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Öğe Baseline characteristics, management patterns and outcome in patients with pulmonary embolism and malignancy: insights from a single-centre study(2025) Hakgör, Aykun; Kültürsay, Barkın; Keskin, Berhan; Sekban, Ahmet; Tokgöz, Hacer Ceren; Tanyeri, Seda; Kaymaz, CihangirBackground and aim: Acute pulmonary embolism (PE) is one of the main causes of death in patients with active cancer. In this study, we evaluated the impact of malignancy on the treatment choices, and short- and long-term clinical outcomes in patients with acute PE. Methods: In this study, 872 acute PE patients (age 61.6 ± 16.8 years, female 57.5 %) from different risk and treatment categories were retrospectively analyzed and divided into two groups according to the presence of active malignancy. Results: Active malignancy was documented in 129 (14.8 %) out of the 872 patients. Ultrasound-assisted-thrombolysis (USAT), rheolytic-thrombectomy (RT), systemic-thrombolysis (ST) and anticoagulation-alone therapies were noted in 27.3 %, 6.4 %, 16.6 % and 49.7 % of overall PE patients. RT and anticoagulation therapies were more frequent in patients with malignancy whereas ST and USAT were more frequently used in the other group. Regardless of the presence of malignancy and the treatment modality chosen, significant improvements were achieved in all treatment targets (p < 0.001 for all). Bleeding rates were similar in both groups, while in-hospital and long-term mortality was higher in the malignancy cohort. Active malignancy was found to be an independent predictor for composite of 60-day mortality and PE-related rehospitalization (adjusted OR: 2.43; 95 % CI: 1.32–4.47, p = 0.04) and long-term mortality (adjusted HR: 2.25, 95 % CI: 1.29–3.91, p = 0.004). Conclusion: Concomitant malignancy adversely affects both short- and long-term outcomes in patients with acute PE. Although these patients are more vulnerable, it is possible to achieve satisfactory treatment success with acceptable bleeding rates with the inclusion of catheter-based methods as treatment option.Öğe Changing patterns in clinical, echocardiographic and haemodynamic characteristics, and management strategies that may be translated to improved survival in pulmonary hypertension(2024) Kaymaz, Cihangir; Tokgöz, Hacer Ceren; Hakgör, Aykun; Kültürsay, B.; Sekban, Ahmet; Tanyeri, S.; Özdemir, Nihal...Öğe Current insights for catheter-directed therapies in acute pulmonary embolism: Systematic review and our single-center experience(NLM (Medline), 2023) Kaymaz, Cihangir; Tokgöz, Hacer Ceren; Kültürsay, Barkın; Hakgör, Aykun; Keskin, Berhan; Sekban, Ahmet; Karagöz, AliIn this review, the current status of the worldwide experience on different catheter-directed treatment systems utilized as alternative reperfusion methods in acute pulmonary-embolism was evaluated, and the risk stratification algorithms in which catheter-directed treatments may be implemented, source of evidence in this setting, adjudication of benefits and risks of available techniques, and innovative multidisciplinary frameworks for referral patterns and care delivery were discussed. Moreover, our perspectives on risk-based catheter-directed treatment utilization strategies in acute pulmonary embolism were summarized.Öğe Efficacy and safety of reduced-dose and slow-infusion intravenous alteplase regimen in patients with acute pulmonary embolism at intermediate-high-risk(2024) Kültürsay, B.; Keskin Meriç, Bengisu; Sekban, Ahmet; Hakgör, Aykun; Tokgöz, Hacer Ceren; Tanyeri, S.; Kaymaz, Cihangir...Öğe Hoarseness as a predictor for pulmonary arterial aneurysm and extrinsic left main coronary artery compression in patients with severe pulmonary hypertension(Turkish Society of Cardiology, 2023) Tokgöz, Hacer Ceren; Tanyeri, Seda; Sekban, Ahmet; Hakgör, Aykun; Kültürsay, Barkın; Keskin, Berhan; Karagöz, Ali; Tosun, Ayhan; Buluş, Çağdaş; Külahçıoğlu, Şeyhmus; Tanboğa, İbrahim Halil; Özdemir, Nihal; Kaymaz, CihangirOBJECTIVE: Pulmonary artery (PA) enlargement is a common finding in patients with severe pulmonary hypertension (PH) and may be associated with extrinsic compression of the left main coronary artery (LMCA-Co) and/or compression of the left recurrent laryngeal nerve resulting in hoarseness named as Ortner syndrome (OS). In this study, we evaluated the diagnostic impact of OS in predicting the PA aneurysm and significant LMCA-Co in patients with PH. METHODS: Our study population comprised retrospectively evaluated 865 with PH confirmed with the right heart catheterization between 2006 and 2022. Patients underwent coronary angiography due to several indications, including the presence of a PA aneurysm on echocardiography, angina symptoms, or the incidental discovery of LMCA-Co on multidetector computed tomography. The LMCA-Co is defined as diameter stenosis ³ 50% in reference distal LMCA segment on two consecutive angiographic planes. RESULTS: The LMCA-Co and hoarseness were documented in 3.8% and 4.3% of patients with PH, respectively. Increasing PA diameter was significantly associated with worse clinical, hemodynamic, laboratory, and echocardiographic parameters. The receiver operating curves revealed that the PA diameter >41 mm was cutoff for hoarseness (AUC: 0.834; sensitivity 69%, specificity 84%, and negative predictive value 98%), and PA diameter >35 mm was cutoff for LMCA-Co >50% (AUC: 0.794; sensitivity 89%, specificity 58 %, and negative predictive value 99%). An odds ratio of hoarseness for LMCA-Co was 83.3 (95% confidence interval; 36.5-190, P < 0.001) with 3.2% sensitivity, 98.7% specificity, and 59% positive and 98% negative predictive values. CONCLUSION: In this study, a close relationship was found between the presence of hoarseness and the probability of extrinsic LMCA-Co by enlarged PA in patients with severe PH. Therefore, the risk of LMCA-Co should be taken into account in patients with PH suffering from hoarseness.Öğe Remembering the Occam’s Razor: Could simple electrocardiographic findings provide relevant predictions for current hemodynamic criteria of pulmonary hypertension?(Turkish Society of Cardiology, 2023) Tokgöz, Hacer Ceren; Öcal, Bahadır Erdem; Erkuş, Yiğit Cengiz; Tanyeri Üzel, Seda; Kültürsay, Barkın; Tosun, Ayhan; Keskin, Berhan; Hakgör, Aykun; Sırma, Dicle; Buluş, Çağdaş; Karagöz, Ali; Tanboğa, İbrahim Halil; Külahçıoğlu, Şeyhmus; Bayram, Zübeyde; Sekban, Ahmet; Özdemir, Nihal; Kaymaz, CihangirBackground: We evaluated the predictive value of electrocardiographic (ECG) findings for pulmonary hemodynamics assessed by right heart catheterization (RHC). Methods: Our study population comprised 562 retrospectively evaluated patients who underwent RHC between 2006 and 2022. Correlations between ECG measures and pulmonary arterial systolic and mean pressures (PASP and PAMP) and pulmonary vascular resistance (PVR) were investigated. Moreover, receiver operating characteristic (ROC) curve analysis assessed the predictive value of ECG for pulmonary hypertension (PH) and precapillary PH. Results: The P-wave amplitude (Pwa) and R/S ratio (r) in V1 and V2, Ra in augmented voltage right (aVR), right or indeterminate axis, but not P wave duration (Pwd) or right bundle branch block (RBBB) significantly correlated with PASP, PAMP, and PVR (P < .001 for all). The partial R2 analysis revealed that amplitude of R wave (Ra) in aVR, R/Sr in V1 and V2, QRS axis, and Pwa added to the base model provided significant contributions to variance for PASP, PAMP, and PVR, respectively. The Pwa > 0.16 mV, Ra in aVR > 0.05 mV, QRS axis > 100° and R/Sr in V1 > 0.9 showed the highest area under curve (AUC) values for PAMP > 20 mm Hg. Using the same cutoff value, Ra in aVR, Pwa, QRS axis, and R/Sr in V1 showed highest predictions for PVR > 2 Wood Units (WU). Conclusion: In this study, Pwa, Ra in aVR, right or indeterminate axis deviations, and R/Sr in V1 and V2 showed statistically significant correlations with pulmonary hemodynamics, and Ra in aVR, R/Sr in V2 and V1, QRS axis, and Pwa contributed to variance for PASP, PAMP, and PVR, respectively. Moreover, Pwa, Ra in aVR, QRS axis, and R/Sr in V1 seem to provide relevant predictions for PH and precapillary PH.
