Browsing by Author "Yildiz, BS"

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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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    Time to Reconsidering the Potential Role of Leech Salivary Proteins in Medicine: Type-II Kounis Syndrome Triggered by Leech Bite
    Tas, S; Yildiz, BS; Ersin, A; Tas, U
    Kounis syndrome also known as allergic myocardial infarction, represents the simultaneous occurrence of acute coronary syndromes with allergic or hypersensitivity reactions. We present a case of a 58-years-old male who developed anaphylaxis following a leech bite, leading to myocardial infarction despite the absence of prior allergic history. He was entubated and cardiopulmonary resusciation had been performed for 10 minutes. The patient was successfully resuscitated and Intravenous antihistamine, prednisolone and adrenaline were given. The patient was stabilized and transferred to the intensive care unit and coronary angiography was performed, which revealed a 90% stenosis in the circumflex coronary artery. A stent was successfully implanted in the affected artery. This report emphasizes the complexity of diagnosing and managing Type-II Kounis syndrome and highlights the need for increased clinical awareness.
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    Two uncommon complications of COVID-19 in same patient: MINOCA and pneumothorax
    Gunduz, R; Yildiz, BS; Ozdemir, IH; Ozen, MB; Erbuyun, SC
    COVID-19 has several clinical manifestations in the respiratory system and the cardiovascular system. Pneu-mothorax and myocardial infarction with nonobstructive coronary arteries (MINOCA) are two different cli-nical complications in COVID-19. However, pneumothorax and MINOCA have not been described yet in the same patient until now.A COVID-19 patient was admitted due to respiratory distress. He had pneumothorax and MINOCA.We re-port how we proceeded with diagnosis and treatment of pneumothorax and MINOCA. Respiratory and cardiovascular system manifestations of COVID-19 have made numerous clinical appearan-ces. MINOCA and pneumothorax are rare clinical appearances, but they can be seen in COVID-19 as shown in our case.
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    Effect of Coronary Thrombus Aspiration in Non ST Elevation Acute Coronary Syndrome Patients on Three-Year Survival- Does it add any Benefit?
    Yildiz, BS; Cetin, N; Gunduz, R; Bilge, A; Ozgur, S; Orman, MN
    We assessed the effect of thrombus aspiration (TA) during percutaneous coronary intervention (PCI) on in-hospital and 3-year mortality in consecutive non-ST segment elevation myocardial infarction (n = 189) and unstable angina pectoris (n = 148) patients (n = 337) between 2011 and 2016. In total, 153 patients (45.4%) underwent TA. The number of patients with postoperative thrombolysis in terms of myocardial infarction grade 3 blood flow (P < .001) and myocardial blush grade 3 (P < .001) were significantly higher in all TA groups. At 6-, 12- and 24-month post-PCI, the mean left ventricular ejection fraction was significantly higher in the all TA groups versus the stand alone PCI group (P < .001). Thrombus aspiration was associated with a significant improvement both in epicardial flow, myocardial perfusion and left ventricular ejection fraction. Thrombus aspiration during PCI in all acute coronary syndrome (except ST segment elevation) patients was associated with better survival compared with stand alone PCI group at 3-year follow-up (P = .019).
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    Comparison of Framingham risk score and atherogenic indices as a predictor of atherosclerosis in patients with myocardial bridge in left anterior descending artery
    Çetin, N; Özlek, B; Özdemir, IH; Yildiz, BS; Yavuz, V; Tikiz, H
    Background Myocardial bridge (MB) is generally considered as a benign condition, but it may trigger atherosclerosis, especially in the adjacent proximal coronary artery segment. In this study, we aimed to investigate whether the Framingham risk score (FRS) or atherogenic indices are risk factors for coronary atherosclerosis in patients with MB in the left anterior descending coronary artery (LAD). Methods We performed a retrospective study evaluating 155 patients who have MB in LAD. The patients were evaluated in two groups according to the presence of atherosclerosis (74 patients in atherosclerotic group vs. 81 patients in non-atherosclerotic group). Baseline characteristics, FRS and atherogenic indices were reviewed between groups. Significant independent risk factors for coronary atherosclerosis were investigated by logistic regression analysis. Results Patients in atherosclerotic group were significantly older (58.15 +/- 10.04 vs. 50.22 +/- 9.27 years, p < .001) and 74.3% of the patients were male. While the mean FRS in the atherosclerotic group was 21.20 +/- 8.81, it was 12.79 +/- 8.61 in the non-atherosclerotic group (p < .001). Among the atherogenic indices, only LDL-c/HDL-c ratio was significantly higher in the atherosclerotic group (3.49 +/- 1.2 vs. 3.11 +/- 0.98, p:.033). Multivariable analysis showed that age (OR: 1.08, 95% CI 1.03-1.13, p < .001) and FRS (OR: 1.06, 95% CI 1.01-1.11, p:.012) were independently associated with the presence of atherosclerotic lesion. Conclusions FRS is an easily applicable predictor in clinical practice that indicates the presence of coronary atherosclerosis in patients with MB in LAD.
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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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    Frontal QRS/T angle can predict mortality in COVID-19 patients
    Gunduz, R; Yildiz, BS; Ozgur, S; Ozen, MB; Bakir, EO; Ozdemir, IH; Cetin, N; Usalp, S; Duman, S
    Aims: The frontal QRS-T (fQRS) angle has been investigated in the general population, including healthy people and patients with heart failure. The fQRS angle can predict mortality due to myocarditis, ischaemic and nonischaemic cardiomyopathies, idiopathic dilated cardiomyopathy, and chronic heart failure in the general population. Moreover, no studies to date have investigated fQRS angle in coronavirus disease 2019 (COVID-19) patients. Thus, the purpose of this retrospective multicentre study was to evaluate the fQRS angle of COVID-19 patients to predict in-hospital mortality and the need for mechanical ventilation.Methods and results: An electrocardiogram was performed for 327 COVID-19 patients during admission, and the fQRS angle was calculated. Mechanical ventilation was needed in 119 patients; of them, 110 died in the hospital. The patients were divided into two groups according to an fQRs angle >90 degrees versus an fQRS angle <_90 degrees. The percentages of mortality and the need for mechanical ventilation according to fQRS angle were 67.8% and 66.1%, respectively, in the fQRs >90 degrees group and 26.1% and 29.9% in the fQRS <_90 degrees group. Heart rate, oxygen saturation, fQRS angle, estimated glomerular filtration rate, and C-reactive protein level were predictors of mortality on the multivariable analysis. The mortality risk increased 2.9-fold on the univariate analysis and 1.6-fold on the multivariate analysis for the fQRS >90 degrees patient group versus the fQRS <_90 degrees group.Conclusion: In conclusion, a wide fQRS angle >90 degrees was a predictor of in-hospital mortality and associated with the need for mechanical ventilation among COVID-19 patients.(c) 2022 Elsevier Inc. All rights reserved.
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    Clinical Outcomes of Comparison Between Type III Coronary Artery Perforation (CAP) and non-CAP Acute Coronary Syndrome Patients During 3-Year Follow-up
    Yildiz, BS; Gunduz, R; Ozgur, S; Cizgici, AY; Ozdemir, IH
    Coronary artery perforation (CAP) is a potentially fatal complication of percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS). This study aimed to investigate in-hospital, 1-year, and 3-year clinical outcomes of type III CAP during PCI in patients with ACS. The study retrospectively evaluated 118 patients with CAP and 43,226 case-control patients. Clinical, angiographic, and procedural characteristics, management, and outcomes were analyzed retrospectively at 1-year and 3-year follow-ups. The mean age of the patients was 66.5 +/- 11.9 years (61.8% males). There was no significant difference in hospital mortality between the type III CAP and non-CAP groups. The all-cause mortality was 33.3% in the CAP group vs 1.8% in the non-CAP group at 1 year, and 28.3% in CAP group vs 6.9% in non-CAP group at 3 years (p < .001 for both comparisons). The procedural, clinical, and 1 and 3-year outcomes of type III CAP showed a relatively high risk of myocardial infarction, coronary artery bypass graft, cerebrovascular event, stent thrombosis, and major bleeding at the 1 and 3-year follow-ups. In addition, non-CAP ACS patients had better survival (log-rank: p <.001, 34.29 months 95% Confidence Interval [33.58-35.00]) than type III CAP ACS patients (29.53 months 95% Confidence Interval [27.28-31.78]) at the 3-year follow-up visit.
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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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    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.