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Öğe Can increased intestinal permeability and low-grade endotoxemia be the triggering pathogenesis in isolated coronary artery ectasia(Lippincott Williams & Wilkins, 2023) Toprak, Kenan; Kaplangöray, Mustafa; Altıparmak, İbrahim Halil; Taşcanov, Mustafa Begenç; Güngören, Fatih; Fedai, Halil; İnanır, Mehmet; Biçer, Asuman; Demirbağ, RecepPurpose Isolated coronary artery ectasia (ICAE) is a rare coronary artery disease (CAD) encountered during coronary angiography. Although many mechanisms have been suggested today that may be associated with ICAE, the underlying pathogenesis has not been fully understood. In this study, we aimed to reveal the possible relationship between intestinal permeability and ICAE. Methods Of the 12 850 patients who underwent coronary angiography, 138 consecutive patients with ICAE and 140 age- and sex-matched subjects with normal coronary arteries as the control group and 140 subjects with stenotic CAD were included in the study. Results Serum zonulin and lipopolysaccharide levels were significantly higher in patients with ICAE than in the control group and CAD group. Additionally, zonulin and lipopolysaccharide levels were significantly higher in the CAD group than in the ICAE group. In the correlation analysis, serum zonulin levels were correlated with the mean diameter and length of the ecstatic segment. In multivariate analysis, zonulin and lipopolysaccharide were identified as independent predictors for ICAE. Conclusion These results suggest that there may be a pathophysiological relationship between increased intestinal permeability and ICAE.Öğe Comparative evaluation of intermountain risk score with Mehran risk score for risk estimation of contrast-induced nephropathy and short-term mortality in ST-segment elevation myocardial infarction patients(Sage Publications Inc, 2023) Toprak, Kenan; Kaplangöray, Mustafa; Memioğlu, Tolga; İnanir, Mehmet; Ermiş, Mehmet Fatih; Toprak, İbrahim Halil; Acar, OsmanContrast-induced nephropathy (CIN) has become one of the most important causes of in-hospital acute renal failure with the increasing use of contrast-mediated imaging tools. This significantly increases the morbidity and mortality of the affected subjects and causes a financial burden on the health system. In this context, prediction of CIN is important and some risk scores have been developed to predict CIN. The most frequently used and popular among these is the Mehran Score (MS), which is based on a number of hemodynamic and metabolic parameters. The Intermountain Risk Score (IMRS) is a recently developed risk score that highly predicts short-term mortality based on common laboratory parameters, and many parameters of this risk score have been found to be closely associated with CIN. In this context, we aimed to compare MS and IMRS in terms of CIN and short-term mortality estimation. The study included 931 patients who underwent percutaneous coronary intervention. CIN developed in 21.5% of patients. Both MS and IMRS independently predicted CIN. In receiver operating characteristic analysis, IMRS was found to be non-inferior to MS in predicting CIN and IMRS was superior to MS in predicting short-term mortality. IMRS and MS were independently associated with short-term mortality.Öğe Comparison of the effect of uric acid/albumin ratio on coronary colleteral circulation with other inflammation-based markers in stable coronary artery disease patients(Sage Publications Ltd, 2023) Memioğlu, Tolga; Toprak, Kenan; Yılmaz, Rüstem; Kaplangoray, Mustafa; İnanır, Mehmet; Akyol, SelahattinBackground: The Uric acid/Albumin ratio (UAR) has recently been identified as a prominent marker in cardiovascular diseases. In this study, we aimed to reveal the effect of UAR on coronary collateral circulation (CCC) in patients with stable coronary artery disease (CAD) patients by comparing it with conventional inflammation-based markers.Methods: In this study, 415 consecutive patients who underwent coronary angiography for stable angina pectoris and were found to have chronic total occlusion in at least one coronary artery were retrospectively included. The study population was divided into two groups as good CCC (Rentrop 2-3) and poor CCC (Rentrop 0-1) according to the Rentrop classification, and the groups were compared in terms of UAR and other traditional inflammation-based markers.Results: In the poor CCC group, C-reactive protein/albumin ratio (CAR), monocyte/high-density lipoprotein cholesterol ratio (MHR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), systemic immune-inflammation index (SII) and UAR were found to be significantly high (p < .05, for all). UAR negatively correlated with rentrop classification (r = -0.383, p < .001). In multivariate regression analysis, MHR, NLR, SII and UAR were determined as independent predictors for poor CCC (p < .05, for all). The ability of UAR to predict poor CCC was superior to uric acid and albumin alone (p < .0001, for both). In addition, UAR was found to be superior to other inflammation-based markers in predicting poor CCC (p < .005, for all).Conclusion: UAR was identified as a strong and independent predictor of CCC. In this context, UAR may be a useful biomarker in the risk prediction of patients with stable CAD.Öğe Comparison of the effect of uric acid/albumin ratio on coronary slow flow with other inflammation-based markers(Future Medicine Ltd, 2024) Toprak, Kenan; Ozen, Kaya; Memioglu, Tolga; Inanir, Mehmet; Kaplangoray, Mustafa; Akyol, Selahattin; Tascanov, Mustafa B.Background: Many inflammation-based markers (IBMs) have been shown to be closely related to coronary slow flow (CSF), but the effect of the uric acid/albumin ratio (UAR) on CSF and its relationship with other IBMs are not clearly known. In this study, we aimed to compare the effects of UAR and other IBMs on CSF. Methods: After the exclusion criteria, 126 patients with CSF detected on coronary angiography and 126 subjects with normal coronary flow as the control group were included in the study. Results: UAR was determined as an independent predictor for CSF. In addition, the UAR was superior to other IBMs in detecting CSF (p < 0.05 for all). Conclusion: This study is the first to investigate the effect of UAR on CSF in comparison with other IBMs.Öğe Could zonulin and presepsin be biomarkers and therapeutic targets for acute myocarditis?(Arquivos Brasileiros Cardiologia, 2023) Toprak, Kenan; İnanır, Mehmet; Memioğlu, Tolga; Kaplangöray, Mustafa; Palice, Ali; Taşcanov, Mustafa BeğençBackground: The diagnosis of acute myocarditis is usually made with clinical and laboratory parameters. This can sometimes be mixed up with diseases that have similar clinical features, making the diagnosis difficult. Therefore, the use of more specific biomarkers, in addition to the classically used biomarkers such as troponin, will accelerate the diagnosis. In addition, these biomarkers may help us to understand the mechanism of myocarditis development and thus predict unpredictable clinical outcomes.Objective: This study aims to reveal the possible relationship between intestinal permeability and acute myocarditis.Methods: In this study, we wanted to evaluate serum levels of zonulin and presepsin in 138 consecutive subjects, including 68 patients with myocarditis and another 70 as the control group, matched for age, gender, and cardiovascular risk factors. P-values <0.05 were considered to be statistically significant.Results: Compared to the control group, zonulin and presepsin were significantly higher in the patient group with myocarditis (p < 0.001, for all). Zonulin levels were positively correlated with presepsin, peak CK-MB, and peak troponin levels (r = 0.461, p < 0.001; r = 0.744, p < 0.001; r = 0.627, p < 0.001; respectively). In regression analysis, presepsin and zonulin were determined as independent predictors for myocarditis (OR 1.002, 95% CI 1.001-1.003, p = 0.025; OR 12.331, 95% CI 4.261-35.689; p < 0.001; respectively). The predictive value of acute myocarditis of presepsin and zonulin in ROC curve analysis was statistically significant (p < 0.001, for both).Conclusion: This study showed that zonulin and presepsin could be biomarkers that can be used in the diagnosis of myocarditis, and they can also be therapeutic targets by shedding light on the developmental mechanism of myocarditis.Öğe Effect of Hand Dominance on Radial Artery Spasm and Occlusion: A Prospective Observational Study(SAGE Publications Inc., 2024) Toprak, Kenan; Inanır, Mehmet; Memioğlu, Tolga; Palice, Ali; Kaplangoray, Mustafa; Yesilay, Asuman Biçer; Tascanov, Mustafa BegencTransradial access has become the most commonly used method for cardiac catheterization. Many medical and technical applications have been proposed to reduce TRA complications. The aim of this study is to examine the effect of hand dominance on radial artery spasm and radial artery occlusionin subjects undergoing CC via TRA. Between April 2020 and August 2022, 1713 subjects who underwent CC via TRA were included in the study. Patient data were obtained in terms of hand dominance of the catheterized side and RAS and RAO during a 1-month follow-up period. RAS was seen in 9.6% of the subjects. The RAS in patients catheterized by the dominant hand was significantly higher than that performed by the non-dominant hand (12 vs 7.8%; P =.004). RAO was seen in 1% of the subjects. RAO was significantly higher in the spasm side than in the no-spasm side (3 vs.8%; P =.009). Hand dominance was determined as an independent predictor of radial artery spasm (P =.006). In our study, RAS and RAO were more common on the dominant hand side than on the non-dominant side. Choosing the non-dominant hand for TRA for CC may reduce the incidence of RAS and RAO. © The Author(s) 2023.Öğe Effects of sleeve gastrectomy surgery on electrocardiographic ventricular arrhythmia markers(Bayrakol Medical Publisher, 2022) İnanir, Mehmet; Memioğlu, Tolga; Yılmaz, Fatih; Eren, Hayati; Toprak, Kenan; Şengül, NerimanAim: Severely obese patients are known to be at risk of malignant arrhythmias. The frequency of ventricular arrhythmia and sudden death is increasing in morbidly obese patients. Ventricular depolarization and repolarization parameters on the electrocardiogram can predict mortality and morbidity. Electrocardiographic (ECG) markers of ventricular depolarization and repolarization parameters like QT, QTc, QTd, QTdc, JT, JTc and Tp-e intervals and Tp-e/QT, Tp-e/QTc, Tp-e/JT and Tp-e/JTc ratios were evaluated before and after sleeve gastrectomy surgery. Material and Methods: ECG recordings of 35 (24 females and 11 males) morbid obese patients without evident cardiovascular disease were analyzed before and 20.3 +/- 9.6 (6-36) months after sleeve gastric surgery. QT, QRS, JT, and Tp-e intervals were measured. QTc, QTd, QTdc, and JTc intervals and Tp-e/QT, Tp-e/ QTc, Tp-e/JT and Tp-e/JTc ratios were calculated. Results: Body mass index (48.29 +/- 7.65 to 31.38 +/- 4.94 kg/m2, p<0.001), QTc interval (405.6 +/- 17.3 to 389.2 +/- 16.6 milisecond (ms), p<0.001), QTd (27.5 +/- 12.4 to 18.3 +/- 9.0 ms, p<0.001), QTdc (30.7 +/- 14.4 to 19.1 +/- 9.1 ms, p<0.001), JTc interval (315.0 +/- 19.0 to 301.2 +/- 20.4 ms, p=0.001), Tp-e interval (81.6 +/- 7.8 to 69.5 +/- 9.3 ms, p<0.001), Tp-e/QT ratio (0.22 +/- 0.03 to 0.19 +/- 0.02, p<0.001), Tp-e/QTc ratio (0.20 +/- 0.02 to 0.18 +/- 0.02, p<0.001), Tp-e/JT ratio (0.29 +/- 0.04 to 0.24 +/- 0.03, p<0.001) and Tp-e/JTc ratio (0.26 +/- 0.03 to 0.23 +/- 0.03, p<0.001) were significantly decreased after sleeve gastrectomy surgery. Discussion: QTc, QTd, QTdc, JTc, and Tp-e intervals and Tp-e/QT, Tp-e/QTc, Tp-e/JT and Tp-e/JTc ratios, which are potential ECG ventricular arrhythmia predictors were significantly decreased. Therefore weight reduction with sleeve gastrectomy surgery may be associated with decreased malign arrhythmia tendency and sudden cardiac death.Öğe HbA1c/C-peptide ratio is associated with angiographic thrombus burden and short-term mortality in patients presenting with ST-elevation myocardial infarction(Lippincott Williams & Wilkins, 2023) Toprak, Kenan; Kaplangoray, Mustafa; Memioğlu, Tolga; İnanır, Mehmet; Omar, Bahadır; Taşcanov, Mustafa BegençObjectivesAngiographic high thrombus burden (HTB) is associated with increased adverse cardiovascular events in patients with ST-elevation myocardial infarction (STEMI). HbA1c and C-peptide are two interrelated bioactive markers that affect many cardiovascular pathways. HbA1c exhibits prothrombogenic properties, while C-peptide, in contrast, exhibits antithrombogenic effects. In this study, we aimed to demonstrate the value of combining these two biomarkers in a single fraction in predicting HTB and short-term mortality in patients with STEMI.Methods1202 patients who underwent primary percutaneous coronary intervention (pPCI) for STEMI were retrospectively included in this study. The study population was divided into thrombus burden (TB) groups and compared in terms of basic clinical demographics, laboratory parameters and HbA1c/C-peptide ratios (HCR). In addition, short-term mortality of the study population was compared according to HCR and TB categories.ResultsHCR values were significantly higher in the HTB group than in the LTB group (3.5 & PLUSMN; 1.2 vs. 2.0 & PLUSMN; 1.1; P < 0.001; respectively). In the multivariable regression analysis, HCR was determined as an independent predictor of HTB both as a continuous variable [odds ratio (OR): 2.377; confidence interval (CI): 2.090-2.704; P < 0.001] and as a categorical variable (OR: 5.492; CI: 4.115-7.331; P < 0.001). In the receiver operating characteristic (ROC) analysis, HCR predicted HTB with 73% sensitivity and 72% specificity, and furthermore, HCR's predictive value for HTB was superior to HbA1c and C-peptide. The Kaplan-Meier cumulative survival curve showed that short-term mortality increased at HTB. In addition, HCR strongly predicted short-term mortality in Cox regression analysis.ConclusionsIn conclusion, HCR is closely associated with HTB and short-term mortality in STEMI patients.Öğe The HbA1c/C-peptide ratio is associated with the no-reflow phenomenon in patients with ST-elevation myocardial infarction(Sage Publications Inc, 2023) Toprak, Kenan; Kaplangoray, Mustafa; Memioğlu, Tolga; İnanır, Mehmet; Omar, Bahadır; Ermiş, Mehmet FatihCurrently, the gold standard treatment for ST-elevation myocardial infarction (STEMI) is primary percutaneous coronary intervention (pPCI), but even after successful pPCI, a perfusion disorder in the epicardial coronary arteries, termed no-reflow phenomenon (NR), can develop, resulting in short- and long-term adverse events. The present study assessed the relationship between NR and HbA1c/C-peptide ratio (HCR) in 1834 consecutive patients who underwent pPCI due to STEMI. Participants were divided into two groups according to NR status and the demographic, clinical and periprocedural characteristics of the groups were compared. NR developed in 352 (19.1%) of the patients in the study. While C-peptide levels were significantly lower in the NR group, HbA1c and HCR were significantly higher (P < .001, for all). In multivariable analysis, C-peptide, HbA1c, and HCR, were determined as independent predictors for NR (P < .05, for all). In Receiver Operating Characteristic (ROC) analysis, HCR predicted the NR with 80% specificity and 77% sensitivity. In STEMI patients, combining HbA1c and C-peptide in a single fraction has a predictive value for NR independent of diabetes. This ratio may contribute to risk stratification of STEMI patients.Öğe How effective is the systemic inflammatory immune index in the etiopathogenesis of isolated coronary artery ectasia?(Arquivos Brasileiros Cardiologia, 2023) Toprak, Kenan; Kaplangöray, Mustafa; İnanir, Mehmet; Memioğlu, TolgaIsolated coronary artery ectasia (ICAE) is frequently encountered in clinical practice with increasing invasive imaging methods, and our knowledge about its etiology, prognosis, and treatment approaches is increasing daily.1,2 We read with great interest the recent retrospective study of Dindas et al.,3 which deals with the relationship between the Systemic Immune Inflammation Index (SII) and ICAE.3 It has been suggested that SII neutrophils, platelets, and lymphocytes collected in a single fraction may be a good indicator of inflammation and immune response.4 Various studies have shown that SII may have a more potent prognostic value than conventional inflammatory markers such as Neutrophil Lymphocyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR).5 We would like to comment on the well-designed and presented article, which we think will contribute significantly to the literature.Öğe Increased whole blood viscosity is associated with primary idiopathic complete atrioventricular block and poor clinical outcomes in these patients(IOS Press, 2023) Toprak, Kenan; Kaplangoray, Mustafa; Palice, Ali; İnanır, Mehmet; Memioğlu, Tolga; Kök, ZaferBACKGROUND: Complete atrioventricular block is most commonly caused by age-related degeneration and fibrosis in the cardiac conduction system and is called primary idiopathic complete atrioventricular (iCAVB). Although many factors affect this situation, which increases with age in the cardiac conduction system, the relationship between whole blood viscosity (WBV) and iCAVB has not been clarified until now. In this study, we aim to reveal the relationship between iCAVB and WBV. METHODS AND RESULTS: 141 patients with dual-chamber permanent pacemaker implanted for iCAVB and 140 ageand sex-matched subjects were included in this study. The WBV values of the study groups were compared in both high shear rate (HSR) and low shear rate (LSR). Both WBV at HSR and WBV at LSR were significantly higher in the iCAVB group compared to the control group (16.11 [15.14-16.89] vs 14.40 [13.62-15.58]; 39.82 [17.43-55.23] vs 1.38 [-13.14-26.73]; p < 0.001, respectively). The patient population was followed up for an median of 38 months for all-cause mortality. Higher mortality rates were found in higher WBV at HSR and WBV at LSR (p < 0.001,for both). CONCLUSIONS: In this study, WBV was found to be an independent predictor for iCAVB, and in these patients WBV was associated with poor clinical outcomes.Öğe Is the predictive value of systemic immune-inflammation index superior to traditional markers in ST-elevation myocardial infarction patients?(Lippincott Williams & Wilkins, 2023) Toprak, Kenan; Kaplangöray, Mustafa; Memioğlu, Tolga; İnanır, MehmetWe read with great interest the recently published article ‘Systemic immune-inflammation index predicts in-hospital and long-term outcomes in patients with ST-segment elevation myocardial infarction’ by Öcal et al [1]. In their valuable, well designed, and presented research, the authors argue that the systemic immune-inflammation index (SII) is superior to traditional markers such as neutrophil-to-lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in predicting in-hospital adverse events in patients with ST-elevation myocardial infarction (STEMI) and they also claim that the discriminative value of SII in predicting in-hospital mortality in STEMI patients is higher than NLR; however, when the whole article is evaluated, we think that some methodological and literary issues should be reviewed by the authors.Öğe The non-HDL-C/HDL-C ratio is a strong and independent predictor of the no-reflow phenomenon in patients with ST-elevation myocardial infarction(Taylor & Francis Ltd, 2024) Toprak, Kenan; Kaplangoray, Mustafa; Akyol, Selahattin; Inanir, Mehmet; Memioglu, Tolga; Tascanov, Mustafa Begenc; Altiparmak, Ibrahim HalilBackground: No-reflow (NR) is the inability to achieve adequate myocardial perfusion despite successful restoration of attegrade blood flow in the infarct-related artery after primary percutaneous coronary intervention. The non-HDL-C/HDL-C ratio has been shown to be superior to conventional lipid markers in predicting most cardiovascular diseases. In this study, we wanted to reveal the predictive value of the NR by comparing the Non-HDL-C/HDL-C ratio with traditional and non-traditional lipid markers in patients who underwent primary percutaneous coronary intervention (pPCI) due to ST-elevation myocardial infarction (STEMI).Methods: A total of 1284 consecutive patients who underwent pPCI for STEMI were included in this study. Traditional lipid profiles were detected and non-traditional lipid indices were calculated. Patients were classified as groups with and without NR and compared in terms of lipid profiles.Results: No-reflow was seen in 18.8% of the patients. SYNTAX score, maximal stent length, high thrombus burden, atherogenic index of plasma and non-HDL-C/HDL-C ratio were determined as independent predictors for NR (p < 0.05, for all). The non-HDL-C/HDL-C ratio predicts the development of NR in STEMI patients with 71% sensitivity and 67% specificity at the best cut-off value. In ROC curve analysis, the non-HDL-C/HDL-C ratio was superior to traditional and non-traditional lipid markers in predicting NR (p < 0.05, for all).Conclusion: The non-HDL-C/HDL-C ratio can be a strong and independent predictor of NR in STEMI patients and and therefore non-HDL-C/HDL-C ratio may be a useful lipid-based biomarker that can be used in clinical practice to improve the accuracy of risk assessment in patients with STEMI.Öğe The relationship between nitrate-induced headache and -blood viscosity: An observational prospective study(Lippincott Williams & Wilkins, 2023) Toprak, Kenan; Kaplangoray, Mustafa; Memioğlu, Tolga; İnanır, Mehmet; Biçer, Asuman; Demirbağ, Recep; Erdoğdu, HamzaNitrates are one of the most prescribed medications in the treatment of angina pectoris today. Headache is the most common side effect of nitrates, and there is limited prospective data on the determinants of this effect. Our aim in this study is to open a foresight window for clinicians in clinical practice by explaining the possible relationship between nitrate-induced headache and whole-blood viscosity (WBV). After coronary revascularization treatment, 869 patients with angina who were prescribed nitrate preparations were divided into groups according to the development of headache or not and categorized according to the 4-grade scale level. Those who had no headache during nitrate use were graded as grade 0, those who felt mild headache were grade 1, those who felt moderate headache were grade 2, and those who described severe headache were graded as grade 3. The groups were compared according to WBV values. A total of 869 participants were included in the study. Most patients (82.1%) experienced some level of headache. Headache severity correlated with both WBV at high shear rate (r = 0.657; P < 0.001) and WBV at low shear rate (r = 0.687; P < 0.001). In multivariate analysis, WBV was determined as an independent predictor of headache experience. WBV predicted nitrate-induced headache with 75% sensitivity and 75% specificity at high shear rate and 77% sensitivity and 77% specificity at low shear rate. WBV seems to be one of the major determinants for nitrate-induced headache. WBV may be a guide for initiating alternative antianginal drugs without prescribing nitrates to the patient to increase patient compliance.Öğe Reply to Letter: HbA1c/C-Peptide Ratio is a Potential Biomarker Used to Predict No-Reflow Phenomenon in Patients With ST-Elevation Myocardial Infarction(Sage Publications Inc, 2024) Toprak, Kenan; Kaplangoray, Mustafa; Inanir, Mehmet; Dursun, Ayten; Tascanov, Mustafa Begenc; Altiparmak, Ibrahim Halil; Bicer, AsumanÖğe SCUBE1 is associated with thrombotic complications, disease severity, and in-hospital mortality in COVID-19 patients(Pergamon-Elsevier Science Ltd, 2022) Toprak, Kenan; Kaplangöray, Mustafa; Palice, Ali; Taşcanov, Mustafa Beğenç; İnanir, Mehmet; Memioğlu, Tolga; Kök, ZaferIntroduction: COVID-19 disease, which has recently become an important cause of mortality and morbidity all over the world, is remarkably associated with thrombotic complications. Although many factors are responsible for these increased thrombotic complications in COVID-19 disease, its relationship with a marker that increases the risk of thrombosis such as Signal peptide-CUB-EGF domain-containing protein 1 (SCUBE1) has not yet been clarified. This is the first study to examine the potential diagnostic and prognostic value of SCUBE1 levels in patients with COVID-19. In this study, we aimed to clarify the relationship between the increased risk of thrombosis and SCUBE1 in the course of COVID-19 disease. Materials and methods: 553 patients with COVID-19 and 553 healthy controls were compared in terms of SCUBE1 levels. Additionally, patients with COVID-19 were divided into two groups according to their SCUBE1 levels and compared in terms of severity of disease, thrombotic complications and in-hospital mortality. Results: SCUBE1 levels were significantly higher in patients with COVID-19 compared to the control group (p < 0.001). Plasma SCUBE1 levels were significantly higher in patients with severe disease and thrombotic complications, those with mild to moderate disease, and those without thrombotic complications (p < 0.001, for both). In addition, SCUBE1 was found to be an independent predictor of in-hospital mortality (p < 0.001). Conclusions: SCUBE1 may be one of the major determinants of thrombotic complications, which is an increased cause of mortality and morbidity in COVID-19 patients so inhibition of this peptide may be among the therapeutic targets in patients with COVID-19.
