Browsing by Author "Gündüz, R"

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    Reply to Letter to the Editor: How Does SARS-CoV-2 Fragment the QRS?
    Özdemir, IH; Özlek, B; Özlek, E; Özen, MB; Gündüz, R; Çetin, N
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    Comparison of anti-factorXa assay and rotational thromboelastogram in evaluating the efficacy of enoxaparine treatment in patients with acute coronary syndrome without ST-segment elevation
    Gündüz, R; Yildiz, BS; Özdemir, IH; Özen, MB; Çetin, N; Yavuzgil, O
    Purpose: The aim of this study was to compare anti-factor Xa assay and tromboelastogram in evaluation of efficacy of enoxaparin in patients with acute coronary syndrome without ST-segment elevation. Materials and Methods: Twenty-five patients with acute coronary syndrome were involved. Two blood samples were taken on admission and 4 hours after the subcutaneous injection of third dose of 1mg/kg enoxaparin to the patients. AntiFXa, tromboelastogram, activated coagulation time were calculated. Results: A non-significant increase in activated coagulation time was observed after the injection of enoxaparin. After injection enoxaparin thromboelastography parameters changed maximum amplitude(MA) increased (MA basal 65.4 +/- 11.9 after 63.4 +/- 7.8), R time increased (from 5 +/- 1.7 to 8.4 +/- 4.6,), K time increased (from 1.89 +/- 1.06 to 2.56 +/- 1.4), angle increased (from 66.34 +/- 5.6 to 57.9 +/- 11.4). AntiFXa increased. (from 0.122 +/- 0.06 to 0.501 +/- 0.359). Conclusion: Tromboelastography method can be used in assessment of efficacy of enoxaparin in patients with acute coronary syndrome without ST-Segment elevation.
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    Is there any link between mortality from COVID-19 infection and QRS duration in healthy people?
    Gündüz, R; Usalp, S; Yildiz, BS
    Aim: Cardiac involvement in COVID-19 infection is associated with in-hospital mortality and morbidity. This study aimed to evaluate the effects of COVID-19 infection on the heart in patients without any known chronic disease using electrocardiographic (ECG) parameters. Material and Methods: The study included a total of 201 consecutive patients, including 150 survivors and 51 non-survivors, who were otherwise healthy and did not take any medication.Results: The QRS duration, heart rate, troponin I, C-reactive protein (CRP), D-dimer and procalcitonin values were higher in the non-survivor group (p<0.05). Cox regression analysis showed that QRS duration [HR 1.038 (1.006-1.071), p=0.023], troponin I [HR 1.255 (1.045-1.506), p=0.035], CRP [HR 1.004 (1.002-1.007), p=0.001], and D-dimer [HR 1.000 (1.000-1.003), p=0.014] values were associated with a high mortality rate due to COVID-19. ROC analyses indicated that the cut-off value of QRS duration predictive of COVID-19 mortality was >85 ms [AUC: 0.615, 95% CI (0.519-0.711), p=0.014]. Kaplan-Meier survival analysis showed that a patient with QRS>85 ms had a higher in-hospital mortality rate at day 30.Discussion: Patients with COVID-19 infection who were otherwise healthy and did not take any medication had a wide QRS duration and an increased risk of mortality during the first admission to the hospital. ECG may be useful for estimating COVID-19 mortality because of its quick and easy results.
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    Prognostic implication of uncontrolled hypertension in hospitalized patients with COVID-19
    Özdemir, IH; Özlek, B; Özen, MB; Gündüz, R; Çetin, N
    Objective: In this study, we aimed to investigate the effect of hypertension (HT) and antihypertensive treatment on prognosis, which is one of the cardiovascular risk factors affecting the prognosis of COVID-19. Methods: We included 117 patients diagnosed with COVID-19 by nasopharyngeal polymerase chain reaction (PCR). The patients were divided into a hypertensive group and a control group. Biochemical, complete blood count and imaging data of the patients were recorded. Mortality of patients with and without HT was evaluated. The effect of antihypertensive therapy on mortality was evaluated. Results: In thorax CT, ground glass opacity and pneumonic consolidation were found statistically significantly higher in the hypertensive group (p <0,001). Hospital stay duration (days) of the patients were significantly longer in the hypertensive group and need for intensive care unit was statistically higher in the hypertensive group (p <0,001). Mortality of hypertensive patients was higher than of those without hypertension (p <0,001). There was no statistically significant difference in mortality in antihypertensive treatment groups (p = 0,801). Conclusion: Hypertension is an important risk factor that increases mortality in COVID-19 patients. Uncontrolled hypertension was common in most patients. Inflammatory parameters are higher especially in patients with uncontrolled hypertension. Patients with uncontrolled hypertension have a higher risk of mortality. There is no data to suggesting that the use of ACEI/ARB worsens prognosis. High blood pressure on admission to the hospital is important and the patient's current antihypertensive therapy should not be discontinued.
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    Prognostic value of C-reactive protein/albumin ratio in hypertensive COVID-19 patients
    Özdemir, IH; Özlek, B; Özen, MB; Gündüz, R; Çetin, N; Özlek, E; Yildiz, BS; Bilge, AR
    Objectives The aim of this study was to investigate the relationship between the C-reactive protein/albumin ratio and the prognosis of hypertensive COVID-19 patients. Methods It was designed as a single center retrospective study. PCR positive COVID-19 patients who were followed up in the intensive care unit (ICU) and received antihypertensive treatment were included in the study. The patients were divided into two groups as survivor and non-survivor. C-reactive protein/albumin (CAR) ratios of the patients were compared. The cut-off value was determined as a mortality predictor. The effect of CAR on mortality was evaluated using Logistic Regression analysis. Results 281 patients were included in the study. Groups consisted of 135 (non-survivor) and 146 (survivor) patients. CAR was significantly higher in the non-survivor group (p<0.001). The area under the ROC curve for CAR for mortality was 0.807, with sensitivity of 0.71 and specificity of 0.71. The cut-off value for CAR was calculated as 56.62. In logistic regression analysis, CAR increases mortality 4.9 times compared to the cut-off value. Conclusion CAR is a powerful and independent prognostic marker for predicting mortality and disease progression in hypertensive COVID-19 patients.
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    Hydroxychloroquine/azithromycin treatment, QT interval and ventricular arrhythmias in hospitalised patients with COVID-19
    Özdemir, IH; Özlek, B; Özen, MB; Gündüz, R; Çetin, N; Bilge, AR
    Background Hydroxychloroquine (HCQ) and azithromycin (AZM) are widely used in off-label treatment of novel coronavirus disease (COVID-19). However, cardiac safety of these drugs is still controversial in COVID-19. Therefore, we aimed to evaluate association of HCQ or HCQ + AZM treatment regimens, corrected QT (QTc) interval and malignant ventricular arrhythmias in hospitalized patients. Methods This is a single-center, retrospective and observational study. All data were extracted from the electronic medical records. The initial and post-treatment mean QTc intervals were calculated and compared in patients with HCQ alone or HCQ + AZM therapy. Associated factors with QTc prolongation, the incidence of ventricular arrhythmia during treatment and in-hospital mortality because of ventricular arrhythmias were evaluated. Results Our cohort comprised 101 hospitalized COVID-19 patients (mean age of 49.60 +/- 18 years, 54.4% men). HCQ + AZM combination therapy group (n = 56) was more likely to have comorbidities. After 5-days treatment, 19 (18.8%) patients had QTc prolongation, and significant increase in the QTc interval was observed in both two groups (P < .001). However, HCQ + AZM combination group had significantly higher Delta QTc compared to HCQ group (22.5 +/- 18.4 vs 7.5 +/- 15.3 ms, P < .001). All of 101 patients completed the 5-days treatment without interruption. Also, no malignant ventricular arrhythmia or death secondary to ventricular arrhythmia occurred during the treatment in both groups. Conclusions The present study revealed that although HCQ + AZM treatment was independently associated with QTc prolongation, none of patients experienced malignant ventricular arrhythmia or death during treatment. Further prospective studies are needed to determine the exact implications of these drugs on arrhythmias in patients with COVID-19.
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    A patient with Duchenne muscular dystrophy and complete AV block undergoing a successful left bundle area pacing implantation
    Gündüz, R; Yildiz, BS; Ozgur, S
    The use of septal pacing, a novel pacemaker technique, is particularly recommended for patients with heart failure and a pacing requirement of >= 40% within a 24-hour period. The feasibility and effectiveness of left bundle area pacing remain unknown in Duchenne muscular dystrophy patients. Our case represents the first instance in Duchenne muscular dystrophy patients demonstrating the applicability of conduction system pacing.
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    Type 1 Kounis Syndrome Induced by Inactivated SARS-COV-2 Vaccine
    Özdemir, IH; Özlek, B; Özen, MB; Gündüz, R; Bayturan, Ö
    Background Vaccination is the most important way out of the novel coronavirus disease 2019 (COVID-19) pandemic. Vaccination practices have started in different countries for community immunity. In this process, health authorities in different countries have preferred different type of COVID-19 vaccines. Inactivated COVID-19 vaccine is one of these options and has been administered to more than 7 million people in Turkey. Inactivated vaccines are generally considered safe. Kounis syndrome (KS) is a rare clinical condition defined as the co-existence of acute coronary syndromes and allergic reactions. Case Report We present the case of a 41-year-old woman with no cardiovascular risk factors who was admitted at our emergency department with flushing, palpitation, dyspnea, and chest pain 15 min after the first dose of inactivated CoronaVac (Sinovac Life Sciences, Beijing, China). Electrocardiogram (ECG) showed V4-6 T wave inversion, and echocardiography revealed left ventricular wall motion abnormalities. Troponin-I level on arrival was elevated. Coronary angiography showed no sign of coronary atherosclerosis. She was diagnosed with type 1 KS. The patient's symptoms resolved and she was discharged from hospital in a good condition. Why Should an Emergency Physician Be Aware of This? To the best of our knowledge, this is the first case of allergic myocardial infarction secondary to inactivated coronavirus vaccine. This case demonstrates that KS can occur after inactivated virus vaccine against COVID-19. Although the risk of severe allergic reaction after administration of CoronaVac seems to be very low, people who developed chest pain after vaccine administration should be followed by ECG and troponin measurements. (C) 2021 Elsevier Inc. All rights reserved.
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    Multi-Center Experience of Coronary Artery Perforation During Percutaneous Coronary Intervention: Clinical and Angiographic Characteristics, Management, and Outcomes Between 2010 and 2020
    Gündüz, R; Yildiz, BS; Çetin, N; Özgür, S; Çizgici, AY; Tülüce, K; Tülüce, SY; Özen, MB; Duman, S; Bayturan, O
    Background: Coronary artery perforations are one of the most feared, rare, and catastrophic complication of percutaneous coronary intervention. Despite the remarkable increase in coronary angiography and percutaneous coronary intervention, there is no large database that collects coronary artery perforation for the Turkish population. Our study aimed to report our experience over a 10-year period for clinical and angiographic characteristics, management strategies, and outcomes of coronary artery perforation during the percutaneous coronary intervention at different cardiology departments in Turkey. Methods: The study data came from a retrospective analysis of 48 360 percutaneous coronary intervention procedures between January 2010 and June 2020. A total of 110 cases who had coronary artery perforation during the percutaneous coronary intervention were found by angiographic review. Analysis has been performed for the basic clinical, angiographic, procedural characteristics, the management of coronary artery perforation, and outcome of all patients. Results: The coronary artery perforation rate was 0.22%. Out of 110 patients with coronary artery perforation, 66 patients showed indications for percutaneous coronary intervention with acute coronary syndrome and 44 patients with stable angina pectoris. The most common lesion type and perforated artery were type C (34.5%) and left anterior descending (41.8%), respectively. The most observed coronary artery perforation according to Ellis classification was type III (37.2%). Almost 52.7% of patients have a covered stent implanted in the perforated artery. The all-cause mortality rate of coronary artery perforation patients in the hospital was 18.1%. Conclusion: The observed rate of coronary artery perforation in our study is consistent with the studies in this literature. However, the mortality rates related to coronary artery perforation are higher than in other studies in this literature. Especially, the in-hospital mortality rate was higher in type II and type III groups due to perforation and its complications. Nevertheless, percutaneous coronary intervention should be done in selected patients despite catastrophic complications.
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    Fragmented QRS is a marker of mortality in patients with severe COVID-19: A retrospective observational study
    Ozdemir, IH; Özlek, B; Özen, MB; Gündüz, R; Çetin, N; Özlek, E; Yildiz, BS; Tikiz, H
    Objective: In this study, we aimed to investigate the association of fragmented QRS (f-QRS) with in-hospital death in patients with severe novel coronavirus disease 2019 (COVID-19). Methods: This was a retrospective and observational study. A total of 201 consecutive patients with severe COVID-19 were enrolled. Demographic data, laboratory parameters, medications, electrocardiographic (ECG) findings, and clinical outcomes were recorded. Patients with and without f-QRS were compared, and predictors of all-cause in-hospital mortality were analyzed. Results: A total of 135 patients without f-QRS (mean age of 64 years, 43% women) and 66 patients with f-QRS (mean age of 66 years, 39% women) were included. C-reactive protein (CRP), D-dimer, troponin I, ferritin levels, and CRP to albumin ratio were significantly higher in patients with f-QRS. The need for invasive mechanical ventilation (63.6% vs. 41.5%, p=0.003) and all-cause in-hospital mortality [54.5% vs. 28.9%, log rank p=0.001, relative risk 1.88, 95% confidence interval (CI) 1.16-4.78] were significantly higher in patients with f-QRS. A number value of f-QRS leads >= 2 yields sensitivity and specificity (85.3% and 86.7%, respectively) for predicting in-hospital all-cause mortality. Multivariable analysis showed that f-QRS (odds ratio: 1.041, 95% Cl: 1.021-1.192, p=0.040) were independently associated with in-hospital death. Conclusion: This study revealed that the presence of f-QRS in ECG is associated with higher in-hospital all-cause mortality in patients with severe COVID-19. f-QRS is an easily applicable simple indicator to predict the risk of death in these patients.