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Öğe Atherogenic indexes versus hematologic inflammatory indexes: What is the most useful predictor of coronary slow flow?(Bayrakol Medical Publisher, 2021) Dindas, Ferhat; Koyun, Emin; Cerik, Idris Bugra; Sahin, Anil; Kilit, Celal; Dogdus, MustafaAim: Previous studies reported that inflammation and atherosclerosis are linked to coronary slow flow (CSF). The predominant pathological mechanism has not been elucidated yet. Hence, we aimed to compare hematologic inflammatory and atherogenic indexes simultaneously between patients with normal coronary flow (NCF) and CSF. Material and Methods: In a single-center retrospective analysis, 91 consecutive NCF patients and 90 consecutive CSF patients constituted two groups according to Thrombolysis in Myocardial Infarction frame count (TFC). Hematological indexes consist of the neutrophil-lymphocyte ratio (NLR), the lymphocyte to monocyte ratio (LMR), and the platelet-lymphocyte ratio (PLR), and the atherogenic indexes consist of an atherogenic index of plasma (AIP), atherogenic coefficient (AC), and Castelli's risk index (CRI). Baseline clinical parameters were compared beside the indexes. Results: NLR, LMR, PLR were similar in groups. AIP, AC and CRI were significantly higher in the CSF group (p<0.05). In correlation analysis, only CRI has significantly positive correlation with mean TFC (r: 0.419 p <0.001). In multivariate regression analysis, CRI was found as independently predictor of CSF (Odds ratio = 2.74, 95% CI = 1.21-6.207; p=0.016). Discussion: An elevated CRI may be an independent predictor for the presence of CSF. Additionally, it can be said that the inflammatory activity in CSF is transformed into atherosclerotic structures.Öğe Effectiveness of Different P2Y12 Inhibitors on Coronary Flow in Patients with ST-Elevation Myocardial Infarction(Sciendo, 2020) Seker, Onur Osman; Cerik, Idris Bugra; Coksevim, Metin; Yenercag, Mustafa; Soylu, KorhanBackground: ST-segment elevation myocardial infarction (STEMI) is a clinical syndrome with high mortality. The main purpose of STEMI treatment is to achieve optimal revascularization for tissue perfusion. Besides the innovations in revascularization strategies, developments in antithrombotic therapy resulted in a significant reduction in STEMI-related mortality. Reperfusion can be demonstrated by resolution of ST-segment elevation (STR), TIMI frame count (TFC), and myocardial blush grade (MBG). Aim of the study: In our study, we investigated the effects of P2Y12 inhibitors clopidogrel, prasugrel, and ticagrelor on reperfusion parameters such as TFC, MBG, and STR, after primary percutaneous coronary intervention (pPCI) in STEMI. Material and Methods: The study was a retrospective analysis of STEMI patients who underwent successful pPCI. A total of 120 patients were included in the study as 3 equal groups according to the type of P2Y12 inhibitor administered in loading dose in the acute phase, and reperfusion parameters were compared between the groups. Results: There was no statistically significant difference between the groups in terms of baseline demographic, clinical, and angiographic parameters. Evaluation of reperfusion parameters indicated that STR, MBG, angina relief after pPCI and corrected TFC (cTFC) were significantly different between the groups (p<0.05). In post-hoc analysis, the percentage of change in STR, MBG, angina relief after pPCI, and cTFC was significantly higher in the prasugrel group (p<0.017). Conclusion: In STEMI patients undergoing pPCI, the analysis of tissue level reperfusion parameters indicates a superior effect of prasugrel compared with other P2Y12 inhibitors used to achieve reperfusion.Öğe Electrocardiographic Prognostic Marker in Pulmonary Arterial Hypertension: RS Time(Arquivos Brasileiros Cardiologia, 2024) Koyun, Emin; Sahin, Anil; Yilmaz, Ahmet; Dindas, Ferhat; Cerik, Idris Bugra; Koyun, Gorkem BernaBackground: Pulmonary hypertension is a condition that involves the remodeling of the right ventricle. Ongoing remodeling is also associated with disease prognosis. During the restructuring process, complex changes such as hypertrophy and dilatation may also be reflected in electrocardiographic parameters. Objectives: Our study aimed to investigate the relationship between prognosis and electrocardiographic parameters in patients with pulmonary arterial hypertension. Methods: The study was designed retrospectively and included patients diagnosed with pulmonary arterial hypertension between 2010 and 2022. The patients were divided into two groups based on their survival outcome. Various parameters, including electrocardiographic, demographic, echocardiographic, catheter, and blood parameters, were compared between the two groups. A p-value of <0.05 was considered statistically significant. Results: In the multivariate Cox analyses, the parameters that were found to be independently associated with survival were the 6-minute walk test, mean pulmonary artery pressure, presence of pericardial effusion, and time between the beginning of the QRS and the peak of the S wave (RS time) (p<0.05 for each). Of all the parameters, RS time demonstrated the best diagnostic performance (AUC:0.832). In the survival analysis, a significant correlation was found between RS time and survival when using a cut-off value of 59.5 ms (HR: 0.06 [0.02-0.17], p < 0.001). Conclusions: According to the results of our study, a longer RS time is associated with poor prognosis in patients with pulmonary arterial hypertension. We can obtain information about the course of the disease with a simple, non-invasive parameter.Öğe Electrocardiographic Prognostic Marker in Pulmonary Arterial Hypertension: RS Time [2](Arquivos Brasileiros Cardiologia, 2024) Koyun, Emin; Sahin, Anil; Yilmaz, Ahmet; Dindas, Ferhat; Cerik, Idris Bugra; Koyun, Gorkem BernaBackground: Pulmonary hypertension is a condition that involves the remodeling of the right ventricle. Ongoing remodeling is also associated with disease prognosis. During the restructuring process, complex changes such as hypertrophy and dilatation may also be reflected in electrocardiographic parameters. Objectives: Our study aimed to investigate the relationship between prognosis and electrocardiographic parameters in patients with pulmonary arterial hypertension. Methods: The study was designed retrospectively and included patients diagnosed with pulmonary arterial hypertension between 2010 and 2022. The patients were divided into two groups based on their survival outcome. Various parameters, including electrocardiographic, demographic, echocardiographic, catheter, and blood parameters, were compared between the two groups. A p-value of <0.05 was considered statistically significant. Results: In the multivariate Cox analyses, the parameters that were found to be independently associated with survival were the 6-minute walk test, mean pulmonary artery pressure, presence of pericardial effusion, and time between the beginning of the QRS and the peak of the S wave (RS time) (p<0.05 for each). Of all the parameters, RS time demonstrated the best diagnostic performance (AUC:0.832). In the survival analysis, a significant correlation was found between RS time and survival when using a cut-off value of 59.5 ms (HR: 0.06 [0.02-0.17], p < 0.001). Conclusions: According to the results of our study, a longer RS time is associated with poor prognosis in patients with pulmonary arterial hypertension. We can obtain information about the course of the disease with a simple, non-invasive parameter.Öğe Employment Preferences of Cardiologists in Türkiye: A Discrete Choice Experiment(Kare Publ, 2024) Cerik, Idris Bugra; Koyun, Emin; Kiyak, Yavuz Selim; Budakoglu, Isil Irem; Dindas, Ferhat; Coskun, OzlemObjective: The homogeneous distribution of physicians is important for ensuring patients' access to health services. To encourage physicians to work in underserved areas, policymakers create incentives. Understanding physicians' employment preferences is essential when developing these incentive packages. This study aims to quantitatively reveal the preferences of cardiologists in T & uuml;rkiye using a discrete choice experiment (DCE). Methods: A DCE questionnaire was distributed electronically to all cardiologists in T & uuml;rkiye. It included 14 different pairs of hypothetical job offers based on seven parameters likely to influence their employment preferences. The data were analyzed using a conditional logit model. The coefficients (CEs) of conditional logistic regression and the willingness -to -accept (WTA) values were calculated. Results: The analysis included 278 cardiologists. It revealed that the most influential parameter was location (CE: 2.86). To move to an undesirable location, the average participant would require an earnings increase of at least 123.3% relative to the average potential earnings of a cardiologist. Other parameters included availability of suitable facilities (CE: 1.07, WTA: 46.3%), harmony with co-workers (CE: 0.92, WTA: 39.61%), working conditions (CE: 0.68, WTA: 29.26%), and the number of night shifts (CE: 0.61, WTA: 26.34%). Conclusion: Location emerged as the most important factor in the employment preferences of cardiologists in T & uuml;rkiye. However, several other monetary and non -monetary factors were also influential, suggesting that policymakers should adopt a holistic approach when developing incentives for cardiologists.Öğe Evaluation of ivabradine in left ventricular dyssynchrony and reverse remodeling in patients with chronic heart failure(Wiley, 2020) Soylu, Korhan; Cerik, Idris Bugra; Aksan, Gokhan; Nar, Gokay; Meric, MuratObjectives: Ivabradine is a pharmacological agent used in patients with heart failure and sinus rhythm. Its only known pharmacological effect is to slow the heart rate. In this study, we investigated the impact of ivabradine on dyssynchrony parameters in heart failure patients. Methods: In this study, we assigned 55 patients taking medication for heart failure to receive ivabradine in addition (Group I). Twenty healthy volunteers comprised Group II. Echocardiographic measurements (dyssynchrony, left ventricular volumes and left ventricular ejection fraction) were taken at baseline, 1 month, and 3 months. Results: A total of 32 heart failure patients in Group I completed the study. There was significant improvement in dyssynchrony parameters after ivabradine treatment in Group I. Interventricular dyssynchrony (IVD) decreased from 42.0 +/- 24.4 milliseconds at baseline to 33.6 +/- 20.7 milliseconds at 1 month (P = .001) and to 30.7 +/- 19.4 milliseconds at 3 months (P < .001). Septal to posterior wall motion delay decreased from 90.3 +/- 21.4 milliseconds to 83.9 +/- 26.9 milliseconds (P = .011) at 1 month and to 81.5 +/- 27.3 milliseconds at 3 months (P = .001). Septal to lateral Ts delay (TsSL) decreased from 42.7 +/- 24.5 milliseconds to 35.8 +/- 22.6 milliseconds at 1 month (P < .001) and to 34.8 +/- 22.4 milliseconds at 3 months (P = .002). Left ventricular end-systolic volume (LVESV) decreased from 139.4 +/- 42.2 mL to 135.3 +/- 39.6 mL at 1 month (P = .006) and to 123.3 +/- 39.5 mL at 3 months (P < .001). Conclusion: The addition of ivabradine to heart failure treatment improves cardiac dyssynchrony parameters in chronic systolic heart failure patients with sinus rhythm.Öğe New prognostic markers in pulmonary arterial hypertension: CRP to albumin ratio and uric acid(Pergamon-Elsevier Science Ltd, 2022) Cerik, Idris Bugra; Dindas, Ferhat; Koyun, Emin; Dereli, Seckin; Sahin, Anil; Turgut, Okan Onur; Gul, IbrahimIntroduction: Idiopathic pulmonary hypertension(IPAH) is a rare disease that causes severe morbidity and mortality despite advances in treatment management. Evaluating the prognosis of the disease is critical in determining therapeutic approaches. We aimed to evaluate the prognostic significance of C-reactive protein/albumin ratio (CAR) and uric acid, which is an easily applicable and inexpensive parameter in patients with IPAH. Methods: Seventy-two IPAH patients and 99 consecutive non-IPAH patients as a control group were enrolled in the study retrospectively. Right heart catheterization(RHC), echocardiography, and laboratory parameters of the two groups and those who died and survived among the IPAH patients were compared. Results: IPAH and control group were compared at the first stage and CAR (1.98(0.28-10.74), 0.75(0.22-4.7), respectively;p < 0.01) and uric acid (0.33(0.19-0.87), 0.3(0.11-0.48) mmol/L, respectively; p = 0.03) values were significantly higher in the pulmonary hypertension group compared to the control group. Compared with the surviving IPAH patients, CAR (4.60(1.39-10.74),1.54(0.28-6.74),respectively;p < 0.001) and uric acid levels (0.458(0.26-0.87), 0.315(0.19-0.56) mmol/L, respectively; p < 0.001) were significantly higher in the group of patients who died. In the multivariate Cox regression models uric acid(p < 0.001) and CAR(p < 0.001) were found to be associated with survival time. Receiver operating characteristic curves (ROC) analyses showed that > 1.54 CAR value (AUC = 0.81,Sens:85.7%,Spec:56.9%,p < 0.001) and > 5.85 mg/dL (>0.348 mmol/L) uric acid value (AUC = 0.864, Sens:85.7%, Spec:78.4%, p < 0.001) are strong predictors for mortality. Conclusion: In this study, we showed that simple markers such as CAR, which augment the inflammation marker feature of CRP, and uric acid can give prognostic information in PAH patients.Öğe Pseudoexfoliation syndrome: Are the eyes the mirror of the heart?(Wiley, 2021) Cerik, Idris Bugra; Dindas, Ferhat; Yalinbas Yeter, DuyguIntroduction Pseudoexfoliation syndrome (PEX) is a disease characterized by the accumulation of fibrillary material in the extracellular matrix in the eye and many tissues. Myocardial involvement occurs as in other storage diseases. Speckle tracking echocardiography is a quantitative echocardiography modality that enables the detection of subclinical changes that cannot be detected by standard echocardiographic evaluation. In this study, we aimed to evaluate potential subclinical myocardial dysfunction in PEX patients by speckle tracking echocardiography. Methods and Results The study group consisting of 29 cardiac asymptomatic pseudoexfoliation syndromes and 30 healthy volunteers were included in this case-control cross-sectional study. Detailed echocardiographic evaluations and strain analyses of all participants were performed. Concerning standard echocardiographic parameters, there was only a marginally significant difference between the two groups in the e' mean wave, and it was lower in the PEX group than the control group (0.07 +/- 0.03, 0.10 +/- 0.08, respectively, P = .06). However, in strain echocardiography, the global longitudinal strain (GLS) value was observed to be significantly lower in the PEX group than the control group (-17.02 +/- 2.02, -19.29 +/- 2.26, respectively P < .001). GLS was observed to be an independent predictor in the multivariable logistic regression model made to determine independent predictors of PEX syndrome (OR = 0.59, CI = 0.418-0.832, P = .003). Conclusion Subclinical myocardial involvement in PEX syndrome, in which standard echocardiographic techniques are blinded, can be detected by the strain echocardiography. PEX causes deterioration in the deformation parameters of the left ventricle. Systemic involvement should not be forgotten in patients with PEX and cardiac functions should be monitored.Öğe Remember Diabetes Mellitus When Assessing Renal Blood Flow in Hypertensive Patients: A Renal Frame Count Study(Kare Publ, 2023) Cerik, Idris Bugra; Dindas, Ferhat; Yilmaz, Mehmet BirhanObjective: Diabetes mellitus (DM) progresses with dynamic changes in renal blood flow and glomerular filtration. Renal frame count (RFC) is a cineangiographical parameter that is capable of presenting microvascular and macrovascular changes in the renal blood flow. We aimed to show the changes, which may be caused by DM in the perfusion, by using RFC. Methods: A total of 110 hypertensive subjects consisting of 55 DM patients and 55 non-DM patients, as a control group who underwent renal angiography, were retrospectively enrolled in the study. The RFC values of all subjects were calculated and compared to each other. Results: There were no significant differences between the two groups in terms of basal de-mographic characteristics and antihypertensive medications. The RFC value measured from the left renal artery was significantly lower in the DM group compared to the control group (11.33 +/- 2.55, 13.49 +/- 3.24, respectively; P <0.001). The RFC value measured in the right renal artery was detected to be significantly lower in the DM group than in the control group (11.07 +/- 2.43, 13.33 +/- 3.07, respectively; P <0.001). The mean RFC value was also significantly lower in the DM group compared to the control group (11.20 +/- 2.18, 13.41 +/- 2.84, respectively; P <0.001). In the multivariable linear regression analysis conducted to determine the variables which may affect mean RFC, it was determined that only the HbA1C level had a relation with the mean RFC value. Conclusion: To the best of our knowledge, this is the first study to show the influence of DM on RFC. The RFC seems to decrease in DM subjects.Öğe Screening Tests Predicting Cancer Metastasis in the Etiology of Pericardial Effusion: HALP Score and PNI(Arquivos Brasileiros Cardiologia, 2024) Koyun, Emin; Dindas, Ferhat; Sahin, Anil; Cerik, Idris Bugra; Dogdus, MustafaBackground: Cancer screening is absolutely necessary in patients with pericardial effusion, given that cancer is one of the most serious diseases in the etiology of pericardial effusion. In previous studies, it was stated that the systemic immune -inflammation index (SII); the prognostic nutrition index (PNI); and the hemoglobin, albumin, lymphocyte, platelet (HALP) score can produce scores related to cancer. Objectives: This study began considering that these scoring systems could predict cancer in the etiology of patients with pericardial effusion. Methods: This study produced a retrospective analysis of patients who underwent pericardiocentesis between 2006 and 2022. Pericardiocentesis was performed in a total of 283 patients with moderate-to-large pericardial effusion or pericardial tamponade within the specified period. HALP, PNI, and SII scores were calculated according to the peripheral venous blood taken before the pericardiocentesis procedure. The statistical significance level was set at p<0.05. Results: The HALP score proved to be 0.173 (0.125-0.175) in cancer patients and 0.32 (0.20-0.49) in non -cancer patients (p<0.001). The PNI score proved to be 33.1 +/- 5.6 in cancer patients and 39.8 +/- 4.8 in non -cancer patients (p<0.001). Conclusion: The HALP score and PNI proved to be easy and fast cancer screening tests that can predict cancer metastasis in the etiology of patients with pericardial effusion.Öğe The relationship between severe acute respiratory syndrome coronavirus 2 (SARS - COV-2) pandemic and fragmented QRS(Churchill Livingstone Inc Medical Publishers, 2020) Bektas, Osman; Cerik, Idris Bugra; Cerik, Hatun Ozturk; Karagoz, Ahmet; Kaya, Yasemin; Dereli, Seckin; Kaya, AhmetObjective: The aim of the study is to determine the frequency of fragmented QRS (FQRS) in patients with SARS-COV-2. Methods: A total of 125 consecutive patients over 20 years of age who were hospitalized for SARS-COV-2 between 20th March 2020 and 18th May 2020 were included in the study. The data of the patients in the inpatient ward and in the intensive care unit were recorded separately. The duration of QRS and presence of FQRS were evaluated by two experienced cardiologists. The patients were divided into two groups as FQRS positive and FQRS negative considering presence of FQRS. Moreover, the frequency of FQRS in the patients in the inpatient ward and in the intensive care unit were compared with each other. Results: FQRS was found in 24% of the patients who had SARS-COV-2. There was no difference between FQRS positive and negative groups in terms of age and gender. Heart rate was higher in FQRS positive group. C-reactive protein (7.25 6.65 mg/dl vs. 4.80 4.48 mg/dl; p = .02) levels were also significantly higher in the FQRS positive group. In patients with SARS-COV-2, intensive care unit requirement increased with increasing levels of troponin (p b .000). A positive correlation was detected between serum CRP levels and FQRS (r = 0.204, p = .024). Conclusions: The frequency of FQRS is high in patients with SARS-COV-2. Serum CRP levels increase with increasing frequency of FQRS in patients with SARS-COV-2 indicating that patients with FQRS are exposed to more inflammation. Presence of FQRS in SARS-COV-2 patients may be useful in predicting cardiovascular outcomes. (c) 2020 Elsevier Inc. All rights reserved.Öğe The relationship of fetuin-a, omentin-1, and chemerin with left ventricular ejection fraction in heart failure(Wolters Kluwer Medknow Publications, 2021) Omur, Sefa Erdi; Cerik, Idris Bugra; Tekin, GulacanBackground: Heart failure (HF) is a clinical syndrome in which the heart cannot pump enough blood for the needs of the human body in terms of life functions. Some biochemical diagnostic tests as well as echocardiography play a role in the early diagnosis of this syndrome. The complex pathophysiology of HF suggests that many other markers may be useful in diagnosis and follow-up. Aim: After many recent studies, it has been suggested that adipokines fetuin-A, omentin-1, and chemerin may be suitable biomarkers for the diagnosis of HF. Our main aim in this study is to determine the relationship between fetuin-A, omentin-1, and chemerin levels with HF clinical classification. Methods: The patients admitted to the cardiology service with symptomatic HF with HF with preserved ejection fraction (HF-pEF, n = 62), HF with reduced EF (HF-rEF, n = 61) and HF with mid-range EF (HF-mrEF, n = 63) were included in the study. A total of 246 participants were evaluated by taking the control group (n = 60) for comparison. The main characteristics of all groups were recorded, and serum levels of fetuin-A, omentin-1, and chemerin were evaluated. Results: When compared with the control group, there was a significant difference for fetuin-A with the HF-rEF group (452.3 [441.4-528.9]; 555.3 [453.7-615.6] P < 0.001, respectively). When evaluating for omentin-1, there was a significant difference between the control group and HF-rEF. However, there was no significant difference for chemerin between the HF groups and the control group. Significant cutoff value for fetuin-A was found to be 485 in receiver operating characteristic analysis (area under curve: 0.74 sens: 0.72 (95% confidence interval [CI]: 0.57-0.82), spec: 0.69 (95% CI: 0.59-0.83), P < 0.001). Conclusion: Serum fetuin-A levels were found to be high in the HF-mrEF and HF-rEF groups from the HF groups and can be used in the diagnosis of the HF-rEF group. © 2022 International Journal of the Cardiovascular Academy Published by Wolters Kluwer-Medknow.Öğe Use of TIMI Risk Index as a Simple and Valuable Prognostic Tool in Patients with ST-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention(Aves, 2022) Cerik, Idris Bugra; Kaya, Ahmet; Dereli, Seckin; Akkaya, Fatih; Yenercag, Mustafa; Bektas, OsmanObjective: Thrombolysis in Myocardial Infarction Risk Index is a risk stratification model developed to determine the prognosis in ST-segment elevation myocardial infarction patients who underwent fibrinolytic therapy. The information on the effectiveness of Thrombolysis in Myocardial Infarction Risk Index in patients who underwent primary percutaneous coronary intervention is limited. This study aimed to demonstrate the predictive value of Thrombolysis in Myocardial Infarction Risk Index on clinical outcomes in patients presenting with ST-segment elevation myocardial infarction and subsequently undergoing primary percutaneous coronary intervention. Methods: A total of 963 patients who presented with ST-segment elevation myocardial infarction and subsequently underwent primary percutaneous coronary intervention were reviewed retrospectively. The discriminative power of Thrombolysis in Myocardial Infarction Risk Index for each outcome of congestive heart failure, death, stroke, and myocardial infarction within 1 month and 1 year after admission was assessed. Results: Congestive heart failure, death, stroke, and myocardial infarction, and the major adverse cardiac events, which is the composite outcome thereof, were higher in the patient groups with high Thrombolysis in Myocardial Infarction Risk Index values (P<.05). Thrombolysis in Myocardial Infarction Risk Index was an independent predictor of the following outcomes: 1-month survival rate [odds ratio:1.054 (1.036-1.073)], 1-year survival rate [odds ratio:1.048 (1.031-1.065)], hospitalization rate due to congestive heart failure within 1 month [odds ratio:1.041(1.026-1.057)], and within 1 year [odds ratio:1.040 (1.024-1.055)]. The Thrombolysis in Myocardial Infarction Risk Index level was found to have good discriminative power for 1-month mortality and 1-year mortality rates (Thrombolysis in Myocardial Infarction Risk Index: 22.76, C-statistic: 0.71-0.68, respectively). Conclusion: The results of this study indicated that Thrombolysis in Myocardial Infarction Risk Index value is an independent predictor of clinical outcomes such as death and heart failure but not subsequent myocardial infarction in ST-segment elevation myocardial infarction patients. The use of Thrombolysis in Myocardial Infarction Risk Index can be considered in ST-segment elevation myocardial infarction patients who underwent primary percutaneous coronary intervention as it is an easily applicable and important indicator of prognosis.
