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Öğe CHA2DS2-VASc and HAS-BLED scores are not associated with cardiac defibrillators therapies(Czech Soc Cardiology & Czech Soc Cardiovascular Surgery, 2021) Alsancak, Yakup; Sari, Hasan; Gurbuz, Ahmet Seyfeddin; Sertdemir, Ahmet Lutfi; Aribas, Alpay; Soylu, AhmetAim: The CHA(2)DS(2)-VASc (heart failure, hypertension, age >75, diabetes mellitus, stroke history, vascular disease, 65-74 age range, gender) and HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history, labile INR, elderly, drugs/alcohol) are scoring system for using to estimate stroke and bleeding development in cases with atrial fibrillation. We aim to evaluate the relationship between the implantable cardioverter defibrillator (ICD) therapies and CHAIDSi-VASc and HAS-BLED scores. Methods: 398 patients were included in this retrospective study after reviewing the data of the patients above the age of 18 who had ICD implantation for any reason between 2014-2019 and who were found to have at least two pacemaker check-ups with 6-month intervals. CHA(2)DS(2)-VASc and HAS-BLED scores were calculated during the device implantation and last control visit date. Results: 148 of the patients received ICD therapy (appropriate shock [n = 1181 and in appropriate therapy In = 301) and 250 of them did not receive any therapy. It was observed that the CHA(2)DS(2)-VASc and HAS-BLED scores were similar in the groups receiving and not receiving therapy (respectively, p = 0.64 and p = 0.60). CHA(2)DS(2)-VASc and HAS-BLED scores were similar in patients with appropriate shock or not (respectively p = 0.89 and p = 0.85) with median follow-up period 5.5 years. Multivariate regression analysis showed that reduced ejection fraction, presence of single-chamber ICD, lapsing of a long time after the implantation were independent risk factors for ICD device therapies (p < 0.05). Conclusions: CHA(2)DS(2)-VASc and HAS-BLED scores are not associated with device-based ICD therapies.Öğe Effect of serum uric acid on the positive predictive value of dobutamine stress echocardiography(Springer, 2016) Aribas, Alpay; Akilli, Hakan; Kayrak, Mehmet; Alibasic, Hayrudin; Yildirim, Oguzhan; Sertdemir, Ahmet Lutfi; Karanfil, MustafaThere is controversial data regarding the relationship between uric acid (UA) and coronary artery disease and cardiovascular events. Despite the deleterious effects of hyperuricemia on endothelial function, the effect of UA on myocardial ischemia has not been previously studied. We aimed to investigate the relationship between UA and myocardial ischemia that was identified using dobutamine stress echocardiography (DSE). In this retrospective study, the laboratory and DSE reports of 548 patients were reviewed. The patients were divided into two groups based on the presence of ischemia and further subdivided into three groups according to the extent of ischemia (none, ischemia in 1-3 segments, ischemia in > 3 segments). Serum UA levels were compared. Determinants of ischemia were assessed using a regression model. UA was increased in patients with ischemia and was correlated with the number of ischemic segments (p < 0.001). A cutoff value of UA > 5 mg/dl had 63.9 % sensitivity, 62.0 % specificity, 42.5 % positive predictive value (PPV), and 79.6 % negative predictive value for ischemia. When the positive DSE exams were further sorted according to the UA cutoff, the PPV of DSE increased from 80.2 to 94.0 %. Uric acid (odds ratio 1.51; 95 % CI 1.14-1.99), diabetes mellitus, HDL and glomerular filtration rate were found to be independent determinants of myocardial ischemia in DSE. Increased UA is associated with both the presence and extent of DSE-identified myocardial ischemia. A UA cutoff may be a good method to improve the PPV of DSE.Öğe Impact of preeclampsia on ventricular repolarization indices(Churchill Livingstone Inc Medical Publishers, 2021) Duran, Mustafa; Ziyrek, Murat; Sertdemir, Ahmet Lutfi; Gunenc, Oguzhan; Bardak, OmerBackground: Because of cardiac hypertrophy and electrophysiological alterations associated with preeclampsia, worsening of preexisting arrhythmias or occurrence of de novo arrhythmias are common in patients with preeclampsia. Tp-e/QT and Tpe/QTc ratios are accepted as reliable indexes for predicting ventricular arrhythmias. In this study, we examined the impact of preeclampsia on ventricular repolarization indices in patients with preeclampsia by using the QT, QTc and Tp-e interval, Tp-e/QTratio, and Tp-e/QTc ratio. Methods: We analyzed electrocardiographic recordings of sixty pregnant women with preeclampsia and thirty age-matched healthy pregnant women. Women presenting with preeclampsia were divided into 2 groups and classified as early (gestational age < 34 weeks at clinical onset) or late (>= 34 weeks) onset preeclampsia. Ventricular repolarization indices were evaluated. Results: The QT and Tp-e intervals were found to be longer in patients with earlyonset preeclampsia compared to patients with late-onset preeclampsia and helthy pregnants (377.6 +/- 23 ms vs 374.3 +/- 15 ms, 362 +/- 15 ms & 82.6 +/- 9.4 ms vs 74.0 +/- 10.6 ms, 68.6 +/- 10 ms). In adition, Tp-e/QT and Tp-e/QTc ratio were significantly higher in this patient population compared to others (0.21 +/- 0.02 vs 0.19 +/- 0.02, 0.18 +/- 0.02 & 0.19 +/- 0.02 vs 0.16 +/- 0.02, 0.15 +/- 0,02, p < 0.05 respectively). Conclusion: Our data showed that preeclampsia has unfavorable effects on electrocardiographic indices of ventricular repolarization compared to healthy pregnant women. This effect is more prominent in patients with early-onset preeclampsia.Öğe Index of cardiac-electrophysiological balance and the effects of thrombolytic therapy on the electrocardiogram of patients with pulmonary embolism(Assoc Medica Brasileira, 2020) Alsancak, Yakup; Sahin, Ahmet Taha; Gurbuz, Ahmet Seyfeddin; Sertdemir, Ahmet Lutfi; Icli, Abdullah; Akilli, Hakan; Duzenli, Mehmet AkifOBJECTIVE: Different parameters on electrocardiograms (ECG) have been investigated to predict arrhythmia and mortality in patients with acute pulmonary embolism (APE). The acute effect of thrombolytic therapy (TT) on these parameters has not been investigated yet. METHODS: We examined the data of 83 patients who were evaluated as high-risk APE and discharged from the hospital after TT First, the high-risk APE patients' ECGs were compared with healthy control subjects (n = 55). After their admission and 24 hours later, the ECGs of patients with APE were compared. Heart rate, P-wave morphology, QRS duration, QT distance, Tp-e, and the index of cardiac electrophysiological balance (iCEB) were analyzed. RESULTS: Although P maximum was not different between the groups' ECGs, heart rate, QT, QTc (corrected QT) interval, Tp-e intervals, Tp-e/QT ratio, and P wave dispersion were significantly higher in the APE group (P values < 0.031). iCEB or iCEBc (corrected iCEB) values were lower in APE group (P < 0.001). After TT, we determined a decrease in heart rate, Tp-e interval, and Tp-e/QT ratio (P < 0.001). Although we detected a decrease in the QT and QTc interval and QT dispersion (QTd), QTd had no statistical significance (respectively P-value 0.013, 0.029, and 0.096). The iCEB and iCEBc levels were lower after TT (P-value was 0.035 and 0.044 respectively). CONCLUSION: The QT, QTc, Tp-e interval, Tp-e/QTc ratio, iCEB, and iCEBc values significantly decreased after TT It may be thought that effective TT causes partial improvement in ventricular repolarization in an early period.Öğe Index of cardiac-electrophysiological balance and the effects of thrombolytic therapy on the electrocardiogram of patients with pulmonary embolism(Assoc Medica Brasileira, 2020) Alsancak, Yakup; Sahin, Ahmet Taha; Gurbuz, Ahmet Seyfeddin; Sertdemir, Ahmet Lutfi; Icli, Abdullah; Akilli, Hakan; Duzenli, Mehmet AkifOBJECTIVE: Different parameters on electrocardiograms (ECG) have been investigated to predict arrhythmia and mortality in patients with acute pulmonary embolism (APE). The acute effect of thrombolytic therapy (TT) on these parameters has not been investigated yet. METHODS: We examined the data of 83 patients who were evaluated as high-risk APE and discharged from the hospital after TT First, the high-risk APE patients' ECGs were compared with healthy control subjects (n = 55). After their admission and 24 hours later, the ECGs of patients with APE were compared. Heart rate, P-wave morphology, QRS duration, QT distance, Tp-e, and the index of cardiac electrophysiological balance (iCEB) were analyzed. RESULTS: Although P maximum was not different between the groups' ECGs, heart rate, QT, QTc (corrected QT) interval, Tp-e intervals, Tp-e/QT ratio, and P wave dispersion were significantly higher in the APE group (P values < 0.031). iCEB or iCEBc (corrected iCEB) values were lower in APE group (P < 0.001). After TT, we determined a decrease in heart rate, Tp-e interval, and Tp-e/QT ratio (P < 0.001). Although we detected a decrease in the QT and QTc interval and QT dispersion (QTd), QTd had no statistical significance (respectively P-value 0.013, 0.029, and 0.096). The iCEB and iCEBc levels were lower after TT (P-value was 0.035 and 0.044 respectively). CONCLUSION: The QT, QTc, Tp-e interval, Tp-e/QTc ratio, iCEB, and iCEBc values significantly decreased after TT It may be thought that effective TT causes partial improvement in ventricular repolarization in an early period.Öğe Predictive Value of Increased Ankle-Brachial Index in Contrast Nephropathy Development Due to Coronary Angiography(Elsevier Science Inc, 2013) Yildirim, Serkan; Kayrak, Mehmet; Eris, Mehmet Doguscan; Akilli, Hakan; Solak, Yalcin; Sertdemir, Ahmet Lutfi[Abstract Not Availabe]Öğe The Relationship Between Neutrophil / Lymphocyte Ratio and Myocardial Ischemia Detected in Dobutamine Stress Echocardiography(Elsevier Science Inc, 2013) Akilli, Hakan; Kayrak, Mehmet; Alibasic, Hajrudin; Aribas, Alpay; Yildirim, Oguzhan; Karanfil, Mustafa; Sertdemir, Ahmet Lutfi[Abstract Not Availabe]Öğe The relationship between red blood cell distribution width and myocardial ischemia in dobutamine stress echocardiography(Lippincott Williams & Wilkins, 2014) Akilli, Hakan; Kayrak, Mehmet; Aribas, Alpay; Alibasic, Hajrudin; Yildirim, Oguzhan; Sertdemir, Ahmet Lutfi; Ozdemir, KurtulusObjectivesAlthough elevated red blood cell distribution width (RDW) is associated with adverse outcomes in patients with cardiovascular disease, its role in demonstrating the presence and extent of myocardial ischemia for coronary artery disease is not known. The purpose of this study is to investigate the relationship between RDW and myocardial ischemia by using dobutamine stress echocardiography (DSE).MethodsA total of 917 patients were included in this prospective study. A complete blood analysis was performed for RDW before DSE. According to DSE results, patients were divided into two groups: DSE negative and DSE positive. According to the number of ischemic segments in DSE, patients were divided into three groups: no-ischemic segment, 1-3 ischemic segments, and 4 ischemic segments. In addition, coronary angiography results of DSE-positive groups were assessed in respect of RDW.ResultsThe RDW of the DSE-positive group (n=277) was higher than for the DSE-negative group (n=640) (13.51.5 vs. 12.7 +/- 1.3%, P<0.001, respectively). Elevated RDW values were also related to higher number of ischemic segments (no-ischemic segment group: 12.7 +/- 1.3, 1-3 ischemic segments group: 13.2 +/- 1.5, and 4 ischemic segments group: 14.2 +/- 1.3, P<0.001). A receiver operating curve analysis showed a cut-off value of RDW greater than 13.5% for predicting myocardial ischemia (sensitivity: 57.0%, specificity: 77.8%, positive predictive value: 52.7%, negative predictive value: 80.7%). In addition, positive predictive value of DSE was increased from 82.4 to 94.2% for detecting coronary artery disease by coronary angiography, when RDW (>13.5%) was used.ConclusionRDW is related to the presence and extent of myocardial ischemia in DSE. A high RDW increases the diagnostic accuracy of DSE.Öğe The Relationship Between Red Blood Cell Distribution Width and Myocardial Ischemia in Dobutamine Stress Echocardiography(Elsevier Science Inc, 2013) Akilli, Hakan; Kayrak, Mehmet; Aribas, Alpay; Alibasic, Hajrudin; Yildirim, Oguzhan; Sertdemir, Ahmet Lutfi; Ozdemir, Kurtulus[Abstract Not Availabe]Öğe Scanning of paroxysmal atrial fibrillation as an etiological risk factor in patients with acute ischemic stroke: prospective study(Associacao Paulista Medicina, 2022) Gunduz, Zahide Betul; Sertdemir, Ahmet Lutfi; Buyukterzi, ZaferBACKGROUND: Prevention of recurrence of stroke depends on recognition of the underlying mechanism of ischemia. OBJECTIVE: To screen patients who were hospitalized with diagnosis of acute ischemic stroke in terms of atrial fibrillation (AF) with repeated Holter electrocardiography recordings. DESIGN AND SETTING: Prospective study conducted at Konya Education and Research Hospital, Turkey. METHODS: Patients with a diagnosis of acute ischemic stroke, without atrial fibrillation on electrocardiog-raphy (ECG), were evaluated. Their age, gender, histories of previous ischemic attack, occurrences of parox-ysmal atrial fibrillation (PAF) and other risks were assessed during the first week after acute ischemic stroke and one month thereafter. ECG recordings were obtained from 130 patients through 24-hour ambulatory Holter. Patients without PAF attack during the first Holter were re-evaluated. RESULTS: PAF was detected through the first Holter in 33 (25.4%) out of 130 acute ischemic stroke pa-tients. A second Holter was planned for 97 patients: 53 (54.6%) of them could not attend due to COVID-19 pandemic; while 44 (45.3%) patients had the second Holter and, among these, 4 (9.1%) had PAF. The only parameter associated with PAF was older age. Four (10.8%) of the 37 patients with PAF had also symptom-atic carotid stenosis. CONCLUSIONS: Detecting the presence of PAF by screening patients with no AF in the ECG through Holter ECG examinations is valuable in terms of changing the course of the treatment. It should be kept in mind that the possibility of accompanying PAF cannot be ruled out in the presence of other factors that pose a risk of stroke.Öğe Scanning of paroxysmal atrial fibrillation as an etiological risk factor in patients with acute ischemic stroke: prospective study(Associacao Paulista Medicina, 2022) Gunduz, Zahide Betul; Sertdemir, Ahmet Lutfi; Buyukterzi, ZaferBACKGROUND: Prevention of recurrence of stroke depends on recognition of the underlying mechanism of ischemia. OBJECTIVE: To screen patients who were hospitalized with diagnosis of acute ischemic stroke in terms of atrial fibrillation (AF) with repeated Holter electrocardiography recordings. DESIGN AND SETTING: Prospective study conducted at Konya Education and Research Hospital, Turkey. METHODS: Patients with a diagnosis of acute ischemic stroke, without atrial fibrillation on electrocardiog-raphy (ECG), were evaluated. Their age, gender, histories of previous ischemic attack, occurrences of parox-ysmal atrial fibrillation (PAF) and other risks were assessed during the first week after acute ischemic stroke and one month thereafter. ECG recordings were obtained from 130 patients through 24-hour ambulatory Holter. Patients without PAF attack during the first Holter were re-evaluated. RESULTS: PAF was detected through the first Holter in 33 (25.4%) out of 130 acute ischemic stroke pa-tients. A second Holter was planned for 97 patients: 53 (54.6%) of them could not attend due to COVID-19 pandemic; while 44 (45.3%) patients had the second Holter and, among these, 4 (9.1%) had PAF. The only parameter associated with PAF was older age. Four (10.8%) of the 37 patients with PAF had also symptom-atic carotid stenosis. CONCLUSIONS: Detecting the presence of PAF by screening patients with no AF in the ECG through Holter ECG examinations is valuable in terms of changing the course of the treatment. It should be kept in mind that the possibility of accompanying PAF cannot be ruled out in the presence of other factors that pose a risk of stroke.
