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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 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 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 Evaluation of aortic stiffness parameters in premenopausal migraine patients(Cukurova Univ, Fac Medicine, 2020) Gunturk, Ertugrul Emre; Dogan, Selcuk; Topuz, Ayse NurPurpose: Migraine is an episodic primary headache disorder, which affects approximately 10% of the adult population, predominantly females. Based on the changes detected in migraine and previous findings, arterial stiffness can be considered to be an important contributor to vascular events in patients with migraine. The aim of this study was to investigate the associations between atherosclerosis and migraine through the evaluation of aortic stiffness in premenopausal migraine patients. Materials and Methods: The study included 68 female patients with migraine, and a control group of 39 healthy females. To reveal the association between migraine and arterial stiffness, echocardiography was applied and aortic stiffness was evaluated. Blood pressure measurements, basic biochemical tests and the 12 derivation-ECG recordings of each patient were taken simultaneously. Results: Basic echocardiographic findings were similar in patients and the control group. Systolic and diastolic diameters of the aorta, and the change in aortic diameter were also similar in both groups. Aortic distensibility, aortic strain and beta indices were also similar in both groups. No significant differences were determined between patients with and without aura migraine and the control group in respect of systolic blood pressure, diastolic blood pressure and pulse pressure. Conclusion: As a marker of atherosclerosis, the aortic stiffness parameters didn't differ between migraine and control group.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 Investigation of Left Atrial Spontaneous Echo Contrast as a Marker Indicating Ineffective Anticoagulation in Patients with Mitral Valve Replacement Receiving Warfarin(2019) Gunturk, Ertugrul Emre; Demirbas, Melih; Dogan, Yasemin; Dogan, Selcuk; Gunturk, InayetObjectives: This study aimed to evaluate predictive role of left atrial (LA) spontaneous echo contrast (SEC) for ineffec-tive anticoagulation by assessing time in therapeutic range (TTR) via international normalized ratio (INR) monitoring in patients with mitral valve replacement (MVR) and to determine its relationship with increased thromboembolic events.Methods: The study included patients with mechanical MVR. TTR was estimated using serial INR measurements. On transthoracic echocardiography, left ventricular end-systolic/end-diastolic diameters, LA diameter, ejection fraction were measured, and the presence of SEC was determined.Results: The study included 65 patients with MVR (30 with LA SEC) and 35 without LA SEC. There was a trend for higher rates of cerebrovascular event in the patients with SEC than in those without (30% vs. 14.3%, p=0.046). The LA diameter was higher and the TTR was lower in the patients with SEC than in those without. There was a significant negative cor-relation between TTR and thromboembolic events. Multivariable logistic regression analysis revealed the TTR and LA diameter as independent factors affecting SEC.Conclusion: In patients with MVR, low TTR and enlarged left atrium were independent predictors for future throm-boembolic events. Monitoring INR is important to achieve higher TTR in the presence of LA SEC.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 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.Öğe The Systemic Immune-Inflammation Index Predicts In-Hospital Mortality in Patients Who Underwent On-Pump Cardiac Surgery(Arquivos Brasileiros Cardiologia, 2024) Gunturk, Inayet; Ozmen, Rifat; Ozocak, Okan; Gunturk, Ertugrul Emre; Dagli, Fatma; Yazici, CevatBackground: Systemic immune-inflammation index (SII), a new inflammatory index calculated using platelet, neutrophil, and lymphocyte counts, has been demonstrated to be an independent risk factor for the identification of high-risk coronary artery disease in patients undergoing percutaneous coronary intervention and cardiovascular surgery with cardiopulmonary bypass (CPB). The relationship between SII and CPB-related mortality rates remains unclear. Objective: This research was designed to investigate the use of SII to predict in-hospital mortality in patients undergoing cardiac surgery with CPB. Methods: Four hundred eighty patients who underwent a cardiac procedure involving CPB over 3 years, were obtained from the hospital's database. The demographic data, comorbidities, hematological and biochemical profiles, and operative data of the groups were compared. Multiple logistic regression analyses were done to determine independent predictors of mortality. Prognostic factors were assessed by multivariate analysis, and the predictive values of SII, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) for mortality were compared. A p-value <0.05 was considered significant. Results: Of 480 patients, 78 developed in-hospital mortality after cardiac surgery. SII was an independent predictor of in-hospital mortality (Odds ratio: 1.003, 95% confidence interval: 1.001-1.005, p<0.001). The cut-off value of the SII was >811.93 with 65% sensitivity and 65% specificity (area under the curve: 0.690). The predictive values of SII, PLR, and NLR were close to each other. Conclusion: High preoperative SII scores can be used for early determination of appropriate treatments, which may improve surgical outcomes of cardiac surgery in the future.
