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    Addition of the duration of ST segment depression to Duke treadmill score for diagnostic accuracy of exercise electrocardiography to predict obstructive coronary artery disease
    (Taylor & Francis Ltd, 2022) Turhan Çağlar, Fatma Nihan; Gök, Gülay; Öztimer, Gülsüm; Katkat, Fahrettin; Karakozak, Dilay; Öztaş, Didem Melis; Beyaz, Metin Onur; Uğurlucan, Murat
    Introduction Exercise electrocardiography (EET) is a safe and cost-effective method to predict the presence, prognosis, and severity of coronary artery disease (CAD). Various score models have been developed to increase predictive power of EET. In this study, we aimed to evaluate whether adding ST depression duration could have an effect on increasing the value of Duke treadmill score (DTS) in predicting obstructive CAD. Methods In this single centred, cross-sectional study, we evaluated a total of 258 patients who presented with a complaint of chest pain and undergone coronary angiogram in result of a positive EET. DTS was calculated for all the patients. The new score-revised DTS- was calculated by adding total ST depression time to classical DS parameters. We compared area under the curve (AUC) of DTS and revised DTS by Delongi method. Results Mean age of the group was 58.43 +/- 9.37, and 37.2% (n = 96) were female. Mean total ST-depression duration was 171.72 +/- 91.43 msec in normal artery group,241.54 +/- 118.11 msec in non-obstructive CAD group, and 281.26 +/- 113.64 in obstructive CAD group.ST-depression duration in both exercise and recovery, and total ST depression duration were significantly higher in obstructive CAD group than non-obstructive and normal artery groups (p = 0.024, p = 0.01, p < 0.01, and p < 0.01, respectively). Revised DTS had significantly higher predictive value of obstructive CAD compared to classical DS (AUC (95%CI): 0.744 vs. 0.626, p < 0.001). The AUC of DS was significantly lower than the new score (z-score:3.274, p = 0.011). Conclusion In conclusion, adding ST depression duration to DTS calculation is increasing the discriminative value of DTS to predict obstructive CAD. Benefits of EET within the context of the management of CAD is well-known, hence, it is clear that physicians may use revised DTS.
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    Is there any association between rs1303 (Pi*M3) variant of alpha-1 antitrypsin gene and atrial septal aneurysm development?
    (Wiley, 2019) Turhan Çağlar, Fatma Nihan; Işıksaçan, Nilgün; Bıyık, İsmail; Oktay Türeli, Hande; Katkat, Fahrettin; Karabulut, Dilay; Öztaş, Didem Melis; Uğurlucan, Murat
    Aim Atrial septal aneurysm (ASA) is one of the congenital heart defects. The underlying pathophysiology of ASA has not been fully understood yet. Alpha-1 antitrypsin (A1AT) is a serine protease inhibitor glycoprotein, which is held responsible from tissue wall proteolysis if it is deficient in the body. The aim of this study was to investigate A1AT serum levels and the rs1303 (Pi*M3) variant in A1AT gene in patients with ASA. Material and Methods Thirty patients (7 male and 23 female) with isolated ASA and 33 patients (11 male and 22 female) with normal atrial septum on echocardiography were included in this study. A1AT serum levels of study patients were measured quantitatively by the enzyme-linked immune sorbent assay (ELISA) method. The A1AT gene mutation rs1303 was analyzed by genotyping, which is performed on genomic DNA extracted from circulating mononuclear blood cells. Single-nucleotide polymorphism was evaluated on polymerase chain reaction using commercial kits. Results A1AT serum levels were not statistically different among patients with and without ASA (9.52 +/- 4.33 mu g/mL vs 9.83 +/- 5.27 mu g/mL, respectively, P = .80). A1AT homozygote mutation (PiM3M3) was significantly higher in the ASA group than the control group (21 vs 11, OR (95% CI): 6.68 [2.09-21.40], P = .001). A1AT serum levels were similar among patients with normal A1AT allele (PiMM), homozygote variant (PiM3M3), and heterozygote variant (PiMM3) (P = .79). Conclusion This preliminary study revealed that homozygote A1AT rs1303 (PiM3M3) variant is significantly higher in patients with isolated ASA and may be associated with ASA development. Large scale comprehensive studies are needed to validate these results.
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    Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio are associated with cryptogenic stroke in patients with patent foramen ovale
    (Termedia Publishing House Ltd., 2020) Turhan Çağlar, Fatma Nihan; Alp, Murat Erdem; Karabulut, Nilay; Işıksaçan, Nilgün; Katkat, Fahrettin; Cebe, Hülya; Oflar, Ersan; Öztaş, Didem Melis; Rodoplu, Orhan; Ünal, Orçun; Conkbayır, Cenk; Aktürk, Faruk; Uğurlucan, Murat
    Introduction: Although most ischaemic strokes are due to cardioembolism, about 25-40% of strokes are cryptogenic. Patent foramen ovale has been associated with cryptogenic stroke; however, the precise mechanism of this association has not been demonstrated. The aim of this study was to evaluate the association between inflammatory markers and cryptogenic stroke in patients with patent foramen ovale.Material and methods: We included 206 patients with patent foramen ovale. Ninety-four (45.63%) out of 206 patients had had stroke, and 112 (54.37%) had not had stroke. The ratio of the total neutrophil count to the total lymphocyte count was defined as the neutrophil to lymphocyte ratio, and the ratio of the absolute platelet count to the absolute lymphocyte count was determined as the platelet to lymphocyte count.Results: The neutrophil to lymphocyte ratio was significantly higher in patients who had stroke than in those who did not (2.41 ±1.69 vs. 2.19 ±1.74, p = 0.047). Although the platelet to lymphocyte count was also higher in patients who had had stroke than in those who had not, it was not statistically significant (120.94 ±55.45 vs. 118.01 ±52.21, p = 0.729). 1.62 was the cut-off value for neutrophil to lymphocyte ratio to be associated with stroke with 73.4% sensitivity and 45.05% specificity (p = 0.042).Conclusions: This study demonstrated that elevated neutrophil to lymphocyte ratio and platelet to lymphocyte count could be associated with cryptogenic stroke in patients with patent foramen ovale.