1
|
Akyol D, Çankayalı İ, Ersel M, Demirağ K, Uyar M, Can Ö, Özçete E, Karbek-Akarca F, Yağdı T, Engin Ç, Özgiray E, Yurtseven T, Yağmur B, Nalbantgil S, Ekren P, Bozkurt D, Şirin H, Çilli F, Sezer ED, Taşbakan M, Yamazhan T, Pullukçu H, Sipahi H, Arda B, Ulusoy S, Sipahi OR. Impact of the empirical therapy timing on the clinical progress of septic shock patients. Diagn Microbiol Infect Dis 2024; 108:116149. [PMID: 38142580 DOI: 10.1016/j.diagmicrobio.2023.116149] [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: 05/20/2023] [Revised: 11/11/2023] [Accepted: 11/24/2023] [Indexed: 12/26/2023]
Abstract
AIM To evaluate the effect of timing of antimicrobial therapy on clinical progress of patients with septic shock. MATERIALS AND METHOD We included 204 adult patients diagnosed with septic shock according to Sepsis-3 criteria between March 2016 and April 2021. One-month survival was evaluated using univariate and logistic regression analysis. RESULTS Antibiotic treatment was initiated within 1 h of the vasopressors in 26.4 % of patients. One-month mortality did not differ significantly between patients with and without empirical therapy coverage on etiological agents. Univariate factors that significantly affected one-month survival were starting antibiotics at the first hour, the unit where the case was diagnosed with septic shock, SOFA scores, qSOFA scores, and lactate level. In multivariate analysis, diagnosis of septic shock in the Emergency Service, SOFA score ≥11, qSOFA score of three and lactate level ≥4 were significantly associated with one-month mortality. CONCLUSION Training programs should be designed to increase the awareness of septic shock diagnosis and treatment in the Emergency Service and other hospital units. Additionally, electronic patient files should have warning systems for earlier diagnosis and consultation.
Collapse
Affiliation(s)
- Deniz Akyol
- Ege University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey.
| | - İlkin Çankayalı
- Ege University Faculty of Medicine, Department of Anesthesiology and Reanimation, Izmir, Turkey
| | - Murat Ersel
- Ege University Faculty of Medicine, Department of Emergency Department, Izmir, Turkey
| | - Kubilay Demirağ
- Ege University Faculty of Medicine, Department of Anesthesiology and Reanimation, Izmir, Turkey
| | - Mehmet Uyar
- Ege University Faculty of Medicine, Department of Anesthesiology and Reanimation, Izmir, Turkey
| | - Özge Can
- Ege University Faculty of Medicine, Department of Emergency Department, Izmir, Turkey
| | - Enver Özçete
- Ege University Faculty of Medicine, Department of Emergency Department, Izmir, Turkey
| | - Funda Karbek-Akarca
- Ege University Faculty of Medicine, Department of Emergency Department, Izmir, Turkey
| | - Tahir Yağdı
- Ege University Faculty of Medicine, Department of Cardiovascular Surgery, Izmir, Turkey
| | - Çağatay Engin
- Ege University Faculty of Medicine, Department of Cardiovascular Surgery, Izmir, Turkey
| | - Erkin Özgiray
- Ege University Faculty of Medicine, Department of Neurosurgery, Izmir, Turkey
| | - Taşkın Yurtseven
- Ege University Faculty of Medicine, Department of Neurosurgery, Izmir, Turkey
| | - Burcu Yağmur
- Ege University Faculty of Medicine, Department of Cardiology, Izmir, Turkey
| | - Sanem Nalbantgil
- Ege University Faculty of Medicine, Department of Cardiology, Izmir, Turkey
| | - Pervin Ekren
- Ege University Faculty of Medicine, Department of Pulmonology, Izmir, Turkey
| | - Devrim Bozkurt
- Ege University Faculty of Medicine, Department of Internal Medicine, Izmir, Turkey
| | - Hadiye Şirin
- Ege University Faculty of Medicine, Department of Neurology, Izmir, Turkey
| | - Feriha Çilli
- Ege University Faculty of Medicine, Department of Medical Microbiology İzmir, Turkey
| | - Ebru Demirel Sezer
- Ege University Faculty of Medicine, Department of Medical Biochemistry, Izmir, Turkey
| | - Meltem Taşbakan
- Ege University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - Tansu Yamazhan
- Ege University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - Hüsnü Pullukçu
- Ege University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - Hilal Sipahi
- Bornova Public Health Directorate, Izmir, Turkey
| | - Bilgin Arda
- Ege University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - Sercan Ulusoy
- Ege University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - Oğuz Reşat Sipahi
- Ege University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey; King Hamad University Hospital, Bahrain Oncology Center, Infectious Diseases and Clinical Microbiology, Bahrain
| |
Collapse
|
2
|
Murat S, Çavuşoğlu Y, Yılmaz MB, Yıldırımtürk Ö, Ülvan N, Çelik A, Küçük M, Kılıçaslan B, Nalbantgil S, Yiğit Z, Altay H. Patient Perception, Knowledge and Adaptation in The Management of Heart Failure: A Multicenter, Cross-Sectional, Observational, Questionnaire-Based Study: ADAPTATION HF. Turk Kardiyol Dern Ars 2024; 52:18-26. [PMID: 38221834 DOI: 10.5543/tkda.2023.53574] [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: 01/16/2024] Open
Abstract
OBJECTIVE The aim of this study is to reveal the perception levels of heart failure (HF) patients about the disease, their adaptation to the disease process, their compliance with the treatment, and their knowledge and thoughts about the disease from the patient's perspective. METHOD Patients with a diagnosis of HF for at least 6 months who applied to the cardiology clinics of 10 different centers were included in this cross-sectional, multicenter and questionnaire-based study. A questionnaire consisting of sections that included demographic information, evaluation of the patient's symptoms, knowledge and experience of clinical follow-up, knowledge of HF, compliance and awareness of treatment was applied to the patients. RESULTS 504 patients with a mean age of 59.8 ± 14.9 years (M/F: 360/144, 71.4%/28.6%) were included in the study. 61.2% of the patients stated that they knew about HF disease before. Most of the patients knew that the complaints of shortness of breath, fatigue and palpitation could develop due to HF (95.4%; 92.7%; 89.7%, respectively). The patients reported that they were mostly worried about not being able to provide their own self-care without the support of another person (67.5%). While the majority of patients (37.6%) thought that the worst disease was to have a cerebrovascular disease; only 10.9% stated that HF was the worst disease. While 98.8% of the patients stated that they used HF drugs regularly, a relatively large part of the patients did not know that the drugs were effective on kidney functions (68.5%) and blood pressure (76.9%). In the daily practice of the patients, the rate of weight follow-up was 35.5%, the rate of blood pressure monitoring was 26.9%, and the rate of patients who exercised was 27%. Among the patients, 73.3% said that they pay attention to the amount of salt they take with diet, and 33.5% have a completely salt.free diet. There was no difference between the groups with low and high knowledge scores in terms of Pittsburgh Sleep Quality Index (P > 0.005). The knowledge level score was significantly higher in patients with previous myocardial infarction (P = 0.002). CONCLUSION Most of the HF patients participating in the study are aware of the signs and symptoms of HF, follow the recommendations of their physicians, and use drugs regularly. These patients should have more information about blood pressure monitoring, weight monitoring, diet and sodium restriction, exercise, which are included in the non-pharmacological part of treatment management.
Collapse
Affiliation(s)
- Selda Murat
- Department of Cardiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Türkiye
| | - Yüksel Çavuşoğlu
- Department of Cardiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Türkiye
| | - Mehmet Birhan Yılmaz
- Department of Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, Türkiye
| | - Özlem Yıldırımtürk
- Department of Cardiology, University of Health Sciences, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Nedret Ülvan
- Department of Cardiology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
| | - Ahmet Çelik
- Department of Cardiology, Mersin University Faculty of Medicine, Mersin, Türkiye
| | - Murathan Küçük
- Department of Cardiology, Akdeniz University, Antalya, Türkiye
| | - Barış Kılıçaslan
- Clinic of Cardiology, Tepecik Training and Research Hospital, İzmir, Türkiye
| | - Sanem Nalbantgil
- Department of Cardiology, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Zerrin Yiğit
- Istanbul University-Cerrahpasa University, Institute of Cardiology, Istanbul, Türkiye
| | - Hakan Altay
- Department of Cardiology, Baskent University Faculty of Medicine, Istanbul, Türkiye
| |
Collapse
|
3
|
Ergi DG, Kahraman Ü, Akkuş G, Durmaz S, Balcıoğlu Ö, Engin Ç, Yağmur B, Nalbantgil S, Çiçek C, Özbaran M, Yağdı T. Antibody Response to SARS-CoV-2 Vaccination in Heart Failure Patients: Retrospective Single-Center Cohort Study. Diagnostics (Basel) 2023; 13:3460. [PMID: 37998596 PMCID: PMC10670598 DOI: 10.3390/diagnostics13223460] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/28/2023] [Accepted: 11/04/2023] [Indexed: 11/25/2023] Open
Abstract
We sought to investigate the impact of heart failure on anti-spike antibody positivity following SARS-CoV-2 vaccination. Our study included 103 heart failure (HF) patients, including those with and without left ventricular assist devices (LVAD) selected from our institutional transplant waiting list as well as 104 non-heart failure (NHF) patients who underwent open heart surgery at our institution from 2021 to 2022. All the patients received either heterologous or homologous doses of BNT162b2 and CoronaVac. The median age of the HF group was 56.0 (interquartile range (IQR): 48.0-62.5) and the NHF group was 63.0 (IQR: 56.0-70.2) years, and the majority were males in both groups (n = 78; 75.7% and n = 80; 76.9%, respectively). The majority of the patients in both the HF and NHF groups received heterologous vaccinations (n = 43; 41.7% and n = 52; 50.3%, respectively; p = 0.002). There was no difference in the anti-spike antibody positivity between the patients with and without heart failure (p = 0.725). Vaccination with BNT162b2 led to significantly higher antibody levels compared to CoronaVac alone (OR: 11.0; 95% CI: 3.8-31.5). With each passing day after the last vaccine dose, there was a significant decrease in anti-spike antibody positivity, with an OR of 0.9 (95% CI: 0.9-0.9). Furthermore, hyperlipidemia was associated with increased antibody positivity (p = 0.004).
Collapse
Affiliation(s)
- Defne Güneş Ergi
- Department of Cardiovascular Surgery, Faculty of Medicine, Ege University, Bornova, 35100 Izmir, Turkey; (D.G.E.); (Ü.K.); (Ç.E.); (M.Ö.)
| | - Ümit Kahraman
- Department of Cardiovascular Surgery, Faculty of Medicine, Ege University, Bornova, 35100 Izmir, Turkey; (D.G.E.); (Ü.K.); (Ç.E.); (M.Ö.)
| | - Gözde Akkuş
- Department of Microbiology, Faculty of Medicine, Ege University, Bornova, 35100 Izmir, Turkey; (G.A.); (C.Ç.)
| | - Seyfi Durmaz
- Department of Public Health, Faculty of Medicine, Ege University, Bornova, 35100 Izmir, Turkey;
| | - Özlem Balcıoğlu
- Department of Cardiovascular Surgery, Near East University Hospital, 99138 Nicosia, Cyprus;
| | - Çağatay Engin
- Department of Cardiovascular Surgery, Faculty of Medicine, Ege University, Bornova, 35100 Izmir, Turkey; (D.G.E.); (Ü.K.); (Ç.E.); (M.Ö.)
| | - Burcu Yağmur
- Department of Cardiology, Faculty of Medicine, Ege University, Bornova, 35100 Izmir, Turkey; (B.Y.); (S.N.)
| | - Sanem Nalbantgil
- Department of Cardiology, Faculty of Medicine, Ege University, Bornova, 35100 Izmir, Turkey; (B.Y.); (S.N.)
| | - Candan Çiçek
- Department of Microbiology, Faculty of Medicine, Ege University, Bornova, 35100 Izmir, Turkey; (G.A.); (C.Ç.)
| | - Mustafa Özbaran
- Department of Cardiovascular Surgery, Faculty of Medicine, Ege University, Bornova, 35100 Izmir, Turkey; (D.G.E.); (Ü.K.); (Ç.E.); (M.Ö.)
| | - Tahir Yağdı
- Department of Cardiovascular Surgery, Faculty of Medicine, Ege University, Bornova, 35100 Izmir, Turkey; (D.G.E.); (Ü.K.); (Ç.E.); (M.Ö.)
| |
Collapse
|
4
|
Yağmur B, Şimşek E, Kayıkçıoğlu M, İlkay Yüce Ersoy E, Beyazıt Candemir Y, Nalbantgil S, Moğolkoç N, Can L, Kültürsay H. Could Impedance Cardiography be a Non-Invasive Alternative Method of Measuring Cardiac Output in Patients with Pulmonary Hypertension? Anatol J Cardiol 2023; 27:650-656. [PMID: 37466025 PMCID: PMC10621604 DOI: 10.14744/anatoljcardiol.2023.2820] [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: 12/26/2022] [Accepted: 06/13/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Pulmonary hypertension guidelines recommend invasive right heart catheterization for diagnosis and clinical follow-up. Our aim was to compare non-invasive impedance cardiography with invasive techniques for cardiac index measurements and mortality prediction in patients with pulmonary hypertension. METHODS Between 2008 and 2018, 284 right heart catheterizations were performed for the diagnosis of pulmonary hypertension in 215 patients with mean pulmonary artery pressure >25 mm Hg, and at least 2 methods used for cardiac output measurement were included in the study retrospectively. Patients were evaluated with Pearson's correlation in 3 groups: estimated Fick (eFick) method and thermodilution (group 1), eFick method and impedance cardiography (group 2), and thermodilution and impedance cardiography (group 3). We also compared the predictive power of cardiac index measured by different methods for 1-year overall mortality and hospitalizations. RESULTS There were strong and moderate positive correlations in groups 1 and 3, respectively (r = 0.634, P <.001, r = 0.534, P =.001), and the weakest correlation was in group 2 (r = 0.390, P =.001). The mean difference (bias) between eFick method versus impedance cardiography, impedance cardiography vs. thermodilution, and eFick method vs. thermodilution was 0.6 mL/min, 0.47 mL/min, and -0.2 mL/min respectively, but limits of agreement were wide. In both groups, cardiac index <2.5 L/min/m2 as measured by thermodilution significantly predicted 1-year mortality. Also, impedance cardiography was better than eFick method in predicting mortality (P =.02). CONCLUSIONS Our single-center real-life data showed that for cardiac output and cardiac index measurements, impedance cardiography provides a moderate correlation with thermodilution and is fair with eFick method methods. Moreover, thermodilution appeared superior to both eFick method and impedance cardiography, while impedance cardiography was even better than eFick method in predicting 1-year adverse events, including total mortality and hospitalization, in patients with pulmonary hypertension.
Collapse
Affiliation(s)
- Burcu Yağmur
- Department of Cardiology, Faculty of Medicine, Ege University, İzmir, Türkiye
| | - Evrim Şimşek
- Department of Cardiology, Faculty of Medicine, Ege University, İzmir, Türkiye
| | - Meral Kayıkçıoğlu
- Department of Cardiology, Faculty of Medicine, Ege University, İzmir, Türkiye
| | - Elif İlkay Yüce Ersoy
- Department of Cardiology, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Türkiye
| | | | - Sanem Nalbantgil
- Department of Cardiology, Faculty of Medicine, Ege University, İzmir, Türkiye
| | - Nesrin Moğolkoç
- Department of Pulmonology, Faculty of Medicine, Ege University, İzmir, Türkiye
| | - Levent Can
- Department of Cardiology, Faculty of Medicine, Ege University, İzmir, Türkiye
| | - Hakan Kültürsay
- Department of Cardiology, Faculty of Medicine, Ege University, İzmir, Türkiye
| |
Collapse
|
5
|
Kaya E, Kocabaş U, Şimşek E, Nalbantgil S, Engin Ç, Özbaran M, Akilli A. Effect of Aortic Valve Opening Pattern on Endothelial Function After Continuous-Flow Left Ventricular Assist Device Implantation. ASAIO J 2023; 69:e429-e436. [PMID: 37773149 DOI: 10.1097/mat.0000000000002025] [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: 10/01/2023] Open
Abstract
This study aimed to evaluate the effects of aortic valve opening patterns on endothelial functions in patients undergoing continuous-flow left ventricular assist device (CF-LVAD) implantation. This study included 43 patients who underwent CF-LVAD implantation and 35 patients with heart failure reduced ejection fraction (HFrEF; control group). The CF-LVAD group was divided into three subgroups based on aortic valve opening patterns: open with each beat, intermittently opening, and not opening groups. Flow-mediated dilatation (FMD) and pulsatility index (PI) were compared before and 3 months after CF-LVAD implantation. Cardiopulmonary exercise test (CPET) and 6 minute walk test (6-MWT) scores were measured at baseline and follow-up in the CF-LVAD group. The mean FMD and PI of patients in the CF-LVAD group reduced 3 months after implantation. Patients with intermittently opening and not opening aortic valves had worse endothelial function at follow-up. Before and 3 months after implantation FMD% did not significantly differ in patients whose aortic valves were open with each beat (4.72 ± 1.06% vs. 4.67 ± 1.16%, p = 0.135). Pulsatility index changes paralleled FMD changes. Cardiopulmonary exercise test and 6-MWT scores improved after implantation but without significant differences between subgroups. Maintaining normal aortic valve function after CF-LVAD implantation may reduce endothelial dysfunction; however, larger studies are needed for long-term clinical effects.
Collapse
Affiliation(s)
- Ersin Kaya
- From the Department of Cardiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Umut Kocabaş
- Department of Cardiology, Baskent University, Izmir, Turkey
| | - Evrim Şimşek
- From the Department of Cardiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Sanem Nalbantgil
- From the Department of Cardiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Çağatay Engin
- Department of Cardiovascular Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Mustafa Özbaran
- Department of Cardiovascular Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Azem Akilli
- From the Department of Cardiology, Faculty of Medicine, Ege University, Izmir, Turkey
| |
Collapse
|
6
|
Musayev O, Kayıkçıoğlu M, Shahbazova S, Nalbantgil S, Moğulkoç N, Ibrahimov F, Kültürsay H. Could Heart Rate Variability Serve as a Prognostic Factor in Patients with Pulmonary Hypertension? A Single-center Pilot Study. Turk Kardiyol Dern Ars 2023; 51:454-463. [PMID: 37861265 DOI: 10.5543/tkda.2023.27078] [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 Heart rate variability (HRV), which is defined as cyclic changes in sinus rate with time, is used as a measure of cardiac autonomic tone. Our aim was to determine the impact of HRV on short-term prognosis in pulmonary hypertension (PH). METHODS We enrolled 64 PH patients and 69 healthy subjects (control group). Patients were evaluated by Holter-ECG, echocardiography, and laboratory tests. 24-h Holter-ECG monitoring was used for HRV. The development of adverse events (right heart failure, hospitalization, syncope, and death) during the 6-month follow-up was evaluated in PH group. RESULTS PH group (39 ± 16 years, 37.5% males) comprised of 16 patients with idiopathic pulmonary arterial hypertension (PAH) (25%), 36 patients with PAH associated with congenital heart disease (56.3%), 3 PAH associated with connective tissue disease (4.7%), 1 with portopulmonary (1.6%), and 8 chronic thromboembolic PH (12.5%). The time-dependent (standard deviation of all NN intervals for a selected time period [SDNN], standard deviation of the 5-min mean R-R intervals tabulated over an entire day [SDANN], SDNN Index, and Triangular Index) and frequency-dependent HRV indices (low frequency, high-frequency power, and total power,) were significantly reduced in those with PH. Functional class was negatively associated with SDNN, SDANN, SDNN Index, and Triangular Index. Adverse events developed in 25% of the patients during the 6-month follow-up period (200 ± 92 days) (7 patients had right-heart failure, 5 syncope, 12 patients were hospitalized, and 9 had died). All the time and frequency-dependent indices significantly associated with adverse events. Mortality correlated with SDNN (rS = -0.354, P = 0.005), SDANN (rS = -0.368, P = 0.004), SDNN Index (rS = -0.257, P = 0.045), Triangular Index (rS = -0.310, P = 0.014), and VLF (rS = -0.265, P = 0.039). CONCLUSION HRV is significantly depressed in patients with PH and is associated with the clinical status. HRV indices might predict clinical deterioration, adverse events, and mortality for 6 months. Non-invasive assessment of HRV through Holter-ECG may be a valuable and practical tool in risk stratification of patients with PH for short-term outcomes.
Collapse
Affiliation(s)
- Ogtay Musayev
- Department of Cardiology, Central Clinic Hospital, Baku, Azerbaijan
| | - Meral Kayıkçıoğlu
- Department of Cardiology, Ege University School of Medicine, İzmir, Türkiye
| | - Shafa Shahbazova
- Department of Cardiology, Central Clinic Hospital, Baku, Azerbaijan
| | - Sanem Nalbantgil
- Department of Cardiology, Ege University School of Medicine, İzmir, Türkiye
| | - Nesrin Moğulkoç
- Department of Pulmonology, Ege University School of Medicine, İzmir, Türkiye
| | | | - Hakan Kültürsay
- Department of Cardiology, Ege University School of Medicine, İzmir, Türkiye
| |
Collapse
|
7
|
Yağmur B, Kayıkçıoğlu M, Şimşek E, Nalbantgil S, Kültürsay H. Long-Term Natural Course of Patients with Pulmonary Artery Pressures in the Range of 21-24 mmHg: Insights from a Single-Center Study. Turk Kardiyol Dern Ars 2023; 51:478-485. [PMID: 37861260 DOI: 10.5543/tkda.2023.65724] [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 Slightly elevated mean pulmonary artery pressure (mPAP) was previously termed as ''borderline pulmonary hypertension (PH)''. We examined the long-term prognosis of patients with mPAP values between 21 and 24 mmHg, who were referred with the suspicion of pulmonary hypertension. METHODS Our retrospective study included patients with moderate-to-high echocardiographic risk who underwent right heart catheterization (RHC) between 2008 and 2021 and were followed for at least 1 year. Patients with mPAP <21 mmHg and mPAP 21-24 mmHg were compared. Demographic and clinical characteristics and prognoses of the groups were compared. All-cause mortality over a mean follow-up of 5 years (min 1-max 13 years) was evaluated. RESULTS A total of 140 patients (mean age 53.1 ± 14.8 years, female 74.5%) with mPAP values <25 mmHg measured of the 395 diagnostic RHCs. Mean follow-up was 4.92 ± 3.13 years. NT-pro-BNP and 6-min walking distance were better in patients with mPAP <21 mmHg. Echocardiographic findings suggestive of PH were more common in mPAP 21-24 mmHg group (P < 0.05). Both the pulmonary artery wedge pressure and cardiac index values were significantly deteriorated in individuals with mPAP 21-24 mmHg (P = 0.001). All-cause mortality tended to be higher in the borderline PH group but did not reach to statistical significance. CONCLUSION Our single-center observational study revealed that the individuals with an mPAP of 21-24 mmHg tended to have a worser prognosis than those with mPAP of <21 mmHg for up to 13-year follow-up.
Collapse
Affiliation(s)
- Burcu Yağmur
- Department of Cardiology, Ege University Faculty of Medicine, İzmir, Türkiye
| | - Meral Kayıkçıoğlu
- Department of Cardiology, Ege University Faculty of Medicine, İzmir, Türkiye
| | - Evrim Şimşek
- Department of Cardiology, Ege University Faculty of Medicine, İzmir, Türkiye
| | - Sanem Nalbantgil
- Department of Cardiology, Ege University Faculty of Medicine, İzmir, Türkiye
| | - Hakan Kültürsay
- Department of Cardiology, Ege University Faculty of Medicine, İzmir, Türkiye
| |
Collapse
|
8
|
Celik A, Ural D, Sahin A, Colluoglu IT, Kanik EA, Ata N, Arugaslan E, Demir E, Ayvali MO, Ulgu MM, Temizhan A, Cavusoglu Y, Acar RD, Nalbantgil S, Asarcikli LD, Murat S, Birinci S, Yilmaz MB. Trends in heart failure between 2016 and 2022 in Türkiye (TRends-HF): a nationwide retrospective cohort study of 85 million individuals across entire population of all ages. Lancet Reg Health Eur 2023; 33:100723. [PMID: 37953995 PMCID: PMC10636276 DOI: 10.1016/j.lanepe.2023.100723] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/16/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 11/14/2023]
Abstract
Background Data on the burden of heart failure (HF) outside western countries are limited, but available data suggest it may present differently in other countries. The aim of this study was to examine the incidence, prevalence, and survival rates of HF in Türkiye, with a specific focus on how these rates vary according to age, sex, comorbidities, and socioeconomic status (SES). Methods We harnessed the extensive National Electronic Database of the Turkish Ministry of Health, covering Turkey's entire population from January 1, 2016, to December 31, 2022, to identify 2,722,151 cases of HF and their associated comorbidities using ICD-10 codes. Analyzing the primary endpoint of all-cause mortality, our study utilized anonymized data to examine patient demographics, comorbidities, socioeconomic status, and survival patterns, employing statistical techniques to delve into relationships and trends. The data were segmented by gender, socioeconomic status, and age, involving cross-tabulations and statistical metrics to explore connections, odds ratios, and survival rates. Findings The estimated prevalence of HF was 2.114% in Türkiye at the end of 2022, with an annual incidence ranging between 3.00 and 6.06 per 1000 person years. Females were older than males (69.8 ± 13.9 years vs. 66.8 ± 13.9 years, respectively). The most common comorbidities were congenital heart diseases and anemia under the age of 20, and hypertension and atherosclerotic cardiovascular disease in the adult population. Only 23.6% (643,159/2,722,151) of patients were treated with any triple guideline-directed medical therapy (GDMT) and 3.6% (96,751/2,722,151) of patients were on quadruple GDMT. The survival rates for patients with HF at 1, 5, and 7 years were 83.3% (95% CI: 83.2-83.3), 61.5% (95% CI: 61.4-61.6), and 57.7% (95% CI: 57.6-57.8) among females, and 82.1% (95% CI: 82.0-82.2), 58.2% (95% CI: 58.1-58.3), and 54.2% (95% CI: 54.0-54.3) among males. Despite a tendency for an increase from the highest to the lowest SES, the prevalence of HF and mortality were paradoxically lowest in the lowest SES region. Interpretation The prevalence, incidence, and survival rates of HF in Türkiye were comparable to western countries, despite the notable difference of HF onset occurring 8-10 years earlier in the Turkish population. Drug usage statistics indicate there is a need for effective strategies to improve treatment with GDMT. Funding None.
Collapse
Affiliation(s)
- Ahmet Celik
- Department of Cardiology, Mersin University, Faculty of Medicine, Mersin, Türkiye
| | - Dilek Ural
- Department of Cardiology, Koç University, Faculty of Medicine, Istanbul, Türkiye
| | - Anil Sahin
- Department of Cardiology, Sivas Cumhuriyet University, Faculty of Medicine, Sivas, Türkiye
| | - Inci Tugce Colluoglu
- Department of Cardiology, Karabük University, Faculty of Medicine, Karabük, Türkiye
| | - Emine Arzu Kanik
- Department of Biostatistics and Medical Informatics, Mersin University, Faculty of Medicine, Mersin, Türkiye
| | - Naim Ata
- General Directorate of Information Systems, Ministry of Health, Ankara, Türkiye
| | - Emre Arugaslan
- Health Science University, Faculty of Medicine, Ankara City Hospital, Ankara, Türkiye
| | - Emre Demir
- Department of Cardiology, Ege University, Faculty of Medicine, Izmir, Türkiye
| | - Mustafa Okan Ayvali
- General Directorate of Information Systems, Ministry of Health, Ankara, Türkiye
| | - Mustafa Mahir Ulgu
- General Directorate of Information Systems, Ministry of Health, Ankara, Türkiye
| | - Ahmet Temizhan
- Health Science University, Faculty of Medicine, Ankara City Hospital, Ankara, Türkiye
| | - Yuksel Cavusoglu
- Department of Cardiology, Osmangazi University, Faculty of Medicine, Eskisehir, Türkiye
| | - Rezzan Deniz Acar
- Department of Cardiology, Health Science University, Faculty of Medicine, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Türkiye
| | - Sanem Nalbantgil
- Department of Cardiology, Ege University, Faculty of Medicine, Izmir, Türkiye
| | - Lale Dinc Asarcikli
- Department of Cardiology, Health Science University, Faculty of Medicine, Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Selda Murat
- Department of Cardiology, Osmangazi University, Faculty of Medicine, Eskisehir, Türkiye
| | - Suayip Birinci
- Deputy Minister of Health, Ministry of Health, Ankara, Türkiye
| | - Mehmet Birhan Yilmaz
- Department of Cardiology, Dokuz Eylül University, Faculty of Medicine, Izmir, Türkiye
| |
Collapse
|
9
|
Yaylalı YT, Yağmur B, Sinan ÜY, Meriç M, Başarıcı İ, Kılıçkıran Avcı B, Şenol H, Nalbantgil S, Küçükoğlu S, Öngen Z. Risk Assessment Tool Implementation in Congenital Heart Disease-Associated Pulmonary Arterial Hypertension. Anatol J Cardiol 2023; 27:479-485. [PMID: 37288853 PMCID: PMC10406152 DOI: 10.14744/anatoljcardiol.2023.2885] [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: 12/09/2022] [Accepted: 04/04/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Risk assessment is recommended for patients with congenital heart disease-associated pulmonary arterial hypertension. This study aims to compare an abbreviated version of the risk assessment strategy, noninvasive French model, and an abridged version of the Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management 2.0 risk score calculator, Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management Lite 2. METHODS We enrolled a mixed prevalent and incident cohort of patients with congenital heart disease-associated pulmonary arterial hypertension (n = 126). Noninvasive French model comprising World Health Organization functional class, 6-minute walk distance, and N-terminal pro-hormone of brain natriuretic peptide or brain natriuretic peptide was used. Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management Lite 2 includes functional class, systolic blood pressure, heart rate, 6-minute walk distance, brain natriuretic peptide/N-terminal pro-hormone of brain natriuretic peptide, and estimated glomerular filtration rate. RESULTS The mean age was 32.17 ± 16.3 years. The mean follow-up was 99.41 ± 58.2 months. Thirty-two patients died during follow-up period. Most patients were Eisenmenger syndrome (31%) and simple defects (29.4%). Most patients received monotherapy (76.2%). Most patients were World Health Organization functional class I-II (66.6%). Both models effectively identified risk in our cohort (P =.0001). Patients achieving 2 or 3 noninva-sive low-risk criteria or low-risk category by Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management Lite 2 at follow-up had a significantly reduced risk of death. Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management Lite 2 approximates noninvasive French model at discriminating among patients based on c-index. Age, high risk by Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management Lite 2, and the presence of 2 or 3 low-risk criteria by noninvasive French model emerged as an independent predictors of mortality (multivariate hazard ratio: 1.031, 95% CI: 1.005-1.058, P =.02; hazard ratio: 4.258, CI: 1.143-15.860, P =.031; hazard ratio: 0.095, CI: 0.013-0.672, P =.018, respectively). CONCLUSIONS Both abbreviated risk assessment tools may provide a simplified and robust method of risk assessment for congenital heart disease-associated pulmonary arterial hypertension. Patients not achieving low risk at follow-up may benefit from aggressive use of available therapies.
Collapse
Affiliation(s)
- Yalın Tolga Yaylalı
- Department of Cardiology, Faculty of Medicine, Pamukkale University, Denizli, Türkiye
| | - Burcu Yağmur
- Department of Cardiology, Faculty of Medicine, Ege University, İzmir, Türkiye
| | - Ümit Yaşar Sinan
- Department of Cardiology, İstanbul University Cardiology Institute, İstanbul, Türkiye
| | - Murat Meriç
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Türkiye
| | - İbrahim Başarıcı
- Department of Cardiology, Faculty of Medicine, Akdeniz University, Antalya, Türkiye
| | - Burçak Kılıçkıran Avcı
- Department of Cardiology, Cerrahpaşa Faculty of Medicine, İstanbul University Cerrahpaşa, İstanbul, Türkiye
| | - Hande Şenol
- Department of Biostatistics, Faculty of Medicine, Pamukkale University, Denizli, Türkiye
| | - Sanem Nalbantgil
- Department of Cardiology, Faculty of Medicine, Ege University, İzmir, Türkiye
| | - Serdar Küçükoğlu
- Department of Cardiology, İstanbul University Cardiology Institute, İstanbul, Türkiye
| | - Zeki Öngen
- Department of Cardiology, Cerrahpaşa Faculty of Medicine, İstanbul University Cerrahpaşa, İstanbul, Türkiye
| |
Collapse
|
10
|
Çelik A, Kılıçaslan B, Temizhan A, Güvenç TS, Altay H, Çavuşoğlu Y, Yılmaz MB, Yıldırımtürk Ö, Nalbantgil S, Ural D. How to Use Natriuretic Peptides in Patients with Heart Failure with Non-Reduced Ejection Fraction? Anatol J Cardiol 2023; 27:308-318. [PMID: 37257015 DOI: 10.14744/anatoljcardiol.2023.3297] [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: 06/02/2023] Open
Affiliation(s)
- Ahmet Çelik
- Department of Cardiology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Barış Kılıçaslan
- Department of Cardiology, Faculty of Medicine, İzmir Health Sciences University, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Ahmet Temizhan
- Department of Cardiology, Faculty of Medicine, Health Sciences University, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Tolga Sinan Güvenç
- Department of Cardiology, Faculty of Medicine, İstinye University, İstanbul, Turkey
| | - Hakan Altay
- Department of Cardiology, Faculty of Medicine, Başkent University, İstanbul, Turkey
| | - Yüksel Çavuşoğlu
- Department of Cardiology, Faculty of Medicine, Osmangazi University, Eskişehir, Turkey
| | - Mehmet Birhan Yılmaz
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Özlem Yıldırımtürk
- Department of Cardiology, Faculty of Medicine, Health Sciences University, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Sanem Nalbantgil
- Department of Cardiology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Dilek Ural
- Department of Cardiology, Faculty of Medicine, Koç University, İstanbul, Turkey
| |
Collapse
|
11
|
Gustafsson F, Damman K, Nalbantgil S, Van Laake LW, Tops LF, Thum T, Adamopoulos S, Bonios M, Coats AJ, Crespo-Leiro MG, Mehra MR, Filippatos G, Hill L, Metra M, Jankowska E, de Jonge N, Kaye D, Masetti M, Parissis J, Milicic D, Seferovic P, Rosano G, Ben Gal T. Inotropic therapy in patients with advanced heart failure. A clinical consensus statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2023; 25:457-468. [PMID: 36847113 DOI: 10.1002/ejhf.2814] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/20/2023] [Accepted: 02/24/2023] [Indexed: 03/01/2023] Open
Abstract
This clinical consensus statement reviews the use of inotropic support in patients with advanced heart failure. The current guidelines only support use of inotropes in the setting of acute decompensated heart failure with evidence of organ malperfusion or shock. However, inotropic support may be reasonable in other patients with advanced heart failure without acute severe decompensation. The clinical evidence supporting use of inotropes in these situations is reviewed. Particularly, patients with persistent congestion, systemic hypoperfusion, or advanced heart failure with need for palliation, and specific situations relevant to implantation of left ventricular assist devices or heart transplantation are discussed. Traditional and novel drugs with inotropic effects are discussed and use of guideline-directed therapy during inotropic support is reviewed. Finally, home inotropic therapy is described, and palliative care and end-of-life aspects are reviewed in relation to management of ongoing inotropic support (including guidance for maintenance and weaning of chronic inotropic therapy support).
Collapse
Affiliation(s)
- Finn Gustafsson
- Department of Cardiology, Rigshospitalet, University of Copenhagen, København, Denmark
| | - Kevin Damman
- University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Sanem Nalbantgil
- Cardiology Department, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Linda W Van Laake
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Laurens F Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Thomas Thum
- Institute of Molecular and Therapeutic Strategies (IMTTS), Hannover Medical School, and Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany
| | | | | | | | - Maria G Crespo-Leiro
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), CIBERCV, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | - Mandeep R Mehra
- Center for Advanced Heart Disease, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology, Athens University Hospital, Attikon, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Loreena Hill
- School of Nursing & Midwifery, Queen's University, Belfast, UK
| | - Marco Metra
- Cardiology, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Ewa Jankowska
- Institute of Heart Diseases, Wroclaw Medical University and Institute of Heart Diseases, University Hospital, Wroclaw, Poland
| | - Nicolaas de Jonge
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - David Kaye
- The Alfred Hospital, Melbourne, Vic, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Marco Masetti
- Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - John Parissis
- Heart Failure Unit and University Clinic of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Davor Milicic
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine & University Hospital Centre Zagreb, Zagreb, Croatia
| | - Petar Seferovic
- Faculty of Medicine, University of Belgrade, and Serbian Academy of Arts and Sciences, Belgrade, Serbia
| | | | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
12
|
Demir E, Ceylan N, Bayraktaroğlu S, Çinkooğlu A, Candemir A, Candemir YB, Güneş MT, Yeniyol Ş, Yılmaz EB, Zoghi M, Akıllı A, Gürgün C, Nalbantgil S. The outcome of peripartum cardiomyopathy patients-single center experience. Echocardiography 2022; 39:1608-1615. [PMID: 36447302 DOI: 10.1111/echo.15498] [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: 08/21/2022] [Revised: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE Peripartum cardiomyopathy (PPCM) diagnosis made by excluding identifiable causes of heart failure (HF) and occurs end of the pregnancy or during the postpartum period of five months. It presents a clinical HF spectrum with left ventricular systolic dysfunction. BACKGROUND The purpose of this study is to retrospectively evaluate the clinical characteristics, cardiac magnetic resonance (CMR) imaging features, and end-points consisting of left ventricle recovery, left ventricular assist device implantation, heart transplantation, and all-cause mortality. METHOD Outpatient HF records between 2008 to 2021 were screened. Thirty-seven patients were defined as PPCM. Twenty-five patients had CMR evaluation at the time of diagnosis, and six patients were re-evaluated with CMR. RESULTS The mean age was 30.5 ± 5.6 years, and the mean LVEF was 28.2% ± 6.7%. In 13(35.7%) patients, LVEF recovered during the follow-up course. The median recovery time was 281(IQR [78-358]) days. LVEF on CMR was 35.3 ± 10.5, and three patients exhibited late gadolinium enhancement(LGE) patterns. Sub-endocardial and mid-wall uptake pattern types were detected. 18(75%) patients met the Petersen left ventricle non-compaction cardiomyopathy(LVNC) criteria. Patients with NC/C ratio lower than 2.3 had lower LVEDVi and LVESVi (124.9 ± 35.4, 86.4 ± 7.5, p = .003; 86.8 ± 34.6, 52.6 ± 7.6, p = .006), respectively. The median follow-up time was 2129 (IQR [911-2634]) days. The primary endpoint-free 1-year survival was 88.9% (event rate 11.1%), and 5-year survival was 75.7% (event rate 24.3%). CONCLUSION In a retrospective cohort of PPCM patients, 35.7% of patients' LVEF recovered, and the primary end-point of free-5-year survival was 75%. Twenty-five patients were assessed with CMR; three of four met the Petersen CMR-derived LVNC at initial evaluation.
Collapse
Affiliation(s)
- Emre Demir
- Ege University School of Medicine Cardiology Department, Izmir, Turkey
| | - Naim Ceylan
- Ege University School of Medicine Radiology Department, Izmir, Turkey
| | | | - Akın Çinkooğlu
- Ege University School of Medicine Radiology Department, Izmir, Turkey
| | - Aytaç Candemir
- Ege University School of Medicine Cardiology Department, Izmir, Turkey
| | - Yeşim B Candemir
- Ege University School of Medicine Cardiology Department, Izmir, Turkey
| | | | | | | | - Mehdi Zoghi
- Ege University School of Medicine Cardiology Department, Izmir, Turkey
| | - Azem Akıllı
- Ege University School of Medicine Cardiology Department, Izmir, Turkey
| | - Cemil Gürgün
- Ege University School of Medicine Cardiology Department, Izmir, Turkey
| | - Sanem Nalbantgil
- Ege University School of Medicine Cardiology Department, Izmir, Turkey
| |
Collapse
|
13
|
Demir E, Bayraktaroğlu S, Çinkooğlu A, Candemir A, Candemir YB, Öztürk RO, Dadaş ÖF, Orman MN, Zoghi M, Akıllı A, Ceylan N, Gürgün C, Nalbantgil S. Characteristics and long-term survival of patients with left ventricular non-compaction cardiomyopathy. ESC Heart Fail 2022; 9:4219-4229. [PMID: 36111517 PMCID: PMC9773712 DOI: 10.1002/ehf2.14081] [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: 11/25/2021] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS Left ventricular non-compaction cardiomyopathy (LVNC) is a poorly understood entity resulting in heart failure. Whether it is a distinct form of cardiomyopathy or an anatomical phenotype is a subject of discussion. The current diagnosis is based on morphologic findings by comparing the compacted to non-compacted myocardium. The study aimed to compare demographic and prognostic variables of patients with dilated cardiomyopathy (DCM) and LVNC. Emphasis was given to cardiac magnetic resonance (CMR) imaging analysis. Data on survival were also assessed. METHODS AND RESULTS We retrospectively evaluated the characteristics and outcomes of 262 non-ischaemic cardiomyopathy patients with LVNC and DCM phenotypes. Petersen's CMR criteria of non-compacted to the compacted myocardial ratio 2.3 were used to diagnose LVNC. The primary endpoint was a composite endpoint of major adverse cardiovascular events comprising cardiovascular-related death, left ventricular assisted device implantation, or heart transplantation. A total of 262 patients with CMR data were included in the study. One hundred fifty-five patients who fulfilled CMR criteria were diagnosed as LVNC. CMR findings revealed that LVNC patients had higher left ventricular end-diastolic (137.2 ± 51.6, 116.8 ± 44.6, P = 0.002) and systolic volume index (98.4 ± 49.5, 85.9 ± 42.7, P = 0.049). Cardiac haemodynamics, cardiac output (5.61 ± 2.03, 4.96 ± 1.83; P = 0.010), stroke volume (73.9 ± 28.8, 65.1 ± 25.1; P = 0.013), and cardiac index (2.85 ± 1.0, 2.37 ± 0.72; P < 0.0001), were higher in LVNC patients. Of all the 249 patients, 102 (40.9%) patients demonstrated late gadolinium enhancement (LGE). According to Petersen's criteria, the Kaplan-Meier survival outcome did not reveal significant differences (hazard ratio [HR]: 1.53, 95% confidence interval [CI]: [0.89-2.63], P = 0.11). The presence or pattern of LGE did not show significant importance for endpoint-free survival. Most of the sub-epicardial LGE pattern was found in LVNC patients (94.4%). When receiver operator characteristics analysis was applied to NC/C ratio to discriminate the primary endpoint, a higher NC/C ratio of 2.57 was associated with adverse events (HR: 1.90, 95% CI: [1.12-3.24], P = 0.016). CONCLUSIONS Our study questions the criteria being used for the diagnosis of LVNC. Further evaluation of CMR variables and association of these findings with demographic variables and survival is mandatory.
Collapse
Affiliation(s)
- Emre Demir
- Department of CardiologyEge University School of MedicineBornovaTurkey
| | | | - Akın Çinkooğlu
- Department of RadiologyEge University School of MedicineBornovaTurkey
| | - Aytaç Candemir
- Department of CardiologyEge University School of MedicineBornovaTurkey
| | - Yeşim B. Candemir
- Department of CardiologyEge University School of MedicineBornovaTurkey
| | - Rıza O. Öztürk
- Department of CardiologyEge University School of MedicineBornovaTurkey
| | - Ömer F. Dadaş
- Department of Biostatistics and BionformaticsEge University School of MedicineBornovaTurkey
| | - Mehmet N. Orman
- Department of Biostatistics and BionformaticsEge University School of MedicineBornovaTurkey
| | - Mehdi Zoghi
- Department of CardiologyEge University School of MedicineBornovaTurkey
| | - Azem Akıllı
- Department of CardiologyEge University School of MedicineBornovaTurkey
| | - Naim Ceylan
- Department of RadiologyEge University School of MedicineBornovaTurkey
| | - Cemil Gürgün
- Department of CardiologyEge University School of MedicineBornovaTurkey
| | - Sanem Nalbantgil
- Department of CardiologyEge University School of MedicineBornovaTurkey
| |
Collapse
|
14
|
Cavusoglu Y, Celik A, Altay H, Nalbantgil S, Ozden O, Temizhan A, Ural D, Unlu S, Yilmaz MB, Zoghi M. Heart failure with non-reduced ejection fraction: Epidemiology, pathophysiology, phenotypes, diagnosis and treatment approaches. Turk Kardiyol Dern Ars 2022; 50:S1-S34. [DOI: 10.5543/tkda.2022.s1] [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
|
15
|
Çavuşoğlu Y, Altay H, Aras D, Çelik A, Ertaş FS, Kılıçaslan B, Nalbantgil S, Temizhan A, Ural D, Yıldırımtürk Ö, Yılmaz MB. Cost-of-disease of Heart Failure in Turkey: A Delphi Panel-based Analysis of Direct and Indirect Costs. Balkan Med J 2022; 39:282-289. [PMID: 35872647 PMCID: PMC9326952 DOI: 10.4274/balkanmedj.galenos.2022.2022-3-97] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Heart failure (HF) is considered a significant public health issue with a substantial and growing epidemiologic and economic burden in relation to longer life expectancy and aging global population. Aims: To determine cost-of-disease of heart failure (HF) in Turkey from the payer perspective. Study Design: Cross-sectional cost of disease study. Methods: In this cost-of-disease study, annual direct and indirect costs of management of HF were determined based on epidemiological, clinical and lost productivity inputs provided by a Delphi panel consisted of 11 experts in HF with respect to ejection fraction (EF) status (HF patients with reduced EF (HFrEF), mid-range EF (HFmrEF) and preserved EF (HFpEF)) and New York Heart Association (NYHA) classification. Direct medical costs included cost items on outpatient management, inpatient management, medications, and non-pharmaceutical treatments. Indirect cost was calculated based on the lost productivity due to absenteeism and presenteeism. Results: 51.4%, 19.5%, and 29.1% of the patients were estimated to be HFrEF, HFmrEF, and HFpEF patients, respectively. The total annual direct medical cost per patient was $887 and non-pharmaceutical treatments ($373, 42.1%) were the major direct cost driver. Since an estimated nationwide number of HF patients is 1,128,000 in 2021, the total annual national economic burden of HF is estimated to be $1 billion in 2021. The direct medical cost was higher in patients with HFrEF than in those with HFmrEF or HFpEF ($1,147 vs. $555 and $649, respectively). Average indirect cost per patient was calculated to be $3,386 and was similar across HFrEF, HFmrEF and HFpEF groups, but increased with advanced NYHA stage. Conclusion: Our findings confirm the substantial economic burden of HF in terms of both direct and indirect costs and indicate that the non-pharmaceutical cost is the major direct medical cost driver in HF management, regardless of the EF status of HF patients.
Collapse
|
16
|
Cavusoglu Y, Altay H, Nalbantgil S, Temizhan A, Yilmaz MB. Pre-Discharge and Post-Discharge Management and Treatment Optimization in Acute Heart Failure. Turk Kardiyol Dern Ars 2022; 50:378-394. [DOI: 10.5543/tkda.2022.22329] [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
|
17
|
Uzun HG, Simsek E, Engin C, Yagdi T, Karapolat H, Ozbaran M, Nalbantgil S. Relation Between Frailty and 1-Year Outcomes After Implantation of a Left Ventricular Assist Device. Am J Cardiol 2022; 173:88-93. [PMID: 35361473 DOI: 10.1016/j.amjcard.2022.02.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 11/30/2021] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 11/17/2022]
Abstract
Frailty has been associated with morbidity and mortality in patients with heart failure and those who underwent cardiac surgery. We aimed to study the effect of frailty on cardiovascular outcomes and the reversibility of frailty after the left ventricular assist device (LVAD) implantation. A total of 51 consecutive patients (44 men; aged 54 ± 10 years) scheduled to undergo LVAD implantation were assessed for frailty (Fried's phenotype, frail ≥3/5), cognitive function (using Mini-Cog), and depression (utilizing Patient Health Questionnaire-9) before the surgery and 3 months afterward. Patients were observed for mortality and adverse events [all-cause readmission, bleeding, renal dysfunction, and ventricular fibrillation (VF)/sustained ventricular tachycardia (VT)] for 12 months. More than half of the patients (54%) were designated as frail. Although there was no statistical difference in mortality among frail and nonfrail patients, frail ones were more likely to have a prolonged length of stay [adjusted odds ratio (AOR) 14.9, 95% confidence interval 1.6 to 132.5, p = 0.01]. At the 3-month reassessment after operation, frailty and cognition rates were better (frailty score [lower is better]: 3 vs 1.5, p <0.0001; cognition score [higher is better]: 4.5 vs 5, p = 0.001), and patients had less depression (Patient Health Questionnaire-9 score [lower is better]: 8 vs 4, p <0.0001). Of the secondary outcomes, only postoperative VF/sustained VT reached statistical significance in being more common among frail patients than nonfrail ones (p = 0.02). Although frailty was not associated with mortality at 1 year, prolonged length of stay occurred more with frail LVAD patients. Frailty status, cognitive function, and depressive mood all improved in most patients after LVAD.
Collapse
Affiliation(s)
| | | | | | | | - Hale Karapolat
- Physical Medicine and Rehabilitation, Ege University, Izmir, Turkey
| | | | | |
Collapse
|
18
|
Dorken Gallastegi A, Ergi GD, Kahraman Ü, Yağmur B, Çinar E, Karapolat H, Nalbantgil S, Engin Ç, Yağdi T, Özbaran M. Prognostic Value of Cardiopulmonary Exercise Test Parameters in Ventricular Assist Device Therapy. ASAIO J 2022; 68:808-813. [PMID: 34494984 DOI: 10.1097/mat.0000000000001571] [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: 11/26/2022] Open
Abstract
Cardiopulmonary exercise test (CPET) parameters are established prognosticators in heart failure. However, the prognostic value of preimplantation and postimplantation CPET parameters in left ventricular assist device (LVAD) therapy is unclear and it is evaluated in this study. Adult patients who were implanted with an LVAD and underwent CPET during the preimplantation or postimplantation period were retrospectively analyzed. Five CPET parameters were calculated: vO2 max, oxygen uptake efficiency slope (OUES), VE/vCO2 Slope, VE/vCO2 min, and VE/vCO2 max. The relationship between CPET parameters and postimplantation outcomes was evaluated with multivariable analysis. Pre and postimplantation CPET cohorts included 191 and 122 patients, respectively. Among preimplantation CPET parameters: vO2 max and OUES were associated with 1, 3, and 5 year mortality, VE/vCO2 min was associated with 3 and 5 year mortality, whereas VE/vCO2 Slope was associated with 5 year mortality. From postimplantation CPET parameters: vO2 max was an independent predictor of 3 and 5 year mortality, whereas VE/vCO2 max was an independent predictor of 3 year mortality following LVAD implantation. Preimplantation CPET parameters have a prognostic value for long-term survival following LVAD implantation, whereas their association with early postimplantation outcomes appears to be weaker. Postimplantation vO2 max and VE/vCO2 max values are associated with survival on device support and may provide a second chance for prognostication in patients without preimplantation CPET data.
Collapse
Affiliation(s)
| | | | | | | | - Ece Çinar
- Physical Medicine and Rehabilitation, Ege University School of Medicine, Izmir, Turkey
| | - Hale Karapolat
- Physical Medicine and Rehabilitation, Ege University School of Medicine, Izmir, Turkey
| | | | | | - Tahir Yağdi
- From the Departments of Cardiovascular Surgery
| | | |
Collapse
|
19
|
Yağmur B, Nalbantgil S, Kayıkçıoğlu M. Two Case Reports of Progressive Pulmonary Hypertension with Type-1 Gaucher Disease: Efficient PAH-Specific Therapy and 1-Year Follow-Up. Anatol J Cardiol 2022; 26:584-588. [PMID: 35791716 PMCID: PMC9361332 DOI: 10.5152/anatoljcardiol.2022.1254] [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: 11/26/2022] Open
|
20
|
Avci G, Nalbantgil S, Kemal H, Ertugay S, Engin C, Yagdi T, Ozabaran M. Preoperative and perioperative predictors of right ventricular failure after left ventricular assist device implantation. Int J Cardiovasc Acad 2022. [DOI: 10.4103/ijca.ijca_2_22] [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
|
21
|
Altay H, Çavuşoğlu Y, Çelik A, Demir Ş, Kılıçarslan B, Nalbantgil S, Temizhan A, Tokgöz B, Ural D, Yeşilbursa D, Yıldırımtürk Ö, Yılmaz MB. Management of Hyperkalemia in Heart Failure. Turk Kardiyol Dern Ars 2021; 49:1-32. [PMID: 34738907 DOI: 10.5543/tkda.2021.s1] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Hyperkalemia is a common electrolyte abnormality in heart failure (HF) that can cause potentially life-threatening cardiac arrhythmias and sudden cardiac death. HF patients with diabetes, chronic kidney disease and older age are at higher risk of hyperkalemia. Moreover, hyperkalemia is also often associated with the use of renin-angiotensin-aldosterone system inhibitors (RAASi) including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists and sacubitril-valsartan. In clinical practice, the occurrence of hyperkalemia is a major concern among the clinicians and often limits RAASi use and/or lead to dose reduction or discontinuation, thereby reducing their potential benefits for HF. Furthermore, recurrent hyperkalemia is frequent in the long-term and is associated with an increase in hyperkalemia-related hospitalizations. Therefore, management of hyperkalemia has a special importance in HF patients. However, treatment options in chronic management are currently limited. Dietary restriction of potassium is usually ineffective with variable adherence. Sodium polystyrene sulfonate is commonly used, but its effectiveness is uncertain and reported to be associated with intestinal toxicity. New therapeutic options such as potassium binders have been suggested as potentially beneficial agents in the management of hyperkalemia. This document discusses prevalence, predictors and management of hyperkalemia in HF, emphasizing the importance of careful patient selection for medical treatment, uptitration of the doses of RAASi, regular surveillance of potassium and treatment options of hyperkalemia.
Collapse
Affiliation(s)
- Hakan Altay
- Başkent Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, İstanbul, Türkiye
| | - Yüksel Çavuşoğlu
- Eskişehir Osmangazi Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Eskişehir, Türkiye
| | - Ahmet Çelik
- Mersin Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Mersin, Türkiye
| | | | - Barış Kılıçarslan
- Tepecik Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, İzmir, Türkiye
| | - Sanem Nalbantgil
- Ege Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, İzmir, Türkiye
| | - Ahmet Temizhan
- Sağlık Bilimleri Üniversitesi, Ankara Şehir Hastanesi, Kardiyoloji Anabilim Dalı, Ankara, Türkiye
| | - Bülent Tokgöz
- Erciyes Üniversitesi Tıp Fakültesi, Nefroloji Bilim Dalı, Kayseri, Türkiye
| | - Dilek Ural
- Koç Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, İstanbul, Türkiye
| | - Dilek Yeşilbursa
- Uludağ Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Bursa, Türkiye
| | - Özlem Yıldırımtürk
- Sağlık Bilimleri Üniversitesi, Dr. Siyami Ersek Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi, Kardiyoloji Bölümü, İstanbul, Türkiye
| | - Mehmet Birhan Yılmaz
- Dokuz Eylül Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, İzmir, Türkiye
| |
Collapse
|
22
|
Yaylali Y, Yagmur B, Sinan UY, Meric M, Basarici I, Kilickiran-Avci B, Senol H, Nalbantgil S, Kucukoglu MS, Ongen Z. Risk assessment tool implementation in congenital heart disease associated pulmonary arterial hypertension. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1950] [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: 11/13/2022] Open
Abstract
Abstract
Background
Risk assessment is recommended for patients with congenital heart disease associated pulmonary arterial hypertension (CHD-PAH). Patients in intermediate or high risk may need intensified therapies to improve their survival.
Purpose
To compare an abbreviated version of the risk assessment strategy proposed by the current European PH guidelines, noninvasive French model, and an abridged version of the REVEAL 2.0 risk score calculator, REVEAL Lite 2.
Methods
We enrolled a mixed prevalent and incident cohort of patients with CHD-PAH from 6 PAH centers from January 2006 to December 2019 (n=126). Noninvasive French model comprising WHO functional class (FC), 6-minute walk distance (6 MWD), and N-terminal pro–brain natriuretic peptide (NT-pro BNP) or BNP was used. REVEAL Lite 2 includes FC, systolic blood pressure, heart rate, 6MWD, BNP/NT-pro BNP, and estimated glomerular filtration rate. Patients were grouped into three categories according to the number of non-invasive low-risk criteria (French model) and REVEAL Lite 2 scores. Risk was calculated based on the last available assessment at 12 months' follow-up, starting from enrollment. Kaplan-Meier (KM) survival was assessed in patients in each risk group with all-cause mortality as the end point. Log-rank test was used to compare estimates.
Results
The mean age was 32±16 years at diagnosis. The mean follow up was 99.41±58.2 months. 32 patients had died. Most patients were Eisenmenger Syndrome (39.4%) and simple defects (19.7%). Most patients had received monotherapy (74.5%). 66.6% of patients were WHO FC I–II, 29.3% III, and 3.9% IV (Table). Both models effectively discriminated risk in our cohort (p=0.0001). Patients achieving two or more noninvasive low-risk criteria or low risk category by REVEAL Lite 2 at follow-up had a significantly reduced risk of death. Figure demonstrates KM survival curves for noninvasive French model (A) and REVEAL Lite 2 (B). 51% of patients achieved 2 or more low risk criteria at follow-up. 56% of patients were in low risk at follow-up (REVEAL lite 2). The estimated survival rate at 5 years of patients meeting 2 and more low-risk criteria at follow-up was 100% vs. 86.8% for patients meeting 1 low-risk criterion and 59.6% for patients meeting 0 low-risk criterion. The corresponding survival rate was 65% for high-risk patient, 76.2% for intermediate-risk patient, and 100% for low-risk patient (REVEAL lite 2) (p=0.0001 by log-rank test; Figure). REVEAL Lite 2 approximates noninvasive French model at discriminating among patients at low, intermediate, or high risk based on c-index.
Conclusions
Both noninvasive French model and REVEAL Lite 2 provide a simplified and robust method of risk assessment for CHD-PAH. This analysis also supports the value of goal-oriented treatment in CHD-PAH. Patients who have less than 2 low-risk criteria or who have not achieved low risk category at follow-up may benefit from escalation of their treatment regimen.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- Y Yaylali
- Pamukkale University, Cardiology, Denizli, Turkey
| | - B Yagmur
- Ege University, Cardiology, Izmir, Turkey
| | - U Y Sinan
- Istanbul University Cardiology Institute, Istanbul, Turkey
| | - M Meric
- 19 Mayis University, Cardiology, Samsun, Turkey
| | - I Basarici
- Akdeniz University, Cardiology, Antalya, Turkey
| | - B Kilickiran-Avci
- Istanbul University Cerrahpasa Faculty of Medicine, Cardiology, Istanbul, Turkey
| | - H Senol
- Pamukkale University, Biostatistics, Denizli, Turkey
| | | | - M S Kucukoglu
- Istanbul University Cardiology Institute, Istanbul, Turkey
| | - Z Ongen
- Istanbul University Cerrahpasa Faculty of Medicine, Cardiology, Istanbul, Turkey
| |
Collapse
|
23
|
Dorken Gallastegi A, Hoşcoşkun EB, Kahraman Ü, Yağmur B, Nalbantgil S, Engin Ç, Yağdı T, Özbaran M. Long-term Outcomes in Ventricular Assist Device Outflow Cannula Anastomosis to the Descending Aorta. Ann Thorac Surg 2021; 114:1377-1385. [PMID: 34627768 DOI: 10.1016/j.athoracsur.2021.08.071] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/27/2021] [Accepted: 08/30/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Left ventricular assist device (LVAD) implantation via thoracotomy with outflow cannula anastomosis to the descending aorta is an alternative implantation technique that uses a single incision and avoids anterior mediastinal planes. We evaluated long-term survival and hospital readmissions following LVAD implantation via thoracotomy with outflow cannula anastomosis to the descending aorta. METHODS Adult patients implanted with a continuous flow centrifugal LVAD at an academic center were retrospectively analyzed. Patients were assigned to one of the two cohorts based on the anastomosis site of the LVAD outflow cannula: ascending aorta cohort (Asc-Ao) and descending aorta cohort (Desc-Ao). Primary and secondary outcomes were survival and hospital readmissions during device support. Readmission analysis included patients with ≥30-day survival following discharge. Multivariable analysis and propensity score matching were performed. RESULTS Survival analysis included 330 patients (Asc-Ao: 272, Desc-Ao: 58). Readmission analysis included 277 patients (Asc-Ao: 231, Desc-Ao: 46) and a total of 1028 readmissions during 654 patient-years of follow-up were analyzed. There was no significant difference in in-hospital, 6-month, 1-year, 3-year and 5-year mortality between the two cohorts. Readmission-free survival, 30-day readmission, number of admissions per year and hospital length of stay per year were not significantly different between the 2 cohorts following adjustment for patient characteristics. CONCLUSIONS This study found no difference in long-term survival or hospital readmissions between LVAD implantation via thoracotomy with outflow cannula anastomosis to the descending aorta and standard implantation.
Collapse
Affiliation(s)
| | | | - Ümit Kahraman
- Cardiovascular Surgery, Ege University School of Medicine
| | | | | | - Çağatay Engin
- Cardiovascular Surgery, Ege University School of Medicine
| | - Tahir Yağdı
- Cardiovascular Surgery, Ege University School of Medicine
| | | |
Collapse
|
24
|
Yilmaz Coskun F, Engin C, Yagdi T, Ozbaran M, Nalbantgil S. The Impact of First Year Clinical Variables of Heart Transplant Recipients on Ten-Year Survival. Eur J Ther 2021. [DOI: 10.5152/eurjther.2021.21028] [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: 11/22/2022]
|
25
|
Çinier G, Nalbantgil S. Epicardial fat: More than an adipose tissue. Turk Kardiyol Dern Ars 2021; 49:427-429. [PMID: 34523589 DOI: 10.5543/tkda.2021.21189] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Göksel Çinier
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Sanem Nalbantgil
- Department of Cardiology, Ege University School of Medicine, İzmir, Turkey
| |
Collapse
|
26
|
Ben Gal T, Ben Avraham B, Milicic D, Crespo-Leiro MG, Coats AJS, Rosano G, Seferovic P, Ruschitzka F, Metra M, Anker S, Filippatos G, Altenberger J, Adamopoulos S, Barac YD, Chioncel O, de Jonge N, Elliston J, Frigerio M, Goncalvesova E, Gotsman I, Grupper A, Hamdan R, Hammer Y, Hasin T, Hill L, Itzhaki Ben Zadok O, Abuhazira M, Lavee J, Mullens W, Nalbantgil S, Piepoli MF, Ponikowski P, Potena L, Ristic A, Ruhparwar A, Shaul A, Tops LF, Tsui S, Winnik S, Jaarsma T, Gustafsson F. Guidance on the management of left ventricular assist device (LVAD) supported patients for the non-LVAD specialist healthcare provider: executive summary. Eur J Heart Fail 2021; 23:1597-1609. [PMID: 34409711 DOI: 10.1002/ejhf.2327] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/10/2021] [Accepted: 08/05/2021] [Indexed: 12/28/2022] Open
Abstract
The accepted use of left ventricular assist device (LVAD) technology as a good alternative for the treatment of patients with advanced heart failure together with the improved survival of patients on the device and the scarcity of donor hearts has significantly increased the population of LVAD supported patients. Device-related, and patient-device interaction complications impose a significant burden on the medical system exceeding the capacity of LVAD implanting centres. The probability of an LVAD supported patient presenting with medical emergency to a local ambulance team, emergency department medical team and internal or surgical wards in a non-LVAD implanting centre is increasing. The purpose of this paper is to supply the immediate tools needed by the non-LVAD specialized physician - ambulance clinicians, emergency ward physicians, general cardiologists, and internists - to comply with the medical needs of this fast-growing population of LVAD supported patients. The different issues discussed will follow the patient's pathway from the ambulance to the emergency department, and from the emergency department to the internal or surgical wards and eventually back to the general practitioner.
Collapse
Affiliation(s)
- Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Binyamin Ben Avraham
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Davor Milicic
- Department for Cardiovascular Diseases, Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - Marisa G Crespo-Leiro
- Complexo Hospitalario Universitario A Coruña (CHUAC), CIBERCV, Instituto de Investigacion Biomedica A Coruña (INIBIC), Universidad de a Coruña (UDC), La Coruña, Spain
| | | | - Giuseppe Rosano
- Cardiovascular Clinical Academic Group, St George's Hospitals NHS Trust University of London, London, UK.,IRCCS San Raffaele Pisana, Rome, Italy
| | - Petar Seferovic
- Serbian Academy of Sciences and Arts, Heart Failure Center, Faculty of Medicine, Belgrade University Medical Center, Belgrade, Serbia
| | - Frank Ruschitzka
- Department of Cardiology, University Hospital, University Heart Center, Zurich, Switzerland
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Stefan Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Gerasimos Filippatos
- Heart Failure Unit, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.,School of Medicine, University of Cyprus, Nicosia, Cyprus
| | | | - Stamatis Adamopoulos
- Heart Failure and Heart Transplantation Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - Yaron D Barac
- Department of Cardiothoracic Surgery, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C.C. Iliescu', Bucharest, Romania.,University of Medicine Carol Davila, Bucharest, Romania
| | - Nicolaas de Jonge
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeremy Elliston
- Anesthesiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maria Frigerio
- Transplant Center and De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | | | - Israel Gotsman
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel
| | - Avishai Grupper
- Heart Failure Institute, Lev Leviev Heart Center, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Righab Hamdan
- Department of Cardiology, Beirut Cardiac Institute, Beirut, Lebanon
| | - Yoav Hammer
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Hasin
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Osnat Itzhaki Ben Zadok
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miriam Abuhazira
- Department of Cardiothoracic Surgery, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Lavee
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Ramat Gan, Israel
| | - Wilfried Mullens
- Ziekenhuis Oost Limburg, Genk, Belgium.,University Hasselt, Hasselt, Belgium
| | - Sanem Nalbantgil
- Department of Cardiology, Ege University Hospital, Izmir, Turkey
| | - Massimo F Piepoli
- Heart Failure Unit, Cardiology, G. da Saliceto Hospital, Piacenza, Italy
| | - Piotr Ponikowski
- Centre for Heart Diseases, University Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Luciano Potena
- Heart and Lung Transplant Program, Bologna University Hospital, Bologna, Italy
| | - Arsen Ristic
- Department of Cardiology of the Clinical Center of Serbia, Belgrade University School of Medicine, Belgrade, Serbia
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Aviv Shaul
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Laurens F Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Steven Tsui
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Stephan Winnik
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Tiny Jaarsma
- Department of Nursing, Faculty of Medicine and Health Sciences, University of Linköping, Linköping, Sweden
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
27
|
Dorken Gallastegi A, Kahraman Ü, Yağmur B, Çınar E, Nalbantgil S, Engin Ç, Yağdı T, Özbaran M. Exercise capacity following ventricular assist device implantation via thoracotomy with outflow cannula anastomosis to the descending aorta. Artif Organs 2021; 45:1317-1327. [PMID: 34153119 DOI: 10.1111/aor.14021] [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: 02/21/2021] [Revised: 04/20/2021] [Accepted: 06/19/2021] [Indexed: 11/29/2022]
Abstract
Left ventricular assist device (LVAD) implantation via left lateral thoracotomy with outflow cannula anastomosis to the descending aorta is an alternative technique that avoids anterior mediastinal planes and requires a single incision. This study compares changes in exercise capacity following LVAD implantation with outflow cannula anastomosis to the descending aorta versus ascending aorta. Adult patients who received a continuous flow centrifugal LVAD implantation and completed both pre- and postimplantation cardiopulmonary exercise tests (CPETs) and or 6-minute walk tests (6MWT) were included. Change in CPET parameters (maximum oxygen intake: vO2 max, oxygen uptake efficiency ratio: OUES, ventilatory efficiency ratio: vE/vCO2 Slope) and 6MWT distance were compared between ascending and descending aorta anastomosis groups. Ascending and descending aorta anastomosis cohorts included 59 and 14 patients, respectively. Pre- and postimplantation CPETs were performed 63 ± 12 days before and 216 ± 17 days following implantation. The improvement in CPET parameters (vO2 max, OUES, vE/vCO2 Slope) or 6MWT distance was not significantly different between the ascending and descending aorta anastomosis groups. This study found no significant difference in the improvement of CPET parameters or 6MWT distance between LVAD implantation via thoracotomy with outflow cannula anastomosis to descending aorta and standard implantation via sternotomy with outflow cannula anastomosis to ascending aorta.
Collapse
Affiliation(s)
| | - Ümit Kahraman
- Cardiovascular Surgery, Ege University School of Medicine, İzmir, Turkey
| | - Burcu Yağmur
- Cardiology, Ege University School of Medicine, İzmir, Turkey
| | - Ece Çınar
- Physical Medicine and Rehabilitation, Ege University School of Medicine, İzmir, Turkey
| | | | - Çağatay Engin
- Cardiovascular Surgery, Ege University School of Medicine, İzmir, Turkey
| | - Tahir Yağdı
- Cardiovascular Surgery, Ege University School of Medicine, İzmir, Turkey
| | - Mustafa Özbaran
- Cardiovascular Surgery, Ege University School of Medicine, İzmir, Turkey
| |
Collapse
|
28
|
Dorken Gallastegi A, Hoşcoşkun E, Kahraman Ü, Yağmur B, Nalbantgil S, Engin Ç, Yağdı T, Özbaran M. Outcomes in LVAD Implantation via Lateral Thoracotomy with Outflow Cannula Anastomosis to the Descending Aorta. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.319] [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: 11/27/2022] Open
|
29
|
Gallastegi AD, Ergi D, Kahraman Ü, Yağmur B, Çınar E, Üzümcügil Karapolat H, Nalbantgil S, Engin Ç, Yağdı T, Özbaran M. Prognostic Value of Cardiopulmonary Exercise Test Parameters in Ventricular Assist Device Therapy. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1226] [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: 10/21/2022] Open
|
30
|
Yaylali Y, Yagmur B, Kilickiran Avci B, Sinan U, Senol H, Nalbantgil S, Kucukoglu M, Ongen Z. Evaluation of the REVEAL 2.0 simplified three-category model in a pulmonary arterial hypertension cohort enriched with congenital heart disease. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2301] [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
Objectives
Despite a remarkable progress in the management of pulmonary arterial hypertension (PAH) over the past decade, PAH still has a poor long-term outlook and remains an incurable condition. Risk assessment continues to be refined to identify patients at risk of early morbidity and mortality. We aimed to evaluate a new model, the US Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL) 2.0 risk score proposed for the follow-up of patients in our cohort.
Methods
We enrolled a mixed prevalent and incident cohort of patients with idiopathic PAH (20%), heritable (2.5%), congenital heart disease (CHD) (59.2%), and connective tissue diseases (18.3%) subsets (n=121) from 4 PAH centers from March 2007 to January 2019. Individual patient REVEAL 2.0 risk scores were applied at 12 months after the diagnosis (follow-up). Risk scores were calculated with 7 or more variables. Kaplan-Meier survival was estimated for a simplified three-category (low, intermediate, and high risk) model up to 60 months from 1 year after the diagnosis, with all-cause mortality as the end point. Log-rank test was used to compare estimates.
Results
The mean age was 46±16 years (78.5% women). 2/3 of the patients were CHD. The median survival was 60 months. 25 patients had died. The majority of the patients were NYHA FC II (48.8%) and III (42.1%) at follow-up. Figure 1 demonstrates KM 12- and 60- month survival in our cohort according to the simplified three-category (low, intermediate, and high risk) REVEAL 2.0 model. Overall, 58.7%, 15.7%, and 25.6% of the patients were classified as low, intermediate, and high risk, respectively, at follow-up. The REVEAL 2.0 model effectively discriminated risk in our cohort. Both 1 year- and 5 year-survival differed significantly between the 3 risk categories: 12-month mortality estimates were 1.41% for low risk, 5.3% for intermediate risk, and 16.1% for high risk (log-rank, P=0.013); and 60- month mortality estimates were 2.8% for low risk, 10.5% for intermediate risk, and 51.6% for high risk (log-rank, P=0.0001).
Conclusions
The REVEAL 2.0 simplified three-category model can be applied for risk assessment of the PAH subsets, particularly congenital heart disease at follow-up.
Figure 1
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- Y.T Yaylali
- Pamukkale University, Cardiology, Denizli, Turkey
| | - B Yagmur
- Ege University, Cardiology, Izmir, Turkey
| | - B Kilickiran Avci
- Istanbul University Cerrahpasa, Cerrahpasa Faculty of Medicine, Cardiology, Istanbul, Turkey
| | - U.Y Sinan
- Istanbul University Cardiology Institute, Cardiology, Istanbul, Turkey
| | - H Senol
- Pamukkale University, Biostatistics, Denizli, Turkey
| | | | - M.S Kucukoglu
- Istanbul University Cardiology Institute, Cardiology, Istanbul, Turkey
| | - Z Ongen
- Istanbul University Cerrahpasa, Cerrahpasa Faculty of Medicine, Cardiology, Istanbul, Turkey
| |
Collapse
|
31
|
Dorken Gallastegi A, Öztürk P, Demir E, Engin Ç, Nalbantgil S, Yağdı T, Özbaran M. Prospective evaluation of ventricular assist device risk scores' capacity to predict cardiopulmonary exercise parameters. Interact Cardiovasc Thorac Surg 2020; 30:223-228. [PMID: 31628803 DOI: 10.1093/icvts/ivz248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/15/2019] [Revised: 08/30/2019] [Accepted: 09/11/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Risk scores for left ventricular assist device (LVAD) therapy are known to predict morbidity and adverse events in addition to mortality. This study evaluates the capacity of popular LVAD risk scores to predict cardiopulmonary exercise parameters. METHODS Adult patients undergoing continuous flow LVAD implantation were prospectively followed. Five risk scores were calculated before implantation: Model for End-stage Liver Disease (MELD), MELD excluding international normalized ratio (MELD-XI), MELD including sodium (MELD-Na), HeartMate2 Risk Score (HMRS) and Destination Therapy Risk Score (DTRS). Cardiopulmonary exercise tests (CPETs) were performed before and after implantation; peak oxygen consumption (vO2max), the lowest ventilation to carbon dioxide output ratio (vE/vCO2) and exercise time were measured. RESULTS Ninety-two patients were implanted during the study period; of these, 30 patients completed preimplantation and postimplantation CPETs (CPET cohort). The mean preimplantation and postimplantation CPET dates were 29 ± 10 days before and 109 ± 5 days following implantation. CPET parameters significantly improved after implantation (P < 0.05). In multivariate analysis, MELD, MELD-XI, MELD-Na and HMRS independently predicted both preimplantation and postimplantation vE/vCO2, while MELD-Na and HMRS were also independent predictors of preimplantation and postimplantation vO2max, respectively. CONCLUSIONS Four preimplantation LVAD risk scores (HMRS, MELD, MELD-Na and MELD-XI) independently predict important cardiopulmonary exercise parameters such as vE/vCO2 and vO2 max in LVAD therapy. Out of these 4 risk scores, MELD-Na and HMRS appear to be the best predictors of preimplantation and postimplantation CPET parameters, respectively.
Collapse
Affiliation(s)
| | - Pelin Öztürk
- Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Emre Demir
- Cardiology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Çağatay Engin
- Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | | | - Tahir Yağdı
- Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Mustafa Özbaran
- Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| |
Collapse
|
32
|
Hekimsoy İ, Kibar Öztürk B, Soner Kemal H, Kayıkçıoğlu M, Dadaş ÖF, Kavukçu G, Orman MN, Nalbantgil S, Tamsel S, Kültürsay H, Özbek SS. Hepatic and splenic sonographic and sonoelastographic findings in pulmonary arterial hypertension. Ultrasonography 2020; 40:281-288. [PMID: 32660202 PMCID: PMC7994737 DOI: 10.14366/usg.20076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 07/07/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose The aim of this study was to evaluate the associations of sonographic and sonoelastographic parameters with clinical cardiac parameters, as well as to assess their value in predicting survival in patients with pulmonary arterial hypertension (PAH). Methods Thirty-six patients with PAH and normal liver function were prospectively enrolled in this prospective study along with 26 healthy controls, all of whom underwent ultrasound and point shear wave elastography examinations. Additionally, the portal vein pulsatility index (PVPI), inferior vena cava collapsibility index, and clinical cardiac variables were obtained in PAH patients. The values of hepatic (LVs) and splenic shear wave velocity (SVs) were compared between PAH patients and controls. The relationships between all sonographic and clinical parameters in the PAH patients were analyzed. Furthermore, their prognostic value in predicting survival was investigated. Results LVs values in PAH patients (median, 1.62 m/s) were significantly higher than in controls (median, 0.99 m/s), while no significant difference was observed in SVs values. Patients with higher grades of tricuspid regurgitation (TR) had significantly different values of PVPI (P=0.010) and sonoelastographic parameters (P<0.001 for LVs and P=0.004 for SVs) compared to those with less severe TR. Tricuspid annular plane systolic excursion values were the only investigated parameter found to be associated with survival (hazard ratio, 0.814; 95% confidence interval, 0.694 to 0.954; P=0.011). Conclusion Our results demonstrated a direct association between cardiac congestion (i.e., the severity of TR) and liver stiffness, which should be kept in mind during the assessment of fibrosis in patients with PAH.
Collapse
Affiliation(s)
- İlhan Hekimsoy
- Department of Radiology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Burçin Kibar Öztürk
- Department of Radiology, İzmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Hatice Soner Kemal
- Department of Cardiology, Near East University Faculty of Medicine, Nicosia, Cyprus
| | - Meral Kayıkçıoğlu
- Department of Cardiology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ömer Faruk Dadaş
- Department of Biostatistics and Medical Informatics, Ege University Faculty of Medicine, Izmir, Turkey
| | - Gülgün Kavukçu
- Department of Radiology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Mehmet Nurullah Orman
- Department of Biostatistics and Medical Informatics, Ege University Faculty of Medicine, Izmir, Turkey
| | - Sanem Nalbantgil
- Department of Cardiology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Sadık Tamsel
- Department of Radiology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Hakan Kültürsay
- Department of Cardiology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Süha Süreyya Özbek
- Department of Radiology, Ege University Faculty of Medicine, Izmir, Turkey
| |
Collapse
|
33
|
Aktoz M, Altay H, Aslanger E, Atalar E, Atar İ, Aytekin V, Baykan AO, Barçın C, Barış N, Boyacı A, Çavuşoğlu Y, Çelik A, Çinier G, Değertekin M, Demircan S, Ergönül Ö, Ertürk M, Erol MK, Görenek B, Gürsoy MO, Hünük B, Kahveci G, Karabay CY, Karaca I, Kayıkçıoğlu M, Keskin M, Kılıç T, KılıçkıranAvcı B, Kırma C, Kocabaş U, Kocakaya D, Küçükoğlu S, Mutlu B, Nalbantgil S, Okuyan E, Okyay K, KaptanÖzen D, Özgül S, Özpelit E, Pirat B, Sert S, Sinan ÜY, Şener YZ, Tatlı E, Tekkeşin Aİ, Tutar E, Ural D, Yıldırımtürk Ö, Yıldızeli B. [Turkish Cardiology Association Consensus Report: COVID-19 Pandemic and Cardiovascular Diseases (May 13, 2020)]. Turk Kardiyol Dern Ars 2020; 48:1-87. [PMID: 32406873 DOI: 10.5543/tkda.2020.36713] [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
In December 2019, in the city of Wuhan, in the Hubei province of China, treatment-resistant cases of pneumonia emerged and spread rapidly for reasons unknown. A new strain of coronavirus (severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2]) was identified and caused the first pandemic of the 21st century. The virus was officially detected in our country on March 11, 2020, and the number of cases increased rapidly; the virus was isolated in 670 patients within 10 days. The rapid increase in the number of patients has required our physicians to learn to protect both the public and themselves when treating patients with this highly infectious disease. The group most affected by the outbreak and with the highest mortality rate is elderly patients with known cardiovascular disease. Therefore, it is necessary for cardiology specialists to take an active role in combating the epidemic. The aim of this article is to make a brief assessment of current information regarding the management of cardiovascular patients affected by COVID-19 and to provide practical suggestions to cardiology specialists about problems and questions they have frequently encountered.
Collapse
Affiliation(s)
- Meryem Aktoz
- Department of Cardiology, Trakya University Faculty of Medicine, Edirne
| | - Hakan Altay
- Cardiology Clinic, Baskent University Istanbul Hospital, Health Practice and Research Center, İstanbul
| | - Emre Aslanger
- Yeditepe University Faculty of Medicine, Department of Cardiology, İstanbul
| | - Enver Atalar
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara
| | - İlyas Atar
- Cardiology Department, Private Ankara Güven Hospital, Ankara
| | - Vedat Aytekin
- Department of Cardiology, Koç University Faculty of Medicine, İstanbul
| | | | - Cem Barçın
- Cardiology Clinic, S.B.Ü. Gülhane Training and Research Hospital, Ankara
| | - Nezihi Barış
- Department of Cardiology, Dokuz Eylül University Faculty of Medicine, İzmir
| | | | - Yüksel Çavuşoğlu
- Department of Cardiology, Eskişehir Osmangazi University Hospital, Eskişehir
| | - Ahmet Çelik
- Department of Cardiology, Mersin University Faculty of Medicine, Mersin
| | - Göksel Çinier
- İstanbul Dr. Siyami Ersek Chest and Cardiovascular Surgery Training and Research Hospital, İstanbul
| | | | - Sabri Demircan
- Cardiology Department, Memorial Şişli Hospital, İstanbul
| | - Önder Ergönül
- Department of Infectious Diseases, Koç University School of Medicine, İstanbul
| | - Mehmet Ertürk
- S.B.Ü. Mehmet Akif Ersoy Chest Cardiovascular Surgery Training and Research Hospital, İstanbul
| | - M Kemal Erol
- Cardiology Clinic, Şişli Kolan International, İstanbul
| | - Bülent Görenek
- Department of Cardiology, Eskişehir Osmangazi University Hospital, Eskişehir
| | - Mustafa Ozan Gürsoy
- Clinic of Cardiology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir
| | - Burak Hünük
- Yeditepe University Faculty of Medicine, Department of Cardiology, İstanbul
| | - Gökhan Kahveci
- Cardiology Clinic, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, İstanbul
| | - Can Yücel Karabay
- İstanbul Dr. Siyami Ersek Chest and Cardiovascular Surgery Training and Research Hospital, İstanbul
| | - Ilgın Karaca
- Department of Cardiology, Fırat University Faculty of Medicine,Elazığ
| | - Meral Kayıkçıoğlu
- Department of Cardiology, Ege University Medical Faculty Hospital, İzmir
| | - Muhammed Keskin
- Cardiology Clinic, İstanbul Sultan Abdülhamid Han Training and Research Hospital, İstanbul
| | - Teoman Kılıç
- Department of Cardiology, Kocaeli University Faculty of Medicine, Kocaeli
| | - Burçak KılıçkıranAvcı
- Department of Cardiology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul
| | - Cevat Kırma
- Cardiology Clinic, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, İstanbul
| | - Umut Kocabaş
- Cardiology Clinic, Baskent University Istanbul Hospital, Health Practice and Research Center, İstanbul
| | - Derya Kocakaya
- Department of Chest Diseases, Marmara University Pendik Training and Research Hospital, Pendik
| | - Serdar Küçükoğlu
- Department of Cardiology, İstanbul University Cardiology Institute, İstanbul
| | - Bülent Mutlu
- Department of Cardiology, Marmara University Faculty of Medicine, İstanbul
| | - Sanem Nalbantgil
- Department of Cardiology, Ege University Medical Faculty Hospital, İzmir
| | - Ertuğrul Okuyan
- Cardiology Clinic, İstanbul Bağcılar Training and Research Hospital, İstanbul
| | - Kaan Okyay
- Department of Cardiology, Başkent University Faculty of Medicine, Ankara
| | - Deniz KaptanÖzen
- Cardiology Clinic, Kocaeli Derince Training and Research Hospital, Kocaeli
| | - Sami Özgül
- Kahramanmaraş İstiklal University, Kahramanmaraş
| | - Ebru Özpelit
- Department of Cardiology, Dokuz Eylül University Faculty of Medicine, İzmir
| | - Bahar Pirat
- Department of Cardiology, Başkent University Faculty of Medicine, Ankara
| | - Sena Sert
- İstanbul Dr. Siyami Ersek Chest and Cardiovascular Surgery Training and Research Hospital, İstanbul
| | - Ümit Yaşar Sinan
- Department of Cardiology, İstanbul University Cardiology Institute, İstanbul
| | - Yusuf Ziya Şener
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara
| | - Ersan Tatlı
- Department of Cardiology, Sakarya University Faculty of Medicine, Sakarya
| | - Ahmet İlker Tekkeşin
- İstanbul Dr. Siyami Ersek Chest and Cardiovascular Surgery Training and Research Hospital, İstanbul
| | - Eralp Tutar
- Department of Cardiology, Ankara University Faculty of Medicine, Ankara
| | - Dilek Ural
- Department of Cardiology, Koç University Faculty of Medicine, İstanbul
| | - Özlem Yıldırımtürk
- İstanbul Dr. Siyami Ersek Chest and Cardiovascular Surgery Training and Research Hospital, İstanbul
| | - Bedrettin Yıldızeli
- Department of Thoracic Surgery, Marmara University Pendik Training and Research Hospital, İstanbul
| |
Collapse
|
34
|
Aktoz M, Altay H, Aslanger E, Atalar E, Aytekin V, Baykan AO, Barçın C, Barış N, Boyacı AA, Çavuşoğlu Y, Çelik A, Çinier G, Değertekin M, Ergönül Ö, Ertürk M, Erol MK, Görenek B, Gürsoy MO, Hünük B, Kahveci G, Karabay CY, Karaca I, Kayıkçıoğlu M, Keskin M, Kılıç T, Kırma C, Kocabaş U, Küçükoğlu S, Mutlu B, Nalbantgil S, Okuyan E, Okyay K, Kaptan Özen D, Özgül S, Özpelit E, Pirat B, Sert S, Sinan ÜY, Şener YZ, Tatlı E, Tekkeşin Aİ, Tutar E, Ural D, Yıldırımtürk Ö. [Consensus Report from Turkish Society of Cardiology: COVID-19 and Cardiovascular Diseases. What cardiologists should know. (25th March 2020)]. Turk Kardiyol Dern Ars 2020; 48:1-48. [PMID: 32250347 DOI: 10.5543/tkda.2020.97198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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
In December 2019, in the city of Wuhan, in the Hubei province of China, treatment-resistant cases of pneumonia emerged and spread rapidly for reasons unknown. A new strain of coronavirus (severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2]) was identified and caused the first pandemic of the 21st century. The virus was officially detected in our country on March 11, 2020, and the number of cases increased rapidly; the virus was isolated in 670 patients within 10 days. The rapid increase in the number of patients has required our physicians to learn to protect both the public and themselves when treating patients with this highly infectious disease. The group most affected by the outbreak and with the highest mortality rate is elderly patients with known cardiovascular disease. Therefore, it is necessary for cardiology specialists to take an active role in combating the epidemic. The aim of this article is to make a brief assessment of current information regarding the management of cardiovascular patients affected by COVID-19 and to provide practical suggestions to cardiology specialists about problems and questions they have frequently encountered.
Collapse
Affiliation(s)
- Meryem Aktoz
- Department of Cardiology,Trakya University Faculty of Medicine, Edirne
| | - Hakan Altay
- Department of Cardiology, Başkent University Istanbul Hospital, Health Practice and Research Center, İstanbul
| | - Emre Aslanger
- Department of Cardiology, Yeditepe University School of Medicine, İstanbul
| | - Enver Atalar
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara
| | - Vedat Aytekin
- Department of Cardiology, Koç University Faculty of Medicine, İstanbul
| | | | - Cem Barçın
- Department of Cardiology, University of Health Sciences, Gülhane Training and Research Hospital, Ankara
| | - Nezihi Barış
- Department of Cardiology, Dokuz Eylül University Faculty of Medicine, İzmir
| | | | - Yüksel Çavuşoğlu
- Department of Cardiology, Department of Cardiology, Eskişehir Osmangazi University Hospital, Eskişehir
| | - Ahmet Çelik
- Department of Cardiology, Mersin University Faculty of Medicine, Mersin
| | - Göksel Çinier
- İstanbul Siyami Ersek Chest and Cardiovascular Surgery Training and Research Hospital, İstanbul
| | | | - Önder Ergönül
- Department of Infectious Diseases, Koç University Faculty of Medicine, İstanbul
| | - Mehmet Ertürk
- University of Health Sciences, Mehmet Akif Ersoy Chest Cardiovascular Surgery Training and Research Hospital, İstanbul
| | - M Kemal Erol
- Department of Cardiology, Şişli Kolan International, İstanbul
| | - Bülent Görenek
- Department of Cardiology, Department of Cardiology, Eskişehir Osmangazi University Hospital, Eskişehir
| | - Mustafa Ozan Gürsoy
- Department of Cardiology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir
| | - Burak Hünük
- Department of Cardiology, Yeditepe University School of Medicine, İstanbul
| | - Gökhan Kahveci
- Department of Cardiology, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, İstanbul
| | - Can Yücel Karabay
- İstanbul Siyami Ersek Chest and Cardiovascular Surgery Training and Research Hospital, İstanbul
| | - Ilgın Karaca
- Department of Cardiology, Fırat University Faculty of Medicine, Elazığ
| | - Meral Kayıkçıoğlu
- Department of Cardiology, Ege University Medical Faculty Hospital, İzmir
| | - Muhammed Keskin
- Department of Cardiology, İstanbul Sultan Abdülhamid Han Training and Research Hospital, İstanbul
| | - Teoman Kılıç
- Department of Cardiology, Kocaeli University Faculty of Medicine, Kocaeli
| | - Cevat Kırma
- Department of Cardiology, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, İstanbul
| | - Umut Kocabaş
- Department of Cardiology, Başkent University Istanbul Hospital, Health Practice and Research Center, İstanbul
| | - Serdar Küçükoğlu
- Department of Cardiology, İstanbul University Cardiology Institute, İstanbul
| | - Bülent Mutlu
- Department of Cardiology, Marmara University Faculty of Medicine, İstanbul
| | - Sanem Nalbantgil
- Department of Cardiology, Ege University Medical Faculty Hospital, İzmir
| | - Ertuğrul Okuyan
- Department of Cardiology, İstanbul Bağcılar Training and Research Hospital, İstanbul
| | - Kaan Okyay
- Department of Cardiology, Başkent University Faculty of Medicine, Ankara
| | - Deniz Kaptan Özen
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, Kocaeli
| | - Sami Özgül
- Kahramanmaraş İstiklal University, Kahramanmaraş
| | - Ebru Özpelit
- Department of Cardiology, Dokuz Eylül University Faculty of Medicine, İzmir
| | - Bahar Pirat
- Department of Cardiology, Başkent University Faculty of Medicine, Ankara
| | - Sena Sert
- İstanbul Siyami Ersek Chest and Cardiovascular Surgery Training and Research Hospital, İstanbul
| | - Ümit Yaşar Sinan
- Department of Cardiology, İstanbul University Cardiology Institute, İstanbul
| | - Yusuf Ziya Şener
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara
| | - Ersan Tatlı
- Department of Cardiology, Sakarya University Faculty of Medicine, Sakarya
| | - Ahmet İlker Tekkeşin
- İstanbul Siyami Ersek Chest and Cardiovascular Surgery Training and Research Hospital, İstanbul
| | - Eralp Tutar
- Department of Cardiology, Ankara University Faculty of Medicine, Ankara
| | - Dilek Ural
- Department of Cardiology, Koç University Faculty of Medicine, İstanbul
| | - Özlem Yıldırımtürk
- İstanbul Siyami Ersek Chest and Cardiovascular Surgery Training and Research Hospital, İstanbul
| |
Collapse
|
35
|
Ozturk P, Ozturk T, Demir E, Kahraman U, Engin C, Yagdi T, Nalbantgil S, Ozbaran M. Eye of Stranger: Evaluate of Chorioretinal Microvascular Networks on Ventricular Assist Device. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.164] [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: 11/26/2022] Open
|
36
|
Çavuşoğlu Y, Altay H, Cahn A, Celik A, Demir S, Kılıçaslan B, Nalbantgil S, Raz I, Temizhan A, Yıldırımtürk Ö, Yılmaz MB. [Sodium glucose co-transporter 2 inhibitors in heart failure therapy]. Turk Kardiyol Dern Ars 2020; 48:330-354. [PMID: 32281958 DOI: 10.5543/tkda.2020.74332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Yüksel Çavuşoğlu
- Eskişehir Osmangazi Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Eskişehir
| | - Hakan Altay
- Başkent Üniversitesi, Kardiyoloji Anabilim Dalı, İstanbul
| | - Avivit Cahn
- Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Ahmet Celik
- Mersin Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Mersin
| | | | - Barış Kılıçaslan
- Tepecik Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, İzmir
| | | | - Itamar Raz
- Başkent Üniversitesi, Kardiyoloji Anabilim Dalı, İstanbul
| | - Ahmet Temizhan
- Sağlık Bilimleri Üniversitesi, Ankara Şehir Hastanesi, Kardiyoloji Anabilim Dalı, Ankara
| | - Özlem Yıldırımtürk
- Sağlık Bilimleri Üniversitesi, Dr. Siyami Ersek Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi, Kardiyoloji Bölümü, İstanbul
| | | |
Collapse
|
37
|
Simsek E, Nalbantgil S, Demir E, Kemal HS, Mutlu I, Ozturk P, Engin C, Yagdi T, Ozbaran M. Survival Benefit of Implantable-Cardioverter Defibrillator Therapy in Ambulatory Patients With Left Ventricular Assist Device. Transplant Proc 2019; 51:3403-3408. [DOI: 10.1016/j.transproceed.2019.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/14/2019] [Accepted: 06/05/2019] [Indexed: 11/26/2022]
|
38
|
Simsek E, Kilic S, Kemal HS, Nalbantgil S, Ozturk P, Yildirim I, Yagdi T, Engin C, Ozbaran M. Effect of Testosterone Level on Mortality in Patients With Left Ventricular Assist Device. Transplant Proc 2019; 51:3418-3423. [PMID: 31733796 DOI: 10.1016/j.transproceed.2019.07.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 07/28/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Testosterone deficiency is associated with mortality in patients with heart failure; however, its effects on patients undergoing Left Ventricular Assist Device (LVAD) implantation are unclear. We investigated the role of total testosterone (TT) and free testosterone (FT) levels on mortality undergoing LVAD implantation. METHODS Between December 2010 and December 2014, 101 consecutive male patients who underwent LVAD implantation and had plasma testosterone measurement (TT and FT) in the last month before operation were included in the study. Demographics, follow-up, and mortality data were analyzed retrospectively. RESULTS The mean age of the patients was 51.7 ± 11 years. TT and FT levels were in the below normal range of 31.6% (n = 32) and 65.3% (n = 66) of the patients, respectively. The mean follow-up time was 355 ± 268 days, and 32 (31%) patients died during follow-up. Cumulative survival rates were significantly worse in patients with low TT and FT than patients in the normal range (P < .001 and P = .029, respectively). Multivariate analysis after adjustment for clinical variables, age, albumin, C-reactive protein, total cholesterol, chronic kidney disease, diabetes mellitus (DM), and leukocytosis showed that low TT and FT were independently associated with poor survival (HR, 3.680; 95% CI, 1.615-8.385 P = .002 and HR, 3.816; 95% CI, 1.279-11.383, P = .016, respectively). CONCLUSION Low TT and FT levels were independent risk factors for mortality in patients with LVAD.
Collapse
Affiliation(s)
- Evrim Simsek
- Ege University Faculty of Medicine, Department of Cardiology, Izmir, Turkey.
| | - Salih Kilic
- Doctor Ersin Arslan Training and Research Hospital, Department of Cardiology, Gaziantep, Turkey
| | - Hatice Soner Kemal
- Near East University Faculty of Medicine, Department of Cardiology, Cyprus
| | - Sanem Nalbantgil
- Doctor Ersin Arslan Training and Research Hospital, Department of Cardiology, Gaziantep, Turkey
| | - Pelin Ozturk
- Ege University Faculty of Medicine, Department of Cardiovascular Surgery, Izmir, Turkey
| | - Ilgin Yildirim
- Ege University Faculty of Medicine, Department of Internal Medicine, Izmir, Turkey
| | - Tahir Yagdi
- Ege University Faculty of Medicine, Department of Cardiovascular Surgery, Izmir, Turkey
| | - Cagatay Engin
- Ege University Faculty of Medicine, Department of Cardiovascular Surgery, Izmir, Turkey
| | - Mustafa Ozbaran
- Ege University Faculty of Medicine, Department of Cardiovascular Surgery, Izmir, Turkey
| |
Collapse
|
39
|
Simsek E, Tamnik F, Demir E, Nalbantgil S. P3140Burden and the clinical significance of the retained cardiac implantable electronic device components after heart transplantation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0215] [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: 11/13/2022] Open
Abstract
Abstract
Background
Cardiovascular implantable electronic devices (CIEDs) are common in patients undergoing heart transplantation (HT), and complete removal is not always possible at the time of transplantation. Frequency and clinical significance of retained CIED components after HT is not well studied.
Methods
Adult heart failure patients whom had heart transplantation in our institution from date June 2000 to December 2018 were retrospectively evaluated. Pre-post operative chest x-rays and recorded fluoroscopy images of the previous coronary angiograms or endomyocardial biopsies were reviewed by a single observer for retained CIED components. All patients clinical records were also reviewed for adverse outcomes of retained components such as deep venous thrombosis of upper extremity, infection and mortality.
Results
A total of 226 patients had bicaval orthotopic heart transplantation during study time. 73 (32%) of the patients had CIED before transplantation and 24 (32.8%) of the patients had retained lead components after HT. (Table 1) All of the components were part of a superior vena cava coil of the right ventricular ICD lead. Mean follow up time was 46.6±49.8 months and only 1 (1.3%) adverse event (right subclavian DVT) occurred in a patient with retained lead. There were not any statistical significance for mortality and infection between patients with and without lead fragments. Patients were also compared for history of any cardiac surgery before HT, especially ventricular assist device procedures and no differences were observed between groups.
For history of any cardiac surgery p=0.748, for assist device surgery, p=0.269). Patient's medical records reviewed for a history of magnetic resonance imaging (MRI). Two patients with retained lead fragments had non-thorocic (abdominal and cranial) MRI and any clinical pathology did not observed after MRI.
Table 1 All Patients With Retained CIED comp. Without Retained CIED comp. p (n=226) (n=24) (n=49) Age ± sd 42.91±12.2 44.88±12.6 41.59±13 0.290 Ischemic etiology 65 (28.8%) 8 (33.3%) 13 (26.5%) 0.546 CIED type CRT-D 5 (20.8%) 5 (%10.2) 0.215 DR-ICD 5 (20.8%) 8 (16.3%) 0.636 VR-ICD 14 (58.3%) 35 (71.4%) 0.263 Dual coil ICD lead 24 (100%) 48 (97%) 1 Mortality (%) 96 (42.5) 7 (37%) 20 (40.8%) 0.463
Conclusion
Retained CIED components were seen 32.8% of the HT patients with CIED prior to transplantation. According to our data retained leads are not associated with severe adverse clinical outcomes. Also non cardiac MRI could be safe in patients with retained lead fragments.
Collapse
Affiliation(s)
- E Simsek
- Ege University, Faculty of Medicine, Department of Cardiology, Izmir, Turkey
| | - F Tamnik
- Ege University, Faculty of Medicine, Department of Cardiology, Izmir, Turkey
| | - E Demir
- Ege University, Faculty of Medicine, Department of Cardiology, Izmir, Turkey
| | - S Nalbantgil
- Ege University, Faculty of Medicine, Department of Cardiology, Izmir, Turkey
| |
Collapse
|
40
|
Ozbaran M, Yagdi T, Engin C, Nalbantgil S, Ozturk P. Left ventricular assist device implantation with left lateral thoracotomy with anastomosis to the descending aorta. Interact Cardiovasc Thorac Surg 2019; 27:186-190. [PMID: 29554252 DOI: 10.1093/icvts/ivy061] [Citation(s) in RCA: 15] [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] [Received: 06/26/2017] [Accepted: 02/06/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Standard implantation of the HeartWare left ventricular assist system is performed using the full sternotomy approach. However, successful implantation of left ventricular assist devices in patients with a previous median sternotomy, especially in high-risk patients, remains challenging. Herein, we compared the HeartWare left ventricular assist system implantation by thoracotomy with anastomosis of the outflow graft to the descending aorta with the standard sternotomy approach. METHODS Between March 2013 and June 2016, we implanted 118 adult patients with a HeartWare left ventricular assist system, excluding implants with concurrent procedures, paediatric cases and biventricular left ventricular assist device. Of these implants, 30 implants were performed with a lateral thoracotomy with outflow graft anastomosis to the descending aorta. The remaining implants were carried out with the standard median sternotomy with outflow graft anastomosis to the ascending aorta. Propensity matching using the variables age, body mass index, right atrial pressure, blood urea nitrogen, creatinine, cardiomyopathy type and Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) levels resulted in a comparative data set of 30 thoracotomy and 30 sternotomy patients. RESULTS Within the first 30 days, the incidence of right heart failure (17% vs 10%, thoracotomy vs sternotomy) and bleeding (10% vs 7%, respectively) were similar between the surgical approaches. Thirty-day survival was 93.3% for both groups. Currently, 3 patients in the thoracotomy cohort have been transplanted and 17 remain on support, while in the sternotomy cohort, 1 patient has been transplanted and 21 remain on support. CONCLUSIONS In our single-centre experience, the lateral thoracotomy with outflow graft anastomosis to the descending aorta had similar early outcomes compared to the standard sternotomy.
Collapse
Affiliation(s)
- Mustafa Ozbaran
- Department of Cardiovascular Surgery, Ege University Hospital, Izmir, Turkey
| | - Tahir Yagdi
- Department of Cardiovascular Surgery, Ege University Hospital, Izmir, Turkey
| | - Cagatay Engin
- Department of Cardiovascular Surgery, Ege University Hospital, Izmir, Turkey
| | - Sanem Nalbantgil
- Department of Cardiology, Ege University Hospital, Izmir, Turkey
| | - Pelin Ozturk
- Department of Cardiovascular Surgery, Ege University Hospital, Izmir, Turkey
| |
Collapse
|
41
|
Akhan O, Demir E, Bayraktaroglu S, Ozerkan Cakan F, Nalbantgil S. P462Noncompaction cardiomyopathy and cardiac MR imaging in Ege University. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez118.045] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- O Akhan
- Ege University, Cardiology Department, Izmir, Turkey
| | - E Demir
- Ege University, Cardiology Department, Izmir, Turkey
| | | | | | - S Nalbantgil
- Ege University, Cardiology Department, Izmir, Turkey
| |
Collapse
|
42
|
Demir E, Nalbantgil S, Öztürk P, Simsek E, Engin C, Yağdı T, Özbaran M. Efficacy and Safety of Ferric Carboxymaltose Therapy in Continuous Flow LVAD Patients. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.953] [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: 10/27/2022] Open
|
43
|
Uzun H, Demir E, Simsek E, Capanoglu T, Karapolat H, Engin C, Yagdi T, Ozturk P, Ozbaran M, Nalbantgil S. Frailty and Clinical Outcomes Following Left Ventricular Assist Device Implantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.190] [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: 10/27/2022] Open
|
44
|
Çelik A, Altay H, Azap A, Çavuşoğlu Y, Nalbantgil S, Şenol E, Temizhan A, Yılmaz MB. Vaccination of adults with heart failure and chronic heart conditions: Expert opinion. Turk Kardiyol Dern Ars 2018; 46:723-734. [PMID: 30516533 DOI: 10.5543/tkda.2018.10.5543/tkda.2018.37048] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Affiliation(s)
- Ahmet Çelik
- Department of Cardiology, Mersin University Faculty of Medicine, Mersin, Turkey.
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Zeytunlu M, Uğuz A, Ünalp Ö, Ergün O, Karasu Z, Günşar F, Akarca U, Yılmaz F, Turan İ, Nart D, Tekin F, Özütemiz Ö, Ulukaya S, Deniz N, Aydoğdu S, Özgenç F, Tasçı E, Sertöz R, Parıldar M, Elmas N, Harman M, Güler E, Kısmalı E, Akyol R, Yamazhan T, Taşbakan M, Tiftikcioğlu Y, Bacakoğlu F, Nalbantgil S, Noyan A, Karapınar B, Kılınç A, Uyar M, Demirağ K, Özalp S, Özdemir N, Aras S, Altuğ N. Results of 1001 liver transplantations in 23 years: Ege University experience. Turk J Gastroenterol 2018; 29:664-668. [PMID: 30381274 PMCID: PMC6284687 DOI: 10.5152/tjg.2018.18058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/15/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND/AIMS Liver transplantation (LT) is now the standard of care for most end-stage liver diseases. Over the next 30 years, advances in medicine and technology will greatly improve the survival rates of patients after this procedure. The aim of the present study was to analyze retrospectively the results of 1001 patients withLT. MATERIALS AND METHODS Medical reports of 989 patients were analyzed retrospectively. Data were obtained from the patient's data chart. Descriptive statistics were used to describe continuous variables (mean, median, and standard deviation). RESULTS A total of 1001 LTs for 989 recipients were performed at Ege University Organ Transplantation and Research Center between 1994 and 2017. Therewere 639 male and 350 female recipients. Among 1001 LTs, there were 438 deceased donors and 563 living donors. The age interval of the patients was 4 months to 71 years old. The median Model for End-Stage Liver Disease score was 20. There were 12 deceased liver donors using the split method. There were 12 cases subject to retransplantation. In living donor LT grafts, 423 right lobes, 46 left lobes, and 94 left lateral sectors were used. In the first monitoring,the total annual mortality rate was 130 cases (13%). The mortality rate in retransplantation was found to be 66%. A 1-year survival rate of 87% was generally stablished. CONCLUSION LThas been improving consistently over the last two decades. Ege University is one of the biggest liver transplant centers in Turkey for both technical and educational perspective.
Collapse
Affiliation(s)
- Murat Zeytunlu
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Alper Uğuz
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ömer Ünalp
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Orkan Ergün
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Zeki Karasu
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Fulya Günşar
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ulus Akarca
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Funda Yılmaz
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - İlker Turan
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Deniz Nart
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Fatih Tekin
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ömer Özütemiz
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Sezgin Ulukaya
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Nuri Deniz
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Sema Aydoğdu
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Funda Özgenç
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ezgi Tasçı
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Rüçhan Sertöz
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Mustafa Parıldar
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Nevra Elmas
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Mustafa Harman
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ezgi Güler
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Erkan Kısmalı
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Rahmi Akyol
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Tansu Yamazhan
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Meltem Taşbakan
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Yiğit Tiftikcioğlu
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Feza Bacakoğlu
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Sanem Nalbantgil
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ayşin Noyan
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Bülent Karapınar
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Arda Kılınç
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Mehmet Uyar
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Kubilay Demirağ
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Sibel Özalp
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Nebile Özdemir
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Sinem Aras
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Nurşen Altuğ
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| |
Collapse
|
46
|
Erol Y, Ergönül AG, Özdil A, Nalbantgil S, Çağırıcı U, Turhan K, Çakan A. Assessment of Cardiac Complications in Patients Undergoing Pulmonary Resection. Heart Lung Circ 2018; 28:1099-1101. [PMID: 30269871 DOI: 10.1016/j.hlc.2018.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/12/2017] [Revised: 07/20/2018] [Accepted: 08/30/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients who underwent lung resection in our clinic were retrospectively investigated in terms of development of postoperative cardiac complications. METHODS The file records of 207 patients who underwent lung resection between the years 2010 and 2014 were reviewed. One hundred and eighteeen (118) (57%) of the patients were evaluated by the preoperative cardiologist and the risk level of the patients was determined according to the Lee index. Postoperative cardiac complication relation was compared with each parameter. RESULTS The difference between the mean age of the patients with and without complication was statistically significant (p=0.024). When the patients were grouped as over and under 65 years old, the risk of developing postoperative complications was higher and statistically significant (p=0.015) in patients over 65 years of age. When the patients were evaluated in line with the presence of additional disease, smoking and electrocardiogram (ECG) findings, patients with hypertension developed more complications than those without hypertension (p=0.002). When the logistic regression was adjusted according to age and sex, the development of cardiac complications in patients with hypertension was 3.25 times greater. CONCLUSIONS It should be kept in mind that the presence of hypertension in patients who will undergo lung resection and advanced age increases the risk of cardiac complications and that preoperative cardiology care may be appropriate for these patients.
Collapse
Affiliation(s)
- Yeliz Erol
- Departments of Thoracic Surgery, İzmir Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Turkey.
| | - Ayşe Gül Ergönül
- Ege University, School of Medicine, Departments of Thoracic Surgery, İzmir, Turkey
| | - Ali Özdil
- Ege University, School of Medicine, Departments of Thoracic Surgery, İzmir, Turkey
| | - Sanem Nalbantgil
- Ege University, School of Medicine, Departments of Cardiology, İzmir, Turkey
| | - Ufuk Çağırıcı
- Ege University, School of Medicine, Departments of Thoracic Surgery, İzmir, Turkey
| | - Kutsal Turhan
- Ege University, School of Medicine, Departments of Thoracic Surgery, İzmir, Turkey
| | - Alpaslan Çakan
- Ege University, School of Medicine, Departments of Thoracic Surgery, İzmir, Turkey
| |
Collapse
|
47
|
Kayikcioglu M, Tokgozoglu L, Biteker M, Akil MA, Ertas F, Nalbantgil S, Yilmaz E, Yilmaz DC, Askin L, Asarcikli LD, Mutluer FO, Ural D, Temizhan A. P3468What we learned from the analysis of first 301 patients from the Turkish Peripartum Cardiomyopathy Registry? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3468] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - L Tokgozoglu
- Hacettepe University, Cardiology, Ankara, Turkey
| | - M Biteker
- Sitki Koçman Universty, School of Medicine, Cardiology, Mugla, Turkey
| | - M A Akil
- Diyarbakir University Hospital, Cardiology, Diyarbakir, Turkey
| | - F Ertas
- Diyarbakir University Hospital, Cardiology, Diyarbakir, Turkey
| | - S Nalbantgil
- Ege University, Faculty of Medicine, Izmir, Turkey
| | - E Yilmaz
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiology, Istanbul, Turkey
| | - D C Yilmaz
- Mersin University, Cardiology, Mersin, Turkey
| | - L Askin
- Adiyaman University Training and Research Hospital, Cardiology, Adiyaman, Turkey
| | - L D Asarcikli
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Cardiology, Istanbul, Turkey
| | - F O Mutluer
- Koc University, Cardiology, Istanbul, Turkey
| | - D Ural
- Koc University, Cardiology, Istanbul, Turkey
| | - A Temizhan
- Turkiye Yuksek Ihtisas Hospital, Cardiology, Ankara, Turkey
| | | |
Collapse
|
48
|
Yuce EI, Demir E, Simsek E, Ozturk P, Parildar Z, Engin Ç, Yagdi T, Ozbaran M, Nalbantgil S, Gurgun C. P5118Changes in plasma neprilysin levels after left ventricular assist device implantation and association with short-term outcomes. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- E I Yuce
- Ege University, cardiology department, Izmir, Turkey
| | - E Demir
- Ege University, cardiology department, Izmir, Turkey
| | - E Simsek
- Ege University, cardiology department, Izmir, Turkey
| | - P Ozturk
- Ege University, cardiovascular surgery department, Izmir, Turkey
| | - Z Parildar
- Ege University, biochemistry department, Izmir, Turkey
| | - Ç Engin
- Ege University, cardiovascular surgery department, Izmir, Turkey
| | - T Yagdi
- Ege University, cardiovascular surgery department, Izmir, Turkey
| | - M Ozbaran
- Ege University, cardiovascular surgery department, Izmir, Turkey
| | - S Nalbantgil
- Ege University, cardiology department, Izmir, Turkey
| | - C Gurgun
- Ege University, cardiology department, Izmir, Turkey
| |
Collapse
|
49
|
Simsek E, Bayazit Y, Demir E, Kayikcioglu M, Nalbantgil S, Mogolkoc N, Can L, Kultursay H. P3558Comparison of cardiac output measurement methods for mortality prediction in pulmonary hypertension. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3558] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Simsek
- Ege University, Faculty of Medicine, Department of Cardiology, Izmir, Turkey
| | - Y Bayazit
- Ege University, Faculty of Medicine, Department of Cardiology, Izmir, Turkey
| | - E Demir
- Ege University, Faculty of Medicine, Department of Cardiology, Izmir, Turkey
| | - M Kayikcioglu
- Ege University, Faculty of Medicine, Department of Cardiology, Izmir, Turkey
| | - S Nalbantgil
- Ege University, Faculty of Medicine, Department of Cardiology, Izmir, Turkey
| | - N Mogolkoc
- Ege University, Faculty of Medicine, Department of Pulmonology, Izmir, Turkey
| | - L Can
- Ege University, Faculty of Medicine, Department of Cardiology, Izmir, Turkey
| | - H Kultursay
- Ege University, Faculty of Medicine, Department of Cardiology, Izmir, Turkey
| |
Collapse
|
50
|
Crespo-Leiro MG, Metra M, Lund LH, Milicic D, Costanzo MR, Filippatos G, Gustafsson F, Tsui S, Barge-Caballero E, De Jonge N, Frigerio M, Hamdan R, Hasin T, Hülsmann M, Nalbantgil S, Potena L, Bauersachs J, Gkouziouta A, Ruhparwar A, Ristic AD, Straburzynska-Migaj E, McDonagh T, Seferovic P, Ruschitzka F. Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2018; 20:1505-1535. [DOI: 10.1002/ejhf.1236] [Citation(s) in RCA: 373] [Impact Index Per Article: 62.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 05/17/2018] [Accepted: 05/21/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- Maria G. Crespo-Leiro
- Complexo Hospitalario Universitario A Coruña (CHUAC); Instituto de Investigación Biomédica de A Coruña (INIBIC), CIBERCV, UDC; La Coruña Spain
| | - Marco Metra
- Cardiology; University of Brescia; Brescia Italy
| | - Lars H. Lund
- Department of Medicine, Unit of Cardiology; Karolinska Institute; Stockholm Sweden
| | - Davor Milicic
- Department for Cardiovascular Diseases; University Hospital Center Zagreb, University of Zagreb; Zagreb Croatia
| | | | | | - Finn Gustafsson
- Department of Cardiology; Rigshospitalet; Copenhagen Denmark
| | - Steven Tsui
- Transplant Unit; Royal Papworth Hospital; Cambridge UK
| | - Eduardo Barge-Caballero
- Complexo Hospitalario Universitario A Coruña (CHUAC); Instituto de Investigación Biomédica de A Coruña (INIBIC), CIBERCV, UDC; La Coruña Spain
| | - Nicolaas De Jonge
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Maria Frigerio
- Transplant Center and De Gasperis Cardio Center; Niguarda Hospital; Milan Italy
| | - Righab Hamdan
- Department of Cardiology; Beirut Cardiac Institute; Beirut Lebanon
| | - Tal Hasin
- Jesselson Integrated Heart Center; Shaare Zedek Medical Center; Jerusalem Israel
| | - Martin Hülsmann
- Department of Internal Medicine II; Medical University of Vienna; Vienna Austria
| | | | - Luciano Potena
- Heart and Lung Transplant Program; Bologna University Hospital; Bologna Italy
| | - Johann Bauersachs
- Department of Cardiology and Angiology; Medical School Hannover; Hannover Germany
| | - Aggeliki Gkouziouta
- Heart Failure and Transplant Unit; Onassis Cardiac Surgery Centre; Athens Greece
| | - Arjang Ruhparwar
- Department of Cardiac Surgery; University of Heidelberg; Heidelberg Germany
| | - Arsen D. Ristic
- Department of Cardiology of the Clinical Center of Serbia; Belgrade University School of Medicine; Belgrade Serbia
| | | | | | - Petar Seferovic
- Department of Internal Medicine; Belgrade University School of Medicine and Heart Failure Center, Belgrade University Medical Center; Belgrade Serbia
| | - Frank Ruschitzka
- University Heart Center; University Hospital Zurich; Zurich Switzerland
| |
Collapse
|