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Öğe Acute Mesenteric Ischemia: The Diagnostic Value of QT Parameters and their Relationship with CT Findings(Bentham Science Publ Ltd, 2024) Alan, Bircan; Alan, Sait; Gurel, Safiye; Inanir, Mehmet; Acar, Emrah; Donmez, Ibrahim; Kalaycioglu, OyaBackground: One of the greatest challenges in the diagnosis of acute mesenteric ischemia (AMI) is the lack of specific laboratory tests that support multidetector computed tomography (CT). Our aim is to investigate the diagnostic value of electrocardiographic QT parameters in AMI and their relationship with CT findings. Materials and Methods: Patients who were admitted to the emergency department with abdominal pain were recruited retrospectively from the hospital information system. Grouping was carried out on the basis of AMI (n=78) and non-AMI (n=78). In both groups, the corrected QT (QTc) and QT dispersion (QTD) were measured on electrocardiographs, and the qualitative and quantitative CT findings were evaluated on CT examinations. Results: The QTc and QTD values were higher in the AMI group. The median QTc values were 456.16 (IQR: 422.88-483.16) for the AMI group and 388.83 (IQR: 359.74-415.83) for the control group (p<0.001), and the median QTD values were 58 (IQR: 50.3-68.25) for the AMI group and 46 (IQR: 42-50) for the control group (p<0.001). In the CT analysis, the QTc values were significantly higher among AMI patients, with images of paper-thin bowel walls and the absence of bowel wall enhancement (p=0.042 and p=0.042, respectively). Meanwhile, the QTD values were significantly higher among patients with venous pneumatosis findings on CT (p=0.005). In the regression analysis, a significant relationship was found between the QT parameters and AMI (p<0.001). For QTc, an AUC of 0.903 (95% CI: 0.857-0.950, p<0.001), a sensitivity of 80.8%, and a specificity of 82.3% were found. For QTD, an AUC of 0.821 (95% CI: 0.753-0.889, p<0.001), a sensitivity of 73.1%, and a specificity of 82.3% were found. Conclusion: We found the QTc and QTD values to be significantly higher among AMI patients. Furthermore, we found a significant relationship between the CT findings and QTc and QTD and a significant relationship between survival and QTc in the AMI group.Öğe The combined S velocity achieved from tricuspid annulus and pulmonary annulus with tissue Doppler imaging could predict the proximal right coronary artery occlusion in patients with inferior myocardial infarction(2022) Acar, Emrah; Ozgul, Neryan; Donmez, Ibrahim; Yalcin, Osman Yasin; Kayabas, Oguz; Alan, Sait; Izgi, Ibrahim AkinAim: To investigate if combined S velocity (CSV) calculated from tricuspid annulus and pulmonary annulus\rwith tissue Doppler imaging in individuals with acute inferior myocardial infarction were linked to proximal\rRCA lesions.\rMethods: The study comprised 48 patient who had been diagnosed with acute inferior myocardial infarction\rand had culprit lesions in the right coronary artery. The RCA occlusion in Group A was proximal to the right\rventricular branch, while the RCA occlusion in Group B was distant to the RV branch. The combined S\rvelocity was tested, as well as other echocardiographic parameters.\rResults: In terms of metrics indicating right ventricular function, there were substantial disparities between\rthe groups. A favorable association was established in the univariate correlation analysis between CSV and\rtissue Doppler imaging derived tricuspid annulus systolic velocity (St), pulmonary annulus motion velocity\revaluated by TDI (PAMVUT), RV tricuspid annular plane systolic excursion (TAPSE), and fractional area\rchange (FAC). CSV was identified as an independent predictor of proximal RCA occlusion in a multivariate\rlogistic regression test. In the ROC analysis, CSV<18.3 cm/s and PAMVUT<8.6 cm/s indicated proximal\rRCA occlusion with 83 percent sensitivity and 71 percent specificity (AUC=0.83, p<0.001), and 85 percent\rsensitivity and 71 percent specificity (AUC=0.81, p<0.001), respectively.\rConclusion: CSV measurements were revealed to be an important predictor of proximal RCA occlusions in\rthis investigation.Öğe Combined systolic velocities using tissue Doppler imaging could predict the severity of cirrhosis: A prospective cohort study(Clinics Cardive Publishing Pty Ltd, 2023) Dönmez, İbrahim; Acar, EmrahAim: Recent research has demonstrated that the contractile characteristics of the right ventricular outflow tract (RVOT) play a significant role in right ventricular function. Pulmonary annular motion velocity (PAMVUT) is a reliable marker of RVOT function. Also, combined systolic velocity [PAMVUT added to tricuspid annular systolic velocity (St)] has been revealed as a suitable parameter for right ventricular systolic function. In this study, we examined the association between the severity of the illness in cirrhotic patients and the combined S velocities (CSV). Methods: Seventy-four patients with cirrhosis went to the echocardiography laboratory of the Cardiology Department in our centre. Traditional echocardiographic measurements, PAMVUT and CSV values were recorded. The Child-Pugh classes of the patients were determined. Results: Receiver operating characteristic curve analysis demonstrated that a CSV of 23 cm/s constituted the cut-off value for predicting a moderate-to-severe form of cirrhosis with 76% sensitivity and 65.3% specificity (area uder the curve = 0.735, p < 0.001). Conclusion: CSV values could predict the severity of cirrhosis more precisely than traditional right ventricular systolic function parameters.Öğe The Effect Of Ranolazine Treatment Administered Before Coronary Artery Bypass Surgery On Perioperative Myocardial Damage In Patients With Stable Angina Pectoris(2022) Yilmaz, Mehmet Fatih; Efe, Süleyman Çağan; Acar, Emrah; Geçtin, Çetin; Inanir, Mehmet; Karabay, Can Yücel; Izgi, Ibrahim AkınObjective:Ranolazineisapiperazinederivativethathasbeenapprovedasanantianginal agent.Itisprimarilyusedasasecondlineantianginalagentinstablecoronaryarterydisease.Thestudywasdesignedconsideringthattheactiveingredientranalozine,\rwhich has antiischemic effectsthrough ischemic sodiumchannels, can reduce ischemia in the perioperative period and reduce\rthe frequency of perioperative myocardialinfarction.\rMethods: The study included patients with stable angina pectoris who underwent coronary angiography between January\r1, 2015 and June 30, 2016 at Koşuyolu Training and Research Hospital and who were diagnosed with multi-vessel disease\ror LMCA disease, and then for whom the joint council of Cardiology-Cardiovascular Surgery made a decision in favor of\rcoronary artery bypass grafting.\rResults: The mean age was 61.2 ± 8.6 years in the ranolazine group, while the mean age of the patients receiving standard\rtherapy was 57.9 ± 8.8 years (p = 0.073).The EuroSCOREs of the patients before the operation which were used to predict\rintraoperative mortality were similar. Mean troponin value of Group 1 patients at 0 hour was 1.70 (1.13-2.77), while mean\rtroponin value of the patients in Group 2 at 0 hour was 2.76(1.69-6.20)(p=0,01).\rConclusion:In the presentstudy,the immediate postoperative troponin 0 valuewasfound to be lowerin the ranolazine group.\rThere was no statistical difference in terms of troponin valuesmeasured at 12 and 24 hours.In thisstudy,we showed that early\rmyocardial damage was significantly reduced with ranolazine treatment.Öğe Evaluation of the effects of 3D mapping ablation on atrial conduction times in patients with paroxysmal atrial fibrillation(Bayrakol Medical Publisher, 2022) Dönmez, İbrahim; Memioğlu, Tolga; Acar, Emrah; Erdem, FatmaAim: Atrial fibrillation (AF) causes structural, electrical, and cellular remodeling in the atrium. Evaluation of intra-and interatrial conduction time, indicates structural and electrical remodeling in the atrium. This study aimed to evaluate the effect of pulmonary vein isolation applied with radiofrequency ablation (RF) therapy on intra-and interatrial conduction time and to investigate the structural and electrically remodeling after treatment.Material and Methods: Fifty-two patients with symptomatic PAF despite at least one antiarrhythmic drug and without structural heart disease were included in the study. Two patients were excluded because of complications developed during and after the operation. Fifty patients (28 female; mean age: 51.68 +/- 11.731; mean left atrial diameter: 36.79 +/- 4.318) who underwent CARTO (R) 3D pulmonary vein isolation applied with the RF ablation system were followed-up. Intra-and inter-atrial electromechanical delay was measured in all patients using tissue doppler echocardiography before and three months after RF ablation.Results: All intra-and interatrial conduction times were significantly decreased 3 months after RF ablation procedure (PA lateral p = 0.022; PA septum p = 0.002; PA tricuspid p = 0.019, interatrial conduction delay p= 0,012, intra-atrial conduction delay p = 0.029).Discussion: The results of our study suggest that providing stable sinus rhythm with RF ablation may slow down, stop or even improve structural remodeling at substrate level secondary to AF even in patients with paroxysmal AF who did not yet develop atrial fibrosis and permanent structural changes.Öğe Evaluation of the neutrophil-lymphocyte ratio and mean platelet volume in hypertensive patients with coronary artery ectasia(2020) İnanır, Mehmet; Alıcı, Gökhan; Acar, Emrah; Eren, Hayati; Gürler, Müjgan; Alan, SaitIntroduction: Coronary artery ectasia (CAE) is associated with increased morbidity and mortality, and is known to also be associated with atherosclerosis. CAE is considered a variant of coronary artery disease, and is more common in patients with hypertension. We aimed to evaluate the neutrophil-lymphocyte ratio (NLR) and mean platelet volume (MPV) in hypertensive patients with CAE.Patients and Methods: The study was designed retrospectively in the cardiology unit of Bolu Abant Izzet Baysal University Medical Faculty Hospital between January 2017 and October 2019. A total of 7287 coro-nary angiographies were retrospectively analyzed to detect the incidence of ischemic heart disease. Diagnosis of CAE was made visually by two cardiologists who were blinded to the study aims. All included patients had a diagnosis of hypertension. After appropriate exclusions, hypertensive patients were divided into CAE and normal coronary artery groups, and the laboratory parameters of the two groups were compared.Results: The neutrophil counts [4.2 (2.4-8.6) vs. 4.2 (2.0-6.7) u/mm3, p= 0.015], red cell distribution width [15.7 (12.8-21.6) vs. 15.3 (13.2-18.6) %, p= 0.002], platelet distribution width [17.9 (15.5-23.0) vs. 17.5 (15.9-20.8) %, p= 0.001], NLR [2.1 (0.7-12.8) vs. 1.9 (0.8-4.5), p< 0.001], platelet-lymphocyte ratio [109.8 (63.0-321.8) vs. 100.9 (34.7-223.6), p= 0.001], MPV (8.4 ± 1.4 vs. 7.9 ± 1.0 fL, p< 0.001), and plateletcrit (0.19 ± 0.05 vs. 0.18 ± 0.4 %, p= 0.007) were significantly higher, and the lymphocytes counts [2.1 (0.5-4.2) vs. 2.2 (1.1-6.7) u/mm3, p= 0.013] were significantly lower in hypertensive patients with CAE than in those without.Conclusion: Hemogram parameters could be useful biomarkers for determining a thrombotic state and in-flammatory response in hypertensive patients with CAE.Öğe Hepatic venous doppler assessment can anticipate simplified pulmonary embolism severity index and right ventricle dysfunction in patients with acute pulmonary embolism(Wiley, 2020) Acar, Emrah; İzci, Servet; İnanır, Mehmet; Yılmaz, Mehmet F.; İzgi, İbrahim A.; Gökçe, Mustafa; Kırma, CevatPurpose Acute pulmonary embolism (APE) is a life-threating cardiothoracic thromboembolic emergency in which right ventricle dysfunction (RVD) is a major concern. In the present study, we examined the hepatic veins (HVs) blood flow with pulsed-wave spectral Doppler ultrasonography to determine its relationship with the simplified pulmonary embolism severity index (sPESI) and the patient's RVD status. Methods We divided the 243 patients who met the inclusion criteria into two groups based on both their sPESI scores and their RVD status. Transthoracic echocardiography was performed to evaluate the RVD and the HVs within 1 hour after patient admission. The liver was evaluated using subcostal and intercostal echocardiographic windows in grayscale B-mode, and HVs were assessed using color and spectral Doppler assessment though the same echocardiographic windows. Result A cut-off value of the systolic reverse flow velocity-time integral (SrVTI) = 2.2 cm carried a sensitivity and specificity of 84.29% and 74.89%, respectively, for the prediction of sPESI >= 1. A SrVTI cut-off value of 2.1 cm yielded a sensitivity and specificity of 83.03% and 73.91%, respectively, for the prediction of RVD. Conclusion HV Doppler assessment could be a useful method for anticipating the sPESI and the presence of RVD in patients with APE. In addition, it may provide information regarding the hemodynamic impact of APE.Öğe The left distal transradial access site could give a safe alternate site for transradial coronary intervention (The Litaunent Study)(SAGE Publications Inc, 2023) Acar, Emrah; İzci, Servet; Dönmez, Ibrahim; Yılmaz, Mehmet Fatih; Özgül, Neryan; Güneş, YılmazTransradial Access (TRA) is the suggested method when performing coronary procedures. TRA has several advantages over the transfemoral approach, but also some restrictions. The present study compared the efficacy and safety of the traditional proximal transradial approach (pTRA) with a newer technique known as the distal transradial approach (dTRA) for performing a coronary angiography (CAG) and percutaneous coronary intervention (PCI). Patients (n = 700) were placed into one of two categories (dTRA or pTRA) based on a random technique. The primary endpoint was RAO at follow-up. The secondary endpoints included the time required for sheath insertion, the rate of successful sheath insertion, rate of successful completion of CAG and PCI, total procedure time, total fluoroscopy time, total radiation dose, total contrast volume used, pain perception (visual analog scale 0-10), and hemostasis duration. dTRA patients had more skin punctures, failed punctures, failed wiring, overlap of access sites, sheath insertion time, and pain evaluation scale, while the pTRA group had more hemostasis time and first-time cannulation. RAO and pseudoaneurysm (PseA) were lower in the dTRA group. In this randomized study, dTRA had lower RAO and PseA than pTRA. However, multicenter, larger-patient trials are needed to provide definitive evidence.Öğe A mix of aminophylline and heparin plus nitroglycerin can reduce bradycardia during rotational atherectomy on the right coronary artery and dominant circumflex artery(Urban & Vogel, 2023) Acar, Emrah; İzci, Servet; Dönmez, İbrahim; Özgül, Neryan; Özcan, Eda; Kaygusuz, TubaBackgroundRotational atherectomy (RA) may cause bradyarrhythmias and transitory atrioventricular block when performed in the right coronary artery (RCA) or a dominant circumflex (CX) coronary artery. However, there are no studies of a solution that can prevent coronary flow deterioration and bradycardia complications that may occur during RA. We aimed to create an alternative rota-flush solution to minimize the risk of bradycardia and complete atrioventricular block (AVB) that can occur during RA.Materials and methodsThe study comprised 60 patients who were randomly divided into two groups: 30 received rotaphylline (= 240 mg aminophylline, 10,000 U unfractionated heparin, and 2000 mcg nitroglycerin to 1000 mL saline), and 30 received the traditional rota-flush (= 10,000 U unfractionated heparin, 2000 mcg nitroglycerin, and 1000 mL saline). The incidence of bradycardia or high-grade AVB (HAVB) during RA, coronary slow-flow phenomenon or no-reflow phenomenon, and coronary spasm were the primary endpoints of the study. Procedure success and RA-related procedural complications were secondary endpoints.ResultsThe use of rotaphylline was an independent predictor of bradycardia and HAVB after accounting for all other factors (OR: 0.47, 95% CI: 0.24-0.79, p < 0.001). Lesion length (OR: 2.17, 95% CI: 1.24-3.04, p < 0.001), burr-to-artery ratio (OR: 0.59, 95% CI: 0.39-1.68, p < 0.001), and total run duration (OR: 0.79, 95% CI: 0.35-1.43, p < 0.001) were additional independent predictors.ConclusionBradycardia and the development of HAVB may be avoided by rotaphylline intracoronary infusion during RA applied to the RCA and dominant CX lesions. Multicenter studies including sizable patient populations should be conducted to validate the present findings.Öğe One-stent double-kissing nano crush- osdokina crush-technique could be a game-changer in the treatment of medina 0.0.1 lesion(Kare Publishing, 2023) Acar, Emrah; Güneş, Yılmaz; İzgi, İbrahim Akın; Kırma, CevatIn terms of percutaneous coronary interventions (PCI) performed in coronary bifurcation lesions, one of the most interesting lesions is Medina 0.0.1 lesions or isolated osteal side branch lesions.1-4 There are 5 important problems that should be answered with regard to PCI of Medina 0.0.1 lesion: (1) is osteal side branch stenosis serious enough to cause ischemia? (2) will possible complications develop in the main branch (such as dissection, plaque or carina shift-induced stenosis, and thrombus formation)? (3) if it is to be intervened, which technique? (4) how do we prepare the lesion? (5) if we are going to place a stent on the osteal lesion, will we be able to cover this lesion completely without overflowing into the main branch?Öğe The pulmonary annular motion velocity assessed using tissueDoppler imaging could predict the proximal right coronary arteryocclusion in patients with inferior myocardial infarction(2021) Acar, Emrah; Özgül, Neryan; Dönmez, Ibrahim; Yalçin, Osman Yasin; Alan, SaitObjective: The right ventricle myocardial infarction (RVMI) is one of the leading reasons for right ventricle(RV) dysfunction. RVMI occurs in 20-50% of inferior infarctions. Echocardiography was applied to study RV involvement and proximal right coronary artery (RCA) occlusion in individuals with acute inferior MI. The objective of this study was to investigate if pulmonary annulus motion velocity (PAMVUT) levels in individuals with acute inferior myocardial infarction were linked to proximal RCA lesions.Method: The study comprised 50 people who had been diagnosed with acute inferior myocardial infarction and had culprit lesions in the right coronary artery. The RCA occlusion in Group A was proximal to the right ventricular branch, while the RCA occlusion in Group B was distant to the RV branch. The PAMVUT was tested, as well as other echocardiographic parameters.Results: In terms of metrics indicating right ventricular function, there were substantial disparities between the groups. A favorable association was established in the univariate correlation analysis between PAMVUT and RV TAPSE, with FAC, and with St.PAMVUT was identified as an independent predictor of proximal RCA occlusion in a multivariate logistic regression test. In the ROC analysis, PAMVUT<8,5 cm/s indicated proximal RCA occlusion with 85 percent sensitivity and 69 percent specificity (AUC=0.80, p<0.001).Conclusion: PAMVUT measurements were revealed to be an important predictor of proximal RCA occlusions in this investigation.Öğe Reply to letter to the editor: Pros and cons of a novel coronary stenting technique for medina 0.0.1 lesions: Osdokina crush(Kare Publication, 2023) Acar, Emrah; Güneş, Yılmaz; İzgi, İbrahim Akın; Kırma, CevatTo the Editor, We would like to express our gratitude to the authors for carefully reading and analyzing our case report.1 One of the most intriguing lesions in terms of percutaneous coronary interventions carried out in coronary bifurcation lesions is Medina 0.0.1 or isolated ostial side branch (SB) lesions.2 Percutaneous coronary interventions techniques for Medina 0.0.1 lesions are generally divided into 2 categories in the literature: those that involve stenting the ostial lesion and those that involve balloon angioplasty with atherectomy on the ostial lesion.Öğe Reply to Letter to the Editor: “Pros and Cons of a Novel Coronary Stenting Technique for Medina 0.0.1 Lesions: Osdokina Crush”(Turkish Society of Cardiology, 2023) Acar, Emrah; Güneş, Yılmaz; İzgi, İbrahim Akın; Kırma, Cevat[No abstract available]Öğe The right ventricle outflow tract systolic function could predict the severity of the cirrhosis(Tubitak Scientific & Technological Research Council Turkey, 2024) Donmez, Ibrahim; Can, Guray; Acar, EmrahBackground/aim: The distinctive liver framework is converted into structurally abnormal nodules as a consequence of tissue fibrosis in cirrhosis. Cardiac dysfunction in cirrhosis was described, and the term cirrhotic cardiomyopathy (CCM) was coined to describe this syndrome. Recent research has shown that the contractile characteristics of the right ventricular outflow tract (RVOT) have a significant impact on right ventricular functions. The right ventricular outflow tract -systolic excursion is an important systolic function marker of RVOT (RVOT-SE). There has yet to be published research on RVOT function in cirrhotic patients. We looked at the relationship between cirrhosis severity and the RVOT-SE. Materials and methods: Sixty-nine consecutive hepatic cirrhotic patients were recruited for the research between June 1, 2018 and January 1, 2022. A medical history, thorough physical examination, laboratory investigations, echocardiographic evaluation, and RVOT-SE were obtained. The patients were separated into two groups: those with compensated cirrhosis (Child -Pugh class 1) and those with decompensated cirrhosis (Child -Pugh class 2 and 3). Results: On the numerous standard echocardiographic parameters that examined the diameter and function of the left ventricle, we observed no significant difference between groups. Nevertheless, a statistically significant difference in Right Ventricle Wall (RVW) (p = 0.014), systolic pulmonary artery pressure (sPAP) (p = 0.034), RVOT-SE (p = 0.003), and Tricuspid Annular Plane Systolic Excursion (TAPSE) (p = 0.042) was detected across cirrhosis groups. The RVOT-SE had a positive correlation with cirrhosis severity (OR: 0.607; 95% CI: 0.425-0.866; p = 0.006), according to multiple logistic regression studies. According to the ROC curve study, RVOT-SE 8.8 cm/s predicted decompensated cirrhosis with 72% sensitivity and 72.7% specificity (AUC = 0.715, p: 0.001). Conclusion: In the current study, we found that RVOT-SE was related to the severity of cirrhosis. Larger patient cohorts and multicenter investigations will provide light on the notion.Öğe The right ventricle systolic force ratio could predictthe severity of the tricuspid regurgitation-RIVIERA ratio(Wiley, 2023) Acar, Emrah; İzci, Servet; Dönmez, İbrahim; Yılmaz, Mehmet Fatih; Özgül, Neryan; Seymen, Hande; Özcan, Eda; Güneş, YılmazPurpose: For assessing the severity of tricuspid regurgitation (TR), there is no gold standard. We developed a parameter, the right ventricular systolic force ratio-RIVIERA, using the continious wave Doppler analysis of TR and pulsed-wave analysis of the right ventricle outflow tract. We hypothesized that the RIVIERA would facilitate the ability to identify severe TR in clinical settings.Materials and Methods: We obtained data from routine transthoracic echocardiograms. All records reporting no or mild TR (n = 732), moderate TR (n = 584), and severe TR (n = 519) TR were reanalyzed to measure vena contracta (VC) width, TR jet area, effective regurgitant orifice (EROA) derived with the proximal isovelocity surface area method, the RIVIERA, and right-sided chamber volumes.Results: Significant linear trends were demonstrated for right atrial volume index, end-diastolic volume index, RVOT velocity time integral, TR jet area, TR-Vmax, TR-VTI, TR acceleration, VC width, EROA with increasing TR severity. Independent predictors of severe RT included RIVIERA <4.8, VC width =0.7 cm, TR jet area > 10 cm(2), and EROA =0.4 cm(2).Conclusion: The RIVIERA is a feasible, effective, and independent predictor of severe TR that enhances established techniques for estimating TR severity. For clinical decision-making and management, accurate measurement and classification of TR severity are essential. Therefore, it should be thought about include the RIVIERA in the integrative method to assessing TR severity.Öğe Right ventricular early inflow-outflow index-a new method for echocardiographic evaluation of right ventricle dysfunction in acute pulmonary embolism(Wiley, 2020) Acar, Emrah; İzci, Servet; İnanir, Mehmet; Yılmaz, Mehmet Fatih; İzgi, İbrahim Akın; Kırma, CevatIntroduction Acute pulmonary embolism (APE) is a cardiothoracic thromboembolic emergency at risk of life-threatening. Several risk graduation algorithms may be applied to delineate short-term mortality in patients with APE. In this study, we aim to depict the relationship between the right ventricular early inflow-outflow (RVEIO) index, which is a Doppler-based parameter, and the pulmonary embolism severity index(PESI) in acute pulmonary embolism. Methods In the presented study, a total of 160 patients who were diagnosed with APE using pulmonary computed tomography angiography or ventilation/perfusion scintigraphy were comprised. Patients were separated to 2 groups based on the simplified PESI (sPESI): sPESI < 1 (n = 88) and sPESI >= 1 (n = 72). Echocardiographic parameters, including the RVEIO index, were measured. Results There were no significant differences between the groups in age and gender distribution, or the presence of diabetes mellitus, hypertension, smoking, and history of coronary artery disease. There was a positive correlation with the mortality rate and RVEIO index; the mortality was higher in patients with a higher RVEIO index(<0.001). In receiver operating characteristic (ROC) curve analysis using a cutoff level of 14.39, RVEIO index predicted mortality with a sensitivity of 80.4% and specificity of 57.6%(ROC area under curve:0.694; 95%CI, 0.581-0.814; P < .001). RVEIO index was higher in the sPESI >= 1(n:72) than in the patients with sPESI < 1(14.27 +/- 2.13 vs 10.63 +/- 2.09; P < .001). There was a positive correlation between RVEIO index and sPESI score(+0.428; P < .001). Conclusion As well as predicting the degree of tricuspid regurgitation (TR), the RVEIO index is well-correlated with sPESI score and is associated with mortality in patients with APE. This easily measurable parameter may be used to predict short-term mortality in APE patients.Öğe Serum heparanase levels and left atrial/left atrial appendage thrombus in patients with nonvalvular atrial fibrillation(URBAN & VOGEL, 2022) Yılmaz, Mehmet Fatih; Acar, Emrah; İnanır, Mehmet; Karabay, Can Yücel; İzgi, İbrahim AkınIntroduction Data regarding the possible role of heparanase (HPA) in the occurrence of left atrial/left atrial appendage (LA/LAA) thrombus in patients with atrial fibrillation (AF) is lacking. The goal of the present study was to assess the association between plasma levels of HPA and LA/LAA thrombus in AF. Methods A total of 687 patients with nonvalvular AF (NVAF) without anticoagulation therapy were included from January 2016 to June 2019. Serum HPA analysis was performed with a commercially available human ELISA kit. Logistic regression models were used to test for association. Results Serum HPA levels were significantly higher in patients with LA/LAA thrombus than in those without LA/LAA thrombus (270.8 [193.4 +/- 353.2] pg/mL vs 150.3 [125.2 +/- 208.4] pg/mL; P < 0.001). In multivariate analysis, serum HPA remained a significantly independent predictor of LA/LAA thrombus (odds ratio 1.674, 95% confidence interval [CI] 1.339-2.289, P < 0.001). In the receiver operating characteristic (ROC) curve analysis, HPA showed a predictive value with an area under the curve (AUC) of 0.757 (95% CI 0.652-0.810, P < 0.001). The optimal cutoff level for HPA predicting LA/LAA thrombus was 210.7 pg/mL, with a sensitivity of 74.3% and a specificity of 64.8%. Conclusion An elevated HPA level was associated with the presence of LA/LAA thrombus in patients with AF. HPA might portend the risk for the prothrombotic state in AF patients.Öğe Serum uric acid to HDL-cholesterol ratio could be promising predictor of atrioventricular nodal reentrant tachycardia(2023) Donmez, Ibrahim; Cosgun, Mehmet; Bayraktar, Muhammed Fatih; Korkmaz, Ufuk Turan Kursat; Demirel, Mustafa Enes; Acar, Emrah; Gunes, YilmazAim: Paroxysmal supraventricular tachycardia (PSVT), particularly atrioventricular nodal reentrant tachycardia (AVNRT), is a common arrhythmia with no associated structural heart disease. Inflammation has been implicated in the pathogenesis of arrhythmias. Uric acid to high density lipoprotein (HDL)-cholesterol ratio (UHR) is a novel inflammation marker that has been investigated in various conditions. This study aimed to explore the potential association between UHR and AVNRT. Materials and Methods: A total of 136 patients were included in the study, including 86 patients with AVNRT and 50 controls with normal electrophysiological study. All patients’ medical records were reviewed, and data were obtained retrospectively. We recorded baseline features, hematologic and biochemical markers, and determined the UHR value. Results: UHR (p=0.031) and uric acid (p<0.001) levels were significantly higher, while HDL cholesterol (p=0.031) levels were significantly lower in the AVNRT group. Neutrophil leukocyte ratio (NLR) was also higher in the AVNRT group (p=0.034). However, in multivariate analysis, only UHR emerged as an independent predictor for AVNRT (OR: 1.088; 95%CI: 1.022 – 1.159; p=0.008). ROC curve analysis suggested a UHR cut-off > 14.05 for predicting AVNRT with 56% sensitivity and 76% specificity. Conclusion: This study identifies UHR as a promising predictor for AVNRT, shedding light on the potential role of inflammation in the arrhythmia’s development. Utilizing UHR as a readily accessible marker in the evaluation of AVNRT patients may have clinical implications.Öğe Significance of mitral early diastolic inflow velocity to left atrial strain ratio in patients with Acute Coronary Syndrome (AYISIT-ACS study)(Kare Publ, 2022) Acar, Emrah; Dönmez, İbrahim; İnanır, Mehmet; Kırma, Cevat; Kılıçgedik, Alev; Güneş, Yılmaz; Sincer, İsa: The ratio of mitral early-diastolic inflow peak velocity (E) to left atrial strain (E/LASr) is a novel parameter of the left ventricle diastolic dysfunction.It was shown that E/LASr was a significant predictor of cardiac outcomes in patients with heart failure. This study aims to evaluate the predictive value of E/LASr for death and hospitalisation due to heart failure following acute coronary syndrome (ACS)Öğe Single-stent double-kissing nano-crush technique for the management of side branch ostial lesions: A game changer? Or just another player in the game?(Kare Publishing, 2023) Acar, Emrah; Güneş, Yılmaz; İzgi, İbrahim Akın; Kırma, CevatTo the Editor, We would like to thank the authors1 for reading and thoroughly analyzing our case report.2 Isolated ostial side branch (SB) lesions, also known as Medina 0.0.1 lesions, are among the most fascinating lesions in terms of percutaneous coronary procedures performed in coronary bifurcation lesions.3 Stenting the ostial lesion and balloon angioplasty with atherectomy on the ostial lesion are the 2 main types of percutaneous coronary interventional procedures for Medina 0.0.1 lesions in the literature.4 The biggest argument against balloon-based treatment is that if ostial lesions with a high tendency to dissect and recoil are not covered by a “stentscaffold,” it may increase the risk of target lesion revascularization and target vessel revascularization.4 The “One Stent DOuble KIssing NAno CRUSH (OSDOKINA) technique,” which we have outlined, has a number of potential advantages. The ostial lesion is first to be entirely covered with a stent. Second, the major branch has a nano-protruding SB stent. Third, nano-protruded stent components are crushed in the main branch using an non-compliant balloon. There are 2 kissing balloon inflations to overcome the carina and plaque shift. Finally, a 1 : 1 sized drug-eluted balloon is inflated at the main branch for 90 seconds at 14 atm to prevent balloon-induced barotrauma from causing main branch restenosis.
