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Öğe Assessment of the Relationship Between the Adropin Levels and the Coronary Collateral Circulation in Patients with Chronic Coronary Syndrome(Arquivos Brasileiros Cardiologia, 2022) Akkaya, Hasan; Gunturk, Ertugrul Emre; Akkaya, Fulya; Karabiyik, Ugur; Gunturk, Inayet; Yilmaz, SametBackground: Coronary collateral circulation (CCC) provides an alternative blood flow to myocardial tissue exposed to ischemia and helps to preserve myocardial functions. Endothelial-derived nitric-oxide (NO) production and vascular endothelial growth factor (VEGF) have been suggested as the most important factors in the development of CCC. Adropin is a peptide hormone responsible for energy hemostasis, and is known for its positive effects on the endothelium through NO and VEGF. Objective: The aim of this study is to investigate the association between adropin and the presence of CCC in patients with chronic coronary syndrome (CCS). Methods: A total of 102 patients with CCS, who had complete occlusion of at least one major epicardial coronary artery, were included in the study and were divided into two groups: the group of patients (n:50) with poor CCC (Rentrop 0-1) and the group of patients (n:52) with good CCC (Rentrop 2-3). The level of significance adopted in the statistical analysis was 5%. Results: Mean adropine levels were found as 210.83 +/- 17.76 pg/mL and 268.25 +/- 28.94 pg/mL in the poor and good CCC groups, respectively (p<0.001). Adropin levels proved to be positively correlated with neutrophil-to-lymphocyte ratios (r:0.17, p:0.04) and the rentrop scores (r:0.76, p<0.001), and negatively correlated with age (r:-0.23, p:0.01) and Gensini scores (r:-0.19, p:0.02). Adropin level is a strong independent predictor of good CCC development (OR:1.12, 95% CI:(1.06-1.18), p<0.001). Conclusion: This study suggests that adropin levels may be a possible factor associated with the presence of CCC in CCS patients.Öğe Can platelet count be controlled with ticagrelor in patients with essential thrombocythaemia? A case series(Oxford Univ Press, 2023) Yilmaz, Samet; Cetinkaya, Yakup; Akkaya, Hasan; Arisoy, ArifBackground Essential thrombocythaemia (ET) is defined as a myeloproliferative neoplasm with a tendency to haemorrhage and thrombosis. Acute coronary thrombosis can be observed in 1 out of 10 patients. The management of ET patients with acute coronary syndrome (ACS) is a complex clinical condition that requires close follow-up. Case summary Case-1: a 52-year-old female patient with a diagnosis of ET with Janus kinase (JAK)--2 mutation, despite using cytoreductive agents, platelet counts could not be controlled. Platelet counts started to follow a normal course with the ticagrelor treatment given after ACS. Case-2: a 49-year-old female patient who was given ticagrelor treatment after ACS was found to have JAK-2+ ET. The patient whose platelet count returned to normal after ticagrelor treatment was using a cytoreductive agent before the index event. Case-3: a 54-year-old female patient with ET without any genetic mutation. In the patient whose platelet count did not decrease despite ticagrelor treatment and cytoreductive agents given after ACS, platelet counts returned to normal with interferon therapy. Discussion Platelet counts returned to the normal range with ticagrelor treatment given after ACS in patients with JAK+ ET. Monitoring platelet reduction in JAK+ patients with P2Y12 inhibition is thought to be important for new treatment options.Öğe Coronary artery anomalies and dominance: data from a single center in Turkey(Edizioni Minerva Medica, 2022) Akkaya, Hasan; Gunturk, Ertugrul E.BACKGROUND: Coronary artery anomalies (CAA) are found in 0.2% to 1.3% of coronary angiograms. The aim of the presented study was to describe congenital CAA and their variations, also identifying the prevalence of these anomalies and coronary artery dominance in our center. METHODS: A total of 7858 patients were included in the study retrospectively between August 2015 and March 2020. Patients undergoing coronary angiography (CAG) were reviewed by at least 2 independent and experienced observers. The Angelini's CAA Classification method was used to classify patients. Coronary dominance was determined according to the artery from which the posterior desending artery originated. RESULTS: CAA was detected in 88 (1.1%) out of 7858 patients. Of these patients, 73 (82.9%) had anomalies of origination and course called group A, 7 (7.9%) had anomalies of intrinsic coronary arterial anatomy called group B, and 8 (9.1%) had anomalies of coronary termination called group C. Anomalous collateral vessels called group D were not detected. RCA dominance was N.=5579 (70.99%), Cx dominance was N.=1021 (12.99%), and codominancy was N.=1258 CONCLUSIONS: The incidence of CAA was 1.1% in total and is compatible with other major studies. According to the Angelini CAA clasification, group B anomalies are observed more frequently than other studies. Cx dominance is (Cite this article as: Akkaya H, Giintiirk EE. Coronary artery anomalies and dominance: data from a single center in Turkey.Öğe Determination of the increased risk of developing atrial fibrillation in fibromyalgia syndrome(Bmc, 2020) Akkaya, Hasan; Gunturk, Ertugrul Emre; Kaydok, Ercan; Ozdemir, BetulIntroduction: Atrial fibrillation (AF) is the leading cause of ischemic stroke and is one of the most common arrhythmias. Previous studies have shown that impaired diastolic functions, P wave dispersion (Pd), and prolonged atrial conduction times (ACT) are associated with increased incidence of atrial fibrillation (AF). The aim of this study was to evaluate diastolic functions, Pd, and ACT in fibromyalgia syndrome (FMS) patients to determine whether there is an increase in the risk of developing AF. Methods: The study included a total of 140 female patients (70 FMS group, 70 healthy control group). Pd was evaluated using 12 lead electrocardiography (ECG), and diastolic functions and ACT with echocardiography. The ECG and echocardiographic evaluations were performed by different cardiologists blinded to the clinical information of the subjects. Results: There was no difference between the two groups in laboratory and clinical parameters. Patients with FMS had significantly higher echocardiographic parameters of ACT known as left-sided intra-atrial (13.9 +/- 5.9 vs. 8.1 +/- 1.8, p <0.001), right-sided intra-atrial (21.9 +/- 8.2 vs. 10.4 +/- 3.5, p<0.001) and interatrial [40 (25-64) ms vs. 23 (14-27) ms p<0.001] electromechanical interval (EMI) compared with the control group. Pd was significantly greater in the FMS group compared with the control group [46 (29-62) ms vs. 32 (25-37) ms, p<0.001]. In the FMS group, there was no significant relationship of the echocardiographic parameters of ACT, Pmax and Pd with age, E/A ratio and deceleration time (DT); while all these five parameters were significantly correlated with left atrial dimension, isovolumetric relaxation time (IVRT), fibromyalgia impact questionnaire (FIQ) and visual analogue scale (VAS). There was a strong correlation between FIQ and VAS and echocardiographic parameters of ACT, Pmax and Pd. Conclusions: Impaired diastolic functions, an increase in Pd, and prolongation of ACT were observed in FMS. Current disorders are thought to be associated with an increased risk of AF in FMS. The risk of developing AF increases with the severity of FMS and clinical progression.Öğe Determining the Relationship between Non-HDL Cholesterol and Syntax Score in Patients with Acute Coronary Syndrome Under 45 Years of Age(Kare Publishing, 2021) Akkaya, HasanObjectives: This study aimed to evaluate the relationship between non-HDL cholesterol level, which is a risk factor for coronary artery disease (CAD), and Syntax score. Methods: This retrospective study included patients less than 45 years of age who underwent coronary angiography with a diagnosis of acute coronary syndrome between August 2015 and July 2020. Syntax scores of the patients were evaluated by two experienced cardiologists using the www.syntaxscore.com version on 2.28. Metabolic parameters such as total cholesterol, HDL cholesterol, LDL cholesterol, triglyceride and HbA1c of the patients were obtained from their files. Non-HDL cholesterol levels were calculated by subtracting HDL cholesterol from total cholesterol. Results: In total, 296 patients were included in this study, 264 (89.1%) of patients were male. The mean Syntax score of the patients was 16.7±6.5. A significant positive correlation was determined between the Syntax score and non-HDL cholesterol, total cholesterol, LDL cholesterol, triglyceride, whereas a negative correlation was noted between the Syntax score and HDL cholesterol value (r=0.360 and p<0.001; r=0.426 and p<0.001; r=0.414 and p<0.001; r=0.388 and p=0.001; r=-0.396 and p<0.001, respectively). Besides, there was a significant correlation between Syntax score and HbA1c (r=0.768 and p<0.001). Conclusion: The Syntax score which, indicates the severity and complexity of CAD, was noted to have a significant positive correlation with non-HDL cholesterol, HbA1c, total cholesterol, LDL cholesterol, triglyceride, and a negative correlation with HDL cholesterol. ©Copyright 2021 by Anatolian Journal of Family MedicineÖğe Echocardiographically Measured Epicardial Fat Predicts New-onset Atrial Fibrillation after Cardiac Surgery(Soc Brasil Cirurgia Cardiovasc, 2020) Gunturk, Ertugrul Emre; Topuz, Mustafa; Serhatlioglu, Faruk; Akkaya, HasanObjective: The current study aims to investigate the role of echocardiographically measured epicardial adipose tissue (EAT) thickness in the prediction of new-onset atrial fibrillation (AF) following coronary artery bypass grafting (CABG) surgery. Methods: One hundred and twenty-four patients scheduled to undergo isolated on-pump CABG due to coronary artery disease were enrolled to the current study. Patient characteristics, medical history and perioperative variables were prospectively collected. EAT thickness was measured using transthoracic echocardiography (TTE). Any documented episode of new-onset postoperative AF (POAF) until discharge was defined as the study endpoint. Forty-four participants with POAF served as AF group and 80 patients without AF served as Non-AF group. Results: Two groups were similar in terms of baseline echocardiographic and laboratory findings. In laboratory findings, the groups were similar in terms of the studied parameters, except N-terminal pro-brain natriuretic peptide (NT Pro-BNP), which was higher in AF group than in Non-AF group (P=0.035). The number of left internal mammary artery (LIMA) grafts was not different in both groups. AF group had higher cross-clamp (CC) and cardiopulmonary bypass (CPB) times than Non-AF group (P=0.01 and P<0.001). In multivariate logistic regression analysis, EAT was found an independent predictor for the development of POAF (OR 4.47, 95% CI 3.07-5.87, P=0.001). Conclusion: We have shown that EAT thickness is associated with increased risk of AF development and can be used as a prognostic marker for this purpose.Öğe Epicardial adipose tissue thickness predicts non-dipper statue in newly diagnosed hypertensive patients(Edizioni Minerva Medica, 2021) Emre Gunturk, Ertugrul; Topuz, Mustafa; Akkaya, Hasan; Topuz, Ayse N.BACKGROUND: Hypertension is known to be a major reason for adverse cardiovascular events and increases morbidity and mortality rates. In individuals with a normal circadian rhythm, nocturnal blood pressure falls at a rate of 10-20%. Conversely, <10% of nocturnal blood pressure decline is defined as non-dipping circadian blood pressure (BP) profile. It has been reported that this is an independent predictor of cardiovascular morbidity and mortality both in those with and without hypertension. METHODS: This cross-sectional study included newly diagnosed hypertensive patients who presented at our clinic. All patients underwent a physical examination and the medical history was recorded. Patients with chronic hypertension, any known cardiac or valve disease, cancer, chronic kidney or liver disease, endocrinological disorders, alcohol or drug abuse, or rheumatological disorders were excluded from the study. RESULTS: Group 1 (non-dipper) comprised 50 patients and group 2 (dipper), 40 patients. The baseline characteristics of the study groups are summarized in Table I. In the laboratory analyses, group I had higher total-C, LDL-C, and TG values and lower HDL-C levels than group 2 (P<0.05 for all). Plasma fasting glucose was higher in group 1 than in group 2 (P<0.01). CONCLUSIONS: According to the results of this study, epicardial adipose tissue (EAT) thickness can be classified as an independent factor for the development of non-dipper hypertension. As a simple and inexpensive method, the role of EAT thickness should be kept in mind when physicians encounter a newly diagnosed hypertensive patient.Öğe Evaluation of myocardial functions with, strain and strain rates echocardiography measurements in atrial septal defect patients with percutaneous closure(Edizioni Minerva Medica, 2022) Cosgun, Muharrem S.; Akkaya, HasanBACKGROUND: In this study we aimed to evaluate myocardial functions of patients with atrial septal defect (ASD) by strain and strain rate echocardiography. Because, evaluation of myocardial functions is very important for management of responsive to treatment in congenital heart disease. However, due to complex structure and physiology it is difficult to evaluate right ventricle. Recently, strain and strain rate echocardiography have been introduced as an encouraging method to evaluate myocardial functions. METHODS: Thirty-one patients with ASD and 31 control subjects with similar chracteristics were included in the study. All patients' defect was closed with ASD occlude?' device. In control patients, strain and strain rate echocardiography measurements were conducted additional to conventional echocardiographic parameters. Patients with ASD data were divided into three groups: preprocess, postprocess first and sixth month. The data obtained were compared with the control group and within themselves. RESULTS: After ASD closure, procedure strain and strain rate echocardiography values at right ventricular mid segment (-27.21,1.6/-32.6 +/- 1.1 P <= 0.001 and -2.100.36/-2.90 +/- 0.29 P <= 0.001), right ventricular basal segment (-29.41,1.3/-34.7 +/- 1.2 P <= 0.001 and -2.20-+/- 0.28/-3.09-+/- 0.23 P <= 0.001) and right atrium(37.4 +/- 1.6/43.6 +/- 0.9 P <= 0.001 and 2.60 +/- 0.47/3.47 +/- 0.24 P <= 0.001) were determined to have improved. CONCLUSIONS: It was concluded that strain and strain rate echocardiography could be used for response to treatment and follow up for ASD patients.Öğe Evaluation of the effect of percutaneous mitral balloon valvuloplasty on left ventricular systolic functions using strain and strain rate echocardiography(Tubitak Scientific & Technological Research Council Turkey, 2020) Gunturk, Ertugrul Emre; Baran, Oguzhan; Akkaya, Hasan; Orscelik, OzcanBackground/aim: This study aimed to evaluate the effect of successful percutaneous mitral balloon valvuloplasty (PMBV) on left ventricular systolic functions using strain and strain rate echocardiography in moderate-severe mitral stenosis (MS) patients with normal left ventricular systolic function confirmed by conventional echocardiography. Materials and methods: Patients with moderate-severe MS who had undergone successful PMBV were included. Conventional echocardiographic parameters were evaluated before and after PMBV. Peak systolic strain and strain rate values of basal, mid, and apical segments of the left ventricular anterior, inferior, septum, and lateral walls were determined. Results: After PMBV, significant decreases were determined in the peak and mean gradients of the mitral valve and pulmonary artery pressure, but a significant increase in the mitral valve area. Significant increases (improvement) were determined in the peak systolic strain and strain rate in the basal, mid, and apical segments of the left ventricular septum, lateral, anterior, and inferior walls and in the left ventricular global peak systolic strain (-17.32 +/- 0.58% vs. -12.38 +/- 1.06%) and strain rate (-1.65 +/- 0.07 vs. -1.22 +/- 0.12). Conclusion: Strain and strain rate echocardiography can be used for quantitative evaluation of the effect of PMBV on the left ventricular systolic functions in moderate-severe MS patients.Öğe Relationship between echocardiography and arterial stiffness parameters and chorodial thickness in healthy subjects(Edizioni Minerva Medica, 2022) Akkaya, Hasan; Zor, Kursad R.; Gunturk, Ertugrul E.; Kucuk, Erkut; Yildirim, GamzeABSTR A C T BACKGROUND: Choroid is one of the most vascularized tissues of the body. Enhanced depth imaging optical coher-ence tomography (EDI-OCT) is the diagnostic method for choroid imaging. An increase in arterial stiffness, one of the important determinants of vascular aging, is a prognostic predictor of cardiovascular mortality. Carotid-femoral pulse wave velocity (CFPWV) is the gold standard method for the detection of arterial stiffness and has a high predictive value for undesirable cardiovascular events. The aim of our study was to investigate whether there is a relationship between choroidal thickness and echocardiographic findings, CFPWV, arterial stiffness, aortic distensibility and other basic pa-rameters in healthy middle-aged subjects. METHODS: The study included 80 healthy individuals aged 30-60 years. Firstly, echocardiographic and arterial stiffness levels of volunteers were evaluated, and choroidal thickness was determined by EDI-OCT. The relationship between choroidal thickness and other parameters was evaluated by Pearson correlation test. RESULTS: A total of 80 healthy volunteers (35 females, 43%) were included in the study. The mean age was 42.40-17.68 years (range, 31-60 years). It was found that there were a negative correlation between choroid and age (r=-0.80, P<0.01), left ventricular deceleration time (r=-0.72, P<0.01), isovolumic relaxation time (r=-0.76, P<0.01), ee (r =-0.68, P<0.01), annular late diastolic velocity (r=-0.25, P<0.05), CFPWV (r=-0.70, P<0.01) and aortic stiffness (r=-0.76, P<0.01). There was a significant positive correlation between choroid and aortic distensibility (r=0.81, P<0.01). There was no difference between the genders in terms of choroidal thickness (t[77]=0.47, P>0.05). CONCLUSIONS: Correlation between advanced age, left ventricular diastolic dysfunction, increased arterial stiffness parameters, decreased aortic distensibility and choroidal thinning were observed.Öğe Serum interleukin-18 levels are associated with non-dipping pattern in newly diagnosed hypertensive patients(Lippincott Williams & Wilkins, 2021) Gunturk, Ertugrul Emre; Gunturk, Inayet; Topuz, Ayse Nur; Akkaya, Hasan; Topuz, MustafaBackground Interleukin-18 (IL-18), a pro-inflammatory cytokine, increases inflammation in the endothelium. Increased inflammation plays an important role in the development of hypertension (HT). IL-18 level is higher in hypertensives than normotensives. Objective To investigate the relationship between IL-18 level and diurnal blood pressure (BP) variations in newly diagnosed HT patients. Methods This prospective study included 130 subjects referred to outpatient cardiology clinic with an initial diagnosis of HT. The patients were classified as dipper HT (n = 40), non-dipper HT (n = 50), and normotensive (control, n = 40) according to 24-hour ambulatory BP monitoring. All subjects underwent blood sampling after 12 hours of fasting and transthoracic echocardiography. Results The serum IL-18 level was significantly higher in the patient group compared with the controls (195.17 +/- 93.00 mg/dl vs. 140.75 +/- 71.11 mg/dl, P < 0.01) and also in the non-dipper group than in the dipper group (217.3 +/- 96.90 mg/dl, 167.5 +/- 80.79 mg/dl, P = 0.011). IL-18 level was positively correlated both the night-time SBP and DBP levels (r = 0.29, P = 0.02 and r = 0.34, P < 0.01, respectively). On multivariate linear regression analysis, left atrium diameter, left ventricular mass index, and serum IL-18 level were independent predictors of non-dipping pattern in newly diagnosed HT patients. Conclusion Higher IL-18 level was particularly associated with an increase in the night-time BP levels. IL-18 can be used as a predictor for non-dipper HT in newly diagnosed HT patients.Öğe The relationship between coronary slow flow phenomenon and carotid femoral pulse wave velocity and aortic elastic properties(Sage Publications Ltd, 2020) Akkaya, Hasan; Gunturk, Ertugrul EmreIntroduction: In this study, we aimed to investigate the relationship between coronary slow flow (CSF) and carotid-femoral pulse wave velocity (CFPWV). Methods: 78 (27 women, mean age 43.95 +/- 7.28) patients with CSF, and 70 (22 women, mean age 44.34 +/- 7.08) healthy individuals were included in the study. Arterial stiffness measurement was performed to both groups via CFPWV, which is considered the gold standard. Aortic elastic properties (ASI-beta and aortic distensibility) were evaluated in both groups. Results: The CSF group had significantly higher CFPWV and aortic distensibility values and significantly lower ASI-beta values compared to the control group. There was a positive correlation between TIMI frame count (TFC) obtained in all coronary arteries and CFPWV and aortic distensibility, and a negative correlation between TFC and ASI-beta. It was determined that CFPWV predicted CSF with 97% specificity and 98% sensitivity at a 7.68 cut-off value (ROC area = 994, p < 0.001). ASI-beta was determined to predict CSF with 64% specificity and 47% sensitivity at a 2.98 cut-off value (ROC area = 047, p < 0.001). Aortic distensibility was determined to predict CSF with 76% specificity and 79% sensitivity at a 3.94 cut-off value (ROC area = 706, p < 0.001). Conclusion: Arterial stiffness increases in CSF patients, suggesting that CSF is a systemic pathology rather than a local disease and that a systemic cause such as atherosclerosis plays a role in etiology.Öğe The Relationship between Disability due to Osteoarthritis and Subclinical Atherosclerosis: A Case-Control Study(Kare Publishing, 2021) Akkaya, Hasan; Sarı, Ahmet SinanObjectives: This study aims to evaluate the association between the disability of due to osteoarthritis (OA) and subclinical atherosclerosis. Methods: The disability level of the OA patients attributable to OA was assessed based on the Australian Canadian Osteoarthritis Hand Index (AUSCAN) and the Western Ontario and McMaster Universities Arthritis Index. Subclinical atherosclerosis was assessed based on the results of carotid intima media thickness (CIMT), arterial stiffness index-? (ASI-?), carotid femoral pulse wave velocity (CFPWV), aortic distensibility and echocardiographic calcification (echo-CCS) assessments. Results: A total of 160 (%100.0) patients were divided into hand OA 40 (25.0%), knee OA 40 (25.0%), hip OA 40 (25.0%) and one control group 40 (25.0%). There was a relationship between the Kellgren-Lawrence stage of OA and CIMT, ASI-?, CFPWV, echo-CCS in the hand OA group (r=0.540 and p=0.042; r=0.530 and p=0.044; r=0.720 and p=0.001; r=0.580 and p=0.035, respectively). In addition, a statistically significant positive correlation between the AUSCAN score and CIMT, ASI-?, echo-CCS of the patients in the hand OA group (r=0.460 and p=0.025; r=0.390 and p=0.033; r=0.550 and p=0.010, respectively). Conclusion: The disability level attributable to hand OA may reflect the severity of subclinical atherosclerosis. In primary care, physicians’ awareness on the association between hand OA and subclinical atherosclerosis may be beneficial in the care of asymptomatic patients. ©Copyright 2021 by Anatolian Journal of Family MedicineÖğe The relationship between the new inflammatory markers and disease severity in patients with acute coronary syndrome(Taylor & Francis Ltd, 2024) Seydel, Gonul Seyda; Gunturk, Inayet; Akkaya, Hasan; Gunturk, Ertugrul EmreBackgroundInflammation plays a crucial role in the progression of acute coronary syndrome.AimsThe aim of this study was to investigate the relationship between the SYNTAX score and new inflammatory markers including albumin-globulin ratio (AGR), C-reactive protein-to-albumin ratio (CAR), fibrinogen-to-albumin ratio (FAR), neutrophil-to-albumin ratio (NAR), and neutrophil percentage-to-albumin ratio (NPAR) in STEMI and NSTEMI patients.MethodsThe study involved 53 STEMI and 64 NSTEMI patients, and each patient group was evaluated separately. Multivariate linear regression analysis was utilised to identify independent risk factors associated with SYNTAX scores.ResultsOut of the 64 NSTEMI patients, 42 had low SYNTAX score (65.6%), and 22 had high SYNTAX score (34.4%). Patients with high SYNTAX scores had significantly higher levels of age, glucose, fibrinogen, monocyte, and FAR, and lower levels of albumin and total protein. We found that FAR and monocyte levels were independent predictors of the high SYNTAX score. The study also determined that the cut-off value for FAR as 9.99, with a sensitivity of 81% and a specificity of 73% for predicting high SYNTAX score in NSTEMI patients. Out of the 53 STEMI patients, 42 had low SYNTAX score (79.2%), and 11 had high SYNTAX score (20.8%). Patients with high SYNTAX scores exhibited significantly higher total cholesterol, LDL, and glucose levels, and lower albumin and total protein levels.ConclusionsThe FAR level is significantly linked with the high SYNTAX score and can be a useful marker for predicting the severity of disease in NSTEMI patients.
