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Öğe Association between multidrug resistance-1 C3435T gene polymorphism and right ventricular dysfunction in patients with chronic obstructive pulmonary disease: cross-sectional study(ASSOCIACAO PAULISTA MEDICINA, 2018) Yucel, Oguzhan; Gunes, Hakan; Yucel, Hasan; Zorlu, AliBACKGROUND: Right ventricular (RV) dysfunction may develop over the course of chronic obstructive pulmonary disease (COPD) and is an important predictor of morbidity and mortality Polymorphism of the multidrug resistance-1 (MDR-1) gene has been correlated with worse clinical findings among patients with COPD Our aim here was to investigate the relationship between MDR-1 C3435T gene polymorphism and RV dysfunction in COPD patients. DESIGN AND SETTING: This was a cross-sectional study investigating the relationship between RV dysfunction and genetic defects in COPD patients. METHODS: Forty-one consecutive patients diagnosed with COPD and hospitalized due to acute exacerbation were enrolled Polymorphism was analyzed using the strip assay technique. RV parameters were evaluated, and RV dysfunction was identified via transthoracic echocardiography Patients were categorized into three groups according to gene polymorphism MDR-1 CC (wild type, n = 9), MDR-1 CT (heterozygote mutant, n = 21) or MDR-1 TT (homozygote mutant, n = 11) RESULTS: The study included 14 males and 27 females (mean age 65 +/- 11 years). The mean systolic pulmonary artery pressure was 31.4 +/- 8 mmHg in the wild-type group, 42.2 +/- 12 mmHg in the heterozygote mutant group and 46.5 +/- 14 mmHg in the homozygote mutant group (P = 0.027). Presence of RV dilatation was significantly different among the three groups (33%, 71%, and 100%, respectively; P = 0.005). In multiple logistic regression analysis, MDR-1 C3435T gene polymorphism (OR = 9.000, P = 0.019) was an independent predictor of RV dysfunction after adjustment for potential confounders. CONCLUSION: MDR-1 C3435T gene polymorphism was associated with RV dysfunction in patients with COPD.Öğe Association of CA-125 Levels with Presence of Permanent Atrial Fibrillation in Patients with Systolic Heart Failure(ELSEVIER SCIENCE INC, 2013) Kaya, Hakki; Yucel, Hasan; Zorlu, Ali; Gunes, Hakan; Yimaz, Mehmet Birhan…Öğe Association of neutrophil/lymphocyte ratio and retinal vein occlusion(WICHTIG PUBL, 2015) Dursun, Ayhan; Ozturk, Sultan; Yucel, Hasan; Ozec, Ayse Vural; Dursun, Feyza Gulac; Toker, Mustafa Ilker; Erdogan, Haydar; Arici, Mustafa Kemal; Topalkara, AysenPurpose: To evaluate the association between neutrophil/lymphocyte ratio (NLR) and the development of retinal vein occlusion (RVO). Methods: Forty patients were included in the study. Forty age- and sex-matched healthy volunteers were recruited as the control group. The RVO diagnosis was made clinically, based on the findings of fundus examination. The NLR and file records of the patients and the control group were compared. Results: The mean age of patients was 64 +/- 12 years. Neutrophil levels were higher in RVO patients compared to the control subjects (5.1 +/- 1.9 vs 3.6 +/- 1.0, p<0.001). Lymphocyte levels were lower in RVO patients compared with the control subjects (2.0 +/- 0.7 vs 2.6 +/- 0.9, p = 0.005). The NLR was significantly higher in RVO patients compared with the control subjects (3.0 +/- 2.7 vs 1.5 +/- 0.3, p<0.001). According to the receiver operator characteristics curve analysis, the optimal cutoff value of NLR to predict RVO was > 1.89, with 72.5% sensitivity and 100% specificity. Conclusions: The current study demonstrated that higher NLR was associated with the development of RVO. The NLR may be used as a predictive tool for identifying risk for RVO.Öğe Atrial fibrillation is associated with increased mean platelet volume in patients with type 2 diabetes mellitus(TAYLOR & FRANCIS INC, 2013) Turgut, Okan; Zorlu, Ali; Kilicli, Fatih; Cinar, Ziynet; Yucel, Hasan; Tandogan, Izzet; Dokmetas, Hatice SebilaPlatelet abnormalities in diabetes mellitus (DM) and atrial fibrillation (AF) may underline the etiology of a prothrombotic state in these conditions. Increased mean platelet volume (MPV) is a marker of abnormal platelet function and activation. We aimed to investigate the possible association of chronic AF with MPV in patients who have type 2 DM. Patients who had type 2 DM with either chronic (>= 6 months) AF or normal sinus rhythm (NSR) were included in the study. A total of 162 patients (aged 38-89 years) were divided into 2 groups according to the presence of either AF or NSR. Group 1 consisted of 81 diabetic patients with AF, and group 2 consisted of 81 diabetic patients with NSR. The two groups were not significantly different in terms of age, and gender, as well as in hypertension, smoking, history of coronary artery disease, previous cerebrovascular accidents, microalbuminuria, retinopathy, duration of DM, body mass index, hemoglobin A(1c), total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride (p > 0.05 for all variables). Although no significant difference was present between groups concerning platelet count; for patients with AF, MPV was higher compared with patients with NSR (9.0 +/- 0.2 fl vs. 8.4 +/- 0.2 fl; p = 0.001). Furthermore, no significant difference was noted between groups regarding routine medications received by patients. In multivariate logistic regression analysis, MPV was the only variable independently related to AF (OR = 2.659; 95% CI, 1.286-5.498; p = 0.008). Consequently, it is concluded that AF is associated with increased MPV in patients with type 2 DM, suggesting the presence of tentatively related processes leading to reciprocal interaction.Öğe Atypical antipsychotic use is an independent predictor for the increased mean platelet volume in patients with schizophrenia: A preliminary study(ISFAHAN UNIV MED SCIENCES, 2013) Semiz, Murat; Yucel, Hasan; Kavakci, Onder; Yildirim, Osman; Zorlu, Ali; Yilmaz, Mehmet Birhan; Kucukdurmaz, Zekeriya; Canan, FatihBackground: Cardiovascular diseases, cardiovascular risk factors, and mortality due to these situations are more frequently encountered in schizophrenic patients when compared with the general population. The mean platelet volume (MPV) is a surrogate biomarker of the platelet activity and an useful prognostic test in cardiometabolic diseases. The aim of this study was to investigate what influenced MPV levels in patients with schizophrenia. Materials and Methods: We evaluated hospital records of 60 hospitalized schizophrenia patients. Thirty age-and sex-matched healthy control subjects were also included as a control group. Results: MPV levels were significantly higher in patients who were on atypical antipsychotic drugs than in patients who were not using any drug (9.2 +/- 0.8 vs. 8.6 +/- 0.8 fL, P = 0.016) and also higher than control group (9.2 +/- 0.8 vs. 8.1 +/- 0.9 fL, P < 0.001). Furthermore, patients who were not using antipsychotics had higher MPV than control group (8.6 +/- 0.8 vs. 8.1 +/- 0.9 fL, P = 0.036). Atypical antipsychotic use [Odds ratio (OR) = 6.152, 95% confidence interval (CI,) P = 0.003)] and platelet distribution width (OR = 0.989, 95% CI, P = 0.032) were associated with high MPV levels in univariate analysis. In multivariate logistic regression model, only atypical antipsychotics use (OR = 6.152, 95% CI, P = 0.003) was found to be independent predictor of high MPV levels after adjustment of other potential confounders (age, gender, presence of hypertension, diabetes mellitus, hyperlipidemia, and smoking). Conclusion: MPV seems to be influenced not only by schizophrenia itself but also by atypical antipsychotic drugs. It might be concluded that schizophrenic patients are under increased risk for cardiometabolic diseases and risk factors and this risk is higher in patients on atypical antipsychotic treatment.Öğe Bleeding complications during cardiac electronic device implantation in patients receiving antithrombotic therapy: is there any value of local tranexamic acid?(BMC, 2016) Beton, Osman; Saricam, Ersin; Kaya, Hakki; Yucel, Hasan; Dogdu, Orhan; Turgut, Okan Onur; Berkan, Ocal; Tandogan, Izzet; Yilmaz, Mehmet BirhanBackground: The perioperative use of antithrombotic therapy is associated with increased bleeding risk after cardiac implantable electronic device (CIED) implantation. Topical application of tranexamic acid (TXA) is effective in reducing bleeding complications after various surgical operations. However, there is no information regarding local TXA application during CIED procedures. The purpose of our study was to evaluate bleeding complications rates during CIED implantation with and without topical TXA use in patients receiving antithrombotic treatment. Methods: We conducted a retrospective analysis of consecutive patients undergoing CIED implantation while receiving warfarin or dual antiplatelet (DAPT) or warfarin plus DAPT treatment. Study population was classified in two groups according to presence or absence of topical TXA use during CIED implantation. Pocket hematoma (PH), major bleeding complications (MBC) and thromboembolic events occuring within 90 days were compared. Results: A total of 135 consecutive patients were identified and included in the analysis. The mean age was 60 +/- 11 years old. Topical TXA application during implantation was reported in 52 patients (TXA group). The remaining 83 patients were assigned to the control group. PH occurred in 7.7 % patients in the TXA group and 26.5 % patients in the control group (P = 0.013). The MBC was reported in 5.8 % patients in the TXA and 20.5 % patients in control group (P = 0.024). Univariate logistic regression analysis identified age, history of recent stent implantation, periprocedural spironolactone use, periprocedural warfarin use, perioperative warfarin plus DAPT use, cardiac resynchronization therapy, and topical TXA application during CIED implantation as predicting factors of PH. Multivariate analysis showed that perioperative warfarin plus DAPT use (OR = 10.874, 95 % CI: 2.496-47.365, P = 0.001) and topical TXA application during CIED procedure (OR = 0.059, 95 % CI: 0.012-0.300, P = 0.001) were independent predictors of PH. Perioperative warfarin plus DAPT use and topical TXA application were also found to be independent predictors of MBC in multivariate analyses. No thromboembolic complications was recorded in the study group. Conclusion: The present study demonstrated that the topical TXA application during CIED implantation is associated with reduced PH and MBC in patients with high bleeding risk.Öğe Cancer Antigen 125 is Associated with Length of Stay in Patients with Acute Heart Failure(TEXAS HEART INST, 2017) Kaya, Hakki; Kurt, Recep; Beton, Osman; Zorlu, Ali; Yucel, Hasan; Gunes, Hakan; Oguz, Didem; Yilmaz, Mehmet BirhanLength of stay is the primary driver of heart-failure hospitalization costs. Because cancer antigen 125 has been associated with poor morbidity and mortality rates in heart failure, we investigated the relationship between admission cancer antigen 125 levels and lengths of stay in heart-failure patients. A total of 267 consecutive patients (184 men, 83 women) with acute decompensated heart failure were evaluated prospectively. The median length of stay was 4 days, and the patients were classified into 2 groups: those with lengths of stay <= 4 days and those with lengths of stay > 4 days. Patients with longer lengths of stay had a significantly higher cancer antigen 125 level of 114 U/mL (range, 9-298 U/mL) than did those with a shorter length of stay (19 U/mL; range; 3-68) (P < 0.001). The optimal cutoff level of cancer antigen 125 in the prediction of length of stay was > 48 U/mL, with a specificity of 95.8% and a sensitivity of 96% (area under the curve, 0.979; 95% confidence interval [CI], 0.953-0.992). In the multivariate logistic regression model, cancer antigen 125 > 48 U/mL on admission (odds ratio=4.562; 95% CI, 1.826-11.398; P=0.001), sodium level (P< 0.001), creatinine level (P=0.009), and atrial fibrillation (P=0.015) were also associated with a longer length of stay after adjustment for variables found to be statistically significant in univariate analysis and correlated with cancer antigen 125 level. In addition, it appears that in a cohort of patients with acute decompensated heart failure, cancer antigen 125 is independently associated with prolonged length of stay.Öğe Cancer antigen-125 levels predict long-term mortality in chronic obstructive pulmonary disease(INFORMA HEALTHCARE, 2015) Kaya, Hakki; Zorlu, Ali; Yucel, Hasan; Dogan, Omer Tamer; Sarikaya, Savas; Aydin, Gulay; Kivrak, Tarik; Yilmaz, Mehmet BirhanBackground: Cancer antigen-125 (CA-125) might be a useful biomarker to predict long-term mortality in patients with recent exacerbation of chronic obstructive pulmonary disease (COPD). Methods: A total of 87 consecutive patients with COPD were evaluated prospectively. Mean age of patients was 68 +/- 10 years (55% males, 45% females) with a median follow-up period of 49 months. Optimal cut-off value of CA-125 to predict mortality was found as >93.34 U/ml, with 91% specificity and 40% sensitivity. Results: After follow-up, 20 out of 87 (23%) experienced cardiovascular death. CA-125 levels were higher among those who died compared to those who survived [55 (12-264) versus 28 (5-245) U/ml, p = 0.013]. In multivariate Cox proportional-hazards model with forward stepwise method, only CA-125 > 93.34 U/ml on admission (HR 3.713, 95% Cl: 1.035-13.323, p = 0.044) remained associated with an increased risk of death. Conclusions: For the first time, we demonstrated that CA-125 helps the risk stratification of patients with COPD.Öğe COHgb levels predict the long-term development of acute myocardial infarction in CO poisoning(W B SAUNDERS CO-ELSEVIER INC, 2016) Kaya, Hakki; Coskun, Abuzer; Beton, Osman; Zorlu, Ali; Kurt, Recep; Yucel, Hasan; Gunes, Hakan; Yilmaz, M. BirhanBackground: There are several studies evaluating the cardiac effects of carbon monoxide (CO) poisoning during the acute period; however, the number of studies evaluating the long-term cardiac effects is limited. Objective: The present study aimed to evaluate the effects of blood carboxyhemoglobin (COHb) levels, elevated due to CO poisoning on the long-term development of acute myocardial infarction (AMI). Methods: This cross-sectional cohort study included a total of 1013 consecutive patients who presented to the emergency department (ED) due to CO poisoning, between January 2005 and December 2007. The diagnosis of CO poisoning was made according to the medical history and a COHb level of greater than 5%. In terms of AMI development, the patients were followed up for an average of 56 months. Results: At the end of follow-up, 100 (10%) of 1013 patients experienced AMI. Carboxyhemoglobin levels at the time of poisoning were higher among those who were diagnosed with AMI compared to those who were not (55% +/- 6% vs 30% +/- 7%; P < .001). Using a multivariate Cox proportional hazards model with forward stepwise method, age, COHb level, CO exposure time, and smoking remained associated with an increased risk of AMI after adjustment for the variables found to be statistically significant in a univariate analysis. According to a receiver operating characteristic curve analysis, the optimal cutoff value of COHb used to predict the development of AMI was found to be greater than 45%, with 98% sensitivity and 94.1% specificity. Conclusion: In patients presenting to the ED with CO poisoning, COHb levels can be helpful for risk stratification in the long-term development of AMI. (C) 2016 Elsevier Inc. All rights reserved.Öğe Comparison of maternal serum vitamin D and paraoxonase 1 levels and neutrophil to lymphocyte ratios of preeclamptic and severe preeclamptic, and normal pregnant women(E-CENTURY PUBLISHING CORP, 2016) Akkar, Ozlem Bozoklu; Sancakdar, Enver; Karakus, Savas; Yildiz, Caglar; Arslan, Murat; Yucel, Hasan; Ozcelik, Fatma; Yenicesu, Ayse Gonca Imir; Cetin, Meral; Cetin, AliPreeclampsia is one of the most common causes of maternal and neonatal morbidity and mortality worldwide. We aimed to evaluate the diagnostic values of maternal serum levels of 25-hydroxyvitamin D and paraoxonase 1 (PON1) and neutrophil to lymphocyte ratio (NLR) in the preeclamptic patients and to assess whether they can be used to distinguish the severity of preeclampsia. This prospective study was conducted in women with preeclampsia (n=34) or severe preeclampsia (n=10) and normal pregnancies (n=36), with at least gestational age of 24 weeks. Maternal serum 25-hydroxyvitamin D and PON1 were measured and NLR was calculated. The 25-hydroxyvitamin D levels of the study groups were found comparable (P > 0.05). The normal pregnancy and preeclampsia groups were comparable (P > 0.05) with regard to the PON1 level; however, their PON1 levels were significantly higher compared to the severe preeclampsia group (P < 0.05). The NLRs of the normal pregnancy and preeclampsia groups were found similar (P > 0.05), but the NLR of severe preeclampsia group was significantly higher compared to the normal pregnancy and preeclampsia groups (P < 0.05). The maternal serum 25-hydroxyvitamin D level is not useful as a marker in the diagnosis of preeclampsia; however, the maternal serum PON1 level and NLR may distinguish the patients with preeclampsia with severe features, but not the patients with preeclampsia without severe features.Öğe Correlation of right ventricular dysfunction on acute pulmonary embolism with pulmonary artery computed tomography obstruction index ratio (PACTOIR) and comparison with echocardiography(SPRINGER, 2015) Varol, Kenan; Gumus, Cesur; Yucel, Hasan; Sezer, Ferhat; Seker, Emrah; Inci, Mehmet Fatih; Yucel, Selma; Kaya, Hakki; Berk, Serdar; Yilmaz, Mehmet BirhanThe aim of this study was to determine the pulmonary artery computed tomography obstruction index ratio (PACTOIR) in patients who have been diagnosed with acute pulmonary embolism (APE) with multi-slice computed tomography (MSCT) and to research the predetermination efficiency of right ventricular dysfunction (RVD) compared with echocardiography (ECHO). One hundred patients (50 males, 50 females), who had ECHO findings and were diagnosed with APE, were subsequently examined in this study. Patients who had RVD on ECHO, tricuspid regurgitation, and pulmonary hypertension parameters that were completely positive were accepted to have RVD. RVD was identified in 52 patients (52 %) on echocardiography. The PACTOIR value for patients with RVD were evaluated to be significantly higher than those without RVD (41 +/- A 17 vs 20 +/- A 12 %, p < 0.001). In the ROC analysis, the PACTOIR cut-off value was 37.5 %, the sensitivity value was 67.3 %, and specificity value was 93.7 % (AUC 0.839, 95 % CI 0.752-0.905). We determined that the patients with RVD and PACTOIR values over 37.5 % can be recognized with a 92.1 % positive predictive value. Our conclusions indicated that the PACTOIR rate in RVD diagnosis in patients with APE can recognize the patients with and without RVD.Öğe D-dimer is a predictor of cardiovascular death, and new-onset atrial fibrillation in patients with systolic heart failure(ELSEVIER IRELAND LTD, 2017) Yucel, Oguzhan; Yucel, Hasan; Zorlu, Ali…Öğe Effect of Levosimendan in Patients with Severe Systolic Heart Failure and Worsening Renal Function(ARQUIVOS BRASILEIROS CARDIOLOGIA, 2012) Zorlu, Ali; Yucel, Hasan; Yontar, Osman Can; Karahan, Oguz; Tandogan, Izzet; Katrancioglu, Nurkay; Yilmaz, Mehmet BirhanBackground: Levosimendan, a calcium sensitizer, increases the sensitivity of the heart to calcium, thus increasing myocardial contractility without a rise in intracellular calcium. It was recently shown that levosimendan is beneficial in improving renal function. However, it remains to be established that the beneficial effect is differentially related to renal status during index event. Objective: The purpose of the current study was to determine whether levosimendan could improve renal outcome in acute decompensated heart failure patients with and without worsening renal function. Methods: Forty-five consecutive patients who had a reduced glomerular filtration rate and had at least two consecutive data regarding renal function prior to administration of levosimendan were enrolled in the study. Patients were classified into two groups as those with and without worsening renal function based on an increase in serum creatinine >0.3 mg/dL. Results: A significant improvement was noted in renal function in patients with worsening renal function (serum creatinine from 1.4 +/- 0.16 to 1.21 +/- 0.23 mg/dL, p=0.001 and glomerular filtration rate level from 48.9 +/- 15 to 59.3 +/- 21.8 mL/min/m(2), p=0.011), while there was no significant improvement in those without worsening renal function (serum creatinine from 1.29 +/- 0.33 to 1.37 +/- 0.66 mg/dL, p=0.240 and glomerular filtration rate level from 53.7 +/- 17.6 to 52.9 +/- 21.4 mL/min/m(2), p=0.850). Conclusion: Levosimendan appears to provide a renal-enhancing effect in patients with severe, acute decompensated systolic heart failure and worsening renal function. Consideration of this differential effect might help obtain beneficial renal outcomes. (Arq Bras Cardiol 2012;98(6):537-543)Öğe Elevated gamma glutamyl transferase levels are associated with the location of acute pulmonary embolism. Cross-sectional evaluation in hospital setting(ASSOCIACAO PAULISTA MEDICINA, 2015) Korkmaz, Ozge; Yucel, Hasan; Zorlu, Ali; Berkan, Ocal; Kaya, Hakki; Goksel, Sebahattin; Beton, Osman; Yilmaz, Mehmet BirhanCONTEXT AND OBJECTIVE: The location of embolism is associated with clinical findings and disease severity in cases of acute pulmonary embolism. The level of gamma-glutamyl transferase increases under oxidative stress-related conditions. In this study, we investigated whether gamma-glutamyl transferase levels could predict the location of pulmonary embolism. DESIGN AND SETTING: Hospital-based cross-sectional study at Cumhuriyet University, Sivas, Turkey. METHODS: 120 patients who were diagnosed with acute pulmonary embolism through computed tomography-assisted pulmonary angiography were evaluated. They were divided into two main groups (proximally and distally located), and subsequently into subgroups according to thrombus localization as follows: first group (thrombus in main pulmonary artery; n = 9); second group (thrombus in main pulmonary artery branches; n = 71); third group (thrombus in pulmonary artery segmental branches; n = 34); and fourth group (thrombus in pulmonary artery subsegmental branches; n = 8). RESULTS: Gamma-glutamyl transferase levels on admission, heart rate, oxygen saturation, right ventricular dilatation/ hypokinesia, pulmonary artery systolic pressure and cardiopulmonary resuscitation requirement showed prognostic significance in univariate analysis. The multivariate logistic regression model showed that gamma-glutamyl transferase level on admission (odds ratio, OR = 1.044; 95% confidence interval, CI: 1.011-1.079; P = 0.009) and pulmonary artery systolic pressure (OR = 1.063; 95% CI: 1.005-1.124; P = 0.033) remained independently associated with proximally localized thrombus in pulmonary artery. CONCLUSIONS: The findings revealed a significant association between increased existing embolism load in the pulmonary artery and increased serum gamma-glutamyl transferase levels.Öğe Higher cancer antigen 125 level is associated with the presence of permanent atrial fibrillation in systolic heart failure patients(ACTA CARDIOLOGICA, 2016) Kaya, Hakki; Zorlu, Ali; Yucel, Hasan; Tatlisu, Mustafa Adem; Kivrak, Tarik; Coskun, Abuzer; Yilmaz, Mehmet BirhanIntroduction Atrial fibrillation (AF) is a common arrhythmia in heart failure (HF). Recent studies have shown that serum cancer antigen-125 (CA-125) levels are elevated in HF, and high levels of CA-125 in HF patients with sinus rhythm have been shown to be associated with the development of new onset AF. However, the relation between CA-125 levels and the presence of AF in HF is unknown. In this study we investigated whether plasma CA-125 levels in patients with systolic HF could predict the presence of AF. Methods The study was a retrospective cohort design including 205 stable systolic HF patients who were selected during outpatient clinic visits and who had CA-125 measurement and an electrocardiogram within the last one month before admittance to cardiology clinic. Patients were classified into two groups based on the presence of AF (n=67) or sinus rhythm (n=138). Results The mean age of the patients was 68 11 years. CA-125 levels were significantly higher in patients with AF than patients with SR [33 (3-273) vs 102 (7-296) U/ml, P < 0.001]. CA-125 level, presence of right ventricular dilatation, pericardial effusion, moderate to severe TR and MR, and left atrial diameter were found to be associated with the presence of AF in univariate analysis. In a multivariate logistic regression model, only the CA-125 level remained associated. Also, according to the ROC curve analysis, the optimal cut-off level of CA-125 for predicting AF was 91 U/mL with a specificity of 84% and a sensitivity of 54%. Conclusion We have shown that the CA-125 levels can be used to predict AF in patients with systolic HF.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 Influence of Regular Blood Donation Onto Flow Mediated Vasodilatation(ELSEVIER SCIENCE INC, 2013) Yucel, Hasan; Kaya, Hakki; Zorlu, Ali; Yilmaz, Mehmet Birhan…Öğe Left atrial metastasis of Ewing's sarcoma mimicking atrial myxoma(TURKISH SOC CARDIOLOGY, 2016) Kurt, Recep; Kaya, Hakki; Beton, Osman; Yucel, Hasan; Tekin, Gulacan…Öğe Lymphocytopenia is associated with poor NYHA functional class in chronic heart failure patients with reduced ejection fraction(TURKISH SOC CARDIOLOGY, 2015) Yucel, Hasan; Ege, Meltem Refiker; Zorlu, Ali; Kaya, Hakki; Beton, Osman; Gungor, Hasan; Acar, Gurkan; Temizhan, Ahmet; Cavusoglu, Yuksel; Zoghi, Mehdi; Eren, Mehmet; Ural, Dilek; Yilmaz, Mehmet BirhanObjective: In heart failure (HF) patients, functional capacity has been demonstrated to be a marker of poor prognosis, independent of left ventricular ejection fraction (EF). Lymphocyte count is currently recognized in certain risk stratification scores for chronic HF, and severe HF is associated with lymphocytopenia. However, no data exists on the association between lymphocyte count and functional capacity in patients with stable HF. This study aimed to assess the relationship between lymphocyte count and New York Heart Association (NYHA) functional capacity in systolic HF outpatients. Methods: The Turkish Research Team-HF (TREAT-HF) is a network which undertakes multi-center observational studies in HF. Data on 392 HF reduced ejection fraction (HFREF) patients from 8 HF centers are presented here. The patients were divided into two groups and compared: Group 1 comprised stable HFREF patients with mild symptoms NYHA Class (I-II), while Group 2 consisted of patients with NYHA Class III-IV symptoms. Results: Patient mean age was 60 +/- 14 years. Lymphocyte count was lower in patients with NYHA functional classes III and IV than in patients with NYHA functional classes I and II, 0.9 [0.6-1.5] x1000 versus 1.5 [0.7-2.2] x1000, p<0.001). In multivariate logistic regression analysis, lymphocyte count OR: 0.602, 95% CI: 0.375-0.967, p=0.036), advanced age, male gender, presence of hypertension, EF, left atrium size, systolic pulmonary artery pressure, neutrophil and basophil counts, creatinine level, and diuretic usage were associated with poor NYHA functional class in systolic HF outpatients. Conclusion: The present study demonstrated that in stable HFREF outpatients, lymphocytopenia was strongly associated with poor NYHA function, independent of coronary heart disease risk factors.
