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    Acute left main coronary artery occlusion following transcatheter aortic valve replacement without obvious risk factors of coronary obstruction
    (Turkish Society of Cardiology, 2020) Çakal, Beytullah; Çakal, Sinem; Karaca, Oğuz
    Transcatheter aortic valve implantation (TAVI) has emerged as a prominent alternative for patients with severe aortic stenosis, who are deemed to be at a greater risk for surgical interventions (1). However, extreme caution is recommended against the lethal complications, such as coronary obstruction (CO) or annulus rupture, associated with this procedure that need to be overcome urgently (1). Herein, we report an occlusion of acute left main coronary artery (LMCA) after TAVI, which was treated with triple stenting, due to immediate stent recoils.
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    Acute myocarditis or Kounis Syndrome? Role of cardiac MRI and speckle-tracking echocardiography for differential diagnosis
    (Wiley-Blackwell, 2014) Karaca, Oğuz; Omaygenç, Mehmet Onur; Güler, Ekrem; Kızılırmak, Filiz; Olgun, Erkam; İbişoğlu, Ersin; Barutçu, İrfan; Kılıçaslan, Fethi; Türkmen, Muhsin
    [Abstract Not Available]
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    Acute myocarditis or the kounis syndrome: Role of cardiac MRI and speckle-tracking echocardiography in diagnosis
    (2014) Karaca, Oğuz; Çakal, Beytullah; Çakal, Sinem Deniz; Türkmen, Muhsin
    Introduction: The Kounis syndrome and acute myocarditis are two distinct clinical entities, which could share nearly the same symptomatology as well as ECG (electrocardiography) and laboratory findings. Case Presentation: First case was a 39-year-old male presented with acute chest pain and inferolateral ST elevation on ECG. The second case was a 29-year-old male presented with chest pain and diffuses ST elevation. Diagnosis of acute myocarditis was achieved by demonstrating subepicardial contrast enhancement as well as atypical involvement in both of our clinical cases. Conclusions: We reported two cases in which specific imaging modalities (cardiac magnetic resonance imaging and speckle-tracking echocardiography) were used when the signs and symptoms were indistinguishable.
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    Adding lipoprotein(a) levels to the GRACE score to predict prognosis in patients with non-ST elevation acute coronary syndrome
    (Via Medica, 2013) Güler, Ekrem; Geçmen, Çetin; Güler Babür, Gamze; Karaca, Oğuz; Hicaz Zencirkiran, Agus; Güneş, Hacı Murat; Batgerel, Ulankhuu; Elveran, Ali; Esen, Ali Metin
    Background: High levels of lipoprotein(a) [Lp(a)] are known to be a cardiovascular risk factor associated with premature coronary artery disease. In predicting the long term prognosis in acute coronary syndromes (ACS), the relationship between Lp(a) and risk scoring systems remains unclear. Aim: We investigated whether adding Lp(a) to the GRACE scoring system has an incremental value in predicting prognosis in ACS. Methods: 115 patients (mean age 64 +/- 11 years) with non-ST elevation acute coronary syndromes (NSTE-ACS) were enrolled in this prospective study. Patients were categorised into quartiles according to the Lp(a) levels. Statistically significant variables in the univariate analysis (haemoglobin, creatinine, age, left ventricular ejection fraction, previous myocardial infarction (MI) history, Killip class) were included in the multivariate analysis to determine the independent predictors of cardiovascular outcomes (mortality, rehospitalisation) with and without Lp(a) quartiles for one year follow-up. Results: Previous MI history and Lp(a) quartile were detected as independent predictors of combined cardiovascular events (OR: 2.969 [95% CI 1.413-6.240] and OR: 6.279 [95% CI 1.363-28.927] respectively). Lp(a) quartile also remained as an independent predictor for prognosis when added to a model based on GRACE risk score (OR: 2.589 [95% CI 1.402-4.780]). Serum Lp(a) levels were moderately correlated with GRACE risk score (r = 0.371; p < 0.001). Conclusions: Lipoprotein(a) has an additional prognostic value over GRACE risk score in predicting one-year adverse outcomes in NSTE-ACS. The combination of serum Lp(a) with GRACE risk score could provide enhanced risk stratification in patients with ACS.
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    Adjusting the QRS duration by body mass index for prediction of response to cardiac resynchronization therapy: Does one QRS size fit all?
    (Wiley, 2016) Karaca, Oğuz; Omaygenç, Mehmet Onur; Çakal, Beytullah; Çakal Deniz, Sinem; Güneş, Hacı Murat; Olgun, Erkam; İbişoğlu, Ersin; Savur, Ümeyir; Gökdeniz, Tayyar; Boztosun, Bilal; Kılıçaslan, Fethi
    Background: QRS duration (QRSd) is known to be affected by body weight and length. We tested the hypothesis that adjusting the QRSd by body mass index (BMI) may provide individualization for patient selection and improve prediction of cardiac resynchronization therapy (CRT) response. Methods: A total of 125 CRT recipients was analyzed to assess functional (?1 grade reduction in NYHA class) and echocardiographic (?15% reduction in LVESV) response to CRT at 6 months of implantation. Baseline QRSd was adjusted by BMI to create a QRS index (QRSd/BMI) and tested for prediction of CRT response in comparison to QRSd. Results: Overall, 81 patients (65%) responded to CRT volumetrically. The mean QRS index was higher in CRT responders compared to nonresponders (6.2 ± 1.1 vs 5.2 ± 0.8 ms.m2/kg, P < 0.001). There was a positive linear correlation between the QRS index and the change in LVESV (r = 0.487, P < 0.001). Patients with a high QRS index (?5.5 ms.m2/kg, derived from the ROC analysis, AUC = 0.787) compared to those with a prolonged QRSd (?150 ms, AUC = 0.729) had a greater functional (72% vs 28%, P < 0.001) and echocardiographic (80% vs 44%, P < 0.001) improvement at 6 months. QRS index predicted CRT response at regression analysis. Conclusions: Indexing the QRSd by BMI improves patient selection for CRT by eliminating the influence of body weight and length on QRSd. QRS index is a novel indicator that provides promising results for prediction of CRT response.
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    Angio-seal used as a bailout for incomplete hemostasis after dual perclose ProGlide deployment in transcatheter aortic valve implantation
    (Texas Heart Institute, 2022) Çakal, Beytullah; Çakal, Sinem; Karaca, Oğuz; Kızılırmak Yılmaz, Filiz; Güneş, Hacı Murat; Yıldırım, Arzu; Özcan, Özgür Ulaş; Güler, Yeliz; Boztosun, Bilal
    Background: The failure rate of vascular closure devices remains a significant cause of major vascular complications in contemporary transcatheter aortic valve implantation practice. Methods: This research aimed to evaluate use of the Angio-Seal device in a bailout context in the setting of incomplete hemostasis following use of dual Perclose ProGlide devices in patients undergoing transfemoral transcatheter aortic valve implantation. A total of 185 patients undergoing transfemoral transcatheter aortic valve implantation with either dual Per-close ProGlide (n = 139) or a combination of dual Perclose ProGlide and Angio-Seal (n = 46) were retrospectively analyzed. The baseline, procedural characteristics, and all outcomes (defined according to Valve Academic Research Consortium-2 criteria) were compared. Results: No significant differences were seen between the dual Perclose ProGlide vs dual Perclose ProGlide+Angio-Seal groups with regard to the in-hospital Valve Academic Research Consortium-2 primary end points of major vascular complications (n = 13 [9.4%] vs n = 2 [4.3%]; P =.36), minor vascular complications (n = 13 [9.4%] vs n = 8 [14.7%]; P =.14), major bleeding (n = 16 [11.5%] vs n = 2 [4.3%]; P =.25), and minor bleeding (n = 9 [6.5%] vs n = 5 [10.9%]; P =.34), with higher rates of hematoma in the dual Perclose ProGlide+Angio-Seal group (n = 4 [2.9%] vs n = 5 [10.9%]; P =.044). Conclusion: Finding from the current study suggest that adjunctive Angio-Seal deployment may be feasible and safe, especially in patients with incomplete hemostasis following dual Perclose ProGlide use, and can be an optimal “bailout” procedure. (Tex Heart Inst J. 2022;49(6):e217684).
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    Changes in aortic pulse wave velocity and the predictors of improvement in arterial stiffness following aortic valve replacement
    (Japanese Association for Coronary Artery Surgery, 2017) Cantürk, Emir; Çakal, Beytullah; Karaca, Oğuz; Omaygenç, Onur; Salihi, Salih; Özyüksel, Arda; Akçevin, Atıf
    Background: The interaction between valvular aortic stenosis (AS) and arterial stiffness, as well as the impact of aortic valve replacement (AVR) on arterial stiffness, remains unclear. In this study, we aimed to evaluate the degree of AS severity on non-invasive pulse wave velocity (PWV) measurements. We also searched whether the AVR procedure favorably affects PWV. Methods: In all, 38 patients undergoing AVR for chronic AS were included. The degree of aortic stiffness was measured with PWV at both baseline and 6 months after AVR. Improvement in aortic stiffness was defined as the absolute decrease in PWV at 6 months compared to the baseline value. Results: The study population had a mean age of 59 ± 16 years, mean aortic gradient of 47.1 ± 6.4 mmHg, and mean aortic valve area (AVA) index of 0.45 ± 0.11 cm²/m². Baseline PWV values correlated positively with the mean aortic gradient (r = 0.350, p = 0.031) and negatively with the AVA index (r = -0.512, p = 0.001). The mean PWV improved in 20 patients (53%) and worsened in 18 patients (47%). The baseline New York Heart Association (NYHA) class (odds ratio [OR] = 1.023, 95% confidence interval [CI] = 1.005–1.041, p = 0.041) and AVA index (OR = 1.040, 96% CI = 1.023–1.057, p = 0.028) emerged as the independent predictors of improvement in PWV following AVR. Conclusion: The severity of AS was significantly associated with baseline PWV. In general, the mean PWV did not change with AVR. Baseline NYHA class and the AVA index independently predicted PWV improvement following AVR. Since the change in PWV after AVR was polarized based on the patients’ characteristics, such as preoperative NYHA functional class or AVA index, further studies are needed to confirm clinical significance of PWV change following AVR in severe AS patients.
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    Concomitant right atrial hemangioma resection with lvad implantation first-in-human experience
    (2024) Dursun, Atakan; Hakgör, Aykun; Kenger, Melike Zeynep; Karaca, Oğuz
    Cardiac hemangiomas are exceedingly rare, comprising only 5% to 10% of benign cardiac tumors. We report a patient with a large right atrial mass and end-stage heart failure with severe left ventricular dysfunction. Echocardiography revealed a mass obstructing tricuspid inflow. Contrast-enhanced computed tomography and cardiac magnetic resonance confirmed a 100 mm × 96.5 mm × 104 mm lobulated mass. Simultaneous tumor resection and left ventricular assist device implantation were performed. Histopathologic examination confirmed a cardiac hemangioma. The patient showed significant improvement and remained alive at 3-year follow-up, with only minor gastrointestinal bleeding episodes.
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    Correlationship between plasma osteopontin levels and echocardiography parameters in patients with idiopathic dilated cardiomyopathy
    (Pulsus Group Inc., 2014) Avcı, Anıl; Karaca, Oğuz; Köprülü, Diyar; Alizade, Elnur; Açar, Göksel; Tabakçı, Mehmet Mustafa; Fidan, Serdar; Tellice, Muhammet; Yazıcıo?lu, Mehmet Vefik; Esen, Ali Metin
    Background: Osteopontin (OPN) has been found to be elevated in patients with heart failure (HF). The relationship between OPN and severity of HF has not been widely studied. The aim of this study was to assess correlation of plasma OPN level as a cardiac remodelling biomarker with echocardiographical parameters in patients with idiopathic dilated cardiomyopathy (DCM). Method and results: 62 patients who have idiopathic DCM were included prospectively. Plasma OPN level was determined with a commercially available human OPN enzyme immunoassay (EIA) kit according to its protocol. Echocardiographical parameters were measured according to guidelines. There was no correlation between plasma OPN levels and echocardiographical parameters, NYHA functional capacity, and BNP. Mean plasma OPN level was slightly higher in moderate to severe HF group (NYHA III-IV, n=21) than mild HF group (NYHA I-II, n=41) but it was not statistically significant (6.47±1.92 vs 6.55±2.09, p:0.935). In addition, plasma OPN levels did not show significant difference between idiopathic DCM patients with restrictive pattern and non-restrictive pattern (5.9±1.6 vs 6.72±2.05, p:0.130). Conclusion: We could not find any relation between plasma OPN levels and severity of heart failure in patients with idiopathic DCM.
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    Cystatin C and uncontrolled hypertension
    (Turkish Society of Cardiology, 2020) Omaygenç, Mehmet Onur; Özcan, Özgür Ulaş; Çakal, Beytullah; Karaca, Oğuz
    Objective: Increased serum level of cystatin C, a sensitive biomarker for renal function, seems to predict adverse cardiovascular events. We investigated the predictive value of serum cystatin C for controlling hypertension in an observational study.Methods: We screened 1037 adults residing in both rural and urban communities. They were grouped based on their diagnosis and control of hypertension.Results: Serum cystatin C levels in patients with uncontrolled hypertension were higher than those in patients with controlled hypertension (0.98 +/- 0.23 mg/L vs. 0.89 +/- 0.19 mg/L, p=0.001). However, serum creatinine levels were similar between these groups (0.72 +/- 0.20 mg/dL vs. 0.70 +/- 0.18 mg/dL, p=0.89). Serum cystatin C levels increased the probability of uncontrolled hypertension independent from confounding factors (odds ratio, 1.48; 95% confidence interval, 1.09-5.64; p=0.03).Conclusion: Subtle kidney dysfunction may be detected using serum cystatin C concentrations among patients with poor blood pressure control and normal serum creatinine levels.
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    Echocardiographic determinants of right ventricular systolic dysfunction in non-ischemic dilated cardiomyopathy: Relation to functional status and plasma BNP levels
    (Elsevier, 2013) Karaca, Oğuz; Avcı, Anıl; Güler Babür, Gamze; Alizade, Elnur; Güler, Ekrem; Güneş, Hacı Murat; Göl, Gökhan; Batgerel, Ulaankhuu; Omaygenç, Mehmet Onur; Kızılırmak, Filiz; Geçmen, Çetin; Esen, Ali Metin; Türkmen, Muhsin
    Aim: Right ventricular (RV) functions are well-known to play an important role in prognosis of patients with non-ischemic dilated cardiomyopathy (NICMP) similar to all forms of heart failure. We investigated the echocardiographic determinants of RV systolic dysfunction in patients with NICMP. Methods: Seventy-nine patients with angiographically normal coronary arteries (mean age: 50.5+12, mean EF: 31+4%) were enrolled in this study. Patients were divided into two groups according to their right ventricular (RV) systolic function determined by tissue Doppler systolic velocities (RV-Sm) as: Group A (RV-Sm >10 cm/s, n¼48) and Group B (RV-Sm <10 cm/s, n¼31)
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    Effect of cardiac resynchronization therapy on mitral valve geometry: A novel aspect as "reversed mitral remodeling"
    (Springer, 2018) Karaca, Oğuz; Çakal, Beytullah; Omaygenç, Mehmet Onur; Güneş, Hacı Murat; Kızılırmak, Filiz; Çakal, Sinem Deniz; Naki, Deniz Dilan; Barutçu, İrfan; Boztosun, Bilal; Kılıçaslan, Fethi
    Amelioration of the valvular geometry is a possible mechanism for mitral regurgitation (MR) improvement in patients receiving cardiac resynchronization therapy (CRT). We aimed to establish the precise definition, incidence, and predictors of reversed mitral remodeling (RMR), as well as the association with MR improvement and short-term CRT outcome. Ninety-five CRT recipients were retrospectively evaluated for the end-point of "MR response" defined as the absolute reduction in regurgitant volume (RegV) at 6 months. To identify RMR, changes in mitral deformation indices were tested for correlation with MR response and further analyzed for functional and echocardiographic CRT outcomes. Overall, MR response was observed in 50 patients (53%). Among the echocardiographic indices, the change in tenting area (TA) had the highest correlation with the change in RegV (r = 0.653, p < 0.001). The mean TA significantly decreased in MR responders (4.15 +/- 1.05 to 3.67 +/- 1.01 cm(2) at 6 months, p < 0.001) and increased in non-responders (3.68 +/- 1.04 to 3.98 +/- 0.97 cm(2), p = 0.014). The absolute TA reduction was used to identify patients with RMR (47%) which was found to be associated with higher rates of functional improvement (p = 0.03) and volumetric CRT response (p = 0.036) compared to those without RMR. Non-ischemic etiology and the presence of LBBB independently predicted RMR at multivariate analysis. In conclusion, reduction in TA is a reliable index of RMR, which relates to MR response, and functional and echocardiographic improvement with CRT. LBBB and non-ischemic etiology are independent predictors of RMR.
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    Efficacy of different self-assessment anxiety scales for predicting radial artery spasm during coronary interventions
    (Oxford University Press, 2018) Omaygenç, Mehmet Onur; Karaca, Oğuz; İbişoğlu, Ersin; Özer, Ürün; Çakal, Beytullah; Güneş, Hacı Murat; Omaygenç, Deniz Özden; Boztosun, Bilal
    [Abstract Not Available]
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    Evaluation of adiponectin and lipoprotein(a) levels in cardiac syndrome x
    (Urban & Vogel, 2015) Güler, Ekrem; Güler, Gamze; Kızılırmak, Filiz; Batgerel, Ulaankhuu; Demir, Gültekin Günhan; Güneş, Hacı Murat; Karaca, Oğuz; Özcan, Özgür; Barutçu, İrfan; Türkmen, Muhsin; Esen, Ali Metin
    Aims. Low adiponectin and high lipoprotein(a) [Lp(a)] levels are associated with endothelial dysfunction, atherosclerosis, and coronary artery disease. Cardiac syndrome X (CSX) is characterized by anginal symptoms, positive stress test, and documentation of normal epicardial coronary arteries with angiography. In this study we aimed to investigate the relationship between CSX and circulating levels of adiponectin and Lp(a). Patients and methods. We enrolled 53 female patients with CSX and 33 patients as the control group. The diagnosis of CSX was made according to presence of angina, findings suggestive of ischemia during stress electrocardiography or myocardial perfusion scintigraphy, and documentation of normal coronary arteries in coronary angiography. The control group consisted of patients with atypical angina and normal stress electrocardiography test results. Both groups were matched in terms of hypertension, diabetes mellitus, and metabolic syndrome. Results. Adiponectin levels were significantly decreased in patients with CSX (4.57 mu g/ml vs. 13.18 mu g/ml; p=0.001); however, Lp(a) levels were significantly increased (36.30 mg/dl vs. 7.24 mg/dl; p<0.001). Low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) concentrations did not differ between the case group and the control group (p=0.14, p=0.62, p=0.64, respectively). There was no significant difference between groups in terms of age, body mass index, waist circumference hypertension, hyperlipidemia, diabetes mellitus, or metabolic syndrome. In multivariate analysis, Lp(a) and adiponectin were found to be independent predictors of CSX. An Lp(a) level of >21 mg/dl had 84% sensitivity and 96% specificity {area under the curve (AUC)=0.922, p<0.0001, 95% CI [0.842-0.970]} and an adiponectin level of <= 5.18 mu g/ml also had 58.7% sensitivity and 82.1% specificity (AUC=0.726, p=0.0003, 95% CI [ 0.609-0.823]) for detecting CSX. Conclusion. We detected low adiponectin and high Lp(a) levels in patients with CSX and these findings may be related to the microvascular injury in CSX.
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    Factor XIII Val34Leu polymorphism in patients with cardiac syndrome X
    (Via Medica Journals, 2014) Babür Güler, Gamze; Batgerel, Ulaankhuu; Güler, Ekrem; Karaca, Oğuz; Geçmen, Çetin; Güneş, Hacı Murat; Zencirkıran Ağuş, Hicaz; Esen, Ali Metin; Türkmen, Mehmet Muhsin
    Background: The aim of the study was to examine the frequency of factor XIII polymorphism among patients with cardiac syndrome X (CSX). Methods: This study was designed as a cross-sectional and observational study. Forty-eight female patients with CSX and 36 controls matched by age, gender, diabetes, and hypertension were studied. CSX was defined as typical chest pain during rest or effort, abnormal test result for exercise ECG, and presence of angiographically normal epicardial coronary arteries after ruling out inducible spasm. Factor XIII gene polymorphism was investigated by using CVD Strip Assay (ViennaLab Diagnostic GmbH) commercial kit. Results: The frequency of factor XIII (Val/Leu + Leu/Leu) mutation was significantly higher in patients with CSX (43%) than in controls (19%) (p = 0.02). Frequency of the Leu allele was significantly higher in the patient group (23.5% vs. 11.1%, p = 0.04). Factor XIII (Val//Leu + Leu/Leu) mutation (p = 0.01, OR = 3.42; 95% CI 1.22-9.58) and smoking (p = 0.04, OR = 3.33, 95% CI 1.05-10.58) were identified as independent predictors of the disease in multivariate regression analysis. Conclusions: This study indicates that there is an evidence for association between factor XIII Val34Leu polymorphism and CSX.
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    Focusing on cardio-hepatic syndrome in heart failure and cardiovascular interventions: Is it time to update the prognostic risk scores?
    (Turkish Society of Cardiology, 2023) Karaca, Oğuz
    Heart failure (HF) is a multifactorial, heterogeneous disease characterized by congestion and/or reduced cardiac output, leading to unmet metabolic demands of vital organs. Regardless of the etiology or phenotypic features (ischemic vs. non-ischemic, reduced or preserved ejection fraction, severe valvular stenosis or regurgitation), the “inevitable consequence” of the HF syndrome is the progressive end-organ dysfunction. Failure of one or more organ systems (heart itself, lungs, kidneys, liver, intestine, brain, skeletal muscle) has been the main determinant of survival in HF.1,2 Integration of new pharmacologic agents (saqubitril/valsartan, sodium-glucose cotransporter-2 (SGLT-2) inhibitors) into guideline-directed medical therapy and advancements in interventional and surgical procedures (complex coronary interventions, transcatheter aortic valve implantation (TAVI), Mitra-clip, left ventricular assist devices) have led to a significant improvement in HF mortality in selected patients.3-7 However, HF still remains a global health problem associated with reduced survival, frequent hospitalizations, and impaired quality of life.
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    Giant left ventricular pseudoaneurysm concomitant with severe mitral regurgitation: Multimodality imaging and successful surgical repair
    (Oxford University Press, 2015) Karaca, Oğuz; Güneş, Hacı Murat; Çakal, Beytullah; Türko?lu, Halil
    A 58-year old man with previous myocardial infarction was shown to have a huge pseudoaneurysm (8 × 6 cm) on the left ventricular posterior wall concomitant with severe mitral regurgitation. The left ventricle was reconstructed with resection of the pseudoaneurysm sac and repaired with a Dacron graft (Dor procedure) along with mitral ring annuloplasty (Fig. 1E). Postoperatively, left ventricle was normal in size (5.5 × 3.8 cm) without residual mitral regurgitation.
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    Guideline-adherent therapy for stroke prevention in atrial fibrillation in different health care settings: Results from ramses study
    (Elsevier B.V., 2017) Başaran, Özcan; Doğan, Volkan; Biteker, Murat; Karadeniz Özpamuk, Fatma; Tekkesin, Ahmet İlker; Çakıllı, Yasin; Türkkan, Ceyhan; Hamidi, Mehmet; Demir, Vahit; Gürsoy, Mustafa Ozan; Öztürk, Müjgan Tek; Aksan, Gökhan; Seyis, Sabri; Ballı, Mehmet; Alıcı, Mehmet Hayri; Bozyel, Serdar; Kırma, Cevat; Beton, Osman; Tekinalp, Mehmet; Aykan, Ahmet Çağrı; Kalaycıoğlu, Ezgi; Bolat, İsmail; Taşar, Onur; Şafak, Özgen; Kalçık, Macit; Yaman, Mehmet; İnci, Sinan; Altıntaş, Bernas; Kalkan Semih; Çalık, Feyza; Karaca, Oğuz; Helvacı, Füsun; Akay Halli, Kadriye; Çanga, Yiğit; Çelebi, Savaş; Altuntaş, Emine; Aytürk, Mehmet; Güneş, Hacı Murat; Bezgin, Tahir; Aksakal, Aytekin; Çakal, Beytullah; Çolak, Ayşe; Kaplan, Özgür; Tatlısu, Adem; Gözübüyük, Gökhan; Demirelli, Selami; Kaya, Adnan; Rencüzoğulları, İbrahim; Bayram, Zübeyde; Şimşek, Ziya; Civan, Murat; Batgharel, Ulaankhu; Ata, Ali Ekber; Göl, Gökhan; Mert Gurbet Özge; Mert, Kadir Uğur; Değirmencioğlu, Aleks; Candan, Özkan; Çelebi Özcan, Özlem; Doğan, Cem; Yavuz, Fethi; Ulucan, Şeref; Arısoy, Arif; Şahin Dilekçi, Bingül; Ermiş, Emrah; Gökaslan, Serkan; Pektaş, İdris; Tanındı, Aslı; Tekin, Kamuran; Sancar Memiç, Kadriye; Çekiç, Edip Güvenç; Başaran, Filiz Nesrin; Altun, İbrahim
    Objective No studies have been conducted in Turkey to compare the quality of stroke prevention therapies provided in different healthcare settings in patients with atrial fibrillation (AF). Therefore, we aimed to evaluate possible differences between secondary (SH) and tertiary hospital (TH) settings in the effectiveness of implementing AF treatment strategies. Methods Baseline characteristics of 6273 patients with non-valvular AF enrolled in the RAMSES (ReAl-life Multicentre Survey Evaluating Stroke Prevention Strategies in Turkey) study were compared. Results Of the study population, 3312 (52.8%) patients were treated in THs and 2961 (47.2%) patients were treated in SHs. Patients treated in the SH setting were older (70.8 ± 9.8 vs. 68.7 ± 11.4 years, p < 0.001), had a lower socioeconomic status, had a higher CHA2DS2VASc and HASBLED scores (3.4 ± 1.4 vs. 3.1 ± 1.7, p < 0.001 and 1.7 ± 1.0 vs. 1.6 ± 1.1, p < 0.001 respectively), and had more comorbidities than patients treated in THs. Inappropriate oral anticoagulant use was more prevalent in SHs than THs (31.4% vs. 25.6%, p < 0.001). When over- and undertreatment rates were compared among hospital types, overtreatment was more prevalent in THs (7.6% vs. 0.9%, p < 0.001) while undertreatment was more common in SHs (30.5% vs. 17.9%, p < 0.001). Conclusion This study demonstrates the marked disparity between patient groups with AF presenting at SHs and THs. The use of guideline-recommended therapy is not adequate in either type of centre, overtreatment was more prevalent in THs and undertreatment was more prevalent in SHs.
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    Hemopericardium and cardiac tamponade in a patient treated with dabigatran etexilate
    (Korean Soc Cardiology, 2016) Kızılırmak, Filiz; Güneş, Hacı Murat; Güler, Ekrem; Demir, Gültekin Günhan; Karaca, Oğuz; Canpolat, Habibe Gamze
    Dabigatran etexilate is one of the new oral anticoagulants approved to reduce the risk of stroke in patients with atrial fibrillation (AF). A variety of bleeding complications with dabigatran have been reported, but reports of hemopericardium are rare. We described a case of a 66 year-old female patient with non-valvular AF receiving dabigatran etexilate 150 mg twice daily for one year who suffered from hemopericardium. Her laboratory tests performed 1 year prior were normal and her admission tests revealed acute renal failure and elevated international normalized ratio (INR) level (4.79). Urgent pericardiocentesis was followed by improved renal functions and normalized INR. Dabigatran etexilate is a new oral anticoagulant that is increasingly used in daily practice. However, life-threatening complications warrant caution. Elevated INR may be related with overdose but the association of bleeding risk of dabigatran and INR requires further confirmation.
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    How accurate are manufacturers' recommendations in determining ineligibility for transfemoral transcatheter aortic valve implantation?
    (Sociedade Portuguesa De Cardiologia, 2023) Çakal, Beytullah; Çakal, Sinem; Karaca, Oğuz; Kızılırmak Yılmaz, Filiz; Güneş, Hacı Murat; Yıldırım, Arzu; Güler, Yeliz; Özcan, Özgür Ulaş; Boztosun, Bilal
    Introduction: Up to one-third of patients indicated for transcatheter aortic valve implantation (TAVI) may be unsuitable for transfemoral TAVI (TF-TAVI) according to manufacturers' recommendations and numerous professional societies. Objective: This study aimed to investigate the predictive value of manufacturers' guidelines for major vascular access site complications using the Perclose ProGlide device. Methods: Among 208 patients undergoing TF-TAVI, 144 patients (69.2%) were deemed eligible for TF-TAVI according to the manufacturer's instructions. A minimal lumen diameter (MLD) of the femoral artery below the manufacturer's specified limits and/or the presence of circumferential calcification were the reasons for ineligibility. Calcium score (CS), sheath-to-femoral artery ratio (SFAR) and MLD were estimated from computed tomography imaging. Vascular complications (VCs) (defined according to VARC-2 criteria) were retrospectively compared. Results: Patients in the ineligible group had higher SFAR (1.13±0.15 vs. 0.88±0.107, p<0.001) and CS (1.66±0.99 vs. 1.24±0.73; p=0.003), and significantly lower MLD (7.72±1.03 vs. 6.31±0.96 mm; p<0.001) compared to the eligible group. Major (6.3% vs. 12.3%, p=0.13) and minor VCs (10.4% vs. 15.6%, p=0.29) were similar in the eligible and ineligible groups. The ineligible group had higher rates of rupture (0.7% vs. 6.3%; p=0.03). SFAR was the only independent predictor of major VCs (OR 469.1, 95% CI 4.95-44466.57, p=0.008). Conclusion: The TAVI team should not decide whether the patient is suitable for a femoral approach based solely on the manufacturer's criteria, and should incorporate additional factors that could be predictive of major VCs.