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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 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 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 Reply to Letter to the Editor: Can ARNI Prevent Doxorubicin-Induced Cardiotoxicity?(Aves, 2022) Dindas, Ferhat; Gungor, Huseyin; Ekici, Mehmet; Akokay, Pinar; Erhan, Fusun; Dogdus, Mustafa; Yilmaz, Mehmet Birhan[Abstract Not Available]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 Systemic Immune Inflammation Index is a Novel Marker in Predicting the Presence and Severity of Isolated Coronary Artery Ectasia(Sociedade Brasileira de Cardiologia, 2023) Dindas, Ferhat; Koyun, Emin; Turkyilmaz, Erdem; Abacioglu, Ozge Ozcan; Yildirim, Arafat; Sahin, Anil; Dindar, BarisBackground: The underlying pathology of isolated coronary artery ectasia (CE) has not been fully elucidated. Objective: We aimed to examine the relationship between the systemic immune inflammation index (Sıı), which corresponds to the multiplying of the neutrophil-to-lymphocyte ratio (NLR) and the platelet counts, and isolated CE. Method: The retrospective study population included 200 patients with isolated CE, 200 consecutive with obstructive coronary artery disease, and 200 consecutive with a normal coronary artery angiogram. A 2-sided p-value of <0.05 was considered significant. Results: Sıı, NLR, platelet-to-lymphocyte ratio (PLR), and monocyte-to-high density lipoprotein cholesterol ratio (MHR) were significantly higher in the CE group compared with the other groups (all p<0.001). In multivariate analysis, Sıı (p<0.001, OR = 1.005, 95% CI =1.004-1.005) was found to be an independent predictor of isolated CE. In Receiver Operating Characteristic curve analysis, Sıı had a higher Area Under the Curve than NLR, PLR, and MHR. Sıı value of >517.35 has 79% sensitivity, 76% specificity for the prediction of the CE [AUC: 0.832, (p<0.001)]. Sıı had a significant correlation with the number of ectatic coronary arteries and Markis classification (r:0.214 p=0.002; r:-0.195, p=0.006, respectively). Conclusion: To the best of our knowledge, this is the first study that Sıı was significantly associated with isolated CE presence and anatomical severity. © 2023, Sociedade Brasileira de Cardiologia. All rights reserved.Öğe The Role of Systemic Immune Inflammation Index for Predicting Saphenous Vein Graft Disease in Patients with Coronary Artery Bypass Grafting(Sage Publications Inc, 2023) Dogdus, Mustafa; Dindas, Ferhat; Yenercag, Mustafa; Yildirim, Arafat; Abacioglu, Ozge Ozcan; Kilic, Salih; Yavuz, FethiAs inflammation plays a significant role in the development of coronary artery disease, we hypothesized that there may be a relation between the systemic immune inflammation index (SII) and saphenous vein graft disease (SVGD). The study population consisted of 716 consecutive patients who underwent elective coronary angiography (CAG) >1 year after bypass grafting. The patients were divided into 2 groups depending on the extent of SVG patency. SII value was significantly higher in the SVGD(+) group compared with the SVGD(-) group (P < .001). In multivariate logistic regression analysis, SII (P < .001, odds ratio (OR) = 3.27, 95% CI = 1.94-5.65) and neutrophil-to-lymphocyte ratio (NLR) (P < .001, OR = 2.08, 95% CI = 1.59-3.11) were found to be independent predictors of SVGD. An SII value of >935 (x10(3)/ml) has 89.2% sensitivity and 70.6% specificity for the prediction of the SVGD, and an NLR value of >4.15 has 54.6% sensitivity and 68.5% specificity for the prediction of the SVGD. The AUC of SII was found to be greater than the AUC of NLR (P = .002), platelet-to-lymphocyte ratio (PLR) (P = .009), lymphocyte-to-monocyte ratio (LMR) (P = .013), MPV (P = .011), and C-reactive protein (CRP) (P = .034) in predicting SVGD. In conclusion, we demonstrated that SII, which is among the new inflammation indexes, is a more reliable predictor in determining SVGD than the NLR, PLR, and LMR.
