modification in severity index by multiplying original shock index (heart rate/systolic blood pressure ratio) and a third component, 1/pulse oxymetric saturation (pSat O2%) ratio. The primary endpoint was defined as all-cause mortality and hemodynamic collapse during the hospital stay. RESULTS On the basis of initial risk stratification, ultrasound-assisted thrombolysis, systemic tissue-type plasminogen activator, and unfractionated heparin therapies were utilized in 83 (45.9%), 37 (20.4%), and 61 (33.7%) patients, respectively. The primary end-point occurred in 13 (7.2%) patients. Receiver-operating curve analysis revealed that modification in severity index had the highest area under the curve of 0.739 (0.588-0.890, P =.002) compared with shock index, pulmonary embolism severity index, or its simplified version. The modification in severity index > 0.989 predicted primary endpoint with 73% sensitivity and 54% specificity. CONCLUSIONS The modification in severity index seems to be a simple, quick, and compre-hensive risk assessment tool for bedside evaluation at initial stratification, in monitoring the clinical benefit from therapies, and decision-making for escalation to other reperfusion strategies in patients with acute pulmonary embolism. However, the prognostic value of modification in severity index needs to be validated with further studies.
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Affiliation(s)
- Sevim Türkday Derebey
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Hacer Ceren Tokgöz
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Berhan Keskin
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Ayhan Tosun
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Aykun Hakgör
- Department of Cardiology, Faculty of Medicine, Medipol University, İstanbul, Turkey
| | - Ali Karagöz
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Özgür Yaşar Akbal
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Zübeyde Bayram
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Süleyman Efe
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Cem Doğan
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - İbrahim Halil Tanboğa
- Department of Biostatistics, Faculty of Medicine, Nisantaşı University, İstanbul, Turkey
| | - Nihal Özdemir
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
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12
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Ceren Tokgöz H, Yaşar Akbal Ö, Karagöz A, Kültürsay B, Tanyeri S, Keskin B, Hakgör A, Külahçıoğlu Ş, Bayram Z, Çağan Efe S, Doğan C, Halil Tanboğa İ, Özdemir N, Kaymaz C, Kaymaz C. Maternal and Fetal Outcomes in Pregnant Women with Pulmonary Arterial Hypertension: A Single-Center Experience and Review of Current Literature. Anatol J Cardiol 2022; 26:902-913. [PMID: 35983602 PMCID: PMC9797754 DOI: 10.5152/anatoljcardiol.2022.1762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Although pregnancy in women with pulmonary arterial hypertension has been considered a high-risk condition, current data regarding pregnancy with pulmonary arterial hypertension are scarce. In this study, we aimed to evaluate our single-center data on maternal and fetal outcomes in pregnant women with PAH and review currently available risk-based management strategies. METHODS Our single-center study group comprised 35 women who became pregnant after the diagnosis of pulmonary arterial hypertension or in whom pulmonary arterial hypertension was diagnosed within early post-partum period. Clinical, laboratory, echocardiographic, and hemodynamic characteristics of pregnant and non-pregnant productive women with pulmonary arterial hypertension were compared, and similar comparison was also repeated for survivors and non-survivors in pregnant patient group. RESULTS Pregnancy was noted in 15% of the 228 females with pulmonary arterial hypertension who were of hormonally productive ages, generally well-tolerated until delivery. Elective abortion and pre-term delivery were documented in 1 (2.8%) and 12 (35.3%) pregnant women, respectively. Switching to sildenafil was the standard medication during pregnancy. Cesarian section was the preferred method of delivery in all pregnant women with pulmonary arterial hypertension and was performed without any complication. Clinic deteoriation within the first week of delivery was observed in 5 (41.6%) patients. Maternal mortality was noted in 13 (37.1%) patients and was documented to cumulate within the first month of delivery. However, any sign predicting post-partum clinical deterioration was not found. No fetal mortality was observed. CONCLUSION Despite the development of advanced therapies, pregnancy in pulmonary arterial hypertension still carries a high mortality risk and requires multi-disciplinary expert center care with more proactive management strategies.
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Affiliation(s)
- Hacer Ceren Tokgöz
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Özgür Yaşar Akbal
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Ali Karagöz
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Barkın Kültürsay
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Seda Tanyeri
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Berhan Keskin
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Aykun Hakgör
- Department of Cardiology, Faculty of Medicine, Medipol University, İstanbul, Turkey
| | - Şeyhmus Külahçıoğlu
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Zübeyde Bayram
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Süleyman Çağan Efe
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Cem Doğan
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - İbrahim Halil Tanboğa
- Department of Biostatistics, Faculty of Medicine, Nisantaşı University, İstanbul, Turkey
| | - Nihal Özdemir
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey,Corresponding author:Cihangir Kaymaz✉
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13
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Tanyeri S, Tokgoz HC, Karagoz A, Akbal OY, Keskin B, Kultursay B, Hakgor A, Kulahcioglu Ş, Ceneli D, Tosun A, Efe SC, Bayram Z, Tanboga IH, Ozdemir N, Kaymaz C. Reappraisal of echocardiographic algorithm in predicting the pulmonary hypertension redefined by updated pulmonary artery mean pressure treshold. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Although an adopted echocardiography algorithm based on tricuspid regurgitation jet peak velocity (TRVmax) and suggestive findings (SF) for pulmonary hypertension (PH) has been utilized in the non-invasive prediction of PH probability, reliability of this approach for updated hemodynamic definition of PH remains to be determined.
Aims
In this study, first time, we aimed to evaluate the TRVmax and SF in predicting the probability of PH as defined by mean pulmonary arterial pressure (mPAP) >20 mm Hg and mPAP >25 mm Hg, respectively.
Methods
Our study group comprised of the retrospectively evaluated 1300 patients (age 53.1±18.8 years, female 62.1%) who underwent right heart catheterisation (RHC) with different indications between 2006 and 2018. All echocardigraphic and RHC assessments were performed in accordance with European Society of Cardiology (ESC)/European Respiratory Society (ERS) 2015 PH Guidelines.
Results
Although TRVmax showed a significant relation with mPAP in both definitions, SF offered significant contribution for only in predicting mPAP >25 mm Hg, but not for mPAP >20 mm Hg. In predicting the mPAP >20 mm Hg TR Vmax and SF showed odds ratio (OR) of 2.57 (1.59–4.14, p<0.001) and OR of 1.25 (0.86–1.82, p=0.16), respectively (Table 1). In predicting the mPAP >25 mm Hg, TR Vmax and SF showed OR of 2.33 (1.80–3.04, p<0.001) and OR of 1.54 (1.15–2.08, p<0.001), respectively (Table 1). The TRVmax >2.8 m/sec and TRVmax >3.4 m/sec were associated with 70% and 84% probability of mPAP >20 mm Hg, and 60% and 76% probability of mPAP >25 mm Hg, respectively (Figure 1).
Conclusions
In contrast to those in predicting the mPAP >25 mm Hg, SF did not provide a significant contribution to probability of mPAP >20 mm Hg predicted by TRVmax solely. The impact of the novel mPAP treshold on echocardiographic prediction of PH remains to be clarifed by future studies.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Tanyeri
- Kocaeli Derince Hospital, Cardiology , Kocaeli , Turkey
| | - H C Tokgoz
- Kartal Kosuyolu Heart and Research Hospital, Cardiology , Istanbul , Turkey
| | - A Karagoz
- Kartal Kosuyolu Heart and Research Hospital, Cardiology , Istanbul , Turkey
| | - O Y Akbal
- Kartal Kosuyolu Heart and Research Hospital, Cardiology , Istanbul , Turkey
| | - B Keskin
- Kartal Kosuyolu Heart and Research Hospital, Cardiology , Istanbul , Turkey
| | - B Kultursay
- Kartal Kosuyolu Heart and Research Hospital, Cardiology , Istanbul , Turkey
| | - A Hakgor
- Istanbul Medipol University , Istanbul , Turkey
| | - Ş Kulahcioglu
- Kartal Kosuyolu Heart and Research Hospital, Cardiology , Istanbul , Turkey
| | - D Ceneli
- Kartal Kosuyolu Heart and Research Hospital, Cardiology , Istanbul , Turkey
| | - A Tosun
- Kartal Kosuyolu Heart and Research Hospital, Cardiology , Istanbul , Turkey
| | - S C Efe
- Kartal Kosuyolu Heart and Research Hospital, Cardiology , Istanbul , Turkey
| | - Z Bayram
- Kartal Kosuyolu Heart and Research Hospital, Cardiology , Istanbul , Turkey
| | - I H Tanboga
- Hisar Intercontinental Hospital, Cardiology , Istanbul , Turkey
| | - N Ozdemir
- Kartal Kosuyolu Heart and Research Hospital, Cardiology , Istanbul , Turkey
| | - C Kaymaz
- Kartal Kosuyolu Heart and Research Hospital, Cardiology , Istanbul , Turkey
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14
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Kaymaz C, Tanyeri S, Ceren Tokgöz H, Yaşar Akbal Ö, Karagöz A, Keskin B, Kültürsay B, Hakgör A, Külahçıoğlu Ş, Bayram Z, Çağan Efe S, Halil Tanboğa İ, Doğan C, Akbulut M, Özdemir N. The Consistent Effectiveness and Safety of Macitentan Therapies Across Idiopathic and Congenital Heart Disease-Associated PulmonaryArterial Hypertension: A Single-Center Experience. Anatol J Cardiol 2022; 26:778-787. [PMID: 36196862 PMCID: PMC9623128 DOI: 10.5152/anatoljcardiol.2022.1889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In this single-center study, we evaluated efficacy and safety issues and predictors of survival in patients with idiopathic and congenital heart disease-associated pulmonary arterial hypertension who were under macitentan therapies. METHOD Our study retrospectively evaluated 221 patients with pulmonary arterial hypertension enrolled in our single-center study, and mono, dual, and triple macitentan therapies were noted in 30, 115, and 76 patients, respectively. The longitudinal changes in clinical, neurohumoral, and echocardiographic measures of pulmonary arterial hypertension were evaluated. The Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management, Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management 2.0, and Registry to Evaluate Early and Long- Term Pulmonary Arterial Hypertension Disease Management Lite 2 scores at baseline, Swedish PAH Registry, Comparative Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension registry, and French Pulmonary Hypertension Network registry risk status both at baseline and first control were assessed. RESULT The median follow-up period was 1068 [415-2245] days. Macitentan was associated with significant improvements in functional class, 6-minute walk distance, N-terminal pro-brain natriuretic peptide (NT-proBNP), and echocardiographic measures without any deterioration of hemoglobin or hepatic enzymes. The low-risk scores with each model at baseline and/or first control are related to significantly better survival. Age, gender, and log-NT-proBNP in time-fixed and idiopathic pulmonary arterial hypertension, and log-NT-proBNP in time-dependent Cox proportional hazard regression analyses were independent predictors of mortality. CONCLUSION Mono- or sequential combination macitentan therapies were associated with sustained benefits in functional class, 6-minute walk distance, NT-proBNP, and echocardiographic measures in patients with idiopathic pulmonary arterial hypertension and congenital heart disease-associated pulmonary arterial hypertension, and low-risk scores at baseline and/or first controls can be translated to better survival.
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Affiliation(s)
- Cihangir Kaymaz
- Department of Cardiology, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey,Corresponding author:Cihangir Kaymaz ✉
| | - Seda Tanyeri
- Department of Cardiology, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Hacer Ceren Tokgöz
- Department of Cardiology, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Özgür Yaşar Akbal
- Department of Cardiology, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Ali Karagöz
- Department of Cardiology, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Berhan Keskin
- Department of Cardiology, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Barkın Kültürsay
- Department of Cardiology, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Aykun Hakgör
- Department of Cardiology, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Şeyhmus Külahçıoğlu
- Department of Cardiology, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Zübeyde Bayram
- Department of Cardiology, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Süleyman Çağan Efe
- Department of Cardiology, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - İbrahim Halil Tanboğa
- Department of Cardiology, Faculty of Medicine, Nişantaşı University, İstanbul, Turkey
| | - Cem Doğan
- Department of Cardiology, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Akbulut
- Department of Cardiology, Faculty of Medicine, Fırat University, Elazığ, Turkey
| | - Nihal Özdemir
- Department of Cardiology, University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
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Külahçıoğlu Ş, Ceren Tokgöz H, Yaşar Akbal Ö, Keskin B, Kültürsay B, Tanyeri S, Çeneli D, Bıyıklı K, Karagöz A, Çağan Efe S, Halil Tanboğa İ, Özdemir N, Kaymaz C. Eosinophil-to-Monocyte Ratio as a Candidate for a Novel Prognostic Marker in Acute Pulmonary Embolism: Is it a Consumptive Mechanism? The Anatolian Journal of Cardiology 2022; 26:717-724. [PMID: 35949130 PMCID: PMC9524210 DOI: 10.5152/anatoljcardiol.2022.1780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: The role of eosinophils in thrombotic processes is well known, and the prognostic value of eosinophil to monocyte ratio had been determined in patients with ST elevated myocardial infarction and acute ischemic stroke in recent studies. We aimed to evaluate the impact of the eosinophil-to-monocyte ratio on short- and long-term all-cause mortality in patients with pulmonary embolism, which is another clinical condition closely related to the thrombotic pathway. Methods: In this study, a total of 212 retrospectively evaluated patients with intermediate-high risk and high-risk pulmonary embolism who underwent catheter-directed therapies with ultrasound-assisted thrombolysis or rheolytic thrombectomy (Angiojet©) and intravenous thrombolytic treatment were included. Results: The median Pulmonary Embolism Severity Index score was 105 (86-128; interquartile range: 25-75, min-max: 35-250). The intermediate-high status and high-risk status were noted in 83.5% and 16.5% of the patients, respectively. All of the reperfusion strategies resulted in significant improvements in the measures of pulmonary arterial pressure and right ventricular strain. Death was recorded in 42 (18.6%) patients during the follow-up period (median 1029 days, interquartile range: 651-1358). Multiple Cox regression analysis revealed that a higher pulmonary embolism severity index score (from 85 to 128; hazard ratio = 3.00; 95% CI: 2.11-4.29; P < .001) and a lower eosinophil-to-monocyte ratio (from 0.02 to 0.24; hazard ratio = 0.56; 95% CI: 0.34-0.98; P = .032) were 2 independent predictors for long-term all-cause mortality. The eosinophil-to-monocyte ratio at the admission of less than 0.03 was documented to be associated with higher mortality (P < .001). Conclusion: Our results revealed that a lower eosinophil-to-monocyte ratio and a higher pulmonary embolism severity index score independently predict the long-term mortality in patients with intermediate-high- and high-risk pulmonary embolism.
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Affiliation(s)
- Şeyhmus Külahçıoğlu
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
- Corresponding author:Şeyhmus Külahçıoğlu✉
| | - Hacer Ceren Tokgöz
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Özgür Yaşar Akbal
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Berhan Keskin
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Barkın Kültürsay
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Seda Tanyeri
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Doğancan Çeneli
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Kadir Bıyıklı
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Ali Karagöz
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Süleyman Çağan Efe
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | | | - Nihal Özdemir
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
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Külahçıoğlu Ş, Kültürsay B, Çeneli D, Bıyıklı K, Danışman N, Karaçam M, Tuncer ŞB, Demirci K, Eminoğlu H, Korun O, Karagöz A, Kaymaz C. Obesity Paradox in Coronary Thrombus Burden of Patients with Acute Coronary Syndrome. Metab Syndr Relat Disord 2022; 20:489-496. [PMID: 36037015 DOI: 10.1089/met.2022.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Acute coronary syndrome (ACS) remains a major cause of morbidity and mortality worldwide. Although obesity is a risk factor for ACS, decreased mortality has been shown in overweight individuals. This study aims to determine the association of body fat parameters such as body fat percentage (BFP), relative fat mass (RFM), and coronary thrombus burden with angiographic thrombotic grade in a series of patients presenting with ACS. Methods: Three hundred ninety patients who underwent percutaneous coronary intervention were enrolled in the study. BFP was calculated using the U.S. Navy formula. RFM index was calculated using gender, height, and waist circumference regardless of weight. Body mass index (BMI) is calculated as the weight in kilograms divided by the square of body length in meters (kg/m2). Two experienced interventional cardiologists reviewed coronary angiograms according to the TIMI thrombus scale. Patients were divided into groups according to thrombus classification and clinical status. Results: RFM, which is an anthropometric measurement parameter for obesity, was inversely related to thrombus burden in patients with ACS. There were no significant differences between ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) groups according to demographic, clinical characteristics, and coronary risk factors. Likewise, RFM, BFP, and BMI were comparable between the two groups. BFP and RFM were lower in patients with thrombus present STEMI group compared with no thrombus group. Thrombus presence was also compared in the NSTEMI group, and BMI, BFP, and RFM were lower in patients with thrombus present NSTEMI group. Conclusions: Our analysis demonstrated that RFM was better than BFP and BMI for predicting thrombus presence in patients with ACS.
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Affiliation(s)
- Şeyhmus Külahçıoğlu
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Barkın Kültürsay
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Doğancan Çeneli
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Kadir Bıyıklı
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Neşri Danışman
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Murat Karaçam
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Şeref Berk Tuncer
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Koray Demirci
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Halit Eminoğlu
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Okan Korun
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Ali Karagöz
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
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Ergene O, Aras D, Kaymaz C, Arsava EM, Gonen C, Gurkas E, Arslan U, Cagirici G, Cay S, Kilickap M, Kanat S, Ozpelit E, Vatansever F, Kilickesmez K. The Role of Non-Vitamin K Antagonist Oral Anticoagulants (NOACs) in Atrial Fibrillation: Treatment Management Based on Patient and Drug Characteristics. Turk Kardiyol Dern Ars 2022; 50:356-370. [DOI: 10.5543/tkda.2022.21191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Kaymaz C, Akbal OY, Keskin B, Tokgoz HC, Hakgor A, Karagoz A, Tanyeri S, Kultursay B, Kulahcioglu S, Dogan C, Bayram Z, Efe SÇ, Erkılınç A, Tanboga IH, Akbulut M, Ozdemir N, Tapson V, Konstantinides S. An Eight-year, Single-center Experience on Ultrasound Assisted Thrombolysis with Moderate-dose, Slow-infusion Regimen in Pulmonary Embolism. Curr Vasc Pharmacol 2022; 20:370-378. [PMID: 36324223 DOI: 10.2174/1570161120666220428095705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/19/2022] [Accepted: 03/10/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND There is limited data on moderate-dose with slow-infusion thrombolytic regimen by ultrasound-asssisted-thrombolysis (USAT) in patients with acute pulmonary embolism (PE). AIMS In this study, our eight-year experience on USAT with moderate-dose, slow-infusion tissue-type plasminogen activator (t-PA) regimen in patients with PE at intermediate-high- and high-risk was presented, and short-, and long-term effectiveness and safety outcomes were evaluated. METHODS Our study is based on the retrospective evaluation of 225 patients with PE having multiple comorbidities who underwent USAT. RESULTS High- and intermediate-high-risk were noted in 14.7% and in 85.3% of patients, respectively. Mean t-PA dosage was 35.4±13.3 mg, and the infusion duration was 26.6±7.7 h. Measures of pulmonary artery (PA) obstruction and right ventricle (RV) dysfunction were improved within days (p<0.0001 for all). During the hospital stay, major and minor bleeding and mortality rates were 6.2%, 12.4%, and 6.2%, respectively. Bleeding and unresolved PE accounted for 50% and 42.8% of in-hospital mortality, respectively. Age, rate, and duration of t-PA were not associated with in-hospital major bleeding and mortality. Oxygen saturation exceeded 90% in 91.2% of patients at discharge. During follow-up of median 962 (610-1894) days, high-risk status related to 30-day mortality, whereas age >65 years was associated with long-term mortality. CONCLUSION Our real-life experience with USAT with moderate-dose, slow-infusion t-PA regimen in patients with PE at high-and intermediate-high risk demonstrated clinically relevant improvements in PA obstructive burden and RV dysfunction. Age, rate or infusion duration of t-PA was not related to major bleeding or mortality risk, whereas unresolved obstruction remained as a lethal issue.
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Affiliation(s)
- Cihangir Kaymaz
- Department of Cardiology, Kosuyolu Heart Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ozgur Yasar Akbal
- Department of Cardiology, Kosuyolu Heart Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Berhan Keskin
- Department of Cardiology, Kosuyolu Heart Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Hacer Ceren Tokgoz
- Department of Cardiology, Kosuyolu Heart Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Aykun Hakgor
- Department of Cardiology, Kosuyolu Heart Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ali Karagoz
- Department of Cardiology, Kosuyolu Heart Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Seda Tanyeri
- Department of Cardiology, Kosuyolu Heart Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Barkın Kultursay
- Department of Cardiology, Kosuyolu Heart Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Seyhmus Kulahcioglu
- Department of Cardiology, Kosuyolu Heart Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Cem Dogan
- Department of Cardiology, Kosuyolu Heart Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Zubeyde Bayram
- Department of Cardiology, Kosuyolu Heart Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Süleyman Çağan Efe
- Department of Cardiology, Kosuyolu Heart Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Atakan Erkılınç
- Department of Anesthesiology, Kosuyolu Heart Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | | | - Mehmet Akbulut
- Faculty of Medicine, Department of Cardiology, Fırat University, Elâzığ, Turkey
| | - Nihal Ozdemir
- Department of Cardiology, Kosuyolu Heart Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Victor Tapson
- Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Stavros Konstantinides
- Department of Cardiology, Democritus University Medical School, Thrace, Greece.,Centre for Thrombosis and Haemostasis, University Medical Centre Mainz, Johannes Gutenberg-University, Mainz, Germany
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Keskin B, Tokgöz HC, Akbal ÖY, Hakgör A, Karagöz A, Kültürsay B, Tanyeri S, Külahçıoğlu S, Halil Tanboğa İ, Özdemir N, Kaymaz C. Clinical, imaging and hemodynamic correlates and prognostic impact of syncope in acute pulmonary embolism: A single-center study. Turk Gogus Kalp Damar Cerrahisi Derg 2022; 30:317-326. [PMID: 36303697 PMCID: PMC9580286 DOI: 10.5606/tgkdc.dergisi.2022.22798] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/28/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND We aimed to determine the clinical, echocardiographic and hemodynamic correlates of syncope as a presenting symptom in pulmonary embolism and its impact on in-hospital and long-term outcomes. METHODS Between July 2012 and October 2019, a total of 641 patients with PE (277 males, 364 females; median age: 65 years; range, 51 to 74 years) in whom the diagnostic work-up and risk-based management were performed according to the current pulmonary embolism guidelines were retrospectively analyzed. Clinical, laboratory and imaging data of the patients were obtained from hospital database system. RESULTS Syncope was noted in 193 (30.2%) of patients on admission, and was associated with a significantly higher-risk status manifested by elevated troponin and D-dimer levels, a higher Pulmonary Embolism Severity Index scores, deterioration of right-to-left ventricular diameter ratio, right ventricular longitudinal contraction measures, the higher Qanadli score, and higher rates of thrombolytic therapies (p<0.001) and rheolytic-thrombectomy (p=0.037) therapies. In-hospital mortality (p=0.007) and minor bleeding (p<0.001) were significantly higher in syncope subgroup. Multivariate logistic regression analysis showed that higher Pulmonary Embolism Severity Index scores and right-to-left ventricular diameter ratio were independently associated with syncope, while aging and increased heart rate predicted in-hospital mortality. Malignancy and right-to-left ventricular diameter ratio at discharge, but not syncope, were independent predictors of cumulative mortality during follow-up. CONCLUSION Syncope as the presenting symptom is associated with a higher risk due to more severe obstructive pressure load and right ventricular dysfunction requiring more proactive strategies in patients with pulmonary embolism. However, with appropriate risk-based therapies, neither in-hospital mortality nor long-term mortality can be predicted by syncope.
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Affiliation(s)
- Berhan Keskin
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu High Specialization Training and Research Hospital, Istanbul, Türkiye
| | - Hacer Ceren Tokgöz
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu High Specialization Training and Research Hospital, Istanbul, Türkiye
| | - Özgür Yaşar Akbal
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu High Specialization Training and Research Hospital, Istanbul, Türkiye
| | - Aykun Hakgör
- Department of Cardiology, Medipol Mega University Hospital, Istanbul, Türkiye
| | - Ali Karagöz
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu High Specialization Training and Research Hospital, Istanbul, Türkiye
| | - Barkın Kültürsay
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu High Specialization Training and Research Hospital, Istanbul, Türkiye
| | - Seda Tanyeri
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu High Specialization Training and Research Hospital, Istanbul, Türkiye
| | - Seyhmuş Külahçıoğlu
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu High Specialization Training and Research Hospital, Istanbul, Türkiye
| | | | - Nihal Özdemir
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu High Specialization Training and Research Hospital, Istanbul, Türkiye
| | - Cihangir Kaymaz
- Department of Cardiology, University of Health Sciences, Kartal Koşuyolu High Specialization Training and Research Hospital, Istanbul, Türkiye
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Akbal ÖY, Kaymaz C. Reply to Letter to the Editor: “How Little Things Can Make a Big Difference?”. Anatol J Cardiol 2022; 26:499-500. [PMID: 35703489 PMCID: PMC9361337 DOI: 10.5152/anatoljcardiol.2022.1460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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21
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Yılmaz F, Kültürsay B, Keskin B, Çağan Efe S, Yücel E, Karagöz A, Kaymaz C. Electrification Technique of a Guidewire to Assist in Crossing Iliac Occlusion. Anatol J Cardiol 2022; 26:662-664. [PMID: 35924293 PMCID: PMC9403871 DOI: 10.5152/anatoljcardiol.2022.1477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Fatih Yılmaz
- Department of Cardiology, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Barkın Kültürsay
- Department of Cardiology, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
- Corresponding author:Barkın Kültürsay ✉
| | - Berhan Keskin
- Department of Cardiology, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Süleyman Çağan Efe
- Department of Cardiology, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Enver Yücel
- Department of Cardiology, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul, Turkey
| | - Ali Karagöz
- Department of Cardiology, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
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Çakır H, Kanat S, Karagöz A, Tütüncü A, Yılmaz F, Öcal L, Toprak C, Emiroğlu MY, Demir M, Kaymaz C, Tenekecioğlu E. The effects of catheter ablation of outflow tract premature ventricular complexes on atrial electromechanical delay. Echocardiography 2022; 39:776-782. [PMID: 35576212 DOI: 10.1111/echo.15363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/25/2022] [Accepted: 04/23/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Consistent data from several studies have shown that catheter ablation of frequent premature ventricular complexes (PVCs) results in substantial improvement in left ventricular ejection fraction (LVEF), left ventricular diastolic function, and left atrial volume and mechanics. However, the effects of catheter ablation of PVCs on atrial electromechanical properties have not been documented yet. AIMS In the present study, we investigated the short-term effects of radiofrequency catheter ablation (RFCA) of outflow tract PVCs on atrial electromechanical delay (EMD). METHODS A total of 71 subjects with idiopathic outflow tract PVCs who underwent RFCA were included. Interatrial and intra-atrial EMDs were measured by tissue Doppler imaging before and 3 months after catheter ablation. RESULTS The study population was divided into normal ejection fraction (EF) and low-EF subgroups according to their LVEF. In all study groups, substantial improvement was found in lateral electromechanical coupling time (PA), septal PA, right ventricular PA, interatrial EMD, left-sided intra-atrial EMD, and right-sided intra-atrial EMD. No treatment heterogeneity was observed when comparing low-EF and normal-EF subgroups with respect to atrial EMDs (interatrial EMD, interaction p = .29; left-sided intra-atrial EMD, interaction p = .13; right-sided intra-atrial EMD, interaction p = .88). CONCLUSION RFCA of outflow tract PVC has a favorable early effect on intra- and inter-atrial EMDs irrespective of preprocedural LVEF.
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Affiliation(s)
- Hakan Çakır
- Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Selçuk Kanat
- Department of Cardiology, Bursa Yuksek İhtisas Training and Research Hospital, Health Sciences University, Bursa, Turkey
| | - Ali Karagöz
- Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Ahmet Tütüncü
- Department of Cardiology, Bursa Yuksek İhtisas Training and Research Hospital, Health Sciences University, Bursa, Turkey
| | - Fatih Yılmaz
- Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Lütfi Öcal
- Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Cüneyt Toprak
- Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Mehmet Yunus Emiroğlu
- Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Mehmet Demir
- Department of Cardiology, Bursa Yuksek İhtisas Training and Research Hospital, Health Sciences University, Bursa, Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Erhan Tenekecioğlu
- Department of Cardiology, Bursa Yuksek İhtisas Training and Research Hospital, Health Sciences University, Bursa, Turkey
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Bayram Z, Dogan C, Efe SC, Guvendi B, Karagoz A, Acar RD, Uysal S, Akbas RB, Yilmaz F, Akbal OY, Tokgoz HC, Kirali MK, Kaymaz C, Ozdemir N. Ischaemic versus non-ischaemic: how does heart failure aetiology affect pulmonary arterial capacitance and pulmonary artery pulsatility index in end-stage heart failure? Acta Cardiol 2022; 77:204-210. [PMID: 34923932 DOI: 10.1080/00015385.2021.1951999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aetiology of heart failure may have different effects on right ventricular (RV) function, pulmonary pressures and RV afterload. Pulmonary arterial capacitance (PAC) and pulmonary artery pulsatility index (PAPi) are novel haemodynamic indices used in determining RV afterload and RV function, respectively. We aimed to investigate whether there was a difference in PAC and PAPi between ischaemic cardiomyopathy (ICMP) and non-ischaemic cardiomyopathy (NICMP) in patients with end-stage heart failure. METHODS AND RESULTS A total of 215 subjects undergoing evaluation for heart transplantation or left ventricular (LV) assist device were classified into two groups: ICMP (n = 101) and NICMP (n = 114). The patients with LV ejection fraction ≤ 25% were included in the study. ICMP group had lower PAC and higher PAPi values compared to NICMP group [1.25 (0.82-1.86) vs. 1.58 (1.02-2.21), p = 0.002 and 3.4 (2.2-5.0) vs. 2.5 (1.7-4.0); p = 0.007]. Pulmonary vascular resistance, pulmonary artery systolic and mean pressure were higher in ICMP group compared to NICMP group [3.5 ± 1.8 vs. 2.9 ± 2.3, p = 0.004; 59.0 (42.0-73.0) vs. 46.0 (37.0-59.0), p < 0.001, 35.0 (27.0-46.0) vs. 31.0 (23.0-39.0), p = 0.002]. The patients with ICMP had higher tricuspid annular plane systolic excursion and less RV dilatation. ICMP was an independent risk factor for pulmonary hypertension (OR: 4.02, 95% CI: 1.13-14.24, p = 0.031). CONCLUSION ICMP was associated with lower PAC and higher PAPi. These results indicated that an ischaemic aetiology is associated with higher RV afterload and better RV function in the end-stage heart failure.
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Affiliation(s)
- Zubeyde Bayram
- Cardiology Department, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Cem Dogan
- Cardiology Department, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Suleyman C. Efe
- Cardiology Department, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Busra Guvendi
- Department of Cardiology, Istanbul Maltepe State Hospital, Istanbul, Turkey
| | - Ali Karagoz
- Cardiology Department, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Rezzan Deniz Acar
- Cardiology Department, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Samet Uysal
- Cardiology Department, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Ravza Betul Akbas
- Cardiology Department, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Fatih Yilmaz
- Cardiology Department, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Y. Akbal
- Cardiology Department, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Hacer Ceren Tokgoz
- Cardiology Department, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Kaan Kirali
- Cardiovascular Surgery Department, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Cihangir Kaymaz
- Cardiology Department, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Nihal Ozdemir
- Cardiology Department, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
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24
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Külahçıoğlu Ş, Karagöz IK, Bilen Y, Kültürsay B, Akbaş RB, Yücel E, Tokgöz HC, Uslu A, Karagöz A, Kaymaz C. Evaluation of the relationship between diabetic retinopathy and left atrial deformation parameters. Egypt Heart J 2022; 74:30. [PMID: 35416514 PMCID: PMC9008098 DOI: 10.1186/s43044-022-00265-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 04/05/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Left ventricular systolic dysfunction (LVSD) may develop without coronary artery disease, hypertension (HT), or valvular pathologies in patients with diabetes mellitus (DM), which is defined as diabetic cardiomyopathy (DCM) and its pathophysiology is still unclear. Diabetic retinopathy (DR) is a microvascular complication of DM, and patients with DR have increased risk for the development of heart failure (HF). Two-dimensional speckle tracking echocardiography (2D-STE) evaluates longitudinal deformation in left atrium (LA) myocardium and previous studies utilizing 2D-STE have revealed the detrimental effects of DM on LA functions. Although some studies have shown the association between DR and left ventricle (LV) systolic functions, as far as the researchers of this study investigated, there is no study evaluating the relationship between LA deformation parameters and DR. Hence, we aimed to investigate the relationship between the presence and the degree of DR and LA deformation parameters. RESULTS LA deformation parameters were analyzed in terms of LA reservoir, conduit, and contractile functions according to the degree of DR. LA reservoir strain value was 14.2 ± 3.6 in normal retina group, 12.2 ± 4.1 in non-proliferative diabetic retinopathy (NPDR) group, and 13 ± 3.7 in proliferative diabetic retinopathy (PDR) group (P = 0.04). LA contractile strain was 15.9 ± 6.8 in normal retina group, 13.1 ± 47.4 in NPDR group, and 9.9 ± 4.7 in PDR group (P < 0.001). LA conduit strain was 30.1 ± 6.6 in normal retina group, 25.3 ± 6.5 in NPDR group, and 22.9 ± 4.9 in PDR group (P < 0.001). Proportional odds regression for association between clinical data, echocardiographic parameters, and LA contractile strain function showed that increasing creatinine (from 0.7 to 1.0; OR 0.71; 95% CI 0.51-0.99; P = 0.04), DR presence (OR 0.24; 95% CI 0.11-0.50; P = 0.001), and increasing left atrial volume index (LAVI) (from 33.5 to 52.6; OR 0.62; 95% CI 0.43-0.89; P = 0.01) were associated with decreasing LA function; however, other variables indicated no association. CONCLUSIONS Our results showed the relationship between LA deformation parameters and DR, although microvascular involvement is not a certainly defined cardiovascular risk factor. Further prospective studies are needed to determine the clinical importance of DR presence and its degree for deformation parameters.
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Affiliation(s)
- Şeyhmus Külahçıoğlu
- Department of Cardiology, Kartal Koşuyolu Education and Research Hospital, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Denizer caddesi Cevizli Kavşağı No: 2, Kartal, stanbul, Turkey
| | - Işıl Kutlutürk Karagöz
- Department of Ophtalmology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Yusuf Bilen
- Department of Cardiology, Kartal Koşuyolu Education and Research Hospital, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Denizer caddesi Cevizli Kavşağı No: 2, Kartal, stanbul, Turkey
| | - Barkın Kültürsay
- Department of Cardiology, Kartal Koşuyolu Education and Research Hospital, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Denizer caddesi Cevizli Kavşağı No: 2, Kartal, stanbul, Turkey
| | - Ravza Betül Akbaş
- Department of Cardiology, Kartal Koşuyolu Education and Research Hospital, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Denizer caddesi Cevizli Kavşağı No: 2, Kartal, stanbul, Turkey
| | - Enver Yücel
- Department of Cardiology, Sancaktepe Training and Research Hospital, Istanbul, Turkey
| | - Hacer Ceren Tokgöz
- Department of Cardiology, Kartal Koşuyolu Education and Research Hospital, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Denizer caddesi Cevizli Kavşağı No: 2, Kartal, stanbul, Turkey
| | - Abdülkadir Uslu
- Department of Cardiology, Kartal Koşuyolu Education and Research Hospital, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Denizer caddesi Cevizli Kavşağı No: 2, Kartal, stanbul, Turkey
| | - Ali Karagöz
- Department of Cardiology, Kartal Koşuyolu Education and Research Hospital, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Denizer caddesi Cevizli Kavşağı No: 2, Kartal, stanbul, Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, Kartal Koşuyolu Education and Research Hospital, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Denizer caddesi Cevizli Kavşağı No: 2, Kartal, stanbul, Turkey
- Department of Cardiology, Sancaktepe Training and Research Hospital, Istanbul, Turkey
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Bayram Z, Efe SC, Karagoz A, Dogan C, Guvendi B, Uysal S, Akbal OY, Yilmaz F, Tokgoz HC, Acar RD, Kirali MK, Kaymaz C, Ozdemir N. Prognostic impact of nutritional indices in candidates for heart transplantation. Turk Kardiyol Dern Ars 2022; 50:92-100. [DOI: 10.5543/tkda.2022.21126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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26
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Dogan C, Cinaral F, Karagoz A, Bayram Z, Onal SC, Candan O, Acar RD, Cap M, Erdogan E, Hakgor A, Akbal OY, Uslu A, Kaymaz C, Ozdemir N. Comparison of automated quantification and semiquantitative visual analysis findings of IQ SPECT MPI with conventional coronary angiography in patients with stable angina. Turk Kardiyol Dern Ars 2022. [DOI: 10.5543/tkda.2018.03367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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27
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Çakır H, Güneş A, Er F, Çakır H, Karagöz A, Yılmaz F, Öcal L, Zehir R, Emiroğlu MY, Demir M, Kaymaz C, Tenekecioğlu E. Evaluating the relationship of sleep quality and sleep duration with Framingham coronary heart disease risk score. Chronobiol Int 2022; 39:636-643. [PMID: 35016566 DOI: 10.1080/07420528.2021.2018453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Sleep is an important modulator of cardiovascular function and is recognized to play an important role in the pathogenesis and progression of cardiovascular disease. However, results of the studies investigating the relationship between sleep complaints and cardiovascular outcomes are still controversial. This study aimed to investigate the associations of sleep duration and sleep quality with Framingham 10-year hard coronary heart disease (CHD) risk score in Turkish adults. We included a total of 362 participants (mean age: 48.5 ± 9.0 years, 50.6% males) and measured sleep quality and sleep duration using Pittsburgh Sleep Quality Index (PSQI). Framingham risk scoring system was utilized to calculate the 10-year hard CHD risk of participants. Binary logistic regression analysis was performed to determine the association between sleep quality, sleep duration, and CHD risk. Both short sleep duration (<6 hours) (OR = 3.858, 95% CI: 1.245-11.956) and long sleep duration (≥8 hours) (OR = 2.944, 95% CI: 1.087-7.967) were identified as the predictors of 10-year hard CHD risk. However, sleep quality was not associated with 10-year CHD risk even as a categorical or continuous variable (OR = 0.864, 95% CI: 0.418-1.787 and OR = 0.985, 95% CI: 0.868-1.117, respectively). Our findings highlighted previous studies demonstrating the U-shaped relationship, with both short and long sleep durations to be associated with a higher CHD risk. Evaluation of habitual sleeping patterns may provide additional information in clinical cardiovascular risk assessment. Future research should investigate whether interventions to optimize sleep duration may help to prevent coronary events in large population-based cohorts.
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Affiliation(s)
- Hakan Çakır
- Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Aygül Güneş
- Department of Neurology, Bursa Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Bursa, Turkey
| | - Fahri Er
- Department of Cardiology, Agri State Hospital, Agri, Turkey
| | - Hilal Çakır
- Department of Internal Medicine, Pendik State Hospital, Istanbul, Turkey
| | - Ali Karagöz
- Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Fatih Yılmaz
- Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Lütfi Öcal
- Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Regayip Zehir
- Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Mehmet Yunus Emiroğlu
- Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Mehmet Demir
- Department of Cardiology, Bursa Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Bursa, Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Erhan Tenekecioğlu
- Department of Cardiology, Bursa Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Bursa, Turkey
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Bayram Z, Dogan C, Efe SC, Karagoz A, Guvendi B, Uysal S, Akbas RB, Acar RD, Akbal OY, Yilmaz F, Tokgoz HC, Kirali MK, Kaymaz C, Ozdemir N. Prognostic Importance of Pulmonary Artery Pulsatility Index and Right Ventricular Stroke Work Index in End-Stage Heart Failure Patients. Cardiology 2022; 147:143-153. [PMID: 34979515 DOI: 10.1159/000521205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 11/16/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Right ventricular (RV) failure is an important cause of morbidity and mortality in patients with left ventricular (LV) end-stage heart failure (ESHF). Pulmonary artery pulsatility index (PAPi) and right ventricular stroke work index (RVSWI) are invasive parameters related to RV function. This study aimed to investigate the prognostic impact of PAPi and RVSWI in these patients. METHODS AND RESULTS In this study, 416 patients with ESHF were included. The adverse cardiac event (ACE) was defined as left ventricular assist device (LVAD) implantation, urgent heart transplantation, or cardiac mortality. There were 218 ACE cases and 198 non-ACE cases over a median follow-up of 503.50 days. Patients with ACE had lower PAPi and similar RVSWI compared to those without ACE (3.1±1.9 vs. 3.7±2.3, P=0.003 and 7.3±4.9 vs. 6.9±4.4, P=0.422, respectively). According to the results of multivariate analysis, while PAPi (from 2 to 5.65) was associated with ACE, RVSWI (from 3.62 to 9.75) was not associated with ACE (HR: 0.75, 95% CI (0.55-0.95), P=0.031; HR: 0.79, 95% CI: (0.58-1.09), P=0.081, , respectively). Survival analysis revealed that PAPi ≤2.56 was associated with a higher ACE risk compared to PAPi >2.56 (HR: 1.46, 95% CI: 1.11-1.92, P=0.006). PAPi ≤2.56 could predict ACE with 56.7% sensitivity and 51.3% specificity at one year. Furthermore, the association between RVSWI and ACE was nonlinear (J-curve pattern). Low and high values seem to be associated with higher ACE risk compared to intermediate values. CONCLUSION The low PAPi was an independent risk for ACE and it had a linear association with it. However, RVSWI seems to be have a nonlinear association with ACE (J-curve pattern).
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Affiliation(s)
- Zubeyde Bayram
- Department of Cardiology, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Cem Dogan
- Department of Cardiology, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Suleyman Cagan Efe
- Department of Cardiology, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Ali Karagoz
- Department of Cardiology, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Busra Guvendi
- Department of Cardiology, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Samet Uysal
- Department of Cardiology, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Ravza Betul Akbas
- Department of Cardiology, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Rezzan Deniz Acar
- Department of Cardiology, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Yasar Akbal
- Department of Cardiology, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Fatih Yilmaz
- Department of Cardiology, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Hacer Ceren Tokgoz
- Department of Cardiology, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Kaan Kirali
- Department of Cardiovascular Surgery, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Nihal Ozdemir
- Department of Cardiology, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
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Akbal ÖY, Keskin B, Tokgöz HC, Hakgör A, Karagöz A, Tanyeri S, Kültürsay B, Külahçıoğlu Ş, Bayram Z, Efe S, Erkılınç A, Tanboğa İH, Doğan C, Akbulut M, Özdemir N, Kaymaz C. A seven-year single-center experience on AngioJet rheolytic thrombectomy in patients with pulmonary embolism at high risk and intermediate-high risk. Anatol J Cardiol 2021; 25:902-911. [PMID: 34866585 DOI: 10.5152/anatoljcardiol.2021.28303] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND AIM Angiojet Rheolytic thrombectomy (ART) has been utilized as a catheter-based treatment in acute pulmonary embolism (PE). In this study based on our seven-year experience on ART in patients with PE, we evaluated efficacy and safety outcomes of ART. METHODS Our study is based on retrospective evaluation of 56 patients with high- and intermediate-high-risk PE, age (62 years; interquartile-range (IQR): 50-73) who underwent ART. RESULTS High- and intermediate-high-risk were noted in 21.4 % and in 78.6 % of patients, respectively. ART duration was 304(IQR: 246-468) seconds. Measures of obstruction, right to left ventricle diameter ratio (RV/LV ratio), right to left atrial diameter ratio and pulmonary arterial pressures were improved (p<0.001 for all). During hospital stay, acute renal failure, major and minor bleeding, and mortality rates were 37.5%, 7.1%, 12.5%, and 8.9%, respectively. Aging related to post-procedural nephropathy while high-risk status was associated with in-hospital mortality (p=0.006) and long-term mortality. CONCLUSIONS The ART resulted in significant and clinically relevant improvements in the pulmonary arterial thrombotic burden, RV strain and hemodynamics in patients with PE at high- and intermediate-high-risk. Aging increased the risk of post-procedural nephropathy whereas baseline high-risk status predicted in-hospital and long-term mortality.
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Affiliation(s)
- Özgur Yaşar Akbal
- Department of Cardiology, Hamidiye Faculty of Medicine, University of Health Sciences Turkey, Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
| | - Berhan Keskin
- Department of Cardiology, Hamidiye Faculty of Medicine, University of Health Sciences Turkey, Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
| | - Hacer Ceren Tokgöz
- Department of Cardiology, Hamidiye Faculty of Medicine, University of Health Sciences Turkey, Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
| | - Aykun Hakgör
- Department of Cardiology, Hamidiye Faculty of Medicine, University of Health Sciences Turkey, Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
| | - Ali Karagöz
- Department of Cardiology, Hamidiye Faculty of Medicine, University of Health Sciences Turkey, Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
| | - Seda Tanyeri
- Department of Cardiology, Hamidiye Faculty of Medicine, University of Health Sciences Turkey, Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
| | - Barkın Kültürsay
- Department of Cardiology, Hamidiye Faculty of Medicine, University of Health Sciences Turkey, Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
| | - Şeyhmus Külahçıoğlu
- Department of Cardiology, Hamidiye Faculty of Medicine, University of Health Sciences Turkey, Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
| | - Zübeyde Bayram
- Department of Cardiology, Hamidiye Faculty of Medicine, University of Health Sciences Turkey, Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
| | - Süleyman Efe
- Department of Cardiology, Hamidiye Faculty of Medicine, University of Health Sciences Turkey, Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
| | - Atakan Erkılınç
- Department of Anesthesiology, Hamidiye Faculty of Medicine, University of Health Sciences Turkey, Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
| | - İbrahim Halil Tanboğa
- Department of Cardiology, Faculty of Medicine, Nişantaşı University; İstanbul-Turkey
| | - Cem Doğan
- Department of Cardiology, Hamidiye Faculty of Medicine, University of Health Sciences Turkey, Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
| | - Mehmet Akbulut
- Department of Cardiology, Faculty of Medicine, Fırat University; Elazığ-Turkey
| | - Nihal Özdemir
- Department of Cardiology, Hamidiye Faculty of Medicine, University of Health Sciences Turkey, Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, Hamidiye Faculty of Medicine, University of Health Sciences Turkey, Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
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Dogan C, Bayram Z, Efe SC, Acar RD, Tanboga IH, Karagoz A, Havan N, Ozer T, Uslu A, Kırali MK, Kaymaz C, Ozdemir N. Prognostic value of main pulmonary artery diameter to ascending aorta diameter ratio in patients with advanced heart failure. Acta Cardiol 2021; 76:1108-1116. [PMID: 33501898 DOI: 10.1080/00015385.2021.1872186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES AND BACKGROUND In this study we assessed the prognostic value of main pulmonary artery diameter and its ratio to ascending aorta diameter (P/Ao ratio) in advanced heart failure patients. METHODS Patients with advanced heart failure who were candidates for heart transplantation were retrospectively evaluated. The clinical information, cardiac catheterisation results, and computed tomography images were gathered from institutional database system. The observed and predicted probabilities for survival were analysed in a nomogram. RESULTS The P/Ao ratio was found to be a strong predictor for MACE both in traditional multivariable Cox proportional hazard regression modelling (increase in P/Ao ratio per 2 SD, HR:2.72, 95% CI 1.14-6.48, p = 0.024) and ridge regression analysis (increase in P/Ao ratio per 2SD, HR:3.45, 95% CI 1.53-7.74, p = 0.003). Prediction model showed statistically significant correlation between the observed and predicted probabilities for 1-year survival. CONCLUSION In patients with advanced heart failure, computed tomography derived P/Ao ratio might be a prognostic predictor during follow up.
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Affiliation(s)
- Cem Dogan
- Department of Cardiology, University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Zubeyde Bayram
- Department of Cardiology, University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Süleyman Cagan Efe
- Department of Cardiology, University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Rezzan Deniz Acar
- Department of Cardiology, University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Ibrahim Halil Tanboga
- Department of Cardiology, Atatürk University Department of Biostatistics, Erzurum and Hisar Intercontinental Hospital, Istanbul, Turkey
| | - Ali Karagoz
- Department of Cardiology, University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Nuri Havan
- Department of Radiology, University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Tanıl Ozer
- Department of Cardiovascular Surgery, University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Abdulkair Uslu
- Department of Cardiology, University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Kaan Kırali
- Department of Cardiovascular Surgery, University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Nihal Ozdemir
- Department of Cardiology, University of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
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Bayram Z, Dogan C, Efe SC, Karagoz A, Guvendi B, Uysal S, Aktas RB, Akbal OY, Yilmaz F, Tokgoz HC, Kirali MK, Kaymaz C, Ozdemir N. Effect of Group 2 Pulmonary Hypertension Subgroups on Outcomes: Impact of the Updated Definition of Pulmonary Hypertension. Heart Lung Circ 2021; 31:508-519. [PMID: 34756531 DOI: 10.1016/j.hlc.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 08/24/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Pulmonary hypertension (PH) is a common complication of end-stage heart failure (ESHF) and associated with increased mortality. The definition of PH has recently been changed from a mean pulmonary arterial pressure (PAPm) ≥25 mmHg to a PAPm >20 mmHg. Since this change, there are no data evaluating group 2 PH subgroups on outcomes. The purpose of this study was to determine the impact of updated group 2 PH subgroups on outcomes, as well as to evaluate the clinical, echocardiographic, and haemodynamic characteristics of subgroups, and determine predictors of PH in patients with ESHF. METHOD A total of 416 patients with ESHF with left ventricle ejection fraction (LVEF) ≤25% were divided into three groups. Pulmonary hypertension was defined as PAPm >20 mmHg. Primary outcome was defined as left ventricular assist device (LVAD) implantation, urgent heart transplantation (HT), or death. Secondary outcome was defined as LVAD implantation and HT. RESULTS Over a median follow-up of 503.5 days, combined pre- and postcapillary PH (Cpc-PH) displayed greater risk of primary outcome than those with isolated postcapillary (Ipc-PH) (hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.29-1.91; p<0.001) and those with no PH (HR, 2.47; 95% CI, 1.68-3.63; p<0.001). Patients with Ipc-PH demonstrated greater risk than those with no PH (HR, 1.57; 95% CI, 1.57-1.90; p<0.001). Likelihood ratios of updated PH criteria and old PH criteria (PAPm ≥25 mmHg) in identifying primary outcome were 75.6 (R2=0.179) and 72.09 (R2=0.164). Patients with PAPm 21-24 mmHg had a higher primary outcome than those with PAPm ≤20 mmHg. Severe mitral regurgitation, LVEF, grade 3 diastolic dysfunction, diabetes, and cardiac output were predictors of PH. CONCLUSIONS Pulmonary hypertension increases the risk of LVAD, urgent HT, or death, and Cpc-PH further increases risk in patients with ESHF. Compared to the previous definition, a new PH definition better discriminates death, going to urgent HT, or LVAD implantation for PH subgroups.
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Affiliation(s)
- Zubeyde Bayram
- Kartal Koşuyolu Yüksek Eğitim ve Araştırma Hastanesi, Kartal, Istanbul.
| | - Cem Dogan
- Kartal Koşuyolu Yüksek Eğitim ve Araştırma Hastanesi, Kartal, Istanbul
| | | | - Ali Karagoz
- Kartal Koşuyolu Yüksek Eğitim ve Araştırma Hastanesi, Kartal, Istanbul
| | - Busra Guvendi
- Kartal Koşuyolu Yüksek Eğitim ve Araştırma Hastanesi, Kartal, Istanbul
| | - Samet Uysal
- Kartal Koşuyolu Yüksek Eğitim ve Araştırma Hastanesi, Kartal, Istanbul
| | - Ravza Betul Aktas
- Kartal Koşuyolu Yüksek Eğitim ve Araştırma Hastanesi, Kartal, Istanbul
| | - Ozgur Yasar Akbal
- Kartal Koşuyolu Yüksek Eğitim ve Araştırma Hastanesi, Kartal, Istanbul
| | - Fatih Yilmaz
- Kartal Koşuyolu Yüksek Eğitim ve Araştırma Hastanesi, Kartal, Istanbul
| | | | | | - Cihangir Kaymaz
- Kartal Koşuyolu Yüksek Eğitim ve Araştırma Hastanesi, Kartal, Istanbul
| | - Nihal Ozdemir
- Kartal Koşuyolu Yüksek Eğitim ve Araştırma Hastanesi, Kartal, Istanbul
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Demirel M, Külahçıoğlu Ş, Tokgöz HC, Akbal ÖY, Hakgör A, Karagöz A, Tanyeri S, Keskin B, Kültürsay B, Efe SÇ, Bayram Z, Tanboğa İH, Özdemir N, Kaymaz C. Impaired endothelium-dependent and endothelium-independent systemic vasodilatory reserve in pulmonary hypertension regardless the clinical group: A generalized dysfunction beyond the pulmonary arteries? Anatol J Cardiol 2021; 25:733-740. [PMID: 34622788 DOI: 10.5152/anatoljcardiol.2021.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Endothelium-dependent (ED) and endothelium-independent (EI) flow-mediated vasodilatation (FMD) have been used as measures of systemic arterial vasodilatory reserve. In this study, we aimed to assess both ED-FMD and EI-FMD in different groups with pulmonary hypertension (PH), and to investigate the relationship of these measures with clinical, echocardiographic, and invasive parameters of diseases severity and targeted treatment status. METHODS Our study population comprised 41 patients with PH [28 (68.2%) women, age 46.3±19.6 years] including idiopathic pulmonary arterial hypertension, Eisenmenger syndrome, and chronic thromboembolic PH in whom diagnosis were confirmed in accordance with current guidelines and 17 age and sex-matched healthy controls. The brachial artery (BA) was used for assessment of FMD with Duplex ultrasound, and serial changes in diameter were recorded at baseline, 1, and 3 minutes after termination of 2-minute external occlusive compression for ED-FMD, and after sublingual intake of glycerol trinitrate for EI-FMD, respectively. RESULTS Compared with controls, overall the PH group showed significantly lower ED-FMD (0.65±0.21 vs. 0.30±0.23 and 0.65±0.18 vs. 0.24±0.21) and EI-FMD (0.67±0.15 vs. 0.37±0.25 and 0.75±0.20 vs. 0.32±0.24) responses at 1st and 3rd min (p<0.001 for all). All these changes in the values of ED-FMD and EI-FMD were comparable among the PH subgroups. Neither ED-FMD nor EI-FMD were correlated with measures of PH severity and targeted therapy (TT) status (p>0.05). CONCLUSION Our results suggest an impaired BA vasodilatory reserve in patients with PH regardless of the clinical subgroup. Although these findings seem to be consistent with systemic dysfunction, acute FMD may not reflect the severity of PH and cannot be used as a potential surrogate for outcome in this setting.
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Affiliation(s)
- Muhittin Demirel
- Department of Cardiology, University of Health Sciences, Hamidiye Faculty of Medicine, Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey
| | - Şeyhmus Külahçıoğlu
- Department of Cardiology, University of Health Sciences, Hamidiye Faculty of Medicine, Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey
| | - Hacer Ceren Tokgöz
- Department of Cardiology, University of Health Sciences, Hamidiye Faculty of Medicine, Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey
| | - Özgür Y Akbal
- Department of Cardiology, University of Health Sciences, Hamidiye Faculty of Medicine, Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey
| | - Aykun Hakgör
- Department of Cardiology, Bingöl State Hospital; Bingöl-Turkey
| | - Ali Karagöz
- Department of Cardiology, University of Health Sciences, Hamidiye Faculty of Medicine, Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey
| | - Seda Tanyeri
- Department of Cardiology, University of Health Sciences, Hamidiye Faculty of Medicine, Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey
| | - Berhan Keskin
- Department of Cardiology, University of Health Sciences, Hamidiye Faculty of Medicine, Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey
| | - Barkın Kültürsay
- Department of Cardiology, University of Health Sciences, Hamidiye Faculty of Medicine, Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey
| | - Süleyman Çağan Efe
- Department of Cardiology, University of Health Sciences, Hamidiye Faculty of Medicine, Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey
| | - Zübeyde Bayram
- Department of Cardiology, University of Health Sciences, Hamidiye Faculty of Medicine, Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey
| | | | - Nihal Özdemir
- Department of Cardiology, University of Health Sciences, Hamidiye Faculty of Medicine, Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, University of Health Sciences, Hamidiye Faculty of Medicine, Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey
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Demirel M, Külahçıoğlu Ş, Tokgöz HC, Akbal ÖY, Hakgör A, Karagöz A, Tanyeri S, Keskin B, Kültürsay B, Efe SÇ, Bayram Z, Tanboğa İH, Özdemir N, Kaymaz C. Impaired endothelium-dependent and endothelium-independent systemic vasodilatory reserve in pulmonary hypertension regardless the clinical group: A generalized dysfunction beyond the pulmonary arteries? Anatol J Cardiol 2021. [PMID: 34622788 DOI: 10.5152/anatoljcardiol.2021.474)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Endothelium-dependent (ED) and endothelium-independent (EI) flow-mediated vasodilatation (FMD) have been used as measures of systemic arterial vasodilatory reserve. In this study, we aimed to assess both ED-FMD and EI-FMD in different groups with pulmonary hypertension (PH), and to investigate the relationship of these measures with clinical, echocardiographic, and invasive parameters of diseases severity and targeted treatment status. METHODS Our study population comprised 41 patients with PH [28 (68.2%) women, age 46.3±19.6 years] including idiopathic pulmonary arterial hypertension, Eisenmenger syndrome, and chronic thromboembolic PH in whom diagnosis were confirmed in accordance with current guidelines and 17 age and sex-matched healthy controls. The brachial artery (BA) was used for assessment of FMD with Duplex ultrasound, and serial changes in diameter were recorded at baseline, 1, and 3 minutes after termination of 2-minute external occlusive compression for ED-FMD, and after sublingual intake of glycerol trinitrate for EI-FMD, respectively. RESULTS Compared with controls, overall the PH group showed significantly lower ED-FMD (0.65±0.21 vs. 0.30±0.23 and 0.65±0.18 vs. 0.24±0.21) and EI-FMD (0.67±0.15 vs. 0.37±0.25 and 0.75±0.20 vs. 0.32±0.24) responses at 1st and 3rd min (p<0.001 for all). All these changes in the values of ED-FMD and EI-FMD were comparable among the PH subgroups. Neither ED-FMD nor EI-FMD were correlated with measures of PH severity and targeted therapy (TT) status (p>0.05). CONCLUSION Our results suggest an impaired BA vasodilatory reserve in patients with PH regardless of the clinical subgroup. Although these findings seem to be consistent with systemic dysfunction, acute FMD may not reflect the severity of PH and cannot be used as a potential surrogate for outcome in this setting.
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Affiliation(s)
- Muhittin Demirel
- Department of Cardiology, University of Health Sciences, Hamidiye Faculty of Medicine, Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey
| | - Şeyhmus Külahçıoğlu
- Department of Cardiology, University of Health Sciences, Hamidiye Faculty of Medicine, Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey
| | - Hacer Ceren Tokgöz
- Department of Cardiology, University of Health Sciences, Hamidiye Faculty of Medicine, Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey
| | - Özgür Y Akbal
- Department of Cardiology, University of Health Sciences, Hamidiye Faculty of Medicine, Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey
| | - Aykun Hakgör
- Department of Cardiology, Bingöl State Hospital; Bingöl-Turkey
| | - Ali Karagöz
- Department of Cardiology, University of Health Sciences, Hamidiye Faculty of Medicine, Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey
| | - Seda Tanyeri
- Department of Cardiology, University of Health Sciences, Hamidiye Faculty of Medicine, Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey
| | - Berhan Keskin
- Department of Cardiology, University of Health Sciences, Hamidiye Faculty of Medicine, Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey
| | - Barkın Kültürsay
- Department of Cardiology, University of Health Sciences, Hamidiye Faculty of Medicine, Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey
| | - Süleyman Çağan Efe
- Department of Cardiology, University of Health Sciences, Hamidiye Faculty of Medicine, Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey
| | - Zübeyde Bayram
- Department of Cardiology, University of Health Sciences, Hamidiye Faculty of Medicine, Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey
| | | | - Nihal Özdemir
- Department of Cardiology, University of Health Sciences, Hamidiye Faculty of Medicine, Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, University of Health Sciences, Hamidiye Faculty of Medicine, Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey
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Hakgör A, Tokgöz HC, Akbal ÖY, Tanyeri S, Keskin B, Kültürsay B, Karagöz A, Kaymaz C. Sustained response to targeted therapies in a patient with pulmonary hypertension owing to Langerhans cell histiocytosis. Anatol J Cardiol 2021; 25:665-668. [PMID: 34498599 DOI: 10.5152/anatoljcardiol.2021.49500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Aykun Hakgör
- Department of Cardiology, Bingöl State Hospital; Bingöl-Turkey
| | - Hacer Ceren Tokgöz
- Department of Cardiology, Kartal Koşuyolu High Speciality Training and Research Hospital; İstanbul-Turkey
| | - Özgür Yaşar Akbal
- Department of Cardiology, Kartal Koşuyolu High Speciality Training and Research Hospital; İstanbul-Turkey
| | - Seda Tanyeri
- Department of Cardiology, Kartal Koşuyolu High Speciality Training and Research Hospital; İstanbul-Turkey
| | - Berhan Keskin
- Department of Cardiology, Kartal Koşuyolu High Speciality Training and Research Hospital; İstanbul-Turkey
| | - Barkın Kültürsay
- Department of Cardiology, Kartal Koşuyolu High Speciality Training and Research Hospital; İstanbul-Turkey
| | - Ali Karagöz
- Department of Cardiology, Kartal Koşuyolu High Speciality Training and Research Hospital; İstanbul-Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, Kartal Koşuyolu High Speciality Training and Research Hospital; İstanbul-Turkey
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Efe SC, Cicek MB, Karagöz A, Doğan C, Bayram Z, Guvendi B, Akbal OY, Tokgoz HC, Uysal S, Karabağ T, Kaymaz C, Ozdemir N. Effect of non-dipper pattern on echocardiographic myocardial work parameters in normotensive individuals. Echocardiography 2021; 38:1586-1595. [PMID: 34435388 DOI: 10.1111/echo.15177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/02/2021] [Accepted: 07/31/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND It is known that non-dipper pattern (NDP) is associated with adverse outcomes in hypertensive patients. However, there is insufficient data on the outcome of NDP in normotensive individuals. Using myocardial work (MW) analysis, as a new echocardiographic examination method, this study aimed to determine the early myocardial effects of NDP in normotensive individuals. METHODS This study included 70 normotensive individuals who were followed by ambulatory blood pressure monitoring (ABPM). The subjects were divided into two groups according to dipper pattern (DP) and NDP. Conventional, strain, and MW findings were compared between the groups by making echocardiographic evaluations. RESULTS The demographic characteristics, laboratory parameters, and measurements of cardiac chambers, and left ventricular (LV) walls were similar between the groups. There was no statistical difference between the groups in terms of LV 3-2-4 chambers strains and global longitudinal strain (GLS) values. LVMW parameters, global work index (GWI), and global constrictive work (GCW) were not statistically different between groups (2012 ± 127, 2069 ± 137, p = 0.16; 2327 ± 173, 2418 ± 296, p = 0.18, respectively). However, global waste work (GWW) and global work efficiency (GWE) parameters were different between the groups (144 ± 63.9, 104 ± 24.8, p < 0.001; 93.2 ± 3.17, 95.4 ± 1.28, p < 0.001, respectively). In regression analysis, GWW was independently associated with NDP. GWW model showed better results with higher likelihood chi-square and R2 values than GLS model in discriminating the predictable capability for NDP status. CONCLUSION The results of MW analysis in this study showed that GWW values were higher and the GWE values were lower in normotensive individuals with NDP.
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Affiliation(s)
- Süleyman Cagan Efe
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Mahmut Buğrahan Cicek
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Ali Karagöz
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Cem Doğan
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Zübeyde Bayram
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Busra Guvendi
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Ozgur Yasar Akbal
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Hacer Ceren Tokgoz
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Samet Uysal
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Turgut Karabağ
- Department of Cardiology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Cihangir Kaymaz
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Nihal Ozdemir
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
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Celik M, Yilmaz Y, Kup A, Karagoz A, Kahyaoglu M, Cakmak EO, Celik FB, Sengor BG, Guner A, Izci S, Kilicgedik A, Candan O, Kahveci G, Gecmen C, Kaymaz C. Crochetage sign may predict late atrial arrhythmias in patients with secundum atrial septal defect undergoing transcatheter closure. J Electrocardiol 2021; 67:158-165. [PMID: 34246066 DOI: 10.1016/j.jelectrocard.2021.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/20/2021] [Accepted: 06/28/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Atrial arrhythmias are well-known complications of atrial septal defect (ASD), and associated with substantial morbidity. After ASD closure, right atrial and ventricular enlargement regresses, however, the risk of atrial arrhythmia development continues. In this study, we aimed to investigate the relationship between the Crochetage sign, which is a possible reflection of heterogeneous ventricular depolarization due to long-term hemodynamic overload, and the development of late atrial arrhythmia after ASD closure. METHODS This retrospective study included a total of 314 patients (mean age: 39.5 (30-50) years; male: 115) who underwent percutaneous device closure for secundum ASD. The study population was divided into two groups according to the presence or absence of the Crochetage sign. The Crochetage sign was defined as an M-shaped or bifid pattern notch on the R wave in one or more inferior limb leads. Cox-regression analysis was performed to determine independent predictors of late atrial arrhythmia development. RESULT Fifty-seven patients (18.1%) presented with late atrial arrhythmia. Of these 57 patients, 30 developed new-onset atrial fibrillation/atrial flutter (AF/AFL), and 27 patients with pre-procedure paroxysmal AF/AFL had a recurrence of AF/AFL during follow-up. History of paroxysmal AF/AFL before the procedure (HR: 4.78; 95% CI 2,52-9.05; p < 0.001), the presence of Crochetage sign (HR: 3.90; 95% CI 2.05-7.76; p < 0.001), and older age at the time of ASD closure (HR: 1.03; 95% CI 1.01-1.06; p = 0.002) were found as independent predictors for late atrial arrhythmia. CONCLUSION The presence of Crochetage sign may be used to predict the risk of late atrial arrhythmia development after transcatheter ASD closure.
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Affiliation(s)
- Mehmet Celik
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
| | - Yusuf Yilmaz
- Department of Cardiology, Istanbul Medeniyet Universty, Istanbul, Turkey
| | - Ayhan Kup
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Ali Karagoz
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Muzaffer Kahyaoglu
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Ender Ozgun Cakmak
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Fatma Betul Celik
- Department of Cardiology, Istanbul Medeniyet Universty, Istanbul, Turkey
| | - Busra Guvendi Sengor
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Ahmet Guner
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training & Research Hospital, Istanbul, Turkey
| | - Servet Izci
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Alev Kilicgedik
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Ozkan Candan
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Gokhan Kahveci
- Department of Cardiology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Cetin Gecmen
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
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Efe SC, Karagöz A, Doğan C, Bayram Z, Cakmak EO, Kalkan S, Aslan K, Güven S, Tanboga HI, Ayca B, Karabağ T, Kaymaz C, Ozdemir N. Prognostic significance of malnutrition scores in elderly patients for the prediction of contrast-induced acute kidney injury. Int J Clin Pract 2021; 75:e14274. [PMID: 33908146 DOI: 10.1111/ijcp.14274] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/22/2021] [Accepted: 04/22/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Malnutrition reflects the general condition of a patient including physical condition, protein turnover, and immune competence. Contrast-induced acute kidney injury (CI-AKI) is a disorder that adversely affects the prognosis of older adults. In our study, we aimed to show the relationship between CI-AKI and malnutrition status in elderly patients over 65 years of age with chronic coronary artery disease (CAD). METHODS Study enrolled 360 consecutive patients with coronary angiography performed because of chronic coronary artery disease. Patients pre-procedural and post-procedural blood samples were taken and prognostic nutritional index (PNI), controlling nutritional status (CONUT) score, and geriatric nutritional risk index (GNRI) malnutrition scores were calculated. RESULTS The median age of the patients included in the study was 69 (67-72, IQR) and CI-AKI was seen in 91 (25.2%) patients. Univariate regression analysis showed that age, diabetes mellitus, baseline creatinine, body weight-adapted contrast agent, haemoglobin, left ventricular ejection fraction, CONUT score, PNI score, and GNRI score were independent predictors of CI-AKI. In model 1, increase in CONUT score (2 to 5) (OR: 3.21 (2.11-4.88), in model 2, increase in PNI score (37.4 to 45) (OR: 0.34, (0.24-0.49)), and in model 3, increase in GNRI score (89.5 to 103.8) (OR: 0.55, (0.38-0.81)) were independently associated with the presence of CI-AKI. PNI showed better results than other models in discriminating the predictable capability for CI-AKI. CONCLUSION Malnutrition assessment of elderly patients before performing diagnostic or interventional coronary procedures could help clinicians to identify patients with elevated risk for CI-AKI.
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Affiliation(s)
- Süleyman C Efe
- Department of Cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Ali Karagöz
- Department of Cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Cem Doğan
- Department of Cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Zübeyde Bayram
- Department of Cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Ender O Cakmak
- Department of Cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Sedat Kalkan
- Department of Cardiology, Pendik State Hospital, Istanbul, Turkey
| | - Kürsat Aslan
- Department of Cardiology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Saadet Güven
- Department of Cardiology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | | | - Burak Ayca
- Department of Cardiology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Turgut Karabağ
- Department of Cardiology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Nihal Ozdemir
- Department of Cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
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Akay T, Kaymaz C, Rüçhan Akar A, Orhan G, Yanartaş M, Gültekin B, Şırlak M, Kervan Ü, Gezer Taş S, Biçer M, Yağdı T, İspir S, Doğan R. Raising the bar to ultradisciplinary collaborations in management of chronic thromboembolic pulmonary hypertension. Turk Gogus Kalp Damar Cerrahisi Derg 2021; 29:417-431. [PMID: 34589266 PMCID: PMC8462103 DOI: 10.5606/tgkdc.dergisi.2021.21284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/05/2021] [Indexed: 02/05/2023]
Abstract
Chronic thromboembolic pulmonary hypertension is an underdiagnosed and potentially fatal subgroup of pulmonary hypertension, if left untreated. Clinical signs include exertional dyspnea and non-specific symptoms. Diagnosis requires multimodality imaging and heart catheterization. Pulmonary endarterectomy, an open heart surgery, is the gold standard treatment of choice in selected patients in specialized centers. Targeted medical therapy and balloon pulmonary angioplasty can be effective in high-risk patients with significant comorbidities, distal pulmonary vascular obstructions, or recurrent/persistent pulmonary hypertension after pulmonary endarterectomy. Currently, there is a limited number of data regarding novel coronavirus-2019 infection in patients with chronic thromboembolic pulmonary hypertension and the changing spectrum of the disease during the pandemic. Challenging times during this outbreak due to healthcare crisis and relatively higher case-fatality rates require convergence; that is an ultradisciplinary collaboration, which crosses disciplinary and sectorial boundaries to develop integrated knowledge and new paradigms. Management strategies for the "new normal" such as virtual care, preparedness for further threats, redesigned standards and working conditions, reevaluation of specific recommendations, and online collaborations for optimal decisions for chronic thromboembolic pulmonary hypertension patients may change the poor outcomes.
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Affiliation(s)
- Tankut Akay
- Department of Cardiovascular Surgery, Başkent University Faculty of Medicine Ankara Hospital, Ankara, Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, University of Health Sciences, Hamidiye Medical Faculty, Koşuyolu Heart Center, Istanbul, Turkey
| | - Ahmet Rüçhan Akar
- Department of Cardiovascular Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Gökçen Orhan
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmed Yanartaş
- Department of Cardiovascular Surgery, Çam ve Sakura Hospital, Istanbul, Turkey
| | - Bahadır Gültekin
- Department of Cardiovascular Surgery, Başkent University Faculty of Medicine Ankara Hospital, Ankara, Turkey
| | - Mustafa Şırlak
- Department of Cardiovascular Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ümit Kervan
- Department of Cardiovascular Surgery, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Serpil Gezer Taş
- Department of Cardiovascular Surgery, University of Health Sciences Hamidiye Medical Faculty, Koşuyolu Heart Center, İstanbul, Turkey
| | - Murat Biçer
- Department of Cardiovascular Surgery, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Tahir Yağdı
- Department of Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Selim İspir
- Department of Cardiovascular Surgery, Acıbadem University Faculty of Medicine, Istanbul, Turkey
| | - Rıza Doğan
- Department of Cardiovascular Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Kücükoglu SM, Kaymaz C, Alehan D, Kula S, Akcevin A, Celiker A, Cicek SM, Tokgözoglu LS, Kentli S. Pulmonary arterial hypertension associated with congenital heart disease: lessons learnt from the large Turkish Nationwide Registry (THALES). Pulm Circ 2021; 11:20458940211024206. [PMID: 34211699 PMCID: PMC8216355 DOI: 10.1177/20458940211024206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 05/23/2021] [Indexed: 11/24/2022] Open
Abstract
Pulmonary hypertension is a group of diseases, including pulmonary arterial hypertension associated with congenital heart disease (APAH-CHD), characterized by progressive deterioration in pulmonary hemodynamics associated with substantial morbidity and mortality risk. THALES is a national multicenter, prospective observational registry, providing data on patients with APAH-CHD. The study comprised APAH-CHD patients (>3 months of age) with confirmed diagnosis of right heart catheterization or echocardiographic findings. Initial and follow-up data were collected via regular hospital visits. Descriptive statistics are used for definitive purposes. Overall, 1034 patients aged 3 months–79 years (median 11.2 [Q1–Q3: 2.2–24.3] years) with APAH-CHD were enrolled at 61 centers, 50.3% being retrospectively enrolled. Most had either Eisenmenger's syndrome (49.2%) or systemic-to-pulmonary shunts (42.7%). Patients were mostly in functional class I–II at the time of diagnosis (46.6%). Mean 6-min walk distance (6MWD) was 369 ± 120 m. Mean pulmonary arterial pressure was 54.7 ± 22.2 mmHg for the whole group, and was highest in patients with Eisenmenger's syndrome. Targeted therapies were noted in 398 (38.5%) patients (monotherapy in 80.4%). Follow-up data were available in 506 patients. Survival at 140 months was 79% and was associated with baseline 6MWD >440 m (p = 0.009), brain natriuretic peptide level < 300 ng/L (p < 0.001). Follow-up 6MWD >165 m (p < 0.0001), brain natriuretic peptide level <300 ng/L (p = 0.031), and targeted therapies (p = 0.004) were also predictive of survival. THALES is the largest registry dedicated to APAH-CHD to date and provides important contributions on demographics, clinical characteristics, and gaps in disease management.
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Affiliation(s)
- Serdar M. Kücükoglu
- Department of Cardiology, Istanbul University Cardiology Institute, Istanbul, Turkey
- Serdar M. Kücükoglu, Department of Cardiology, Istanbul University Cardiology Institute, Haseki Caddesi, Istanbul 34096, Turkey.
| | - Cihangir Kaymaz
- Department of Cardiology, University of Health Sciences, Hamidiye Faculty of Medicine, Kartal Koşuyolu Yüksek Ihtisas Training and Research Hospital, Istanbul, Turkey
| | - Dursun Alehan
- Department of Pediatric Cardiology, Hacettepe University Hospitals, Hacettepe University Hospitals, Ankara, Turkey
| | - Serdar Kula
- Department of Pediatric Cardiology, Gazi University Hospital, Ankara, Turkey
| | - Atıf Akcevin
- Department of Pediatric Cardiovascular Surgery, Koc University Hospital, Istanbul, Turkey
| | - Alpay Celiker
- Department of Pediatric Cardiology, Koc University Hospital, Istanbul, Turkey
| | - Sertac M. Cicek
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Lale S. Tokgözoglu
- Department of Cardiology, Hacettepe University Hospitals, Ankara, Turkey
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Rashidi F, Mousavi-Aghdas SA, Kaymaz C. Is the maternal risk of pregnancy acceptable in patients with moderate pulmonary hypertension? Pulm Circ 2021; 11:20458940211023697. [PMID: 34188895 PMCID: PMC8212375 DOI: 10.1177/20458940211023697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Farid Rashidi
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Ali Mousavi-Aghdas
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Cihangir Kaymaz
- Department of Cardiology, Kosuyolu Heart Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Bayram Z, Doğan C, Acar RD, Efe S, Akbal ÖY, Yılmaz F, Güvendi Şengör B, Karaduman A, Uysal S, Karagöz A, Önal Ç, Kırali MK, Kaymaz C, Özdemir N. How does severe functional mitral regurgitation redefined by European guidelines affect pulmonary vascular resistance and hemodynamics in heart transplant candidates? Anatol J Cardiol 2021; 25:437-446. [PMID: 34100731 DOI: 10.5152/anatoljcardiol.2021.36114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Increased pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) are important prognostic factors in patients with heart transplantation (HT). It is well known that severe mitral regurgitation increases pulmonary pressures. However, the European Society of Cardiology and the 6th World Symposium of pulmonary hypertension (PH) task force redefined severe functional mitral regurgitation (FMR) and PH, respectively. We aimed to investigate the effect of severe FMR on PAP and PVR based on these major redefinitions in patients with HT. METHODS A total of 212 patients with HT were divided into 2 groups: those with severe FMR (n=70) and without severe FMR (n=142). Severe FMR was defined as effective orifice regurgitation area ≥20 mm2 and regurgitation volume ≥30 mL where the mitral valve was morphologically normal. A mean PAP of >20 mm Hg was accepted as PH. Patients with left ventricular ejection fraction ≤25% were included in the study. RESULTS The systolic PAP, mean PAP, and PVR were higher in patients with severe FMR than in those without severe FMR [58.5 (48.0-70.2) versus 45.0 (36.0-64.0), p<0.001; 38.0 (30.2-46.6) versus 31.0 (23.0-39.5), p=0.004; 4.0 (2.3-6.8) versus 2.6 (1.2-4.3), p=0.001, respectively]. Univariate analysis revealed that the severe FMR is a risk factor for PVR ≥3 and 5 WU [odds ratio (OR): 2.0, 95% confidence interval (CI): 1.1-3.6, p=0.009; and OR: 3.2, 95% CI: 1.5-6.7, p=0.002]. The multivariate regression analysis results revealed that presence of severe FMR is an independent risk factor for PVR ≥3 WU and presence of combined pre-post-capillary PH (OR: 2.23, 95% CI: 1.30-3.82, p=0.003 and OR: 2.30, 95% CI: 1.25-4.26, p=0.008). CONCLUSION Even in the updated definition of FMR with a lower threshold, severe FMR is associated with higher PVR, systolic PAP, and mean PAP and appears to have an unfavorable effect on pulmonary hemodynamics in patients with HT.
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Affiliation(s)
- Zübeyde Bayram
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
| | - Cem Doğan
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
| | - Rezzan Deniz Acar
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
| | - Süleyman Efe
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
| | - Özgür Yaşar Akbal
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
| | - Fatih Yılmaz
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
| | | | - Ahmet Karaduman
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
| | - Samet Uysal
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
| | - Ali Karagöz
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
| | - Çağatay Önal
- Department of Cardiology, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital; İstanbul-Turkey
| | - Mehmet Kaan Kırali
- Department of Cardiovascular Surgery, Kartal Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
| | - Nihal Özdemir
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
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Tanboğa IH, Canpolat U, Çetin EHÖ, Kundi H, Çelik O, Çağlayan M, Ata N, Özeke Ö, Çay S, Kaymaz C, Topaloğlu S. Cover Image, Volume 93, Number 5, May 2021. J Med Virol 2021. [DOI: 10.1002/jmv.26960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ibrahim Halil Tanboğa
- Department of Cardiology Nişantaşı University & Hisar Intercontinental Hospital Istanbul Turkey
- Department of Biostatistics Ataturk University, Medical School Erzurum Turkey
| | - Uğur Canpolat
- Department of Cardiology Hacettepe University, Medical School Ankara Turkey
| | | | - Harun Kundi
- Department of Cardiology Ankara City Hospital Ankara Turkey
| | - Osman Çelik
- Republic of Turkey Ministry of Health Ankara Turkey
| | | | - Naim Ata
- Republic of Turkey Ministry of Health Ankara Turkey
| | - Özcan Özeke
- Department of Cardiology University of Health Sciences, Ankara City Hospital Ankara Turkey
| | - Serkan Çay
- Department of Cardiology University of Health Sciences, Ankara City Hospital Ankara Turkey
| | - Cihangir Kaymaz
- Department of Cardiology University of Health Sciences, Kartal Kosuyolu Training and Research Hospital Istanbul Turkey
| | - Serkan Topaloğlu
- Department of Cardiology University of Health Sciences, Ankara City Hospital Ankara Turkey
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Tanboğa IH, Canpolat U, Özcan Çetin EH, Kundi H, Turan S, Celik O, Ata N, Çay S, Özeke Ö, Kaymaz C, Topaloğlu S. The prognostic role of cardiac troponin in hospitalized COVID-19 patients. Atherosclerosis 2021; 325:83-88. [PMID: 33910152 PMCID: PMC8052510 DOI: 10.1016/j.atherosclerosis.2021.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/08/2021] [Accepted: 04/13/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS Myocardial injury defined by elevation of cardiac troponins (cTn) in the course of coronavirus disease 2019 (COVID-19) pandemic has been reported, though not fully characterized yet. Using the Turkish nationwide centralized COVID-19 database, we sought to determine whether cTn measured within 24 h of admission may help identify 30-day all-cause mortality in hospitalized patients. METHODS This retrospective cohort study was conducted at all hospitals in Turkey between March 11, 2020, and June 22, 2020. All hospitalized COVID-19 patients (≥18 years) who had cTn measurements within 24 h of admission were included. The primary outcome was 30-day all-cause mortality. RESULTS A total of 14,855 COVID-19 patients (median age 49 years and 54% male) from 81 provinces of Turkey were included. Of these, 2020 patients (13.6%) were transferred to intensive care unit, 1165 patients (7.8%) needed mechanical ventilation, and 882 patients (5.9%) died during hospitalization. The prevalence of cTn positivity was 6.9% (n = 1027) in the hospitalized patients. cTn positivity was 5% in those patients alive at 30-day, and 44% in those who died. In multivariable Cox proportional hazard regression model, age, lactate dehydrogenase, and cTn were the strongest predictors of 30-day mortality, irrespective of cTn definition as a continuous, ordinal variable, or dichotomic variables. CONCLUSIONS A single measurement of cTn at admission in patients with COVID-19 is associated with 30-day all-cause mortality and may have an important prognostic role for optimizing risk stratification.
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Affiliation(s)
- Ibrahim Halil Tanboğa
- Nişantaşı University, Hisar Intercontinental Hospital, Cardiology, Istanbul, Turkey.
| | - Uğur Canpolat
- Hacettepe University, Medical School, Department of Cardiology, Ankara, Turkey
| | | | - Harun Kundi
- Ankara City Hospital, Department of Cardiology, Ankara, Turkey
| | - Sema Turan
- Ankara City Hospital, Department of Intensive Care, Ankara, Turkey
| | - Osman Celik
- Republic of Turkey Ministry of Health, Ankara, Turkey
| | - Naim Ata
- Republic of Turkey Ministry of Health, Ankara, Turkey
| | - Serkan Çay
- University of Health Sciences, Ankara City Hospital, Department of Cardiology, Ankara, Turkey
| | - Özcan Özeke
- University of Health Sciences, Ankara City Hospital, Department of Cardiology, Ankara, Turkey
| | - Cihangir Kaymaz
- University of Health Sciences, Kartal Kosuyolu Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Serkan Topaloğlu
- University of Health Sciences, Ankara City Hospital, Department of Cardiology, Ankara, Turkey
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Kültürsay B, Keskin B, Karagöz A, Akbal ÖY, Kaymaz C. Giant pulmonary artery aneurysm caused by sibutramine-associated pulmonary arterial hypertension: First case in the literature. Anatol J Cardiol 2021; 25:512-514. [PMID: 34236327 DOI: 10.5152/anatoljcardiol.2021.64166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Barkın Kültürsay
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
| | - Berhan Keskin
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
| | - Ali Karagöz
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
| | - Özgür Yaşar Akbal
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital; İstanbul-Turkey
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Kültürsay B, Keskin B, Tanyeri S, Karagöz A, Kaymaz C. Unicuspid aortic valve with false aortic dissection appearance: A case report. Turk Kardiyol Dern Ars 2021; 49:242-244. [PMID: 33847274 DOI: 10.5543/tkda.2021.27793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Unicuspid aortic valve (UAV) is a rare congenital anomaly that usually presents with aortic stenosis or mixed stenosis and regurgitation early in life. Ascending aortic aneurysm and aortic dissection are important complications of UAVs. A 27-year-old man presented to the emergency department with a complaint of acute chest pain. Bedside transthoracic echocardiography (TTE) showed dilatation of ascending aorta (47 mm) and mild aortic regurgitation; computed tomography (CT) angiography revealed a suspicious dissection flap within ascending aorta. A cardiovascular surgeon, a radiologist, and a cardiologist were immediately consulted. TTE performed by the cardiologist revealed a unicuspid unicommissural aortic valve and dilated ascending aorta with no signs of dissection. Aortic dissection image on CT angiogram was interpreted by an experienced radiologist and the cardiovascular surgeon as superior pericardial recess and considered as a false-positive dissection image. Given the patient was pain-free, the CT image was considered false positive and as TTE clearly visualized the ascending aorta, the heart team decided that no further imaging is required. After excluding acute aortic syndrome, acute coronary syndrome, and other causes of acute chest pain, the patient was discharged with close follow-up. Diagnosis of aortic dissection is based on noninvasive imaging modalities, and CT is the first-line imaging choice in most emergency departments. Depending on a single imaging modality may cause false interpretations and lead to unnecessary surgical explorations.
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Affiliation(s)
- Barkın Kültürsay
- Department of Cardiology, Koşuyolu High Specialization Training and Research Hospital, İstanbul, Turkey
| | - Berhan Keskin
- Department of Cardiology, Koşuyolu High Specialization Training and Research Hospital, İstanbul, Turkey
| | - Seda Tanyeri
- Department of Cardiology, Koşuyolu High Specialization Training and Research Hospital, İstanbul, Turkey
| | - Ali Karagöz
- Department of Cardiology, Koşuyolu High Specialization Training and Research Hospital, İstanbul, Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, Koşuyolu High Specialization Training and Research Hospital, İstanbul, Turkey
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Efe SC, Keskin M, Toprak E, Arslan K, Öz A, Güven S, Altıntaş MS, Yüksel Y, Deger S, Onal C, Karagöz A, Doğan C, Bayram Z, Karabağ T, Ayca B, Kaymaz C, Ozdemir N. A Novel Risk Assessment Model Using Urinary System Contrast Blush Grading to Predict Contrast-Induced Acute Kidney Injury in Low-Risk Profile Patients. Angiology 2021; 72:524-532. [PMID: 33769078 DOI: 10.1177/00033197211005206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Contrast-induced acute kidney injury (CI-AKI) can occur after coronary interventions despite protective measures. We evaluated the effect of urinary system contrast blush grading for predicting post-procedure CI-AKI in 486 patients with chronic coronary artery disease. Patient characteristics and blood samples were collected. Urinary system contrast blush grade was recorded during the coronary angiography and interventions. Post-procedure third to fourth day blood samples were collected for diagnosis of CI-AKI. The median age of the patients was 61 years (53-70, interquartile range), and 194 (39.9%) participants were female. Contrast-induced acute kidney injury occurred in 78 (16%) patients. By comparing full and reduced models with the likelihood ratio test, it was observed that in the reduced model, factors such as age, diabetes mellitus, body weight-adapted contrast media (CM), hemoglobin, and urinary system blush were associated with CI-AKI presence. The probability of CI-AKI presence increased slightly from grade 0 to 1 blush, but it increased sharply grade from 1 to 2 blush. According to our results, an increase in body weight-adapted CM and urinary blush grading were the main predictors of CI-AKI. These findings suggest that when body weight-adapted CM ratio exceeds 3.5 mL/kg and urinary contrast blush reaches grade 2, the patients should be followed up more carefully for the development of CI-AKI.
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Affiliation(s)
- Süleyman Cagan Efe
- Department of Cardiology, 111350Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Melike Keskin
- Department of Internal Medicine, 64160Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Ercan Toprak
- Department of Cardiology, 64160Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Kürşat Arslan
- Department of Cardiology, 64160Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Ahmet Öz
- Department of Cardiology, 64160Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Saadet Güven
- Department of Cardiology, 64160Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Sait Altıntaş
- Department of Cardiology, 64160Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Yasin Yüksel
- Department of Cardiology, 64160Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Seyda Deger
- Department of Cardiology, 64160Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Cagatay Onal
- Department of Internal Medicine, 64160Istanbul Education and Research Hospital, Istanbul, Turkey.,Department of Cardiology, 64160Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Ali Karagöz
- Department of Cardiology, 111350Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Cem Doğan
- Department of Cardiology, 111350Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Zübeyde Bayram
- Department of Cardiology, 111350Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Turgut Karabağ
- Department of Cardiology, 64160Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Burak Ayca
- Department of Cardiology, 64160Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, 111350Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Nihal Ozdemir
- Department of Cardiology, 111350Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
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Tanboğa IH, Canpolat U, Çetin EHÖ, Kundi H, Çelik O, Çağlayan M, Ata N, Özeke Ö, Çay S, Kaymaz C, Topaloğlu S. Development and validation of clinical prediction model to estimate the probability of death in hospitalized patients with COVID-19: Insights from a nationwide database. J Med Virol 2021; 93:3015-3022. [PMID: 33527474 PMCID: PMC8014660 DOI: 10.1002/jmv.26844] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/12/2021] [Accepted: 01/25/2021] [Indexed: 12/23/2022]
Abstract
In the current study, we aimed to develop and validate a model, based on our nationwide centralized coronavirus disease 2019 (COVID‐19) database for predicting death. We conducted an observational study (CORONATION‐TR registry). All patients hospitalized with COVID‐19 in Turkey between March 11 and June 22, 2020 were included. We developed the model and validated both temporal and geographical models. Model performances were assessed by area under the curve‐receiver operating characteristic (AUC‐ROC or c‐index), R2, and calibration plots. The study population comprised a total of 60,980 hospitalized COVID‐19 patients. Of these patients, 7688 (13%) were transferred to intensive care unit, 4867 patients (8.0%) required mechanical ventilation, and 2682 patients (4.0%) died. Advanced age, increased levels of lactate dehydrogenase, C‐reactive protein, neutrophil–lymphocyte ratio, creatinine, albumine, and D‐dimer levels, and pneumonia on computed tomography, diabetes mellitus, and heart failure status at admission were found to be the strongest predictors of death at 30 days in the multivariable logistic regression model (area under the curve‐receiver operating characteristic = 0.942; 95% confidence interval: 0.939–0.945; R2 = .457). There were also favorable temporal and geographic validations. We developed and validated the prediction model to identify in‐hospital deaths in all hospitalized COVID‐19 patients. Our model achieved reasonable performances in both temporal and geographic validations.
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Affiliation(s)
- Ibrahim Halil Tanboğa
- Department of Cardiology, Nişantaşı University & Hisar Intercontinental Hospital, Istanbul, Turkey.,Department of Biostatistics, Ataturk University, Medical School, Erzurum, Turkey
| | - Uğur Canpolat
- Department of Cardiology, Hacettepe University, Medical School, Ankara, Turkey
| | | | - Harun Kundi
- Department of Cardiology, Ankara City Hospital, Ankara, Turkey
| | - Osman Çelik
- Republic of Turkey Ministry of Health, Ankara, Turkey
| | | | - Naim Ata
- Republic of Turkey Ministry of Health, Ankara, Turkey
| | - Özcan Özeke
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Serkan Çay
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Serkan Topaloğlu
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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Rashidi F, Barco S, Kamangar F, Heresi GA, Emadi A, Kaymaz C, Jansa P, Reis A, Rashidi A, Taghizadieh A, Rezaeifar P, Moghimi M, Ghodrati S, Mozafari A, Foumani AA, Tahamtan O, Rafiee E, Abbaspour Z, Khodadadi K, Alamdari G, Boodaghi Y, Rezaei M, Muhammadi MJ, Abbasi M, Movaseghi F, Koohi A, Shakourzad L, Ebrahimi F, Radvar S, Amoozadeh M, Fereidooni F, Naseari H, Movalled K, Ghorbani O, Ansarin K. Incidence of symptomatic venous thromboembolism following hospitalization for coronavirus disease 2019: Prospective results from a multi-center study. Thromb Res 2020; 198:135-138. [PMID: 33338976 PMCID: PMC7836837 DOI: 10.1016/j.thromres.2020.12.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/29/2020] [Accepted: 12/04/2020] [Indexed: 12/23/2022]
Abstract
Background Thrombosis and pulmonary embolism appear to be major causes of mortality in hospitalized coronavirus disease 2019 (COVID-19) patients. However, few studies have focused on the incidence of venous thromboembolism (VTE) after hospitalization for COVID-19. Methods In this multi-center study, we followed 1529 COVID-19 patients for at least 45 days after hospital discharge, who underwent routine telephone follow-up. In case of signs or symptoms of pulmonary embolism (PE) or deep vein thrombosis (DVT), they were invited for an in-hospital visit with a pulmonologist. The primary outcome was symptomatic VTE within 45 days of hospital discharge. Results Of 1529 COVID-19 patients discharged from hospital, a total of 228 (14.9%) reported potential signs or symptoms of PE or DVT and were seen for an in-hospital visit. Of these, 13 and 12 received Doppler ultrasounds or pulmonary CT angiography, respectively, of whom only one patient was diagnosed with symptomatic PE. Of 51 (3.3%) patients who died after discharge, two deaths were attributed to VTE corresponding to a 45-day cumulative rate of symptomatic VTE of 0.2% (95%CI 0.1%–0.6%; n = 3). There was no evidence of acute respiratory distress syndrome (ARDS) in these patients. Other deaths after hospital discharge included myocardial infarction (n = 13), heart failure (n = 9), and stroke (n = 9). Conclusions We did not observe a high rate of symptomatic VTE in COVID-19 patients after hospital discharge. Routine extended thromboprophylaxis after hospitalization for COVID-19 may not have a net clinical benefit. Randomized trials may be warranted. In a large multi-center study, the incidence of venous thromboembolism in COVID-19 patients followed for 45 days after hospitalization was relatively low. Routine extended thromboprophylaxis in COVID-19 patients who have been discharged from the hospital may not have a net clinical benefit. Older age, history of recent cancer, and history of recent diabetes were associated with higher risk of mortality after hospital discharge
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Affiliation(s)
- Farid Rashidi
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Stefano Barco
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany; Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Farin Kamangar
- Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, MD, USA
| | - Gustavo A Heresi
- Department of Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, OH, USA
| | - Ashkan Emadi
- Department of Medicine, School of Medicine, University of Maryland, Baltimore, USA; Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD, USA
| | - Cihangir Kaymaz
- Department of Cardiology, Kosuyolu Heart Education and Research Hospital, University of Health Sciences, 34844 Istanbul, Turkey
| | - Pavel Jansa
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Abilio Reis
- Pulmonary Vascular Disease Unit, Medicine Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Arash Rashidi
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center Cleveland, OH, USA
| | - Ali Taghizadieh
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parisa Rezaeifar
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Minoosh Moghimi
- Department of Hematology & Medical Oncology, Vali-e-Asr Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Samad Ghodrati
- Department of Pulmonology, Vali-e-Asr Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Abolfazl Mozafari
- Department of Internal Medical, Qom Branch, Islamic Azad University, Qom, Iran
| | - Ali Alavi Foumani
- Inflammatory Lung Disease Research Center, Department of Internal Medicine, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ouria Tahamtan
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Effat Rafiee
- Department of Pulmonology, Vali-e-Asr Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Zahra Abbaspour
- Department of Endocrinology, Vali-e-Asr Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Kasra Khodadadi
- Department of Internal Medicine, Vali-e-Asr Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Golsa Alamdari
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yasman Boodaghi
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Rezaei
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Meysam Abbasi
- Student Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Fatemeh Movaseghi
- Department of Internal Medical, Qom Branch, Islamic Azad University, Qom, Iran
| | - Ata Koohi
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Shakourzad
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Ebrahimi
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sarvin Radvar
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Amoozadeh
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Fereidooni
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hanieh Naseari
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kobra Movalled
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ozra Ghorbani
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Khalil Ansarin
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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49
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Keskin B, Tokgoz H, Akbal O, Hakgor A, Tanyeri S, Karagoz A, Turkday S, Kulahcioglu S, Tanboga I, Dogan C, Bayram Z, Ozdemir N, Kaymaz C. Syncope in relation to pulmonary arterial obstructive burden, hemodynamic status and short- and long-term outcome in patients with acute pulmonary embolism. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and aims
Although syncope (S) has been reported as one of the presenting findings in patients (pts) with acute pulmonary embolism (APE), its clinical and haemodynamic correlates and impacts on the long-term outcome in this setting remains to be determined. In this single-centre study we evaluated the clinical and haemodynamic significance of S in APE in initial asessment, and during short- and long-term follow-up period.
Methods
Our study was based on the retrospective and prospective analysis of the overall 641 pts (age 65 (51–74 IQR) yrs, 56.2% female) with diagnosis of documented APE who underwent anticoagulant (n=207), thrombolytic (n=164), utrasound-facilitated thrombolysis (UFT) (n=218) or rheolytic thrombectomy (RT) (n=52). The systematic work- up including multidetector computed tomography (MDCT), Echo, biomarkers, and PE severity indexes were performed in all pts, and Qanadli score (QS) was used as the measure of the thrombotic burden in the pulmonary arteries (PA).
Results
The S as the presenting symptom In 30.2% of pts with APE. At baseline assessment, S(+) vs S(−) APE subgroups had a significantly shorter symptom-diagnosis interval, a higher risk status according to the significant elevations in troponin T, D-dimer, the higher PE severity indexes, a more deteriorated right ventricle/left ventricle ratio (RV/LV r), right atrial/left atrial ratio (LA/RAr) and RV longitudinal function indexes including tricuspid annular planary excursion (TAPSE) and tissue velocity (St), a significantly higher PA obstructive burden as assessed by QS and PA pressures. Thrombolytic therapy (36.2% vs 21%, p<0.001) and RT (11.9% vs 6.47%, p=0.037) were more frequently utilized S(+) as compared to S(−) group. However, all these differences between two subgroups were found to disappear after evidence-based APE treatments. In-hospital mortality (IHM) (12.95% vs 6%, p=0.007) and minor bleeding (10.36% vs 2.9%, p<0.001) were significantly higher in S(+) pts as compared to those in S(−) subgroup. Binominal logistic regression analysis revealed that PESI score and RV/LVr independently associated with S while IHM was only predicted by age and heart rate. The COX proportional hazard method showed that RV/LVr at discharge and malignancy were independently associated with cumulative mortality during follow-up duration of 620 (200–1170 IQ) days.
Conclusions
The presence of S in pts with APE was found to be asociated with a higher PA obstructive burden, a more deteriorated RV function and haemodynamics and higher risk status which may need more agressive reperfusion treatments. However, in the presence of the optimal treatments, S did not predict neither in-hospital outcome, nor long-term mortality.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- B Keskin
- Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - H.C Tokgoz
- Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - O.Y Akbal
- Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - A Hakgor
- Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - S Tanyeri
- Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - A Karagoz
- Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - S Turkday
- Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - S Kulahcioglu
- Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - I.H Tanboga
- Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - C Dogan
- Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Z Bayram
- Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - N Ozdemir
- Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - C Kaymaz
- Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
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50
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Tanyeri S, Tokgoz H, Keskin B, Akbal O, Karagoz A, Hakgor A, Bayram Z, Dogan C, Acar R, Kultursay B, Guner Z, Tanboga I, Ozdemir N, Kaymaz C. The reveal, reveal 2.0, compera and fphn risk scores in predciting the pah mortality: a single-centre study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
Several risk prediction models have been developed for risk assessment at the time of diagnosis and during follow-up in patients (pts) with pulmonary arterial hypertension (PAH). In this single-centre study we aimed to compare baseline REVEAL, REVEAL 2.0, COMPERA and FPHN risk scores in predicting the mortality in pts with PAH.
Methods
Study group comprised of 504 pts (age 54.4±18.9 years, female 64.4%) with PAH out of the overall 852 pts with pulmonary hypertension enrolled fourteen year period. Subgroups of PAH were as follows; IPAH (39%), CHD-PAH (51%), CTD-PAH (7.7%) and other PAH (3.3%). Functional-class (FC), six-minute-walking-distance (6MWD), pericardial effusion (PE), right atrial area (RAA), tricuspid-annular-planary-systolic-excursion (TAPSE) and systolic annular velocity (St), Echo and Catheter pulmonary artery mean presures (PAMP) and N-terminal-pro brain natriuretic-peptide (NT-proBNP) measures were evaluated at baseline and periodical control examinations with 6-months apart. Baseline assessments for REVEAL, REVEAL 2.0, COMPERA and FPHN risk scores were performed in all pts.
Results
In baseline assessment mean FC and 6MWD were 3 (3–4 IQR), and 230±100 m, repectively. Mean PAMP was 51.5±26 mm Hg, and pulmonary vascular resistance was 8.8±6.5 Wood units. Mono, dual and triple combination therapies were noted in 42%, 40%, and 18% of pts. Median follow-up time was (1470 (275–4840 IQR)) and overall all-cause mortality was 32.1%. Using the Cox proportional hazard model, likelihood ratio (LR) of scores and p values were as follows; REVEAL: 95.09 (p<0.001), REVEAL-2: 122.16 (p<0.001), COMPERA: 22.73 (p<0.001) and FPHN: 1.63 (p=0.210). Adding the TAPSE on REVEAL 2.0 score did not increase the LR of REVEAL 2.0.
When comparing the different combinations including REVEAL 2.0, with likelihood ratio test, the LR of REVEAL 2.0 plus TAPSE vs REVEAL 2.0 was 7.32 (p=0.12),
Conclusions
In this single-centre study, REVEAL 2.0 as compared to REVEAL, COMPERA and FPHN models provided the highest prediction for mortality, and adding the TAPSE on the REVEAL 2.0 scoring offered no additional benefit for risk assessment.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Tanyeri
- Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - H.C Tokgoz
- Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - B Keskin
- Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - O.Y Akbal
- Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - A Karagoz
- Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - A Hakgor
- Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Z Bayram
- Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - C Dogan
- Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - R.D Acar
- Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - B Kultursay
- Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Z.E Guner
- Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - I.H Tanboga
- Hisar Intercontinental Hospital, Cardiology, Istanbul, Turkey
| | - N Ozdemir
- Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - C Kaymaz
- Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
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