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Öğe Does electrocardiography at admission predict outcome in Crimean-Congo hemorrhagic fever?(MALARIA RESEARCH CENTRE, INDIAN COUNCIL MEDICAL RESEARCH-ICMR, 2011) Yilmaz, Mehmet Birhan; Engin, Aynur; Bektasoglu, Gokhan; Zorlu, Ali; Ege, Meltem Refiker; Bakir, Mehmet; Dokmetas, IlyasBackground & objectives: Crimean-Congo hemorrhagic fever is an acute viral hemorrhagic fever with considerable mortality. Despite increasing knowledge about hemorrhagic fever viruses, the pathogenesis of Crimean-Congo hemorrhagic fever and causes of death were not well described. We aimed to evaluate whether there were electrocardiographic parameters designating mortality among these patients. Study design: This retrospective study was performed among confirmed Crimean-Congo hemorrhagic fever cases in Turkey. Electrocardiography was available in 49 patients within 24 h of hospitalization. All electrocardiograms were evaluated by two expert cardiologists according to Minnesota coding system. Results: Among patients with available electrocardiograms, there were 31 patients who survived, and 18 patients who died of Crimean-Congo hemorrhagic fever. Both groups were similar in terms of age, sex, body temperature, heart rate, and blood parameters. T-wave changes and bundle branch block were more frequently encountered among those who died. Presence of T-wave negativity or bundle branch block in this cohort of patients with Crimean-Congo hemorrhagic fever predicted death with a sensitivity of 72.7%, specificity of 92.6%, positive predictive value of 88.9%, negative predictive value of 80.6%. Conclusions: We think within the light of our findings that simple electrocardiography at admission may help risk stratification among Crimean-Congo hemorrhagic fever cases.Öğe Elevated mean pulmonary artery pressure in patients with mild-to-moderate mitral stenosis: a useful predictor of worsening renal functions?(TURKISH SOC CARDIOLOGY, 2013) Zorkun, Cafer; Amioglu, Gullu; Bektasoglu, Gokhan; Zorlu, Ali; Ekinozu, Ismail; Turgut, Okan Onur; Tandogan, Izzet; Yilmaz, Mehmet BirhanObjective: Renal dysfunction commonly accompanies the course of cardiac disorders and strongly associates with increased morbidity and mortality. Elevated central venous pressure is related to worsening renal function in patients with heart failure. However, predictors of worsening renal function in mitral stenosis-whose pathophysiologic process is similar to heart failure with regard to right heart dysfunction-are unknown. This study aimed to evaluate whether clinical and echocardiographic parameters might predict worsening renal function in patients with mild-to-moderate mitral stenosis. Methods: The current study has a prospective cohort design. Sixty consecutive patients (9 male, 51 female, mean age 50 +/- 13 years) with mild-to- moderate mitral stenosis were followed up for 34 +/- 13 months (range 1-60) and their renal functions were monitored. Worsening renal function was defined as a decline in glomerular filtration rate of >= 20% on follow-up. In order to presence or absence of worsening renal functions, study patients divided into two groups. Statistical analysis was performed using the Chi-square, Independent samples t / Mann-Whitney U tests, univariate and multivariate Cox proportional hazards analyses, receiver operating characteristic (ROC) and Kaplan-Meier curve analyses. Results: Worsening renal function was observed in 14 patients (23%). In univariate analysis, male gender, mean pulmonary artery pressure (mPAP), peak tricuspid regurgitation velocity, systolic pulmonary artery pressure, digitalis and antiplatelet usage, right atrial size, and TEI index were determined to be predictors of worsening renal function. In a multivariate Cox proportional hazards model, mPAP (HR=1.136, 95% CI: 1.058-1.220, p<0.001) and male gender (HR= 4.110, 95% CI: 1.812-9.322, p=0.001) were associated with increased risk of worsening renal function during the follow-up period. In ROC curve analysis, the optimal cut-off value of mPAP to predict worsening renal function was measured as more than 21 mmHg, with 78.6% sensitivity and 58.7% specificity (AUC 0.725, 95% CI 0.595-0.838). According to the Kaplan-Meier curve, a significant difference was found between those who had mPAP of >21 mmHg, and those who did not have, in terms of worsening renal function (p=0.006), and the difference between the groups increased after 30 months of follow-up. Conclusion: Elevated mean pulmonary artery pressure at the time of initial evaluation, in patients with mild-to-moderate mitral stenosis, might help to predict worsening renal function.Öğe Elevated mean pulmonary artery pressure in patients with mild-to-moderate mitral stenosis: a useful predictor of worsening renal functions? Reply(AVES, 2014) Zorkun, Cafer; Amioglu, Gullu; Bektasoglu, Gokhan; Zorlu, Ali; Ekinozu, Ismail; Turgut, Okan Onur; Tandogan, Izzet; Yilmaz, Mehmet Birhan…Öğe Evaluation of the patients' level of knowledge about diagnostic and therapeutic procedures in cardiology(Turkish Soc Cardiology, 2006) Yilmaz, Mehmet Birhan; Turgut, Okan Onur; Yilmaz, Ahmet; Karadas, Filiz; Ozyol, Ali; Kendirlioglu, Omer; Bektasoglu, GokhanObjectives: It is sometimes observed that informing patients about cardiovascular procedures is not taken into appropriate consideration. In this study, we assessed the patients' level of knowledge obtained through informing regarding the procedures performed in cardiology. Study design: A 22-item questionnaire was developed to measure the knowledge of patients about cardiovascular procedures. After validation in a group of 10 volunteer patients, the questionnaire was administered to 200 participants (115 males, mean age 53 years; 85 females, mean age 49 years). The patients were inquired about their knowledge of electrocardiography (ECG), Holter, exercise stress test, echocardiography, coronary angiography (CAG), percutaneous coronary interventions (PCI), electrophysiological study, and pacemaker implantation. Results: Of the participants, 33% had hypertension, 7.5% had diabetes mellitus, and 23% had coronary artery disease. Although the majority of the patients (n=159, 79.5%) had a prior electrocardiogram, only 7% (n=14) responded that it gave information about coronary artery disease. Eighty-six percent (n=172) of the participants did not know what Holter was. According to 44%, CAG was performed for visualization, and to 37%, for patency of the coronary arteries. Concerning the PCI procedure, 42% stated that they did not know how it was carried out, and 35% stated that the balloon was blown up during the procedure. Conclusion: Furnishing patients with necessary information about cardiovascular procedures is important for improved health of individuals and the society at large, and there seems to be a considerable gap in this respect.Öğe Increased d-dimer levels predict cardiovascular mortality in patients with systolic heart failure(SPRINGER, 2012) Zorlu, Ali; Yilmaz, Mehmet Birhan; Yucel, Hasan; Bektasoglu, Gokhan; Ege, Meltem Refiker; Tandogan, IzzetD-dimer is a fibrin degradation product, and is implicated in pathologies of cardiovascular system. Thrombosis within the vascular system in relation with inflammation and stasis might be associated with poor prognosis in patients with systolic heart failure (HF). In this study we aimed to investigate for relationship between d-dimer levels and cardiovascular mortality in patients with systolic HF. A total of 174 consecutive patients with hospitalized systolic HF were evaluated. All hospitalized patients were obtained d-dimer levels within the first 24 h following admission after obtaining informed consent. Patients were followed up for cardiovascular mortality and 40 (23%) patients died. d-dimer levels were higher among those who died compared to those who survived (2727 +/- A 2569 (710-4438) versus. 1029 +/- A 1319 (303-1061) ng/ml, P < 0.001). Optimal cut-off level of d-dimer to predict cardiovascular mortality was found to be > 1435 ng/ml. D-dimer levels were negatively correlated with ejection fraction, positively correlated with left atrium size and left ventricular diastolic diameter. D-dimer > 1435 ng/ml, age, diabetes mellitus, presence of atrial fibrillation, and creatinine level were found to have prognostic significance in univariate analyses. In multivariate Cox proportional-hazards model, d-dimer > 1435 ng/ml (HR = 3.250, 95% CI 1.647-6.414, P = 0.001), creatinine level (HR = 1.269, 95% CI 1.008-1.599, P = 0.043), and presence of atrial fibrillation (HR = 2.159, 95% CI 1.047-4.452, P = 0.037) remained associated with an increased risk of death after adjustment for variables found to be statistically significant in univariate analysis and correlated with d-dimer level. In conclusion, d-dimer measurement could help risk stratification in patients with systolic HF.Öğe Increased gamma-glutamyl transferase levels predict early mortality in patients with acute pulmonary embolism(W B SAUNDERS CO-ELSEVIER INC, 2012) Zorlu, Ali; Yucel, Hasan; Bektasoglu, Gokhan; Turkdogan, Kenan Ahmet; Eryigit, Umut; Sarikaya, Savas; Ege, Meltem Refiker; Tandogan, Izzet; Yilmaz, Mehmet BirhanBackground: Increased gamma-glutamyl transferase (GGT) level is associated with increased oxidative stress, all-cause mortality, the development of cardiovascular disease, and metabolic syndrome. However, its role in acute pulmonary embolism (PE) is unknown. In this study, we aimed to investigate the relationship between GGT and early mortality in patients with acute PE. Methods: A total of 127 consecutive patients with confirmed PE were evaluated. The optimal cutoff value of GGT to predict early mortality was measured as more than 55 IU/L with 94.4% sensitivity and 66.1% specificity. Patients with acute PE were categorized prospectively as having no increased (group I) or increased (group II) GGT based on a cutoff value. Results: Of these 127 patients, 18 patients (14.2%) died during follow-up. Among these 18 patients, 1 (1.4%) patient was in group I, and 17 (30.9%) patients were in group II (P < .001). gamma-Glutamyl transferase level on admission, presence of shock, heart rate, oxygen saturation, right ventricular dilatation/hypokinesia, main pulmonary artery involvement, troponin I, alanine aminotransferase, alkaline phosphatase, and creatinine levels were found to have prognostic significance in univariate analysis. In the multivariate Cox proportional hazards model, GGT level on admission (hazard ratio [HR], 1.015; P = .017), presence of shock (HR, 15.124; P = .005), age (HR, 1.107; P = .010), and heart rate (HR, 1.101; P = .032) remained associated with an increased risk of acute PE-related early mortality after the adjustment of other potential confounders. Conclusions: We have shown that a high GGT level is associated with worse hemodynamic parameters, and it seems that GGT helps risk stratification in patients with acute PE. (C) 2012 Elsevier Inc. All rights reserved.Öğe The relationship between D-dimer level and the development of atrial fibrillation in patients with systolic heart failure(SPRINGER, 2012) Zorlu, Ali; Akkaya, Emre; Altay, Hakan; Bektasoglu, Gokhan; Turkdogan, Kenan Ahmet; Sincer, Isa; Vuruskan, Ertan; Cinar, Ziynet; Tandogan, Izzet; Yilmaz, Mehmet BirhanHeart failure (HF) is one of the most common and leading cause of death worldwide. Clinical trials provide evidence that the development of atrial fibrillation (AF) is a marker of poor prognosis in patients with HF. Furthermore, elevated D-dimer level is associated with increased cardiovascular mortality independent of AF in HF patients. We investigated whether plasma D-dimer levels in patients with hospitalized systolic HF could predict development of AF. A total of 150 consecutive patients with sinus rhythm who admitted to the emergency department with hospitalized systolic HF were evaluated. All hospitalized patients were obtained D-dimer levels within the first 24 h following admission. Atrial fibrillation developed in 31 (20.7%) patients during follow-up period of 6.3 +/- A 5 months. Patients who developed atrial fibrillation had significantly increased levels of D-dimer [608 (339-1,022) ng/ml versus 1,100 (608-2,599) ng/ml, P = 0.001]. Optimal cut-off level of D-dimer to predict development of AF was found to be > 792 ng/ml. D-dimer > 792 ng/ml, right ventricular dilatation, age, systolic pulmonary pressure, left atrium size, moderate to severe tricuspid regurgitation, and beta blocker usage were found to have prognostic significance in univariate analysis. In multivariate Cox proportional-hazards model, D-dimer levels > 792 ng/ml (HR = 3.019, P = 0.006), and right ventricular dilatation (HR = 8.676, P = 0.003) were associated with an increased risk of new-onset AF. In conclusion, D-dimer could predict development of AF in patients with hospitalized systolic HF.Öğe Sleep quality among relatively younger patients with initial diagnosis of hypertension: Dippers versus non-dippers(TAYLOR & FRANCIS LTD, 2007) Yilmaz, Mehmet Birhan; Yalta, Kenan; Turgut, Okan Onur; Yilmaz, Ahmet; Yucel, Oguzhan; Bektasoglu, Gokhan; Tandogan, IzzetBackground. Sleep is a basic physiological process. Normal sleep yields decrease in sympathetic activity, blood pressure ( BP) and heart rate. Those, who do not have expected decrease in their BP are considered "non-dippers''. We aimed to determine if there was any association between the non-dipping status and sleep quality, designed a cross-sectional study, and enrolled and evaluated the sleep quality of relatively young patients with an initial diagnosis of hypertension. Methods. Seventy-five consecutive patients, diagnosed to have stage 1 hypertension by their primary physicians, were referred to our study. Patients had newly diagnosed with stage 1 hypertension. Patients with a prior use of any anti-hypertensive medication were not included. Eligible patients underwent the Pittsburgh Sleep Quality Index (PSQI), which has an established role in evaluating sleep disturbances. All patients underwent ambulatory BP monitoring. Results. There were 42 non-dipper patients (mean age = 47.5 +/- 11.9 years, 24 male/18 female), as a definition, 31 dipper hypertensive patients (mean age = 48.5 +/- 12.8 years, 21 male/10 female) and two with white coat hypertension. Daytime systolic and diastolic mean BPs were not significantly different between the two groups. Night-time mean systolic and diastolic BPs were significantly higher in non-dippers compared with dippers. PSQI scores, globally, were significantly higher in non-dippers compared with dippers. Total PSQI score was not correlated with body mass index. It was noticed that, individually, sleep quality, sleep efficiency and sleep disturbance scores were significantly higher in non-dippers. Being a poor sleeper in terms of high PSQI score (total score > 5) was associated with 2.955-fold increased risk of being a non-dipper (95% confidence interval 1.127-7.747). Conclusion. We showed that the risk of having non-dipping hypertension, a risk factor for poor cardiovascular outcomes among hypertensive individuals, was tripled (odds ratios) among poor sleepers. We think that evaluating sleeping status and sleep quality among the hypertensive population may help unmask non-dipper hypertension, enabling physicians to treat appropriately.Öğe Usefulness of Admission Red Cell Distribution Width as a Predictor of Early Mortality in Patients With Acute Pulmonary Embolism(EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC, 2012) Zorlu, Ali; Bektasoglu, Gokhan; Guven, Fatma Mutlu Kukul; Dogan, Omer Tamer; Gucuk, Esra; Ege, Meltem Refiker; Altay, Hakan; Cinar, Ziynet; Tandogan, Izzet; Yilmaz, Mehmet BirhanRed cell distribution width (RDW) is strongly associated with prognosis in cardiopulmonary disorders such as coronary artery disease, acute myocardial infarction, acute and chronic heart failure, and pulmonary hypertension. However, its prognostic significance in acute pulmonary embolism (PE) is unknown. The aim of this study was to investigate the relation between admission RDW and early mortality in patients with acute PE. One hundred sixty-five patients with confirmed acute PE were included. Patients with previous treatment for anemia, malignancy, or chronic liver disease, those with dialysis treatment for chronic renal failure, and those who received erythrocyte suspension for any reason were excluded. A total of 136 consecutive patients with acute PE were evaluated prospectively. According to receiver-operating characteristic curve analysis, the optimal cut-off value of RDW to predict early mortality was >14.6%, with 95.2% sensitivity and 53% specificity. Patients were categorized prospectively as having unchanged (group 1) or increased (group 2) RDW on the basis of a cut-off value of 14.6%. The mean age of patients was 63 +/- 15 years. The mean follow-up duration was 11 +/- 7 days, and 21 patients died. Among these 21 patients, 1 (1.6%) was in group 1 and 20 (27%) were in group 2 (p <0.001). Increased RDW >14.6% on admission, age, presence of shock, heart rate, oxygen saturation, and creatinine level were found to have prognostic significance in univariate Cox proportional-hazards analysis. Only increased RDW >14.6% on admission (hazard ratio 15.465, p.= 0.012) and the presence of shock (hazard ratio 9.354, p <0.001) remained associated with increased risk for acute PE-related early mortality in a multivariate Cox proportional-hazards model. In conclusion, high RDW was associated with worse hemodynamic parameters, and RDW seems to aid in the risk stratification of patients with acute PE. (C) 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;109:128-134)
