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Çetin Güvenç R, Güvenç TS, Akıl MA, Bekar L, Vural MG, Yılmaz MB. Estimated plasma volume is not a robust indicator of the severity of congestion in patients with heart failure. Am J Med Sci 2023; 366:374-382. [PMID: 37640264 DOI: 10.1016/j.amjms.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/03/2023] [Accepted: 08/24/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Congestion is the main cause of morbidity and a prime determinant of survival in patients with heart failure (HF). However, the assessment of congestion is subjective and estimation of plasma volume (ePV) has been suggested as a more objective measure of congestion. This study aimed to explore the relationships and interactions between ePV, the severity of congestion and survival using a nationwide registry. METHODS Of the 1054 patients with HF enrolled in the registry, 769 had sufficient data to calculate ePV (using the Duarte, Kaplan, and Hakim equations) and relative plasma volume status (rPVS), and these patients were subsequently included in the present analysis. The severity of congestion was assessed using a 6-point congestion score (CS). Patients were divided into three groups according to the degree of congestion. RESULTS Out of four equations tested, only ePVDuarte and rPVS were statistically higher in patients with severe congestion as compared to patients with no congestion (p<0.001 for both). Both ePVDuarte (r = 0.197, p<0.001) and rPVS (r = 0.153, p<0.001) showed statistically significant correlations with CS and both had a modest accuracy (70.4% for ePVDuarte and 69.4% for rPVS) to predict a CS ≥3. After a median follow up of 496 days, both ePVDuarte (OR:1.14,95%CI:1.03-1.26, p = 0.01) and rPVS (OR:1.02, 95%CI:1.00-1.03, p = 0.03) were associated with all-cause mortality after adjusting for demographic and clinical variables. However, none of the indices were associated with mortality following the introduction of CS to the models (p>0.05 for both). CONCLUSIONS Elevated ePVDuarte and rPVS were indicators of congestion but with a limited robustness, and either parameter could be clinically useful when a comprehensive clinical evaluation of congestion is not feasible.
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Affiliation(s)
- Rengin Çetin Güvenç
- Istanbul Okan University School of Medicine, Department of Internal Medical Sciences, Division of Cardiology, Istanbul, Turkey.
| | - Tolga Sinan Güvenç
- Istinye University School of Medicine, Department of Internal Medical Sciences, Division of Cardiology, Istanbul, Turkey
| | - Mehmet Ata Akıl
- Dicle University School of Medicine, Department of Internal Medical Sciences, Division of Cardiology, Diyarbakır, Turkey
| | - Lütfü Bekar
- Hitit University School of Medicine, Department of Internal Medical Sciences, Division of Cardiology, Çorum, Turkey
| | - Mustafa Gökhan Vural
- Sakarya University School of Medicine, Department of Internal Medical Sciences, Division of Cardiology, Sakarya, Turkey
| | - Mehmet Birhan Yılmaz
- Dokuz Eylul University School of Medicine, Department of Internal Medical Sciences, Division of Cardiology, Istanbul, Turkey
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Kayıkcioglu M, Başaran Ö, Doğan V, Mert KU, Mert GÖ, Özdemir İH, Rencüzoğulları İ, Karadeniz FÖ, Tekinalp M, Aşkın L, Demirelli S, Gencer E, Bekar L, Aktaş M, Resulzade MM, Kalçık M, Aksan G, Cinier G, Akay KH, Pekel N, Utku Şenol, Demir V, İnci S, Derviş E, Özlek B, Özlek E, Çelik O, Çil C, Biteker M. Misperceptions and management of LDL-cholesterol in secondary prevention of patients with familial hypercholesterolemia in cardiology practice: Real-life evidence from the EPHESUS registry. J Clin Lipidol 2023; 17:732-742. [PMID: 38072583 DOI: 10.1016/j.jacl.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND AND AIMS Familial hypercholesterolemia (FH) is a common inherited disease, leading to premature atherosclerotic cardiovascular disease (ASCVD) due to elevated low-density lipoprotein cholesterol (LDL-C) levels. Achieving LDL-C goals is extremely important for preventing the complications of this fatal disease. We evaluated the management of FH patients with ASCVD in cardiology practice. METHODS We analyzed patients with ASCVD from the nationwide EPHESUS registry, which was conducted in 40 cardiology outpatient clinics, and compared those with and without FH. RESULTS Of the 1482 consecutively enrolled patients with ASCVD, 618 (41.7%) had FH, among which 455 were categorized as 'Possible FH' and 163 as 'Probable or Definite FH'. Proposed LDL-C goals were not attained in more than 90% of the patients with FH. The proportion of those on statin therapy was 77% for possible and 91% for probable or definite FH, whereas 34.2 % and 59.4% were in use of high-intensity statins, respectively. None of the patients were on PCSK-9 inhibitors, and only 2 used ezetimibe. Adverse media coverage was the most common cause of statin discontinuation (32.5% in 'possible FH' and 45.7% in 'probable/definite FH'). The negative impact of media in the decision to stop lipid lowering therapy (LLT) was increasing with education level. CONCLUSIONS In real life most of the FH patients with ASCVD are undertreated in cardiology practice regarding statin dosing and combined LLT. Drug discontinuation rates are notably high and are mostly media-related, and side effects very rarely cause cessation of LLT. Urgent measures are needed to increase the awareness of FH among healthcare providers and patients and to develop improved treatment strategies aimed at preventing the complications of FH.
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Affiliation(s)
- Meral Kayıkcioglu
- Department of Cardiology (Dr Kayıkcioglu), Ege University Faculty of Medicine, İzmir, Turkey.
| | - Özcan Başaran
- Department of Cardiology (Drs Başaran, Doğan, Özlek, Özlek, Çelik), Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Volkan Doğan
- Department of Cardiology (Drs Başaran, Doğan, Özlek, Özlek, Çelik), Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Kadir Uğur Mert
- Department of Cardiology (Dr Mert), Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Gurbet Özge Mert
- Department of Cardiology (Dr Mert), Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | | | - İbrahim Rencüzoğulları
- Department of Cardiology (Dr Rencüzoğulları), Kafkas University Faculty of Medicine, Kars, Turkey
| | - Fatma Özpamuk Karadeniz
- Department of Cardiology (Dr Karadeniz), Karamanoglu Mehmetbey University Faculty of Medicine, Karaman, Turkey
| | - Mehmet Tekinalp
- Department of Cardiology (Dr Tekinalp), Necip Fazıl State Hospital, Kahramanmaras, Turkey
| | - Lütfü Aşkın
- Department of Cardiology (Dr Aşkın), Dr. Ersin Arslan Education and Research Hospital, Gaziantep, Turkey
| | - Selami Demirelli
- Department of Cardiology (Dr Demirelli), Kayseri City Hospital, Kayseri, Turkey
| | - Erkan Gencer
- Department of Cardiology (Dr Gencer), Şanlıurfa Mehmet Akif İnan Education and Research Hospital, Şanlıurfa, Turkey
| | - Lütfü Bekar
- Department of Cardiology (Drs Bekar, Kalçık), Hitit University Faculty of Medicine, Çorum, Turkey
| | - Müjdat Aktaş
- Department of Cardiology (Dr Aktaş), Arnavutköy State Hospital, Istanbul, Turkey
| | | | - Macit Kalçık
- Department of Cardiology (Drs Bekar, Kalçık), Hitit University Faculty of Medicine, Çorum, Turkey
| | - Gökhan Aksan
- Department of Cardiology (Dr Aksan), Samsun Education and Research Hospital, Samsun, Turkey
| | - Göksel Cinier
- Department of Cardiology (Dr Cinier), Siyami Ersek Education and Research Hsopital, Istanbul, Turkey
| | - Kadriye Halli Akay
- Department of Cardiology (Dr Akay), Kocaeli State Hospital, Kocaeli, Turkey
| | - Nihat Pekel
- Department of Cardiology (Dr Pekel), Tekden Private Hospital Denizli, Turkey
| | - Utku Şenol
- Department of Cardiology (Dr Utku Şenol), Eskişehir Acıbadem Hospital, Eskişehir, Turkey
| | - Vahit Demir
- Department of Cardiology (Dr Demir), Yozgat City Hospital, Yozgat, Turkey
| | - Sinan İnci
- Department of Cardiology (Dr İnci), Aksaray University Faculty of Medicine, Aksaray
| | - Emir Derviş
- Department of Cardiology (Dr Derviş), Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Bülent Özlek
- Department of Cardiology (Drs Başaran, Doğan, Özlek, Özlek, Çelik), Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Eda Özlek
- Department of Cardiology (Drs Başaran, Doğan, Özlek, Özlek, Çelik), Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology (Drs Başaran, Doğan, Özlek, Özlek, Çelik), Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Cem Çil
- Department of Cardiology (Dr Çil), Medlife Medical Center, Muğla, Turkey
| | - Murat Biteker
- Department of Cardiology (Dr Biteker), Private Fethiye Lokman Hekim Hospital, Mugla, Turkey
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Mert GÖ, Özlek B, Özlek E, Zencirkıran Ağuş H, Tekinalp M, Kahraman S, Çil C, Çelik O, Başaran Ö, Doğan V, Caner Kaya B, Rencüzoğulları İ, Ösken A, Bekar L, Ozan Çakır M, Çelik Y, Memiç Sancar K, Sevinç S, Biteker M, Uğur Mert K. Comparing the Diagnostic Performance of HFA-PEFF and H2FPEF Scoring Systems in Heart Failure with Preserved Ejection Fraction Patients: Insights from the APOLLON Registry. Anatol J Cardiol 2023; 27:539-548. [PMID: 37655737 PMCID: PMC10510413 DOI: 10.14744/anatoljcardiol.2023.3345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/28/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Heart failure with preserved ejection fraction is a complex and heterogeneous clinical syndrome, poses significant diagnostic challenges. The HFA-PEFF [Heart Failure Association of ESC diagnostic algorithm, P (Pretest Assessment), E (Echocardiographic and Natriuretic Peptide score), F1 (Functional testing in Case of Uncertainty), F2 (Final Aetiology)] and H2FPEF [Heavy (BMI>30 kg/m2), Hypertensive (use of ≥2 antihypertensive medications), atrial Fibrillation (paroxysmal or persistent), Pulmonary hypertension (Doppler Echocardiographic estimated Pulmonary Artery Systolic Pressure >35 mm Hg), Elderly (age >60 years), Filling pressure (Doppler Echocardiographic E/e' >9)] scoring systems were developed to aid in diagnosing heart failure with preserved ejection fraction. This study aimed to assess the concordance and clinical accuracy of these scoring systems in the 'A comPrehensive, ObservationaL registry of heart faiLure with mildly reduced and preserved ejection fractiON' cohort. METHODS A comPrehensive, ObservationaL registry of heart faiLure with mildly reduced and preserved ejection fractiON study was conducted as a multicenter, cross-sectional, and observational study; to evaluate a group of Heart failure with mildly reduced ejection fraction and heart failure with preserved ejection fraction patients who were seen by cardiologists in 13 participating centers across 12 cities in Türkiye. RESULTS The study enrolled 819 patients with heart failure with preserved ejection fraction, with high probability heart failure with preserved ejection fraction rates of 40% and 26% for HFA-PEFF and H2FPEF scorings, respectively. The concordance between the 2 scoring systems was found to be low (Kendall's taub correlation coefficient of 0.242, P < .001). The diagnostic performance of both scoring systems was evaluated, revealing differences in their approach and ability to accurately identify heart failure with preserved ejection fraction patients. CONCLUSION The low concordance between the HFA-PEFF and H2FPEF scoring systems underscores the ongoing challenge of accurately diagnosing and managing patients with heart failure with preserved ejection fraction. Clinicians should be aware of the strengths and limitations of each scoring system and use them in conjunction with other clinical and laboratory findings to arrive at an accurate diagnosis. Future research should focus on identifying additional diagnostic factors, developing more accurate and comprehensive diagnostic algorithms, and investigating alternative methods of diagnosis or stratification of patients based on different clinical characteristics.
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Affiliation(s)
- Gurbet Özge Mert
- Department of Cardiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Türkiye
| | - Bülent Özlek
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Türkiye
| | - Eda Özlek
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Türkiye
| | - Hicaz Zencirkıran Ağuş
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Mehmet Tekinalp
- Department of Cardiology, Kahramanmaraş Necip Fazıl City Hospital, Kahramanmaraş, Türkiye
| | - Serkan Kahraman
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Cem Çil
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Türkiye
| | - Oğuzhan Çelik
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Türkiye
| | - Özcan Başaran
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Türkiye
| | - Volkan Doğan
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Türkiye
| | - Bedri Caner Kaya
- Department of Cardiology, Mehmet Akif İnan Training and Research Hospital, Şanlıurfa, Türkiye
| | | | - Altuğ Ösken
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Lütfü Bekar
- Department of Cardiology, Hitit University Çorum Erol Olçok Training and Research Hospital, Çorum, Türkiye
| | - Mustafa Ozan Çakır
- Department of Cardiology, Faculty of Medicine, Bülent Ecevit Universiy, Zonguldak, Türkiye
| | - Yunus Çelik
- Department of Cardiology, Kırıkkale Yüksek İhtisas Hospital, Kırıkkale, Türkiye
| | - Kadriye Memiç Sancar
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Samet Sevinç
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Murat Biteker
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Türkiye
| | - Kadir Uğur Mert
- Department of Cardiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Türkiye
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Ekin T, Kış M, Güngören F, Akhan O, Atıcı A, Kunak AÜ, Mutlu D, Katkat F, Demir M, Saraç İ, Soydan E, Karabulut D, Karaduman M, Alp Ç, Bekar L, Böyük F, Adıyaman MŞ, Kaplan M, Zengin İ, Çalışkan S, Kıvrak T, Öz A, Eren H, Bayrak M, Karabulut U, Öztaş S, Düz R, Uluuysal Ö, Balun A, Sağır GN, Kudat H, Pamukçu HE, Abacıoğlu ÖÖ, Göldağ ÖG, Özmen Ç, Günay Ş, Zoghi M, Ergene AO. Awareness and Knowledge of Pneumococcal Vaccination in Cardiology Outpatient Clinics and the Impact of Physicians’ Recommendations on Vaccination Rates. Vaccines (Basel) 2023; 11:vaccines11040772. [PMID: 37112684 PMCID: PMC10142867 DOI: 10.3390/vaccines11040772] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 04/03/2023] Open
Abstract
Aim: We aimed to evaluate the awareness of pneumococcal vaccination (PCV13, PPSV23) in general cardiology outpatient clinics and impact of physicians’ recommendations on vaccination rates. Methods: This was a multicenter, observational, prospective cohort study. Patients over the age of 18 from 40 hospitals in different regions of Turkey who applied to the cardiology outpatient clinic between September 2022 and August 2021 participated. The vaccination rates were calculated within three months of follow-up from the admitting of the patient to cardiology clinics. Results: The 403 (18.2%) patients with previous pneumococcal vaccination were excluded from the study. The mean age of study population (n = 1808) was 61.9 ± 12.1 years and 55.4% were male. The 58.7% had coronary artery disease, hypertension (74.1%) was the most common risk factor, and 32.7% of the patients had never been vaccinated although they had information about vaccination before. The main differences between vaccinated and unvaccinated patients were related to education level and ejection fraction. The physicians’ recommendations were positively correlated with vaccination intention and behavior in our participants. Multivariate logistic regression analysis showed a significant correlation between vaccination and female sex [OR = 1.55 (95% CI = 1.25–1.92), p < 0.001], higher education level [OR = 1.49 (95% CI = 1.15–1.92), p = 0.002] patients’ knowledge [OR = 1.93 (95% CI = 1.56–2.40), p < 0.001], and their physician’s recommendation [OR = 5.12 (95% CI = 1.92–13.68), p = 0.001]. Conclusion: To increase adult immunization rates, especially among those with or at risk of cardiovascular disease (CVD), it is essential to understand each of these factors. Even if during COVID-19 pandemic, there is an increased awareness about vaccination, the vaccine acceptance level is not enough, still. Further studies and interventions are needed to improve public vaccination rates.
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Affiliation(s)
- Tuba Ekin
- Clinic of Cardiology, Sorgun State Hospital, 66700 Yozgat, Turkey
- Correspondence:
| | - Mehmet Kış
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University, 35340 İzmir, Turkey
| | - Fatih Güngören
- Department of Cardiology, Faculty of Medicine, Harran University, 63000 Şanlıurfa, Turkey
| | - Onur Akhan
- Cardiology Department, Bilecik Training and Research Hospital, 11130 Bilecik, Turkey
| | - Adem Atıcı
- Cardiology Department, Faculty of Medicine, Istanbul Medeniyet University, 34722 Istanbul, Turkey
| | - Ayşegül Ülgen Kunak
- Antalya Private Medstar Topçular Hospital Cardiology Clinic, 07200 Antalya, Turkey
| | - Deniz Mutlu
- Department of Cardiology, Istanbul Medical Faculty, Istanbul University, 34452 Istanbul, Turkey
| | - Fahrettin Katkat
- Cardiology Department, Bagcilar Training and Research Hospital, University of Health Sciences, 34165 Istanbul, Turkey
| | - Mevlüt Demir
- Department of Cardiology, Faculty of Medicine, Kütahya Health Sciences University, 43270 Kütahya, Turkey
| | - İbrahim Saraç
- Department of Cardiology, University of Health Sciences, Education and Research Hospital, 25240 Erzurum, Turkey
| | - Elton Soydan
- Department of Cardiology, Faculty of Medicine, Ege University, 35100 İzmir, Turkey
| | - Dilay Karabulut
- Department of Cardiology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, 34450 Istanbul, Turkey
| | - Medeni Karaduman
- Cardiyology Department, Van Yüzüncü Yıl Universty, 65080 Van, Turkey
| | - Çağlar Alp
- Department of Cardiology, Faculty of Medicine, Kırıkkale University, 71450 Kırıkkale, Turkey
| | - Lütfü Bekar
- Department of Cardiology, Hitit University Corum Erol Olcok Training and Research Hospital, 19040 Corum, Turkey
| | - Ferit Böyük
- Department of Cardiology, Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, 34020 Istanbul, Turkey
| | - Mehmet Şahin Adıyaman
- Department of Cardiology, Gazi Yaşargil Training and Research Hospital, 21010 Diyarbakır, Turkey
| | - Mehmet Kaplan
- Department of Cardiology, Gaziantep University School of Medicine, 27310 Gaziantep, Turkey
| | - İsmet Zengin
- Department of Cardiology, Bursa City Hospital, 16110 Bursa, Turkey
| | - Serhat Çalışkan
- Department of Cardiology, Bahçelievler State Hospital, 34476 İstanbul, Turkey
| | - Tarık Kıvrak
- Department of Cardiology, Faculty of Medicine, Elazığ Fırat University, 23119 Elazığ, Turkey
| | - Ahmet Öz
- Department of Cardiology, İstanbul Training and Research Hospital, University of Health Sciences, 34098 İstanbul, Turkey
| | - Hayati Eren
- Department of Cardiology, Elbistan State Hospital, 46300 Kahramanmaraş, Turkey
| | - Murat Bayrak
- Antalya Kepez State Hospital Cardiology Clinic, 07320 Kepez, Turkey
| | - Umut Karabulut
- Department of Cardiology, İstanbul Acıbadem International Hospital, 34149 İstanbul, Turkey
| | - Selvi Öztaş
- Department of Cardiology, Bursa City Hospital, 16110 Bursa, Turkey
| | - Ramazan Düz
- Cardiyology Department, Van Yüzüncü Yıl Universty, 65080 Van, Turkey
| | - Ömer Uluuysal
- Department of Cardiology, Uludağ University, 16059 Bursa, Turkey
| | - Ahmet Balun
- Department of Cardiology, Bandırma Onyedi Eylul University, 10200 Balıkesir, Turkey
| | - Gurur Nar Sağır
- Cardiology Department, Bagcilar Training and Research Hospital, University of Health Sciences, 34165 Istanbul, Turkey
| | - Hasan Kudat
- Department of Cardiology, Istanbul Medical Faculty, Istanbul University, 34452 Istanbul, Turkey
| | - Hilal Erken Pamukçu
- Department of Cardiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, 06110 Ankara, Turkey
| | - Özge Özcan Abacıoğlu
- Department of Cardiology, Adana City Training and Research Hospital, 01120 Adana, Turkey
| | - Ömer Görkem Göldağ
- Department of Cardiology, Training and Research Hospital, 07400 Alanya, Turkey
| | - Çağlar Özmen
- Department of Cardiology, Faculty of Medicine, Cukurova University, 01330 Adana, Turkey
| | - Şeyda Günay
- Department of Cardiology, Uludağ University, 16059 Bursa, Turkey
| | - Mehdi Zoghi
- Department of Cardiology, Faculty of Medicine, Ege University, 35100 İzmir, Turkey
| | - Asım Oktay Ergene
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University, 35340 İzmir, Turkey
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5
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Şabanoğlu C, Sinan ÜY, Akboğa MK, Çoner A, Gök G, Kocabaş U, Bekar L, Gazi E, Cengiz M, Kılıç S, İnanç İH, Çakmak HA, Zoghi M. Long-Term Prognosis of Patients with Heart Failure: Follow-Up Results of Journey HF-TR Study Population. Anatol J Cardiol 2023; 27:26-33. [PMID: 36680444 PMCID: PMC9893707 DOI: 10.14744/anatoljcardiol.2022.2171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/21/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Despite advances in therapeutic management of patients with heart failure, there is still an increasing morbidity and mortality all over the world. In this study, we aimed to present the 3-year follow-up outcomes of patients included in the Journey HF-TR study in 2016 that has evaluated the clinical characteristics and management of patients with acute heart failure admitted to the hospital and present a national registry data. METHODS The study was designed retrospectively between November 2016 and December 2019. Patient data included in the previously published Journey HF-TR study were used. Among 1606 patients, 1484 patients were included due to dropout of 122 patients due to inhospital death and due to exclusion of 173 due to incomplete data. The study included 1311 patients. Age, gender, concomitant chronic conditions, precipitating factors, New York Heart Association, and left ventricular ejection fraction factors were adjusted in the Cox regression analysis. RESULTS During the 3-year follow-up period, the ratio of hospitalization and mortality was 70.5% and 52.1%, respectively. Common causes of mortality were acute decompensation of heart failure and acute coronary syndrome. Angiotensin receptor blockers, betablockers, statin, and sacubitril/valsartan were found to reduce mortality. Hospitalization due to acute decompensated heart failure, acute coronary syndrome, lung diseases, oncological diseases, and cerebrovascular diseases was associated with the increased risk of mortality. Implantation of cardiac devices also reduced the mortality. CONCLUSIONS Despite advances in therapeutic management of patients with heart failure, our study demonstrated that the long-term mortality still is high. Much more efforts are needed to improve the inhospital and long-term survival of patients with chronic heart failure.
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Affiliation(s)
- Cengiz Şabanoğlu
- Department of Cardiology, Kırıkkale Yüksek İhtisas Hospital, Kırıkkale, Turkey
| | - Ümit Yaşar Sinan
- Department of Cardiology, İstanbul University-Cerrahpaşa Institute of Cardiology, İstanbul, Turkey
| | - Mehmet Kadri Akboğa
- Department of Cardiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ali Çoner
- Department of Cardiology, Başkent University Hospital, Antalya, Turkey
| | - Gülay Gök
- Department of Cardiology, Faculty of Medicine, İstanbul Medipol University, İstanbul, Turkey
| | - Umut Kocabaş
- Department of Cardiology, Başkent University Hospital, İzmir, Turkey
| | - Lütfü Bekar
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Emine Gazi
- Department of Cardiology, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Mahir Cengiz
- Department of Cardiology, Faculty of Medicine, İstanbul Aydın University, İstanbul, Turkey
| | - Salih Kılıç
- Department of Cardiology, Adana City Training and Research Hospital, Adana, Turkey
| | - İbrahim Halil İnanç
- Department of Cardiology, Faculty of Medicine, Haliç University, İstanbul, Turkey
| | - Hüseyin Altuğ Çakmak
- Department of Cardiology, Adana City Training and Research Hospital, Adana, Turkey
| | - Mehdi Zoghi
- Department of Cardiology, Ege University Hospital, İzmir, Turkey
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6
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Ekin T, Kis M, Gungoren F, Atici A, Kunak AÜ, Mutlu D, Katkat F, Demir M, Sarac İ, Soydan E, Karaduman M, Bekar L, Boyuk F, Adiyaman MS, Zoghi M. Awareness and knowledge of pneumococcal vaccination in cardiology outpatient clinics and impact of physicians' recommendation on vaccination rates. Eur J Prev Cardiol 2022. [PMCID: PMC9384017 DOI: 10.1093/eurjpc/zwac056.170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Although there is not enough data on pneumococcal vaccination status in patients with cardiovascular disease and or risk factors in our country, it is known that vaccination rates are quite low in the current data.
Purpose
We aimed to evaluate the awareness of pneumococcal vaccination (PCV13, PPSV23) in general cardiology outpatient clinics and impact of physician’s recommendation (with educational brochures) on vaccination rate.
Methods
Awareness of vaccination, before COVID-19 pandemic, was measured in patients admitting to cardiology outpatient clinics from 40 center of our country by a questionnaire contained 19 questions. The demographics (including gender, age, educational level, awareness vaccination level) and comorbidities were obtained. The vaccination rates were calculated within 3-months follow-up from the admitting of patient to cardiology clinics.
Results
The 403 (18.2%) of patients with previous pneumococcal vaccination were excluded from the study. The mean age of study population (n=1808) was 61.9±12.1 years and 55.4% were male. The 58.7% had coronary artery disease, hypertension (74.1%) was the most common risk factor and 32.7% of the patients had never been vaccinated although they had information about vaccination before. The 98.5% were referred to family medicine (n=1412, 78.1%) or vaccination outpatient clinics (n=370, 20.5%) and the vaccination rate was 62.1% during the follow-up period. The differences between vaccinated and not-vaccinated patients are presented in Table 1.
The physician’s recommendation was positively correlated with vaccination intention and behavior in our participants. Multivariate logistic regression analysis showed a significant between vaccination and female sex [OR=1.55 (95% CI=1.25–1.92), p<0.001], higher education level [OR=1.49 (95% CI=1.15-1.92), p=0.002] patients’ knowledge [OR=1.93 (95% CI=1.56-2.40), p<0.001], and their physician’s recommendation [OR=5.12 (95% CI=1.92-13.68), p=0.001].
Conclusion
To our knowledge this is the first report about the awareness pneumococcal vaccination rates and impact of physician’s recommendation in patients with cardiovascular disease by high study population. These findings suggest providing information on the benefits of vaccination by physician’s and educational advice was significantly associated with an increase vaccination rate and have a key role.
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Affiliation(s)
- T Ekin
- Sorgun State Hospital, Cardiology, Yozgat, Turkey
| | - M Kis
- Dokuz Eylul University, Cardiology, Izmir, Turkey
| | | | - A Atici
- Medeniyet University, Istanbul, Turkey
| | - AÜ Kunak
- Medstar Hospital, Antalya, Turkey
| | - D Mutlu
- Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - F Katkat
- Istanbul Education and Research Hospital, Istanbul, Turkey
| | - M Demir
- Kutahya Health Sciences University, Kutahya, Turkey
| | - İ Sarac
- Regional Training and Research Hospital, Erzurum, Turkey
| | | | | | - L Bekar
- HITIT UNIVERSITY, Corum, Turkey
| | - F Boyuk
- Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - MS Adiyaman
- Gazi Yasargil Research Hospital, Diyarbakir, Turkey
| | - M Zoghi
- Ege University, Izmir, Turkey
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7
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Kaya H, Şahin A, Güneş H, Bekar L, Çelik A, Çavuşoğlu Y, Çaldır V, Güngör H, Yılmaz MB. Increased frequency of occurrence of bendopnea is associated with poor outcomes in heart failure outpatients. Acta Cardiol 2021; 76:878-886. [PMID: 32812491 DOI: 10.1080/00015385.2020.1797303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Relationship between the frequency of occurrence of bendopnea during the daily life of heart failure (HF) outpatients and clinical outcomes has never been evaluated before. METHODS Turkish Research Team-Heart Failure (TREAT-HF) is a network between HF centres, which undertakes multicentric observational studies in HF. Herein, the data including stable 573 HF patients with reduced ejection fraction out of seven HF centres were presented. A questionnaire was filled by the patients, with the question 'Do you experience shortness of breath while tying your shoelace?', assessing the presence and frequency of bendopnea. RESULTS To the question related to bendopnea, 48% of the patients answered 'yes, every time', 31% answered 'yes, sometimes', and 21% answered 'No'. Patients were followed for an average of 24 ± 14 months, and the patients who answered 'yes, every time' and 'yes, sometimes' to the bendopnea question were found having increased risk for both HF-related hospitalisations (HR:3.2, p < .001- HR:2.8, p = .005) and composite outcome consisting of 'HF-related hospitalisations and all-cause death in the multi-variate analysis (HR:3.1, p < .001- HR:3.0, p < .001). Kaplan Meier analysis for HF-related hospitalisation, all-cause death, and the composite of these were provided for these three groups, yielding significant and graded divergence curves with the best prognosis in 'no' group, with the moderate prognosis in 'sometimes' group, and with the worst prognosis in the 'every time' group. CONCLUSION For the first time in the literature, our study shows that the increased frequency of bendopnea occurrence in daily life is associated with poor outcomes in HF outpatients.
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Affiliation(s)
- Hakkı Kaya
- Department of Cardiology, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Anıl Şahin
- Antalya Training and Research Hospital, Cardiology Clinics, Antalya, Turkey
| | - Hakan Güneş
- Department of Cardiology, Faculty of Medicine, Sutcu Imam University, Kahramanmaras, Turkey
| | - Lütfü Bekar
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Ahmet Çelik
- Department of Cardiology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Yüksel Çavuşoğlu
- Department of Cardiology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Vedat Çaldır
- Cardiology Clinic, Baskent University Konya Hospital, Konya, Turkey
| | - Hasan Güngör
- Department of Cardiology, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Mehmet Birhan Yılmaz
- Department of Cardiology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
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8
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Mert KU, Başaran Ö, Mert GÖ, Doğan V, Rencüzoğulları İ, Özlek B, Cinier G, Şenol U, Çelik O, Özlek E, Özdemir İH, Karadeniz FÖ, Bekar L, Aktaş M, Resulzade MM, Kalçık M, Aksan G, Akay K, Pekel N, Biteker M, Kayıkçıoğlu M. Management of LDL-cholesterol levels in patients with Diabetes Mellitus in Cardiology Practice: Real-life evidence of Under-treatment from the EPHESUS registry. Eur J Clin Invest 2021; 51:e13528. [PMID: 33630348 DOI: 10.1111/eci.13528] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Effective treatment of high low-density lipoprotein cholesterol (LDL-C) levels has been shown to improve cardiovascular outcomes of patients with diabetes mellitus (DM). Herein, we aimed to provide insight to the real-life management of patients with DM in terms of LDL-C goal attainment and adherence to lipid management recommendations. Our objective was also to reveal the reasons of poor LDL-C goal attainment by assessing the perceptions of both physicians and patients. METHODS We compared the diabetic and non-diabetic patients from the database of a nationwide registry conducted in cardiology outpatient clinics with regard to the demographic characteristics, educational status, comorbidities, medications, laboratory parameters and LDL-C goal attainment. Also, both the patients and attending physicians were surveyed to analyse perceptions and awareness of hypercholesterolemia. RESULTS Of the 1868 consecutively enrolled patients, 873 (47%) had DM. Proportion of patients on statins was significantly lower in patients with DM (67.8% vs 55.3%; P < .001). The proportion of patients who attained LDL-C targets were lower among the diabetic patients (17.8% vs 15%; P = .06). The most common causes of the discontinuation of statin therapy were negative media coverage about statins (32.1%), and recommendations of physicians to stop the lipid lowering therapy (29.6%). Analysis of the physician survey revealed that the physicians could determine the off-target patients accurately (negative predictive value 98.4%) while the positive predictive value (48.8%) was low. The reasons for not attaining the LDL-C goals in diabetic patients were not prescription of statins (38%) and inadequate (eg low-dose, non-adherent) statin (28.3%) dosages. CONCLUSIONS In real-life clinical cardiology practice, diabetic patients are far below the recommended LDL-C treatment goals. High-intensity statin treatment in diabetic population is still avoided because of the concerns about polypharmacy and drug interactions. Also, the inertia of physicians and even cardiologists is probably a major cause of refraining of prescription of optimal statin dosages.
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Affiliation(s)
- Kadir Uğur Mert
- Department of Cardiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Özcan Başaran
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Gurbet Özge Mert
- Department of Cardiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Volkan Doğan
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | | | - Bülent Özlek
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Göksel Cinier
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Utku Şenol
- Department of Cardiology, Eskisehir Acıbadem Hospital, Eskişehir, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Eda Özlek
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | | | | | - Lütfü Bekar
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
| | - Müjdat Aktaş
- Department of Cardiology, Kocaeli University Faculty of Medicine Regional Training and Research Hospital, Kocaeli, Turkey
| | | | - Macit Kalçık
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
| | - Gökhan Aksan
- Department of Cardiology, Sisli Hamidiye Etfal Research and Training Hospital, İstanbul, Turkey
| | - Kadriye Akay
- Department of Cardiology, Kocaeli State Hospital, Kocaeli, Turkey
| | - Nihat Pekel
- Department of Cardiology, Tekden Private Hospital, Denizli, Turkey
| | - Murat Biteker
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Meral Kayıkçıoğlu
- Department of Cardiology, Ege University Faculty of Medicine, İzmir, Turkey
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9
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Çelik O, Çil C, Başaran Ö, Demirci E, Tanık VO, Altuntaş E, Memiç Sancar K, Örsçelik Ö, Yetim M, Bekar L, Karaarslan O, Özlek B, Özlek E, Gökçek A, Doğan T, Resulzade MM, Kaya Ç, Küçük E, Kırış T, Demirtaş AO, Civan M, Asoğlu R, Doğan V, Biteker M. Inappropriate Use of Aspirin in Real-Life Cardiology Practice: Results from the Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study (ASSOS) Study. Balkan Med J 2021; 38:183-189. [PMID: 34142960 PMCID: PMC8880923 DOI: 10.5152/balkanmedj.2021.21143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Indications and appropriateness of aspirin use have not been well investigated in Turkey. Aims: To investigate the prescription patterns and appropriateness of aspirin in a real-world clinical setting. Study Design: Cross-sectional study. Methods: The Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study (ASSOS) is a cross-sectional and multicenter study that included 5007 consecutive patients aged 18 or over who presented to 30 different cardiology outpatient clinics from 14 cities throughout Turkey. Only patients using aspirin (80-325 mg) were included. The study population was divided into 2 groups regarding the use of aspirin: primary prevention (PP) group and secondary prevention (SP) group. The indication of aspirin use was evaluated following the 2016 European Society of Cardiology (ESC) and the 2016 United States Preventative Services Task Force (USPTF) guidelines in the PP group. Results: A total of 5007 patients (mean age 62.15 ± 11.05, 39% female) were enrolled. The PP group included 1132 (22.6%) patients, and the SP group included 3875 (77.4%) patients. Of the 1132 patients, inappropriate use of aspirin was determined in 100% of the patients according to the ESC guidelines, and 71% of the patients according to the USPTF guidelines. Multivariate logistic regression analysis showed age OR: 0.98 CI (0.97-0.99) P = .037, smoking OR: 0.60 CI (0.44-0.82) P = .001, heart failure OR: 2.11 CI (1.14-3.92) P = .017, hypertension OR: 0.51 CI (0.36-0.74) P < .001, diabetes mellitus OR: 0.34 CI (0.25-0.47) P < .001, oral anticoagulant use OR: 3.01 CI (1.10-8.25) P = .032, and female sex OR: 2.73 CI (1.96-3.80) P < .001 were independent predictors of inappropriate aspirin use in PP patients. Conclusion: Although there are considerable differences between the USPTF and the ESC guidelines with respect to recommendations for aspirin use in PP, inappropriate use of aspirin in Turkey is frequent in real-world practice for both guidelines. Besides, heart failure, oral anticoagulant use, and the female sex of the patients were independent predictors of inappropriate use of aspirin.
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Affiliation(s)
- Oğuzhan Çelik
- Department of Cardiology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
| | - Cem Çil
- Department of Cardiology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
| | - Özcan Başaran
- Department of Cardiology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
| | - Erkan Demirci
- Clinic of Cardiology, Kayseri City Hospital, Kayseri, Turkey
| | - Veysel Ozan Tanık
- Department of Cardiology, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Emine Altuntaş
- Department of Cardiology, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul, Turkey
| | - Kadriye Memiç Sancar
- Department of Cardiology, Mehmet Akif Ersoy Training and Research Hospital, İstanbul, Turkey
| | - Özcan Örsçelik
- Department of Cardiology, Mersin University School of Medicine, Mersin, Turkey
| | - Mücahit Yetim
- Department of Cardiology, Hitit University Çorum Erol Olçok Training and Research Hospital, Çorum, Turkey
| | - Lütfü Bekar
- Department of Cardiology, Hitit University Çorum Erol Olçok Training and Research Hospital, Çorum, Turkey
| | - Osman Karaarslan
- Department of Cardiology, Hitit University Çorum Erol Olçok Training and Research Hospital, Çorum, Turkey
| | - Bülent Özlek
- Department of Cardiology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
| | - Eda Özlek
- Department of Cardiology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
| | - Aysel Gökçek
- Department of Cardiology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
| | - Tolga Doğan
- Department of Cardiology, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | | | - Çağlar Kaya
- Department of Cardiology, Trakya University School of Medicine, Edirne, Turkey
| | - Emrah Küçük
- Clinic of Cardiology, Kızıltepe State Hospital, Mardin, Turkey
| | - Tuncay Kırış
- Department of Cardiology, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | | | - Murat Civan
- Department of Cardiology, Bahçelievler Vital Private Hospital, İstanbul, Turkey
| | - Ramazan Asoğlu
- Department of Cardiology, Adıyaman University School of Medicine, Adıyaman, Turkey
| | - Volkan Doğan
- Department of Cardiology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
| | - Murat Biteker
- Department of Cardiology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
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10
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Basaran O, Dogan V, Mert G, Mert K, Ozlek B, Celik O, Ozlek E, Cil C, Bekar L, Aktas M, Resulzade M, Kalcik M, Aksan G, Cinier G, Akay K, Senol U, Demir V, Inci S, Biteker M, Kaykcioglu M. Lipid management and LDL-C goal attainment in primary prevention: An analysis of EPHESUS study. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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11
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Bekar L, Kalçık M, Katar M, Yetim M, Çelik O, Doğan T, Karavelioğlu Y, Gölbaşı Z. Investigation of ICAM-1 levels in hypertensive patients with fragmented QRS complexes. Acta Cardiol 2020; 75:123-129. [PMID: 30650029 DOI: 10.1080/00015385.2018.1555200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objective: Fragmented QRS (fQRS) detected on a 12-lead electrocardiogram (ECG) has been demonstrated to be a marker of myocardial fibrosis. Intercellular adhesion molecule-1 (ICAM-1) is a protein which plays an important role in fibro-inflammatory processes. In this study, we aimed to investigate the relationship between ICAM-1 levels and the presence of fQRS in hypertensive patients.Methods: Ninety consecutive patients who were diagnosed with hypertension were included in the study. ECG and transthoracic echocardiography were performed to all patients. fQRS was defined as additional R' wave or notching/splitting of S wave in two contiguous ECG leads. Serum ICAM-1 levels were measured using the enzyme-linked immunosorbent assay method. Patients were divided into two groups according to the presence of fQRS.Results: A total of 90 patients (female, 65%; mean age: 54.6 ± 8.5 years) were included in the study. fQRS was detected on ECG recordings of 47 (52.2%) patients. The demographic characteristics were similar between the groups. Left atrial diameter (p = .003), interventricular septal thickness (p = .013), posterior wall thickness (p = .01), left ventricular mass (p = .002), left ventricular mass index (p < .001), left ventricular hypertrophy (p = .001), and ICAM-1 levels (p < .001) were found to be significantly increased in fQRS(+) group. In multivariate analysis, only high ICAM-1 level was observed to be an independent predictor for the presence of fQRS (odds ratio: 1.029; 95%Confidence Interval: 1.013-1.045, p < .001).Conclusion: A significant association exists between serum ICAM-1 levels and the presence of fQRS in hypertensive patients. The presence of fQRS may be used as an indicator of inflammation in hypertensive patients.
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Affiliation(s)
- Lütfü Bekar
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
| | - Macit Kalçık
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
| | - Muzaffer Katar
- Department of Biochemistry, Gaziosmanpasa University Faculty of Medicine, Tokat, Turkey
| | - Mucahit Yetim
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology, Muğla Sıtkı Koçman Training and Research Hospital, Muğla, Turkey
| | - Tolga Doğan
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
| | - Yusuf Karavelioğlu
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
| | - Zehra Gölbaşı
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
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12
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Doğan V, Başaran Ö, Özlek B, Çelik O, Özlek E, Çil C, Özdemir IH, Rencüzoğulları I, Özpamuk Karadeniz F, Bekar L, Aktas M, Resulzade MM, Kalçık M, Aksan G, Çinier G, Halli Akay K, Mert KU, Biteker M, Kayıkçıoğlu M. Evaluation of perceptions, knowledge and compliance with guidelines in real-life practice: A survey on the under-treatment of hypercholesterolemia. Turk Kardiyol Dern Ars 2020; 47:599-608. [PMID: 31582673 DOI: 10.5543/tkda.2019.39293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Few studies have directly assessed suboptimal management of dyslipidemia in Turkey. This study was conducted to assess patients' understanding and perceptions of high cholesterol as well as physicians' knowledge and awareness of lipid management strategies. METHODS This was a multicenter, observational study (ClinicalTrials.gov identifier: NCT02608645). Consecutive patients admitted to the participating cardiology clinics who were at least 18 years of age and who had been classified in a secondary prevention (SP) group or a high-risk primary prevention (PP) group were enrolled. The study population included 1868 patients from 40 sites in Turkey. Two-thirds (67.5%) of the patients in the SP group had been prescribed a statin, whereas only 30.1% of the PP group patients received statin therapy (p<0.001). RESULTS It was determined that 18% of the SP patients and 10.6% of the PP patients had a low-density lipoprotein cholesterol level at the recommended level (p<0.001). A patient survey revealed that almost half of the patients in the PP and in the SP groups were aware that their cholesterol levels were high. Negative information about statin treatment disseminated by media programs was the most common reason (9.4%) given for treatment discontinuation. CONCLUSION Perceptions, knowledge and compliance with the guidelines for PP and SP patients in real-life practice have increased, but it remains far below the desired level. Patients and physicians should have more information about the treatment of hyperlipidemia. More accurate media programming could help to prevent the dissemination of misinformation.
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Affiliation(s)
- Volkan Doğan
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Özcan Başaran
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Bülent Özlek
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Eda Özlek
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Cem Çil
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | | | | | | | - Lütfü Bekar
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
| | - Mujdat Aktas
- Department of Cardiology, Kocaeli University Faculty of Medicine Training and Research Hospital, Kocaeli, Turkey
| | | | - Macit Kalçık
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
| | - Gökhan Aksan
- Department of Cardiology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Göksel Çinier
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery, Training and Research Hospital, İstanbul, Turkey
| | | | - Kadir Ugur Mert
- Department of Cardiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Murat Biteker
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Meral Kayıkçıoğlu
- Department of Cardiology, Ege University Faculty of Medicine, İzmir, Turkey
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13
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Kalçık M, Yetim M, Doğan T, Doğan İ, Eser B, Bekar L, Çelik O, Karavelioğlu Y. Comparison of aortic pressures and aortic elastic properties between patients with end-stage renal disease and healthy controls. Interv Med Appl Sci 2020; 11:77-83. [PMID: 32148909 PMCID: PMC7044540 DOI: 10.1556/1646.11.2019.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Current evidence indicates that vascular calcification plays an essential role in the development of cardiovascular diseases in end-stage renal disease (ESRD) patients. Arterial stiffness is a marker of increased cardiovascular risk in various populations. The aim of this study is to evaluate the elastic properties of ascending aorta in patients with ESRD. Methods This single-center study enrolled 96 patients (45 females, age: 57.2 ± 12.8 years) with ESRD and 96 healthy controls (52 females, age: 55.3 ± 10.1 years). Aortic pressures and aortic elastic parameters including aortic strain, aortic distensibility, aortic stiffness index, and aortic compliance were calculated using accepted formulae. Results The hemodynamic parameters including aortic pulse pressure, aortic mean pressure, aortic fractional pulse pressure, and aortic pulsatility index were significantly higher in patients with ESRD. Systolic and diastolic aortic diameters were similar between the groups. However, pulsatile aortic diameter change, aortic strain, aortic distensibility, and aortic compliance were significantly lower, whereas aortic stiffness index was significantly higher in ESRD group. Conclusions The results demonstrated that a significant difference was present in terms of aortic blood pressures between patients with ESRD and controls. In addition, the elastic properties of ascending aorta were decreased in patients with ESRD.
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Affiliation(s)
- Macit Kalçık
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Mucahit Yetim
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Tolga Doğan
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - İbrahim Doğan
- Department of Nephrology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Barış Eser
- Department of Nephrology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Lütfü Bekar
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey
| | - Yusuf Karavelioğlu
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
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Kalçık M, Yesin M, Güner A, Bayam E, Yetim M, Doğan T, Bekar L, Çelik O, Karavelioğlu Y. Echocardiographic measurement of epicardial adipose tissue thickness in patients with microvascular angina. Interv Med Appl Sci 2020; 11:106-111. [PMID: 32148914 PMCID: PMC7044543 DOI: 10.1556/1646.11.2019.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction Impaired coronary microcirculation, inflammation, and endothelial dysfunction were reported etiological factors for microvascular angina (MVA). Recently, increased epicardial adipose tissue (EAT) thickness has been associated with hypertension, metabolic syndrome, and coronary artery disease in general population. In this study, we aimed to evaluate the EAT thickness in patients with MVA. Methods This study enrolled 200 patients (83 males; mean age: 55.4 ± 8.2 years) who have been diagnosed with MVA and 200 controls (89 males; mean age: 54.4 ± 8.5 years). All patients underwent transthoracic echocardiography, and EAT thickness was measured from a parasternal long-axis view as the hypoechoic space on the right ventricular free wall. Results The mean EAT thickness was significantly higher in MVA patients than the controls (5.5 ± 1.1 vs. 4.9 ± 0.7 mm; p < 0.001). Multiple logistic regression analysis showed that increased EAT thickness was an independent predictor of MVA (OR = 1.183, 95% CI = 1.063-1.489; p = 0.023). In receiver operating characteristic curve analyses, EAT thickness above 5.3 mm predicted MVA with a sentivity of 68% and a specificity of 63% (AUC = 0.711, 95% CI = 0.659-0.762; p < 0.001). Conclusions The EAT thickness was observed significantly higher in MVA patients as compared to controls. Increased EAT thickness may be associated with mechanisms that play a major role in the pathogenesis of MVA.
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Affiliation(s)
- Macit Kalçık
- Faculty of Medicine, Department of Cardiology, Hitit University, Çorum, Turkey
| | - Mahmut Yesin
- Department of Cardiology, Kars Harakani State Hospital, Kars, Turkey
| | - Ahmet Güner
- Department of Cardiology, Kosuyolu Kartal Training and Research Hopital, Istanbul, Turkey
| | - Emrah Bayam
- Department of Cardiology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Mucahit Yetim
- Faculty of Medicine, Department of Cardiology, Hitit University, Çorum, Turkey
| | - Tolga Doğan
- Faculty of Medicine, Department of Cardiology, Hitit University, Çorum, Turkey
| | - Lütfü Bekar
- Faculty of Medicine, Department of Cardiology, Hitit University, Çorum, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology, Mugla Sitki Koçman University Training and Research Hospital, Mugla, Turkey
| | - Yusuf Karavelioğlu
- Faculty of Medicine, Department of Cardiology, Hitit University, Çorum, Turkey
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15
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Emren S, Zoghi M, Karagöz U, Inci S, Açiksari G, Bekar L, Emren Z, Ergene O. Assessment of the compatibility of the real-world nonvalvular atrial fibrillation patients in Turkey with the study population of Phase 3 novel oral anticoagulant trials: An auxiliary study of NOAC-TR. Int J Cardiovasc Acad 2020. [DOI: 10.4103/ijca.ijca_39_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Yılmaz MB, Çelik A, Çavuşoğlu Y, Bekar L, Onrat E, Eren M, Kutlu M, Yalta K, Temizhan A, Kılıçaslan B, Güngör H, Açıkel M, Demir M, Akdemir R, Zoghi M, Tokgözoğlu L. [Snapshot evaluation of heart failure in Turkey: Baseline characteristics of SELFIE-TR]. Turk Kardiyol Dern Ars 2019; 47:198-206. [PMID: 30982817 DOI: 10.5543/tkda.2019.66877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Heart failure (HF) is an important health issue of the 21st century and the prevalence in Turkey has been reported as 2.9%. A national profile, frequency data, characteristics of different phenotypes, and risk factors have not yet been well established. The Snapshot Evaluation of Heart Failure Patients in Turkey (SELFIE-TR) was an analysis of a representative sample of HF patients from Turkey. METHODS A total of 23 centers with at least 2 cardiologists from the 12 NUTS-1 regions of Turkey were invited to participate in the research. The contributing centers shared the data of a consecutive enrollment of HF patients, as confirmed by an investigator, on a pre-selected day of each week for the month of October or November of 2015. RESULTS The mean age of the entire cohort was 63.3+-13.3 years (male/female ratio: 751/303, 71.3%/28.7%). There were 712 acute HF patients and 342 chronic HF patients. The total number of HF patients with reduced ejection fraction (HFrEF), heart failure with mid-range ejection fraction, and heart failure with preserved ejection fraction was 801 (75%), 176 (16.7%), and 77 (7.3%), respectively. The patients with chronic HF were younger than those with acute HF (61.1+-13.3 years vs 67.9+-12.1 years; p<0.001). Among the whole cohort, hypertension was observed in 46%, diabetes mellitus was present in 27.5%, chronic obstructive pulmonary disease was present in 12.8%, and previous myocardial infarction was noted in 45.2%. In patients with HFrEF, the use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, a beta blocker, or a mineralocorticoid receptor antagonist was noted in 74.7%, 89.7%, and 60.9%, respectively. CONCLUSION The SELFIE-TR findings provide important insight, since it is the first study to make a snapshot of HF patients in our country. These data may help to create standardized prevention and treatment strategies.
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Affiliation(s)
| | - Ahmet Çelik
- Department of Cardiology, Faculty of Medicine, Mersin University, Mersin
| | - Yüksel Çavuşoğlu
- Department of Cardiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir
| | - Lütfü Bekar
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum
| | - Ersel Onrat
- Department of Cardiology, Faculty of Medicine, Kocatepe University, Afyon
| | - Mehmet Eren
- Cardiology Clinic, Siyami Ersek Education and Research Hospital, Istanbul
| | - Merih Kutlu
- Department of Cardiology, Faculty of Medicine, Karadeniz Teknik University, Trabzon
| | - Kenan Yalta
- Department of Cardiology, Faculty of Medicine, Trakya University, Edirne
| | - Ahmet Temizhan
- Cardiology Clinic, Türkiye Yuksek Ihtisas Education and Research Hospital, Ankara
| | - Barış Kılıçaslan
- Cardiology Clinic, Tepecik Education and Research Hospital, Izmir
| | - Hasan Güngör
- Department of Cardiology, Faculty of Medicine, Adnan Menderes University, Aydın
| | - Mahmut Açıkel
- Cardiology Clinic, Türkiye Yuksek Ihtisas Education and Research Hospital, Ankara
| | - Mesut Demir
- Department of Cardiology, Faculty of Medicine, Çukurova University, Adana
| | - Ramazan Akdemir
- Department of Cardiology, Faculty of Medicine, Sakarya University, Sakarya
| | - Mehdi Zoghi
- Department of Cardiology, Faculty of Medicine, Ege University, Izmir
| | - Lale Tokgözoğlu
- Department of Cardiology, Faculty of Medicine, Hacettepe University, Ankara
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17
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Kalcik M, Bekar L, Celik O, Yetim M, Dogan T, Karaarslan O, Ekinozu I, Yilmaz MM, Gokdeniz T, Karavelioglu Y. P3838Evaluation of echocardiographic determinants of interatrial block in patients with essential hypertension. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Interatrial block (IAB), defined as a conduction delay between the right and left atrium, is manifested on the electrocardiogram as a prolonged P-wave duration. Large number of studies recently have been published regarding the prevalence of IAB and its associations with cardiovascular events. It has been previously reported that myocardial fibrosis may cause conduction delays in hypertensive patients. In this study, we aimed to investigate the echocardiographic determinants of IAB in patients with hypertension.
Methods
This study enrolled a total of 220 patients [male: 93 (42.3%), mean age: 61.8±7.8 years] with hypertension. Patients with atrial fibrillation were excluded. IAB was defined as P wave duration of ≥120 ms with or without presence of notching. Routinely obtained 12-lead electrocardiography recordings were examined, and patients were divided into two groups as those with and without IAB. All patients were evaluated by transthoracic echocardiography.
Results
Electrocardiography revealed IAB in 70 patients. The baseline demographic characteristics of the patients with and without IAB were similar in both groups. Left atrial diameter (LAD), interventricular septal thickness, posterior wall thickness, left ventricular mass, left ventricular mass index, and the prevalence of left ventricular hypertrophy (LVH) were found to be significantly increased in hypertensive patients with IAB. Increased LAD (OR=1.082; 95% CI: 1.006–1.164; p=0.034) and LVH (OR=3.051; 95% CI: 1.164–7.994; p=0.023) were found to be independent predictors of IAB. In the receiver operating characteristic curve analyses, LAD values above 38 mm predicted IAB with a sensitivity of 68%, and a specificity of 58% (AUC= 0.678; 95% CI: 0.601–0.754; p<0.001).
Conclusion
A significant association exists between the presence of IAB and echocardiographic parameters related to left ventricular hypertrophy and left atrial dilatation in patients with essential hypertension. The presence of IAB may be used as an electrocardiographic marker of cardiac remodelling and myocardial fibrosis in hypertensive patients.
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Affiliation(s)
- M Kalcik
- Hitit University Faculty of Medicine, Corum, Turkey
| | - L Bekar
- Hitit University Faculty of Medicine, Corum, Turkey
| | - O Celik
- Hitit University Faculty of Medicine, Department of Cardiology, Corum, Turkey
| | - M Yetim
- Hitit University Faculty of Medicine, Corum, Turkey
| | - T Dogan
- Hitit University Faculty of Medicine, Corum, Turkey
| | - O Karaarslan
- Hitit University Faculty of Medicine, Department of Cardiology, Corum, Turkey
| | - I Ekinozu
- Hitit University Faculty of Medicine, Department of Cardiology, Corum, Turkey
| | - M M Yilmaz
- Hitit University Faculty of Medicine, Department of Cardiology, Corum, Turkey
| | - T Gokdeniz
- Hitit University Faculty of Medicine, Department of Cardiology, Corum, Turkey
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18
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Mert GÖ, Başaran Ö, Mert KU, Doğan V, Özlek B, Çelik O, Özlek E, Çil C, Özdemir İH, Rencüzoğulları İ, Karadeniz FÖ, Bekar L, Aktaş M, Resulzade MM, Kalçık M, Aksan G, Çinier G, Akay K, Pekel N, Şenol U, Biteker M, Kayıkçıoğlu M. The reasons of poor lipid target attainment for secondary prevention in real life practice: Results from EPHESUS. Int J Clin Pract 2019; 73:1-9. [PMID: 31038781 DOI: 10.1111/ijcp.13358] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 04/09/2019] [Accepted: 04/26/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE There are lack of studies considering the suboptimal management of dyslipidemia especially in cardiology outpatient clinics. This study was conducted to assess the patient adherence to cholesterol treatment recommendations and attainment of low-density-lipoprotein cholesterol (LDL-C) goals. METHODS EPHESUS (NCT02608645) is a national, observational and multicenter registry which has been designed as a cross-sectional study to allow inclusion of all consecutive patients with hypercholesterolemia in cardiology outpatient clinics. The present subgroup analyses of the EPHESUS trial included patients with known peripheral artery disease or atherosclerotic cerebrovascular disease, and coronary heart disease namely secondary prevention. RESULTS The present analysis of the EPHESUS study included 1482 patients (62.79 ± 10.4 years, 38.2% female) with secondary prevention from 40 sites in Turkey. Regarding recommended lipid targets for LDL-C, only 267 patients (18%) were below the target of 70 mg/dL. Females were significantly more off-target when compared with male patients (396, 85.5% vs 67, 14.5%; P = 0.017). Moreover, the achievement of LDL-C goal was significantly decreased with illiteracy (233, 19.2% vs 35, 13.1%; P = 0.02). Patients who think that the cholesterol treatment should be terminated when the cholesterol level of a patient has normalised were higher in the off-target group (34.0% vs 24.7%, P < 0.001). Besides, physician perceptions about LDL-C goal for secondary prevention were significantly related with LDL-C target attainment. CONCLUSIONS EPHESUS is an important study with large population in terms of representing real-life practice of the adherence to dyslipidemia guidelines in secondary prevention patients in Turkey. Perceptions, knowledge, and compliance with the guidelines for secondary prevention have increased, but it is far below from the desired levels even in cardiology outpatient clinics. There is a need for patients' and physicians' education regarding the treatment of hyperlipidemia.
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Affiliation(s)
- Gurbet Özge Mert
- Department of Cardiology, Eskişehir Yunus Emre State Hospital, Eskişehir, Turkey
| | - Özcan Başaran
- Department of Cardiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Kadir Uğur Mert
- Department of Cardiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Volkan Doğan
- Department of Cardiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Bülent Özlek
- Department of Cardiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Eda Özlek
- Department of Cardiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Cem Çil
- Department of Cardiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | | | | | | | - Lütfü Bekar
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Müjdat Aktaş
- Department of Cardiology, Faculty of Medicine Regional Training and Research Hospital, Kocaeli University, Kocaeli, Turkey
| | | | - Macit Kalçık
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Gökhan Aksan
- Department of Cardiology, Sıslı Hamıdıye Etfal Research and Training Hospital, İstanbul, Turkey
| | - Göksel Çinier
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, İstanbul, Turkey
| | - Kadriye Akay
- Department of Cardiology, Kocaeli State Hospital, Kocaeli, Turkey
| | - Nihat Pekel
- Department of Cardiology, Tekden Private Hospital, Denizli, Turkey
| | - Utku Şenol
- Department of Cardiology, Eskisehir Acıbadem Hospital, Eskişehir, Turkey
| | - Murat Biteker
- Department of Cardiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Meral Kayıkçıoğlu
- Department of Cardiology, Ege University Faculty of Medicine, İzmir, Turkey
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19
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Basaran O, Doğan V, Mert G, Mert K, Ozlek B, Çelik O, Ozlek E, Çil C, Bekar L, Aktaş M, Resulzade M, Kalçık M, Aksan G, Cinier G, Akay K, Senol U, Demir V, Inci S, Biteker M, Kayıkçıoğlu M. Lipid Lowering Therapy Use In Secondary Prevention: An Analysis Of Ephesus Study. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Özlek E, Çekiç EG, Özlek B, Çil C, Çelik O, Doğan V, Başaran Ö, Tanık VO, Özdemir Hİ, Çelik Y, Kaçmaz C, Şimşek Z, Güneş HM, Şafak Ö, Özkan B, Tasar O, Önal Ç, Bekar L, Biteker M. Rationale, design, and methodology of the EPIC (Epidemiology of Polypharmacy and Potential Drug-Drug Interactions in Elderly Cardiac Outpatients) study. Turk Kardiyol Dern Ars 2019; 47:391-398. [PMID: 31311898 DOI: 10.5543/tkda.2019.27724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The aim of this study is to assess the prevalence of polypharmacy, inappropriate drug use, and drug-drug interactions (DDIs) in elderly patients presenting at outpatient cardiology clinics in Turkey. METHODS The EPIC (Epidemiology of Polypharmacy and Potential Drug-Drug Interactions in Elderly Cardiac Outpatients) study will be an observational, real-world, multicenter study conducted to evaluate DDIs and polypharmacy in elderly cardiac outpatients. All consecutive patients (aged ≥65 years) admitted to outpatient cardiology clinics between July 30, 2018 and July 30, 2019 who provide written, informed consent will be enrolled. A total of approximately 5000 patients are to be enrolled in this non-interventional study. All of the data will be collected at one point in time and current clinical practice will be evaluated (ClinicalTrials.gov NCT03370523). RESULTS Patient demographics, comorbid disease characteristics, laboratory test results, and details of medication use will be collected using self-reports and medical records. The severity of comorbid disease will be recorded and scored according to Charlson Comorbidity Index (CCI) and patients will be divided into 3 groups: mild, those with a CCI score of 1-2; moderate, those with a CCI score of 3-4; and severe, those with a CCI score of ≥5. Polypharmacy will be defined as the use of 5 or more medications at one time. DDIs will be determined using the Lexicomp Online drug interaction screening tool and potentially inappropriate medications will be defined based on the 2015 update of the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Severe drug interactions will be defined as those in category D or X. CONCLUSION EPIC will be the first large-scale study in Turkey to evaluate polypharmacy, potentially inappropriate medications, and DDIs in elderly cardiac outpatients in a real-world clinical setting.
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Affiliation(s)
- Eda Özlek
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Edip Güvenç Çekiç
- Department of Pharmacology, Muğla Sıtkı Koçman University, Faculty of Medicine, Muğla, Turkey
| | - Bülent Özlek
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Cem Çil
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Volkan Doğan
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Özcan Başaran
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Veysel Ozan Tanık
- Department of Cardiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | | | - Yunus Çelik
- Department of Cardiology, Kırıkkale Yüksek İhtisas Hospital, Kırıkkale, Turkey
| | - Caner Kaçmaz
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Zeki Şimşek
- Department of Cardiology, Tuzla State Hospital, İstanbul, Turkey
| | - Hacı Murat Güneş
- Department of Cardiology, Medipol University Faculty of Medicine, İstanbul, Turkey
| | - Özgen Şafak
- Department of Cardiology, Burdur State Hospital, Burdur, Turkey
| | - Buğra Özkan
- Department of Cardiology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Onur Tasar
- Department of Cardiology, Elazığ Training and Research Hospital, Elazığ, Turkey
| | - Çağatay Önal
- Department of Cardiology, Bulanık State Hospital, Muş, Turkey
| | - Lütfü Bekar
- Department of Cardiology, Hitit University Çorum Erol Olcok Training and Research Hospital, Çorum, Turkey
| | - Murat Biteker
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
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Özlek B, Özlek E, Zencirkıran Ağuş H, Tekinalp M, Kahraman S, Çelik O, Çil C, Başaran Ö, Doğan V, Kaya BC, Rencüzoğulları İ, Ösken A, Bekar L, Çakır MO, Çelik Y, Mert KU, Memiç Sancar K, Sevinç S, Mert GÖ, Biteker M. Geographical Variations in Patients with Heart Failure and Preserved Ejection Fraction: A Sub-Group Analysis of the APOLLON Registry. Balkan Med J 2019; 36:235-244. [PMID: 30945522 PMCID: PMC6636651 DOI: 10.4274/balkanmedj.galenos.2019.2019.2.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background: Clinical characteristics of patients with heart failure may vary geographically. However, limited data are available regarding the geographical differences of patients with heart failure and preserved ejection fraction. Aims: The present subgroup analysis aims to investigate the geographical differences in clinical characteristics, management, and primary etiology of patients with heart failure and preserved ejection fraction in Turkey. Study Design: A cross-sectional study. Methods: A comPrehensive, ObservationaL registry of heart faiLure with mid-range and preserved ejection fractiON (APOLLON) is a multicenter and observational study conducted in seven regions of Turkey (NCT03026114). The present study is a post-hoc analysis of the APOLLON registry. In this substudy, we compared the clinical characteristics of 819 consecutive patients with heart failure and preserved ejection fraction (mean age, 67 years; 57.8% women) admitted to cardiology outpatient units in different geographical regions. Results: Based on the geographical distribution of the entire Turkish population, the highest number of patients enrolled were from Marmara (271 patients, 33.1%). All demographical characteristics, clinical and laboratory findings, comorbidities, primary etiology, and medications prescribed were significantly different between the regions. Furthermore, inter-regional gender differences were identified. Comparatively, the Aegean and Mediterranean regions had older patients with heart failure and preserved ejection fraction (p<0.001), and the Black Sea, Southeast, and East Anatolia regions had predominantly male patients (51.2, 54.5, and 56.9%, respectively; p=0.002). Notably, the Mediterranean and Southeast Anatolia had more symptomatic patients, and history of hospitalization for heart failure was more prevalent in Southeast Anatolia (33.3%, p<0.001). Prevalence of atrial fibrillation was higher in the Mediterranean and Southeast Anatolia regions (51 and 48.5%, p<0.001), and patients with heart failure and preserved ejection fraction had a higher prevalence of hypertension in the Mediterranean, Southeast Anatolia, and Black Sea regions (p=0.002). Angiotensin-converting enzyme inhibitors were more frequently prescribed in East Anatolia (52.3%, p=0.001), and the prevalence of patients with heart failure and preserved ejection fraction using loop diuretics (48.8%, p=0.003) was higher in the Black Sea region. Conclusion: This study was the first to show geographical differences in clinical characteristics of patients with heart failure and preserved ejection fraction in Turkey. Determination of the clinical characteristics of the heart failure and preserved ejection fraction population based on the geographical region may enables physicians to adopt a region-specific clinical approach toward heart failure and preserved ejection fraction.
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Affiliation(s)
- Bülent Özlek
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey
| | - Eda Özlek
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey
| | - Hicaz Zencirkıran Ağuş
- Clinic of Cardiology, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Tekinalp
- Clinic of Cardiology, Kahramanmaraş Necip Fazıl City Hospital, Kahramanmaraş, Turkey
| | - Serkan Kahraman
- Clinic of Cardiology, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey
| | - Cem Çil
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey
| | - Özcan Başaran
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey
| | - Volkan Doğan
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey
| | - Bedri Caner Kaya
- Clinic of Cardiology, Şanlıurfa Mehmet Akif İnan Training and Research Hospital, Şanlıurfa, Turkey
| | | | - Altuğ Ösken
- Clinic of Cardiology, İstanbul Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Lütfü Bekar
- Clinic of Cardiology, Hitit University Çorum Erol Olçok Training and Research Hospital, Çorum, Turkey
| | - Mustafa Ozan Çakır
- Department of Cardiology, Zonguldak Bülent Ecevit Universiy School of Medicine, Zonguldak, Turkey
| | - Yunus Çelik
- Clinic of Cardiology, Yüksek İhtisas Hospital, Kırıkkale, Turkey
| | - Kadir Uğur Mert
- Department of Cardiology, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Kadriye Memiç Sancar
- Clinic of Cardiology, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Samet Sevinç
- Clinic of Cardiology, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Gurbet Özge Mert
- Clinic of Cardiology, Eskişehir Yunus Emre State Hospital, Eskişehir, Turkey
| | - Murat Biteker
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey
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22
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Bekar L, Kalçık M, Çelik O, Alp Ç, Yetim M, Doğan T, Ekinözü İ, Karaarslan O, Çamkıran V, Karavelioğlu Y, Gölbaşı Z. Presence of fragmented QRS is associated with increased epicardial adipose tissue thickness in hypertensive patients. J Clin Ultrasound 2019; 47:345-350. [PMID: 30614009 DOI: 10.1002/jcu.22683] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/08/2018] [Accepted: 12/20/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Epicardial adipose tissue (EAT) is a cardiometabolic risk factor, and its possible relationship with hypertension has been reported previously. Fragmented QRS (fQRS) detected on electrocardiography (ECG) has been demonstrated to be a marker of myocardial fibrosis. In this study, we aimed to investigate the relationship between the thickness of EAT, and presence of fQRS in hypertensive patients. METHODS Consecutive patients who were diagnosed with hypertension were included in the study. ECG and transthoracic echocardiography (TTE) were performed to all patients. fQRS was defined as additional R' wave or notching/splitting of S wave in two contiguous ECG leads. Thickness of EAT was measured by TTE. RESULTS This study enrolled 69 hypertensive patients with fQRS on ECG and 45 hypertensive patients without fQRS as the control group. Age (P = .869), and gender distribution (P = .751) were similar in both groups. Left atrial diameter (P = .012), interventricular septal thickness (P < .001), posterior wall thickness (P < .001), left ventricular ejection fraction (P = .009), left ventricular mass (P = .006), left ventricular mass ındex (P = .014), left ventricular hypertrophy (P = .003), and EAT thickness (P < .001) were found to be significantly increased in patients with fQRS. In multivariate analysis, among these variables only EAT was observed to be an independent predictor of fQRS (odds ratio:3.306 [95% confidence interval, 0.030-0.118], P = .001). CONCLUSION A significant association exists between the presence of fQRS and EAT thickness in hypertensive patients. The presence of fQRS, just as EAT thickness, may be used as a cardiometabolic risk factor in hypertensive patients.
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Affiliation(s)
- Lütfü Bekar
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
| | - Macit Kalçık
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology, Hitit University Corum Training and Research Hospital, Turkey
| | - Çağlar Alp
- Department of Cardiology, Hitit University Corum Training and Research Hospital, Turkey
| | - Mucahit Yetim
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
| | - Tolga Doğan
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
| | - İsmail Ekinözü
- Department of Cardiology, Hitit University Corum Training and Research Hospital, Turkey
| | - Osman Karaarslan
- Department of Cardiology, Hitit University Corum Training and Research Hospital, Turkey
| | - Volkan Çamkıran
- Department of Cardiology, Hitit University Corum Training and Research Hospital, Turkey
| | - Yusuf Karavelioğlu
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
| | - Zehra Gölbaşı
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
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Bekar L, Kalçık M, Kilci H, Çelik O, Yetim M, Doğan T, Önalan O. Presence of fragmented QRS may be associated with complex ventricular arrhythmias in patients with essential hypertension. J Electrocardiol 2019; 55:20-25. [DOI: 10.1016/j.jelectrocard.2019.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 04/03/2019] [Accepted: 04/16/2019] [Indexed: 12/16/2022]
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Kalçık M, Yesin M, Güner A, Bayam E, Doğan T, Yetim M, Bekar L, Çelik O. Investigation of Elastic Properties of Aorta in Patients with Coronary Slow Flow. J Clin Exp Invest 2019. [DOI: 10.5799/jcei/5834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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25
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Demirci E, Çelik O, Kalçık M, Bekar L, Yetim M, Doğan T. Evaluation of homocystein and asymmetric dimethyl arginine levels in patients with coronary slow flow phenomenon. Interv Med Appl Sci 2019; 11:89-94. [PMID: 32148911 PMCID: PMC7044542 DOI: 10.1556/1646.11.2019.07] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Previous studies have demonstrated that homocysteine and asymmetric dimethyl arginine (ADMA) levels were strongly associated with cardiovascular diseases including coronary artery disease. The aim of this study was to investigate the role of plasma homocysteine and ADMA levels in the pathogenesis of coronary slow flow (CSF) phenomenon. Methods Twenty-three patients with CSF and 25 controls with normal coronary flow were included in this study. The quantitative measurement of coronary blood flow was performed using the thrombolysis in myocardial infarction frame count method. Plasma homocysteine and ADMA levels were determined using enzymatic assays from venous blood samples. Results The patients with CSF had significantly higher plasma homocysteine levels than controls (16.2 ± 7.6 vs. 12.2 ± 2.2 μM/L; p = 0.023). The uric acid levels were significantly higher in CSF group than controls (5.4 ± 1.1 vs. 4.6 ± 0.9 mg/dl; p = 0.011). Plasma ADMA levels were also higher in the CSF group; however, this was not statistically significant (0.6 ± 0.1 vs. 0.5 ± 0.2 μM/L; p = 0.475). Conclusions Increased homocysteine and uric acid levels may play an important role in the pathogenesis of CSF. Further large scale studies are required to determine the relationship between ADMA levels and CSF.
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Affiliation(s)
- Erkan Demirci
- Department of Cardiology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey
| | - Macit Kalçık
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Lütfü Bekar
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Mucahit Yetim
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Tolga Doğan
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
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Kalçık M, Doğan T, Yetim M, Kocamış Sİ, Dönmez O, Bekar L. The Relationship between the Retinal Nerve Fiber Layer Thickness and the Presence of Fragmented QRS Complexes in Patients with Hypertension. J Clin Exp Invest 2019. [DOI: 10.5799/jcei/5758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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27
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Özlek B, Özlek E, Tekinalp M, Kahraman S, Ağuş HZ, Çelik O, Çil C, Kaya BC, Rencüzoğulları İ, Mert KU, Çakır MO, Ösken A, Bekar L, Çelik Y, Başaran Ö, Doğan V, Mert GÖ, Sancar KM, Sevinç S, Biteker M. Clinical features of heart failure with mid-range and preserved ejection fraction in octogenarians: Results of a multicentre, observational study. Int J Clin Pract 2019; 73:e13341. [PMID: 30865367 DOI: 10.1111/ijcp.13341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/15/2019] [Accepted: 03/08/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To compare real-world characteristics and management of individuals aged 80 and older with heart failure (HF) and mid-range ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF) derived from a large cohort of survey and to compare them with those younger than 80 from the same survey. METHODS This is an observational, multicentre and cross-sectional study conducted in Turkey (NCT03026114). Consecutive 1065 (mean age of 67.1 ± 10.6 years) patients admitted to the cardiology outpatient units with HFmrEF and HFpEF were included. RESULTS Participants aged 80 and older (n = 123, 11.5%) were more likely to be female (66.7% vs 52.5%, P = 0.003), had a higher prevalence of atrial fibrillation (49.6% vs 34%, P = 0.001), and anaemia (46.3% vs 33.4%, P = 0.005) than those who were younger than 80. N-terminal pro B-type natriuretic peptide levels were higher in those aged 80 and older than in those younger than 80 (1037 vs 550 pg/ml, P < 0.001). The prescription rates of HF medications (including in ACE-Is/ARBs, β-blockers, MRAs, digoxin, ivabradine and diuretics) were similar (P > 0.05) in both groups. Octogenarians did not significantly differ from younger patients in the prevalence of HFmrEF (24.4% vs 22.9%) and HFpEF (75.6% vs 77.1%). Coronary artery disease was associated with HFmrEF (P < 0.05), whereas atrial fibrillation was associated with HFpEF (P < 0.05) in octogenarians. CONCLUSIONS This study revealed that nearly 12% of the individuals with HFmrEF and HFpEF in this real-world sample were aged 80 and older. Participants aged 80 and older are more likely to be female and have more comorbidities than those who were younger than 80. However, HF medication profiles were similar in both groups. This study also showed that associated factors with HFmrEF and HFpEF were differ in octogenarians.
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Affiliation(s)
- Bülent Özlek
- Department of Cardiology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey
| | - Eda Özlek
- Department of Cardiology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey
| | - Mehmet Tekinalp
- Department of Cardiology, Kahramanmaras Necip Fazıl City Hospital, Kahramanmaras, Turkey
| | - Serkan Kahraman
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Hicaz Zencirkıran Ağuş
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey
| | - Cem Çil
- Department of Cardiology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey
| | - Bedri Caner Kaya
- Department of Cardiology, Mehmet Akif İnan Training and Research Hospital, Sanlıurfa, Turkey
| | | | - Kadir Uğur Mert
- Department of Cardiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Mustafa Ozan Çakır
- Department of Cardiology, Bulent Ecevit Universiy Medical Faculty, Zonguldak, Turkey
| | - Altuğ Ösken
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Lütfü Bekar
- Department of Cardiology, Hitit University Corum Erol Olcok Training and Research Hospital, Corum, Turkey
| | - Yunus Çelik
- Department of Cardiology, Kirikkale Yuksek İhtisas Hospital, Kirikkale, Turkey
| | - Özcan Başaran
- Department of Cardiology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey
| | - Volkan Doğan
- Department of Cardiology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey
| | - Gurbet Özge Mert
- Department of Cardiology, Yunus Emre State Hospital, Eskisehir, Turkey
| | - Kadriye Memiç Sancar
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Samet Sevinç
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Murat Biteker
- Department of Cardiology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey
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Özlek B, Özlek E, Ağuş HZ, Tekinalp M, Kahraman S, Çil C, Çelik O, Başaran Ö, Doğan V, Kaya BC, Rencüzoğulları I, Ösken A, Bekar L, Çakır MO, Çelik Y, Mert KU, Sancar KM, Sevinç S, Mert GÖ, Biteker M. Patients with HFpEF and HFmrEF have different clinical characteristics in Turkey: A multicenter observational study. Eur J Intern Med 2019; 61:88-95. [PMID: 30446354 DOI: 10.1016/j.ejim.2018.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/28/2018] [Accepted: 11/06/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND To determine and compare the demographic characteristics, clinical profile and management of patients with heart failure with mid-range ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF) in a Turkish cohort. METHODS The APOLLON trial (A comPrehensive, ObservationaL registry of heart faiLure with mid-range and preserved ejection fractiON) is an observational and multicenter study conducted in Turkey. Consecutive patients admitted to the cardiology clinics who were at least 18 years of age and had HFmrEF or HFpEF were included (NCT03026114). RESULTS The study population included 1065 (mean age of 67.1 ± 10.6 years, 54% women) patients from 12 sites in Turkey. Among participants, 246 (23.1%) had HFmrEF and 819 (76.9%) had HFpEF. Compared to patients with HFpEF, those with HFmrEF were more likely to be male (57.7 vs 42.2%; p < 0.001), had higher N-terminal pro-B-type natriuretic peptide levels (853 vs 528 pg/ml, p < 0.001), were more likely to have ECG abnormalities (72.4 vs 53.5%, p < 0.001) and hospitalization history for heart failure (28 vs 18.6%; p = 0.002). HFmrEF patients were more likely to use β-blockers (69.9 vs 55.2%, p < 0.001), aldosterone receptor antagonists (24 vs 14.7%, p = 0.001), statins (37 vs 23%, p < .001), and loop diuretics (39.8 vs 30.5%, p = 0.006) compared to patients with HFpEF. CONCLUSIONS The results of APOLLON study support that the basic characteristics and etiology of HFmrEF are significantly different from HFpEF. This registry also showed that the patients with HFmrEF and HFpEF were younger but undertreated in Turkey compared to patients in western countries.
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Affiliation(s)
- Bülent Özlek
- Department of Cardiology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey.
| | - Eda Özlek
- Department of Cardiology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey
| | - Hicaz Zencirkıran Ağuş
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Tekinalp
- Department of Cardiology, Kahramanmaras Necip Fazıl City Hospital, Kahramanmaras, Turkey
| | - Serkan Kahraman
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Cem Çil
- Department of Cardiology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey
| | - Özcan Başaran
- Department of Cardiology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey
| | - Volkan Doğan
- Department of Cardiology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey
| | - Bedri Caner Kaya
- Department of Cardiology, Mehmet Akif İnan Training and Research Hospital, Sanlıurfa, Turkey
| | | | - Altuğ Ösken
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Lütfü Bekar
- Department of Cardiology, Hitit University Corum Erol Olcok Training and Research Hospital, Corum, Turkey
| | - Mustafa Ozan Çakır
- Department of Cardiology, Bulent Ecevit Universiy Medical Faculty, Zonguldak, Turkey
| | - Yunus Çelik
- Department of Cardiology, Kirikkale Yuksek İhtisas Hospital, Kirikkale, Turkey
| | - Kadir Uğur Mert
- Department of Cardiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Kadriye Memiç Sancar
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Samet Sevinç
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Gurbet Özge Mert
- Department of Cardiology, Kahramanmaras Necip Fazıl City Hospital, Kahramanmaras, Turkey; Department of Cardiology, Yunus Emre State Hospital, Eskisehir, Turkey
| | - Murat Biteker
- Department of Cardiology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey
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Özlek B, Özlek E, Tekinalp M, Kahraman S, Zencirkiran Agus H, Başaran Ö, Kaya BC, Rencüzoğulları İ, Mert KU, Çakır O, Ösken A, Bekar L, Çelik Y, Çil C, Doğan V, Çelik O, Mert GÖ, Memiç Sancar K, Sevinç S, Biteker M. Comparison of clinical characteristics of patients with heart failure and preserved ejection fraction with atrial fibrillation versus sinus rhythm: Insights from the APOLLON registry. Turk Kardiyol Dern Ars 2019; 48:234-245. [PMID: 32281959 DOI: 10.5543/tkda.2019.77236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess the clinical characteristics of patients with heart failure and preserved ejection fraction (HFpEF) and atrial fibrillation (AF) and compare them with those of HFpEF patients without AF. METHODS This study was a sub-group analysis of a multicenter, observational, and cross-sectional registry conducted in Turkey (ClinicalTrials.gov identifier: NCT03026114). Patients with HFpEF were divided into 2 groups: HFpEF with AF and HFpEF with sinus rhythm (SR), and the clinical characteristics of the groups were compared. RESULTS In a total of 819 HFpEF patients (median age: 67 years; 58% women), 313 (38.2%) had AF. Compared to the patients with SR, those with AF were older (70 years vs 66 years; p<0.001) and more symptomatic, with a higher rate of classification as New York Heart Association functional class III-IV, paroxysmal nocturnal dyspnea, orthopnea, palpitations, fatigue, pulmonary crepitations, and peripheral edema. The hospitalization rate for heart failure was higher (28.4% vs 12.6%; p<0.001) in patients with AF, and participants with AF had higher level of N-terminal pro-B-type natriuretic peptide (887 pg/mL vs 394.8 pg/mL; p<0.001) and higher left atrial volume index level. Patients without AF had a higher burden of diabetes mellitus, obstructive sleep apnea, and coronary artery disease. The prescription rate of nondihydropyridine calcium blockers, digoxin, loop diuretics, and anticoagulant drugs was higher in the AF group. CONCLUSION The results of this study revealed that in a large Turkish cohort with HFpEF, significant clinical differences were present between those with and without AF and. Further prospective studies are needed to clarify the prognostic implications of AF in this growing heart failure population in our country.
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Affiliation(s)
- Bülent Özlek
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Eda Özlek
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Mehmet Tekinalp
- Department of Cardiology, Necip Fazıl City Hospital, Kahramanmaraş, Turkey
| | - Serkan Kahraman
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Hicaz Zencirkiran Agus
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Özcan Başaran
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Bedri Caner Kaya
- Department of Cardiology, Mehmet Akif İnan Training and Research Hospital, Şanlıurfa, Turkey
| | | | - Kadir Ugur Mert
- Department of Cardiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Ozan Çakır
- Department of Cardiology, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Altuğ Ösken
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Lütfü Bekar
- Department of Cardiology, Hitit University Çorum Erol Olçok Training and Research Hospital, Çorum, Turkey
| | - Yunus Çelik
- Department of Cardiology, Kırıkkale Yüksek İhtisas Hospital, Kırıkkale, Turkey
| | - Cem Çil
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Volkan Doğan
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Gurbet Özge Mert
- Department of Cardiology, Yunus Emre State Hospital, Eskişehir, Turkey
| | - Kadriye Memiç Sancar
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Samet Sevinç
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Murat Biteker
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
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Doğan T, Yetim M, Çelik O, Kalçık M, Özcan O, Doğan İ, Erenler AK, Bekar L, Karavelioğlu Y. Investigation of mindin levels in hypertensive patients with left ventricular hypertrophy and QRS fragmentation on electrocardiography. Acta Cardiol 2018; 73:544-549. [PMID: 29265929 DOI: 10.1080/00015385.2017.1418616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Mindin was associated with diabetic nephropathy, podocyte injury, colitis, allergic asthma, liver ischaemia and reperpusion injury and ischaemic brain injury. On the other hand, it was reported as a protective factor against obesity, cardiac hypertrophy, fibrosis and remodelling. Fragmented QRS complexes (fQRS) are markers of altered ventricular depolarisation owing to a prior myocardial scar and fibrosis. In this study, we aimed to investigate mindin levels in hypertensive patients with left ventricular hypertrophy and fQRS on electrocardiography. METHODS This observational case-control study enrolled 70 (36 female) hypertensive patients with fQRS and 38 (23 female) hypertensive control patients. All patients were evaluated by transthoracic echocardiography. Mindin levels were measured by the enzyme-linked immunosorbent assay (ELISA). Clinical, echocardiographic and laboratory data were compared between patient and control groups. RESULTS There was no significant difference between patient and control groups in terms of clinical, echocardiographic and routine laboratory parameters. The mindin levels were significantly higher in the patient group than controls (11.3 (7.21-19.31) vs 4.15 (2.86-6.34); p < .001). Multiple logistic regression analyses defined increased mindin levels as an independent predictor for the presence of fQRS (Odds ratio: 1.733; p = .034). Mindin levels >6.74 predicted the presence of fQRS with a sensitifity of 84.3% and specificity of 79.9% on receiver operating characteristic (ROC) curve analysis (The area under the curve:0.889; Confidence Interval: 0.827-0.951; p < .001). CONCLUSION Mindin expressin is upregulated in hypertensive patients with fQRS complexes. In contrary to previous studies, increased mindin levels may be associated with myocardial fibrosis.
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Affiliation(s)
- Tolga Doğan
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
| | - Mucahit Yetim
- Department of Cardiology, Hitit University Çorum Training and Research Hospital, Çorum, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey
| | - Macit Kalçık
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
| | - Oğuzhan Özcan
- Department of Biochemistry, Hatay Mustafa Kemal University, Faculty of Medicine, Hatay, Turkey
| | - İbrahim Doğan
- Department of Nephrology, Hitit University Faculty of Medicine, Çorum, Turkey
| | - Ali Kemal Erenler
- Department of Emergency Medicine, Hitit University Faculty of Medicine, Çorum, Turkey
| | - Lütfü Bekar
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
| | - Yusuf Karavelioğlu
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
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Çelik O, Bekar L, Yetim M, Doğan T, Alp Ç, Kalçık M, Karavelioğlu Y. A rare complication of percutaneous coronary intervention: Coronary pseudoaneurysm formation. Interv Med Appl Sci 2018; 9:208-211. [PMID: 29951287 PMCID: PMC6016209 DOI: 10.1556/1646.9.2017.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Coronary pseudoaneurysms (CPAs) are rare complications developed after percutaneous coronary interventions. They may cause stent thrombosis, distal embolization, and coronary rupture leading to cardiac tamponade. Therefore, high-risk CPA should be promptly treated after diagnosis. They can be managed with percutaneous or surgical intervention. Herein, we aimed to present a patient who developed CPA 3 weeks after percutaneous coronary intervention and successfully treated with percutaneous intervention using a covered stent.
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Affiliation(s)
- Oğuzhan Çelik
- Department of Cardiology, Hitit University Çorum Training and Research Hospital, Çorum, Turkey
| | - Lütfü Bekar
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
| | - Mucahit Yetim
- Department of Cardiology, Hitit University Çorum Training and Research Hospital, Çorum, Turkey
| | - Tolga Doğan
- Department of Cardiology, Hitit University Çorum Training and Research Hospital, Çorum, Turkey
| | - Çağlar Alp
- Department of Cardiology, Hitit University Çorum Training and Research Hospital, Çorum, Turkey
| | - Macit Kalçık
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
| | - Yusuf Karavelioğlu
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
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Kilic S, Sümerkan MÇ, Emren V, Bekar L, Cersit S, Tunc E, Gök G, Altuntas E, Canpolat U, Sinan UY, Özmen N, Zoghi M. Secondary prevention of coronary heart disease in elderly population of Turkey: A subgroup analysis of ELDERTURK study. Cardiol J 2017; 26:13-19. [PMID: 28980279 DOI: 10.5603/cj.a2017.0113] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/10/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Secondary prevention plays an important role after acute coronary event due to high risk of adverse events in elderly. In present study we aimed to evaluate the lifestyle, management of risk factors and medical treatment for secondary protection in elderly patients with known coronary heart disease (CHD). METHODS ELDERTURK is a non-interventional, multi-centered, observational study, which included total of 5694 elderly patients ( > 65 years) from 50 centers in Turkey. In this study elderly patients from the ELDERTURK population with known CHD were evaluated for cardiovascular risk factors, comor- bidities and medication usage. RESULTS A total of 2976 (52.3% of study) out of 5694 patients included in the ELDERTURK study were evaluated. All had known CHD with a mean age of 73.4 ± 6.2 years and 60.3% were male. 13.0% of patients were smokers, 42.4% were overweight and 21.1% were obese. Only 23.6% of patients reported to do regular exercise, 73.4% had history of hypertension, 47.4% had dyslipidemia and 33.9% had diabetes mellitus. The rate of patients with systolic blood pressure > 140 mmHg were 31.1% and only 13.9% of patients had a recommended ≤ 70 mg/dL level of low-density lipoprotein cholesterol. Anti- platelet, statin, beta-blocker and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker usage was limited to 27.3%. CONCLUSIONS The ELDERTURK study shows that many patients with CHD have a high prevalence of modifiable risk factors and unhealthy lifestyle. Apart from this, many patients are not receiving thera- peutic intervention and as a consequence most were not achieving the recommended goals.
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Affiliation(s)
- Salih Kilic
- Department of Cardiology, Ege University Faculty of Medicine, Izmir, Turkey.
| | - Mutlu Çagan Sümerkan
- Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Volkan Emren
- Department of Cardiology, Afyonkarahisar State Hospital, Afyon, Turkey
| | - Lütfü Bekar
- Department of Cardiology, Hitit University Corum Education and Research Hospital, Corum, Turkey
| | - Sinan Cersit
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Elif Tunc
- Department of Cardiology, Izmir Military Hospital, İzmir, Turkey
| | - Gülay Gök
- Department of Cardiology, Mardin State Hospital, Mardin, Turkey
| | - Emine Altuntas
- Department of Cardiology, Bingol State Hospital, Bingol, Turkey
| | - Uğur Canpolat
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Umit Yasar Sinan
- Department of Cardiology, Cardiology Institute of İstanbul University, Istanbul, Turkey
| | - Namık Özmen
- Department of Cardiology, GATA Haydarpaşa Training Hospital, Istanbul, Turkey
| | - Mehdi Zoghi
- Department of Cardiology, Ege University Faculty of Medicine, Izmir, Turkey
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Ozkurt S, Karavelioglu Y, Kalcik M, Dogan I, Musmul A, Yetim M, Dogan T, Bekar L, Celik O, Ekinozu I, Karaarslan O. 5036Assesment of long term cardiovascular effects of unileteral nephrectomy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.5036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bekar L, Katar M, Yetim M, Çelik O, Kilci H, Önalan O. Fragmented QRS complexes are a marker of myocardial fibrosis in hypertensive heart disease. Turk Kardiyol Dern Ars 2017; 44:554-560. [PMID: 27774963 DOI: 10.5543/tkda.2016.55256] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Carboxy-terminal propeptide of type 1 procollagen (PICP) is a marker of extracellular collagen synthesis. Fragmented QRS (fQRS) on a 12-lead electrocardiogram (ECG) has been demonstrated as a marker of myocardial fibrosis. The present objective was to investigate the association between serum PICP concentration and presence of fQRS on ECG in hypertensive patients. METHODS Consecutive patients with previously or newly diagnosed hypertension were included. fQRS was defined as the presence of additional R-wave (R'), or notching of R- or S-waves, or the presence of fragmentation in 2 contiguous ECG leads. Serum PICP levels were measured by ELISA method. RESULTS The study group consisted of 90 hypertensive patients (74% females, with a mean age of 54.7±8.5 years). Of these patients, 47 (52.2%) had fQRS on ECG. Age (p=0.121) and gender distribution (p=0.625) were similar in patients with or without fQRS. Receiver operating characteristic curve analysis yielded a strong predictive ability of PICP levels for the presence of fQRS (area under the curve: 0.850; 95% CI: 0.772-0.929; p<0.0001). In multivariate logistic regression analysis, PICP levels were strongly and independently associated with the presence of fQRS (OR: 1.938; 95% CI: 1.398-2.688). CONCLUSION Serum PICP level is a strong and independent predictor of fQRS. Discriminative performance of serum PICP levels for the presence of fQRS is high. The present results are the first to demonstrate that fQRS may indicate myocardial fibrosis in patients with hypertension.
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Affiliation(s)
- Lütfü Bekar
- Department of Cardiology, Hitit University Çorum Training and Research Hospital, Çorum, Turkey.
| | - Muzaffer Katar
- Department of Medical Biochemistry, Tokat Government Hospital, Tokat, Turkey
| | - Mücahit Yetim
- Department of Cardiology, Hitit University Çorum Training and Research Hospital, Çorum, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology, Hitit University Çorum Training and Research Hospital, Çorum, Turkey
| | - Hakan Kilci
- Department of Cardiology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Orhan Önalan
- Department of Cardiology, Karabük University Faculty of Medicine, Karabük, Turkey
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Bekar L, Zoghi M. The preference of the physicians in diagnosis and treatment of cardiovascular diseases. International Journal of the Cardiovascular Academy 2017. [DOI: 10.1016/j.ijcac.2017.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Emren SV, Şenöz O, Bilgin M, Beton O, Aslan A, Taşkin U, Açiksari G, Asarcikli LD, Çakir H, Bekar L, Bolat İ, Yayla Ç, Çelebi B, Dalgiç O, Çelik O, Şafak Ö, Akyel S, Güngör H, Düzel B, Zoghi M. Drug Adherence in Patients With Nonvalvular Atrial Fibrillation Taking Non-Vitamin K Antagonist Oral Anticoagulants in Turkey: NOAC-TR. Clin Appl Thromb Hemost 2017; 24:525-531. [PMID: 28301907 DOI: 10.1177/1076029617693940] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Adherence to non-vitamin K antagonist oral anticoagulants (NOACs) is an important factor for ensuring efficacy and safety in nonvalvular atrial fibrillation (NVAF). There are controversial results regarding NOAC adherence in real-world data and there are no data about NOAC adherence in Turkish population. This study investigated the NOAC adherence based on self-report, factors affecting nonadherence, and the relation of the adherence level with efficacy and safety outcomes. This multicenter cross-sectional study included 2738 patients (59% female) using NOAC (dabigatran, apixaban, and rivaroxaban) due to NVAF for more than 3 months with >30 days of supply between September 1, 2015, and February 28, 2016. To measure the adherence level, an 8-item Morisky Medication Adherence Scale was used. The mean age of the patients was 70 ± 10 years. Of the 2738 patients, 44% were receiving dabigatran, 38% rivaroxaban, and 18% apixaban. A total of 630 (23%) patients had high medication adherence, 712 (26%) moderate adherence, and 1396 (51%) low adherence. Nonadherence had related to stroke (5.6% vs 2.5%, P < .001) and minor (21.2% vs 11.1%, P < .001) and major (6.1% vs 3.7%, P = .004) bleeding rates. The adherence to NOAC was found to be quite low in Turkey. Nonadherence is associated with bleeding and thromboembolic cardiovascular events. Age, taking NOAC twice a day, and the additional noncardiac diseases, depression, and dementia were the independent factors affecting poor medication adherence.
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Affiliation(s)
- Sadık Volkan Emren
- 1 Department of Cardiology, Afyonkarahisar State Hospital, Afyonkarahisar, Turkey
| | - Oktay Şenöz
- 2 Department of Cardiology, Artvin State Hospital, Artvin, Turkey
| | - Murat Bilgin
- 3 Department of Cardiology, Ankara Dışkapı Research and Education Hospital, Ankara, Turkey
| | - Osman Beton
- 4 Department of Cardiology, Sivas Cumhuriyet University, Sivas, Turkey
| | - Abdullah Aslan
- 5 Department of Cardiology, Dokuz Eylül University, Izmir, Turkey
| | - Uğur Taşkin
- 6 Department of Cardiology, Akşehir State Hospital, Konya, Turkey
| | - Gönül Açiksari
- 7 Department of Cardiology, Istanbul İstinye State Hospital, Istanbul, Turkey
| | - Lale Dinç Asarcikli
- 3 Department of Cardiology, Ankara Dışkapı Research and Education Hospital, Ankara, Turkey
| | - Hakan Çakir
- 8 Department of Cardiology, Darıca Farabi State Hospital, Kocaeli, Turkey
| | - Lütfü Bekar
- 9 Department of Cardiology, Hitit University, Çorum, Turkey
| | - İsmail Bolat
- 10 Department of Cardiology, Fethiye State Hospital, Muğla, Turkey
| | - Çağrı Yayla
- 11 Department of Cardiology, Ankara Yüksek İhtisas Research and Education Hospital, Ankara, Turkey
| | - Barış Çelebi
- 12 Department of Cardiology, Silifke State Hospital, Mersin, Turkey
| | - Onur Dalgiç
- 13 Department of Cardiology, Karşıyaka State Hospital, İzmir, Turkey
| | - Oğuzhan Çelik
- 14 Department of Cardiology, School of Medicine, Hitit University, Çorum, Turkey
| | - Özgen Şafak
- 15 Department of Cardiology, Burdur State Hospital, Burdur, Turkey
| | - Serdar Akyel
- 16 Department of Cardiology, Münif İslamoğlu State Hospital, Kastamonu, Turkey
| | - Hasan Güngör
- 17 Department of Cardiology, Aydın University School of Medicine, Aydın, Turkey
| | - Barış Düzel
- 18 Department of Cardiology, Mersin State Hospital, Mersin, Turkey
| | - Mehdi Zoghi
- 19 Department of Cardiology, Ege University, Izmir, Turkey
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Mandes LA, Sedky Y, Aguiar Rosa S, Militaru C, Kalcik M, Cuddy S, Ciudin R, Platon P, Gurzun M, Mateescu AD, Lacau S, Ginghina C, Coman I, Popescu BA, Romeih S, Simary W, Van Doorn C, Agapito A, Antonio M, Branco L, Sousa L, Oliveira JA, Laranjo S, Martins S, Jalles Tavares N, Cruz Ferreira R, Popara A, Beyer R, Gurzun MM, Zarma L, Popescu BA, Ginghina C, Jurcut R, Dogan T, Yetim M, Bekar L, Karaarslan O, Celik O, Cicek M, Camkiran V, Karavelioglu Y, Kolcow W, Da Costa M, Mylotte D, Smyth Y. Clinical Cases: Congenital heart disease800Late diagnosis of double chambered right ventricle in an adult: diagnostic pitfalls and the role of multimodality imaging801Anomalous origin of left pulmonary artery from ascending aorta: an unusual cause of cardiac failure802An uncommon cause of right ventricular failure803Staged severe evolution and treatment dilemmas in a patient with Marfan syndrome804A rare presentation of coarctation of the aorta: transient ischemic attack due to thrombus formation in the coarcted segment which was treated with oral anticogulation805Penetrating cardiac trauma resulting in a ventricular septal defect, a flail mitral valve leaflet and a right middle cerebral artery infarct, with percutaneous closure of the ventricular septal defect. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Karavelioğlu Y, Kalçik M, Yetim M, Sarak T, Bekar L, Doğan T. A Rare Cause of Dysphagia and Weight Loss in a Nonagenarian with Hypertension: Dysphagia Aortica. J Am Geriatr Soc 2015; 63:1488-9. [PMID: 26189863 DOI: 10.1111/jgs.13544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Yusuf Karavelioğlu
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Macit Kalçik
- Department of Cardiology, İskilip Atıf Hoca State Hospital, Çorum, Turkey
| | - Mücahit Yetim
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Taner Sarak
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Lütfü Bekar
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Tolga Doğan
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
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Bekar L. Left atrial compression. Anadolu Kardiyol Derg 2014; 14:303-312. [PMID: 24662597 DOI: 10.5152/akd.2014.5034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Lütfü Bekar
- Hitit Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Çorum-Türkiye.
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Affiliation(s)
- Fatih Altunkaş
- Department of Cardiology, Faculty of Medicine, Gaziosmanpaşa University, Tokat, Turkey.
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Bekar L, Onalan O, Altunkas F, Ceyhan K. [A consequence of untreated hypertension: giant aneurysm of the aortic arch]. Turk Kardiyol Dern Ars 2010; 38:225. [PMID: 20676007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Affiliation(s)
- Lütfü Bekar
- Gaziosmanpaşa, Universitesi Tip Fakültesi, Kardiyoloji Anabilim Dali, Tokat, Turkey.
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Fleckenstein J, Irnich D, Goldman N, Chen M, Fujita T, Xu Q, Peng W, Liu W, Jensen T, Pei Y, Wang F, Han X, Chen J, Schnermann J, Takano T, Bekar L, Tieu K, Nedergaard M. Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Deutsche Zeitschrift für Akupunktur 2010. [DOI: 10.1016/j.dza.2010.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bekar L, Altunkas F, Ceyhan K, Onalan O. Giant right atrium. Turk Kardiyol Dern Ars 2009; 37:359. [PMID: 19875915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Affiliation(s)
- Lütfü Bekar
- Department of Cardiology, Medicine Faculty of Gaziosmanpaşa University, Tokat, Turkey
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Bekar L, Onalan O, Altunkaş F, Atmaca H, Atasoy I, Ceyhan K. A prominent Chiari network prolapsing into right ventricle. Anadolu Kardiyol Derg 2008; 8:E27. [PMID: 18676295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Lütfü Bekar
- Department of Cardiology, Faculty of Medicine, Gaziosmanpaşa University, Tokat, Turkey
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