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    Akut Koroner Sendromda Serum Fibrinojen Düzeyi İle Stent Restenozu Arasındaki İlişki
    (2020) Karadeniz, Muhammed; Sarak, Taner
    Amaç: İn-stent restenoz, koroner arterlere stent implantasyonu sonrası stentli bölgenin aşamalı olarak yeniden daralmasıdır. İlaç salınımlı stentlerin kullanılmaya başlanmasıyla restenoz oranları azalmış olsa da hala majör problem olmaya devam etmektedir. Bu çalışmada akut koroner sendrom nedeniyle koroner anjiyografi yapılan hastalarda in-stent restenozu ile fibrinojen düzeyi arasındaki ilişkiyi araştırmayı amaçladık. Gereç ve Yöntemler: İki grup arasında yaş, hipertansiyon, diyabetes mellitus, sigara içimi ve sol ventrikül ejeksiyon fraksiyonu açısından fark yoktu (p>0.005, hepsi için). İSR grubunda erkek cinsiyet ve hiperlipidemi oranı İSR olmayan gruba göre daha yüksekti (sırasıyla, p=0.04; 0.007). Biyokimyasal parametrelerden homosistein ve fibrinojen dışında iki grup arasında fark izlenmedi. Serum homosistein ve fibrinojen seviyesi İSR olan grupta İSR olmayan gruba göre istatistiksel olarak anlamlı derecede yüksek saptandı (sırasıyla, p=0.009; 0.032). Dislipidemi, homosistein ve fibrinojen İSR'nin bağımsız prediktörleri olarak saptandı. Bulgular: Tedavi sonrası WOMAC ağrı, WOMAC tutukluk, WOMAC fonksiyonel durum ve WOMAC toplam skorlarında tedavi öncesi değerlere göre her iki grupta da istatistiksel olarak anlamlı gelişme saptandı (p<0.001). Ancak tedavi sonuçları arasında gruplar arası istatistiki olarak anlamlı fark saptanmadı. Sonuç: Koroner arter hastalığı nedeniyle çıplak metal stent implante edilmiş hastalarda plazma fibrinojen düzeyi İSR riskini öngörmede yardımcı olabilecek önemli bir biyokimyasal parametre olabilir.
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    Akut Koroner Sendromlu Hastalarda Çok Damar Hastalığı İle Kardiyovasküler Risk Faktörleri Arasındaki İlişki
    (2019) Alp, Çağlar; Karadeniz, Muhammed; Sarak, Taner; Demir, Vahit
    Amaç: Akut koroner sendrom olgularında ciddi darlık olan koroner arter sayısı ile kardiyovasküler risk faktörleri arasındaki ilişki değerlendirildi. Yöntemler: Bu çalışma retrospektif olarak dizayn edildi. 2016–2018 tarihleri arasında akut koroner sendrom sebebiyle koroner anjiografi yapılan 904 hasta çalışmaya dahil edildi. Ciddi koroner arter darlığı olmayan ve koroner operasyon geçiren hastalar çalışma dışı bırakıldı. Hastalar kritik koroner arter darlıklarına göre tek damar hastalığı (TDH) ve çok damar hastalığı (ÇDH) olacak şekilde iki gruba ayrıldı. ÇDH ile TDH olanlar klasik kardiyovasküler risk faktörleri açısından karşılaştırıldı. Bulgular: Hastaların 544’ünde (%60) ÇDH 365’inde (%40) TDH saptandı. ÇDH olan grupta yaş, hipertansiyon ve diyabet mellitus istatistiksel olarak daha fazla saptandı (sırasıyla p<0.001, p=0.003, p=0.005). TDH olan grupta ise erkek cinsiyet, aile öyküsü ve sigara içiciliği istatistiksel olarak daha fazla saptandı (sırasıyla p=0.006, p<0.001, p<0.001). Sonuç: Diyabet ve hipertansiyon ÇDH grubunda yüksek saptanırken aile öyküsü ve sigara içiciliği TDH grubunda yüksek saptandı. Akut koroner sendrom hastalarında bu risk faktörlerin göz önünde bulundurulması önemlidir.
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    Akut Koroner Sendromlu Hastalarda Kronik Total Oklüzyon Sıklığı ve Risk Faktörleriyle İlişkisi
    (2019) Sarak, Taner; Karadeniz, Muhammed
    Amaç: Bu çalışma kliniğimizde akut koroner sendrom sebebiyle yatarak tedavi edilen hastalarda kronik total oklüzyon (KTO) sıklığı ve bunun kardiyovasküler risk faktörleriyle ilişkisini belirlemek amacıyla yapılmıştır.Gereç ve yöntem: Çalışmaya Nisan 2015 – Eylül 2018 tarihleri arasında akut koroner sendrom sebebiyle koroner anjiyografik değerlendirmeye alınan hastalar dahil edildi. Koroner anjiyografik incelemelerde lezyon bölgesinde TIMI 0 akım olan hastalar KTO olarak kabul edildi. Risk faktörleri anamnez ve laboratuvar bulgularına göre tespit edildi.Bulgular: Çalışmaya kriterlere uyan 904 hasta dahil edildi. İki yüz on dört hastada (%23) KTO tespit edildi. KTO olan hastalarda ortalama yaş (67 11, 60 13, p 0.001), hipertansiyon varlığı (%54.7, %43.0, p 0.004) ve diyabetes mellitus (%41.1, %31.6, p 0.013) istatistiksel olarak daha yüksek saptandı, erkek cinsiyet (%64, %73, p 0.008), prematüre koroner arter hastalığı öyküsü (%10.3, %19.9, p 0.001) ve sigara kullanımı (%28.0, %48.8, p 0.001) ise daha düşük saptandı.Sonuç: Bu çalışmada akut koroner sendrom hastalarında KTO’su olan ve olmayan hasta grupları arasında risk faktörleri açısından anlamlı farklar olduğu tespit edildi Bildiğimiz kadarıyla, bu çalışma literatürdeki kronik total tıkanma ve kardiyovasküler risk faktörleri arasındaki ilişkiyi gösteren ilk çalışmadır.
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    Anterior myocardial infarction in a patient with isolated left ventricular non-compaction
    (Cambridge Univ Press, 2019) Celik, Ibrahim Etem; Kilic, Alparslan; Karadeniz, Muhammed
    We presented a 55-year-old male patient with isolated left ventricular non-compaction who was admitted to our emergency department for chest pain and exertional dyspnoea. He was hospitalised due to anterior myocardial infarction, and during his assessment, isolated left ventricular non-compaction was diagnosed.
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    Assessment of Left Atrial Volumes and Functions in Patients with Coronary Slow Flow
    (2021) Aslan, Burhan; Peker, Tezcan; Tenekecioğlu, Erhan; Aktan, Adem; Özbek, Mehmet; Karadeniz, Muhammed; Çil, Habib
    Objectives: Coronary slow flow phenomenon (CSFP) is the slow or late progression of the opaque material to the distal vascular structures during angiography in patients with normal or near-normal coronary arteries. This study aims to evaluate left atrial volumes and functions using conventional transthoracic and tissue Doppler echocardiographic parameters in patients with CSFP. Materials and Methods: According to criteria determined by Gibson, 50 patients with slow flow in at least one coronary artery were included as cases, and 40 subjects with normal coronary flow were included as controls. Results: In the transmitral and tissue Doppler analysis, mitral early velocity (E), mitral late velocity/mitral early velocity (E/A), and Em were significantly lower in the coronary slow flow (CSF) group. LA, Am, mitral early velocity/earlydiastolic velocity (E/Em), LAVmax, LAVmin, LAVpreA, index volumes, LAAEV, LATEV, and LAAEF were found to be higher in the CSF group. A significant positive correlation was observed between Frame LAD and LAAEF (r=0.66, p<0.001) and between Frame LAD and E/Em (r=0.34, p<0.001). A significant negative correlation was found between LAAEF and E/A ratio (r=-0.4, p=0.003). There was also a significant positive correlation between LAPEF and E/A (r=0.44, p<0.001) and between the mean frame and LAAEF (r=0.4, p=0.002). Conclusion: Impaired LV diastolic functions and significant changes in LA volumes were found in patients with CSFP.
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    Diyabetik hastalarda ayak problemlerinin yönetimi ve vasküler patolojilere yaklaşım
    (2019) Karahan, İrfan; Alp, Çağlar; Çifci, Aydın; Karadeniz, Muhammed
    Diyabet prevalansı tüm dünyada giderek artmakta ve büyük bir halk sağlığı problemine dönüşmektedir. Diyabetin komplikasyonları hastalığın kendisinden daha büyük problemlere neden olmaktadır. Bir diyabetli hastanın ayağında ülser gelişmesi hastalarda ciddi morbidite ve hatta mortaliteye neden olabilmekte, ayrıca sağlık giderlerinin aşırı derecede artması ile sonuçlanmaktadır. Dünya genelinde tüm sağlık harcamalarının yaklaşık 1/6’sı diyabet ve onun getirdiği problemler nedeniyledir. Diyabet hastalarının hayatları boyunca %12-15 oranında diyabetik ayak ülseri geliştirme riski bulunmaktadır ve diyabetlilerin hastaneye yatış nedeninin 1/4’ünü oluşturmaktadır. Ampütasyon insidansı 6-8/1000 DM yıl civarındadır ve travma dışı ampütasyonların dünyada en sık nedeni (%50’den fazlası) diyabettir. Bu hastalarda hem vasküler problemler hem de kan şekeri düzensizliğinin etkisiyle küçük bir enfeksiyon odağı günler içinde hızla sepsise ilerleyip uzuv kaybına yol açabilmektedir. Bu kadar sık karşılaşılan bir problemin önlenmesi en önemli halk sağlığı konularından biridir. Tüm önlemlere rağmen diyabetik bireyler ayak problemi ile karşılaşılmışsa, problem erkenden ortaya konulmalı ve diyabetik ayak ekibi olarak gerekli müdahaleler vakit kaybetmeden yapılmalıdır.
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    Evaluation of Tp-e/QTc Ratio in Obesity
    (Galenos Publ House, 2024) Uyan, Umut; Aydin, Cihan; Demirkiran, Aykut; Karadeniz, Muhammed; Alpsoy, Seref
    Aim: We aimed to detect simple findings that might predict sudden cardiac death in electrocardiography recordings in obese patients. Materials and Methods: Patients were included in our study retrospectively. Two groups with body mass index (BMI) >= 30 kg/m(2) (Group 1) and BMI <30 kg/m(2) (Group 2) were sampled from the study population with similar baseline characteristics, biochemical and echocardiographic features. Ventricular repolarization parameters were compared between the two groups. The Tp-e interval was defined as the period of time between the T waves' peak and their end. Tp-e/QTc ratio was calculated. Results: This study included 190 participants. There were no differences between the two groups in terms of age (p=0.42), diabetes (p=0.238), hypertension (p=0.877), smoking (p=1.000), medical treatment used, laboratory parameters, left ventricular ejection fraction (p=0.673), and left ventricular mass index (p=0.089). The QTc interval was similar between the groups (416.4 +/- 11.6 ms, and 422.1 +/- 14.8 ms; p=0.081). Tp-e, and Tp-e/QTc ratio were greater in Group 1 (93.1 +/- 6.2 ms, and 67.7 +/- 2.5 ms; p=0.00; 0.22 +/- 0.02, and 0.15 +/- 0.01; p=0.001). Twelve months after the first examinations, six deaths were noted in the obese group (p=0.001). Conclusion: Our study results showed that the Tp-e interval and Tp-e/QTc ratio were significantly increased, and sudden cardiac death was more common in patients with BMI >= 30 kg/m(2).
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    Hyperhomocysteinemia Predicts the Severity of Coronary Artery Disease as Determined by the SYNTAX Score in Patients with Acute Coronary Syndrome
    (Taiwan Soc Cardiology, 2018) Karadeniz, Muhammed; Sarak, Toner; Duran, Mustafa; Alp, Caglar; Kandemir, Huseyin; Celik, Ibrahim Etem; kilic, Alparslan
    Background: Hyperhomocysteinemia is a known risk factor for acute coronary syndrome (ACS) and is related with the severity of coronary artery disease (CAD). Previous studies have used less quantifiable scoring systems for assessing the severity of CAD. Therefore, we aimed to assess the relationship between homocysteine levels and SYNTAX score (SXscore), which is currently more widely used to grade the severity of CAD. Methods: A total of 503 patients with adiagnosis of ACS were examined angiographically with SXscore. The patients were divided into three groups according to SXscore; Group 1 a low SXscore <= 22), Group 2 a moderate SXscore (23-32), and Group 3 a high SXscore (>= 33). Results: Plasma homocysteine levels were 16.3 +/- 6.2 nmol/mL in Group 1, 18.1 +/- 9.6 nmol/mL in Group 2, and 19.9 +/- 9.5 nmol/mL in Group 3. Homocysteine levels were significantly higher in Group 2, and Group 3 compared to Group 1 (p = 0.023 and 0.007, respectively). In the correlation analysis, homocysteine levels were correlated with SXscore (r: 0.166, p < 0.01). Conclusions: Serum homocysteine levels on admission were associated with an increased severity of CAD in the patients with ACS.
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    Monocyte count to high-density lipoprotein ratio predicts occlusion of the infarct-related artery in STEMI
    (2017) Zehir, Regayip; Sarak, Taner; Barutçu, Süleyman; Şimşek, Vedat; Karadeniz, Muhammed; Kandemir, Hüseyin
    Amaç: ST segment yükselmeli miyokard enfarktüsü (STEMI) olan hastalarda, primer perkütan koroner girişim (pPKI) öncesi enfarktüs ilişkili arter acıklığı daha iyi klinik sonuçlar ile ilişkilidir. Bununla birlikte, STEMI ortamında pPKI öncesinde IRA açıklığının öngördürücüleri ile ilgili sınırlı veri vardır. STEMI'de monosit sayısı /yüksek yoğunluklu lipoprotein oranı (MHR) ile enfarktla ilişkili arterin acıklığı arasındaki ilişkiyi değerlendirmek istedik.Gereç ve Yöntemler: Toplam 726 hasta çalışmaya alındı. IRA açıklığı, miyokard enfarktüsünde tromboliz (TIMI) akım sınıflaması ile belirlendi. PKI öncesi IRA'da TIMI akım derecesine göre çalışma popülasyonu, TIMI 0,1 veya 2 grup (tıkalı IRA, n=624) ve TIMI 3 grubu (patent IRA, n=102) olmak üzere iki gruba ayrıldı. MHR hesaplamak için basvuruda kan örnekleri toplandı. Tüm hastaların 92'sinde (%20,4) IRA'da pre-pPKI TIMI 3 akımı vardı.Bulgular: MHR, tıkanan IRA grubunda anlamlı derecede yüksekti (22,4 ± 5,4'e karşılık 17,8 ± 6,9, P < ,001). Tıkalı IRA grubunda, glikoz, troponin İ ve trombosit/lenfosit oranı (PLR) düzeyleri de yüksekti (P < 0.05). Çok değişkenli regresyon analizinde, başvuru sırasındaki MHR değeri (odds oranı [1,391]; %95 güven aralığı [CI]: 1,116-1,272, P < 0,001) ve prasugrel veya tikagrelorun hastane öncesi kullanımı (OR: 7,045; CI:1,687-29,414, P = 0,007) IRA açıklığının bağımsız öngördürücüleri olarak bulundu.Sonuçlar: IRA açıklığı, pPKI öncesi hızlı etkili antitrombosit tedavi alan hastalarda daha sık görülmektedir ve daha düşük bir MHR değeri IRA açıklığını bağımsız bir şekilde tahmin eder.
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    Predictors of Severity of Coronary Artery Disease in Patients with Acute ST-elevation Myocardial Infarction
    (Galenos Publ House, 2024) Karadeniz, Muhammed; Aydin, Cihan; Demirkiran, Aykut; Alp, Caglar
    Aim: Our study aims to investigate the relationship between platelet-lymphocyte ratio (PLR), neutrophil/lymphocyte ratio (NLR), and the correlation between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) scores. Materials and Methods: The patients were divided into three groups according to their SYNTAX score. Group 1 included patients with a SYNTAX score <23, group 2 with a SYNTAX score of 23-32, and group 3 with a SYNTAX score of >33. PLR was calculated as the ratio of platelet count to lymphocyte count. Results: In multivariate logistic regression analysis, high PLR and NLR ratios and older age were independent predictors of high SYNTAX score II [odds ratio (OR): 1.052; 95% confidence interval (CI): (0.998-1.119), p=0.011; OR: 1.093; 95% CI: (1.016-1.175), p=0.016; OR:1.023; 95% CI: (1.0101.038), p=0.001, respectively. Patients with high PLR had significantly higher SYNTAX scores [121.7 (114.2-129.3) in group 1; 139.4 (125.9-153.0) in group 2, 187.0 (141.8-232.2) in group 3; p<0.001], and there was a positive correlation between PLR, NLR and SYNTAX scores (r=0.52, p<0.001; r=0.58, p<0.001, respectively). Conclusion: PLR and NLR were associated with the severity and complexity of coronary artery disease in patients with acute ST-elevation myocardial infarction.
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    Prolonged P Wave Peak Time May Be a Sign of LV Diastolic Dysfunction in the Coronary Slow Flow Phenomenon
    (Wiley-Hindawi, 2022) Aslan, Burhan; Isik, Ferhat; Akyuz, Abdurrahman; Unci, Umit; Karadeniz, Muhammed
    Background. The coronary slow flow phenomenon (CSFP) is an atherosclerotic process that causes ischemia at the microvascular level. The CSFP may affect P wave durations, especially P wave peak time (PWPT), by microvascular ischemia, left ventricular diastolic dysfunction, and changes in the left atrial dimension. Therefore, in the present study, we aimed to assess PWPT in the CSFP. Method. One hundred and ninety-five patients were included in this single-center, retrospective study. Ninety patients were enrolled in the CSFP group and 105 patients in the control group. PWPT was defined as the duration between the beginning and peak of the p wave and obtained from the leads D-11 and V-I. Results. The mean age of the study population was 48.5 +/- 9.5, and 108 (55.3%) of the patients were female. We found PWPT was longer in the CSFP group than in the control group. Correlation analysis showed a positive correlation between PWPT in both leads (D-II, V-1) and left atrial anterior-posterior diameter, mean TIMI frame count (TFC), and E/e. A significant relationship was observed between mean TFC, E/e, EF, heart rate, and PWPT in lead D-11 (beta coefficient = 0.33, 95% CI 0.44-1.33, p < 0.001, beta coefficient = 0.23, 95% CI 0.25-1.85, p=0.01, beta coefficient = -0.140, 95% CI -1.04--0.53, p=0.03, and beta coefficient = -0.13, 95% CI -0.29--0.014, p=0.03, respectively) in multivariable linear analysis. Conclusion. In the present study, we found prolonged PWPT in patients with the CSFP and found a relationship between PWPT and mean TFC.
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    The relationship between serum NT-proBNP levels and severity of coronary artery disease assessed by SYNTAX score in patients with acute myocardial infarction
    (Tubitak Scientific & Technical Research Council Turkey, 2019) Sarak, Taner; Karadeniz, Muhammed
    Background/aim: In the present study, we aimed to investigate the relationship between NT-proBNP and SYNTAX score, which is a measure of the complexity of coronary artery disease. Materials and methods: We enrolled 405 consecutive patients with myocardial infarction who underwent coronary angiographic examination. Patients were divided into 3 groups according to their SYNTAX scores. Those with SYNTAX score <= 22 were included in the low SYNTAX score group (LSTX), those with a score of 23-32 were included in the intermediate SYNTAX score group (ISTX), and those with a score of >= 33 were included in the high SYNTAX score group (HSTX). Results: NT-proBNP levels were found to be significantly higher in the HSTX group compared to the other groups (P < 0.001) and in the ISTX group compared to the LSTX group (P < 0.001). The NT-proBNP levels demonstrated an increase from low SYNTAX score to high SYNTAX score tertiles. Conclusions: NT-ProBNP levels in patients with myocardial infarction on admission were independently associated with extent, severity, and complexity of coronary atherosclerosis as assessed by SYNTAX score.
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    Role of simple inflammatory parameters in predicting the severity of coronary artery disease
    (Assoc Medica Brasileira, 2023) Aydin, Cihan; Uyan, Umut; Karadeniz, Muhammed; Demirkiran, Aykut
    OBJECTIVE: In our study, we aimed to find simple, useful biomarkers in patients with non-ST elevation myocardial infarction to predict coronary artery severity.METHODS: Between May 2022 and December 2022, patients diagnosed with non-ST elevation myocardial infarction according to the European cardiology guidelines were included in our study. The Synergy between PCI with Taxus and Cardiac Surgery score was calculated to determine the severity of coronary artery disease. These patients were classified into two groups according to Synergy between PCI with Taxus and Cardiac Surgery >= 23 and Synergy between PCI with Taxus and Cardiac Surgery<23 scores. Biochemical markers such as platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio were studied in blood tests taken before coronary angiography in patients diagnosed with non-ST elevation myocardial infarction according to current guidelines. These two groups were compared in terms of the data obtained.RESULTS: There were 281 patients in group 1 and 67 patients in group 2. There was no significant difference between the two groups in terms of demographic data such as age and gender. Platelet-to-lymphocyte ratio [group 1=125 (26-134) and group 2=156 (73-293); p=0.001] and neutrophil-to-lymphocyte ratio [group 1=2.71 (1.3-30.2) and group 2=3.2 (2.1-32.1); p=0.002] were higher in the group of patients with a Synergy between PCI with Taxus and Cardiac Surgery score of <23, while lymphocyte-to-monocyte ratio [group 1=3.6 (0.56-11) and group 2=3.4 (0.64-5.75); p=0.017] was lower in group 2.CONCLUSION: We observed that elevated platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios showed coronary artery severity. Multivessel disease and chronic total occlusion rates were observed to be higher in patients with high platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios.
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    Serum pentraxin-3 levels and flow-mediated dilation in dipper and non-dipper hypertension
    (Wiley, 2019) Alp, Caglar; Dogru, Mehmet Tolga; Karadeniz, Muhammed; Sarak, Taner; Demir, Vahit; Celik, Yunus; Kisa, Ucler
    Background Endothelial dysfunction is one of the main pathological processes of hypertension. The association of serum pentraxin-3 (PTX3) levels and endothelial dysfunction becomes a more interesting scientific research issue due to high potential of PTX3 as a diagnostic and prognostic biomarker. We aimed to investigate the relationship between serum PTX3 levels and flow-mediated dilation results in patients with dipper and non-dipper hypertension. Methods This study included 90 hypertensive patients were divided into two groups based on 24 hours ambulatory blood pressure monitoring (ABPM): 38 patients with a dipper pattern and 52 patients with non-dipper pattern. Noninvasive evaluation of the endothelial functions was performed using flow-mediated dilation (FMD) method. Results Serum pentraxin-3 levels were higher in patients with non-dipper HT compared to dipper hypertension (P = 0.028). In addition, we found negative correlation between serum PTX3 and FMD basal/FMD hyperemia ratio (r = -0.297, P = 0.05 for FMD basal/FMD hyperemia ratio, respectively). Conclusions Serum PTX3 levels are closely related with the measures of indirect noninvasive evaluation methods (FMD) in both DH and NDH patients.
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    The relationship between serum homocysteine levels and development of coronary collateral circulation in patients with acute coronary syndrome
    (2020) Karadeniz, Muhammed; Karadeniz, Tuba Betül; Sarak, Taner; Alp, Çağlar
    Aim: Homocysteine is an amino acid that plays a role in folate metabolism and inhibits endothelial cell proliferation which is important for angiogenesis. In this study, we aimed to investigate the relationship between serum homocysteine levels and coronary collateral development. Material and Method: Consecutive 176 patients, with acute coronary syndrome and chronic total occlusion, were divided into two groups according to coronary collateral development. Rentrop 0 and 1 were regarded as group I and Rentrop 2 and 3 as group II. Results: Plasma homocysteine levels were 18.2±7.0 ?mol/L in the group I and 15.7±5.1 ?mol/L in the group II. Univariate logistic regression analysis showed that mean platelet volume and homocysteine were associated with poor coronary collateral. Multivariate logistic regression analysis showed that homocysteine level was independently associated with poor coronary collateral circulation (OR 1.069 [95% CI 1.012-1.130]; p=0.018). Conclusion: In this study clearly demonstrates that high serum homocysteine level is associated with poor collateral development in patients with acute coronary syndrome.