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    Marital status and outcomes in chronic heart failure: Does it make a difference of being married, widow or widower?
    (2021) Şentürk, Bihter; Kaya, Hakkı; Çelik, Ahmet; Bekar, Lütfü; Güngör, Hasan; Zoghi, Mehdi; Yılmaz, Mehmet Birhan
    OBJECTIVE: We aimed to compare the outcomes of chronic heart failure (HF) patients with reduced ejection fraction (CHFrEF) in the Turkish Research Team in HF (TREAT-HF) registry according to marital status with a specific focus on being the widowed (widow/widower) versus the married.METHODS: TREAT-HF is a network, enrolling CHFrEF with a follow up for HF-related hospitalization (HFrH) and all-cause mortality (ACM). In this cohort, the widowed patients were compared with patients who were married before and after propensity score (PS) matching analysis.RESULTS: There were 723 cHFrEF patients with a complete dataset, including reported marital status at baseline for this analysis. Out of 723 patients with HF, 37 “never-married” and “divorced” patients were excluded from the analysis. Then, out of 686 remaining patients with HF, who had at least one reported marriage in the database, widowed patients with HF (n=124) were compared with married patients (n=562). The mean follow up period was 21±12 months up to 48 months. The widowed patients had a higher risk of HFrH (p=0.047), although ACM remained similar compared to married patients (p=0.054). After PS matching, HFrH remained more frequent among the widowed compared with the married (p=0.039) although ACM yielded similar rates. Of note, it was shown that being a widower (p=0.419) was not linked to increased risk of HFrH during follow up contrary to being a widow (p=0.037) despite similar age, ejection fraction, creatinine, NYHA functional class distribution and a similar rate of life-saving medications.CONCLUSION: PS matching analysis yielded that the widowed had increased the risk for HFrH. Of note, widowers did not seem to have an increased risk for HFrH, contrary to widows.
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    Noncompliance with Dietary Salt Restriction and Outcomes in Chronic Heart Failure: A Propensity Score Matching Analysis from TREAT-HF Registry
    (2021) Şentürk, Bihter; Kaya, Hakkı; Çelik, Ahmet; Bekar, Lütfü; Güngör, Hasan; Zoghi, Mehdi; Yılmaz, Mehmet Birhan
    Aim: To compare chronic heart failure patients with reduced ejection fraction (cHFrEF) who stated to comply with salt restriction in their diets versus those who did not. Methods: Patients without salt restriction were compared to those with salt restriction regarding HF-related hospitalization (HFrH) and all-cause mortality (ACM) before and after propensity score (PS) matching analysis. Results: The study included a total of 723 patients. 136 of them stated not to comply with salt restriction, 587 of them stated to comply with salt restriction. More frequent HFrH were observed in patients without salt restriction compared to those with salt restriction (75% vs. 62.9%, p=0.007), though, ACM was similar in both groups (29.4% vs 27.6%, p=0.672). After PS matching, HFrH during follow-up remained more frequent in those without salt restriction compared to those with salt restriction (73.7% vs 59.3%, p=0.019) but ACM was not different in both groups (30.5% vs 29.7%, p=0.887). Noncompliance to dietary salt restriction was found as one of the independent predictors of HFrH. Conclusion: In cHFrEF outpatients, noncompliance to dietary salt restriction does not seem to increase the risk for ACM but it poses an increased risk for HFrH.
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    Right-sided electrocardiogram usage in acute pulmonary embolism
    (W.B. Saunders, 2016) Kozacı, Nalan; Ay, Mehmet Oğuzhan; Beydilli, İnan; Kartal, Zeynep Aslı; Çelik, Ahmet; Şaşmaz, İkbal; Güven, Ramazan
    Introduction Diagnostic sensitivity and specificity of standard electrocardiogram (ECG) in acute pulmonary embolism (APE) are low. Presence of findings of concomitant right ventricular strain suggests that the use of right-sided ECG recording may be helpful in APE. This study was aimed to investigate the diagnostic usefulness of right-sided ECG in APE. Materials and methods Patients determined to be at moderate and high risk according to Wells’ Criteria and who underwent pulmonary computed tomography angiography imaging were included in the study. Right-sided ECG recording was performed along with standard ECG recording during the first examination of patients. Results A total of 117 patients were included in the study. Sixty-four patients (55%) were female. The mean age was 62 ± 16 years for men and 64 ± 17 years for women. Acute pulmonary embolism was detected in 75 patients (64%) by pulmonary computed tomography angiography. Although T-wave inversions were most common in leads V2 to V4 (sensitivity, 31%) in standard ECG of patients with APE, right-sided ECG showed T-wave inversions most commonly in V3R to V6R (sensitivity, 64%) and ST-segment elevations in V3R to V6R (sensitivity, 29%). In APE patients with hypotensive shock, T-wave inversions in leads III and aVF (sensitivity, 57%) in standard ECG and T-wave inversions in V3R to V6R (sensitivity, 57%) and ST-segment elevations in V3R-V6R (sensitivity, 50%) in right-sided ECG were most commonly observed. Conclusion The right-sided ECG has a higher sensitivity than standard ECG for the diagnosis of APE. In patients with clinical APE suspicion, routine use of right-sided ECG along with standard ECG in the first evaluation can be useful. © 2016 Elsevier Inc.
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    Snapshot evaluation of acute and chronic heart failure in real-life in Turkey: A follow-up data for mortality
    (2020) Yılmaz, Mehmet Birhan; Aksakal, Emrah; Aksu, Uğur; Altay, Hakan; Yıldırım, Nesligül; Çelik, Ahmet; Tokgözoğlu, Lale
    Objective: Heart failure (HF) is a progressive clinical syndrome. SELFIE-TR is a registry illustrating the overall HF patient profile of Turkey. Herein, all-cause mortality (ACM) data during follow-up were provided. Methods: This is a prospective outcome analysis of SELFIE-TR. Patients were classified as acute HF (AHF) versus chronic HF (CHF) and HF with reduced ejection fraction (HFrEF), HF with mid-range ejection fraction, and HF with preserved ejection fraction and were followed up for ACM. Results: There were 1054 patients with a mean age of 63.3±13.3 years and with a median follow-up period of 16 (7–17) months. Survival data within 1 year were available in 1022 patients. Crude ACM was 19.9% for 1 year in the whole group. ACM within 1 year was 13.7% versus 32.6% in patients with CHF and AHF, respectively (p<0.001). Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta blocker, and mineralocorticoid receptor antagonist were present in 70.6%, 88.2%, and 50.7%, respectively. In the whole cohort, survival curves were graded according to guideline-directed medical therapy (GDMT) scores ?1 versus 2 versus 3 as 28% versus 20.2% versus 12.2%, respectively (p<0.001). Multivariate analysis of the whole cohort yielded age (p=0.009) and AHF (p=0.028) as independent predictors of mortality in 1 year. Conclusion: One-year mortality is high in Turkish patients with HF compared with contemporary cohorts with AHF and CHF. Of note, GDMT score is influential on 1-year mortality being the most striking one on chronic HFrEF. On the other hand, in the whole cohort, age and AHF were the only independent predictors of death in 1 year
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    Snapshot evaluation of heart failure in Turkey: Türkiye’de kalp yetersizliğinin anlık görüntüsü: SELFIE-TR bazal karakteristik özellikleri
    (2019) Yılmaz, Mehmet Birhan; Çelik, Ahmet; Çavuşoğlu, Yüksel; Bekar, Lütfü; Onrat, Ersel; Eren, Mehmet; Tokgozoglu, Lale
    Amaç: Kalp yetersizliği (KY) 21. yüzyılın önemli bir sağlık sorunudur ve ülkemizdeki sıklığı %2.9’dur. Bu hastalığın ülke profili, farklı fenotiplerin sıklığı ve özellikleri, risk faktörleri net olarak ortaya konulmamıştır. Bu çalışmada, ülkemizi temsil eden bir örnekte KY hastaları (SELFIE-TR – Snapshot Evaluation of Heart Failure Patients in Turkey) incelenmiştir. Yöntemler: Ülkemizdeki 12 NUTS-1 bölgesinden en az iki kardiyoloji uzmanının çalıştığı 23 merkez çalışmaya davet edildi. Merkezler, Ekim veya Kasım aylarından tercih ettiği bir tanesinde, tercih edilen ay içindeki 4 haftanın yine tercih edilen bir gününde, tanısı kılavuzlara uygun olarak doğrulanmış KY hastalarını ardışık olarak çalışmaya dahil ettiler. Bulgular: Tüm grubun (n=1054) yaş ortalaması 63.3±13.3 yıl idi (E/K oranı: 751/303, %71.3/%28.7). Tüm kohortta kronik KY/akut KY hasta sayıları sırasıyla 712 ve 342; düşük ejeksiyon fraksiyonlu KY (DEF-KY), sınırda ejeksiyon fraksiyonlu KY (SEF-KY) ve korunmuş ejeksiyon fraksiyonlu KY (KEF-KY) hasta sayıları sırasıyla 801 (%76), 176 (%16.7), 77 (%7.3) olarak tespit edildi. Kronik KY olan hastalar akut KY olan hastalara göre daha gençti (61.1±13.3 yıl ve 67.9±12.1 yıl, p<0.001). Tüm kohortta, KY hastalarının %46’sında hipertansiyon, %27.5’inde diyabet (DM), %12.8’inde kronik obstrüktif akciğer hastalığı ve %45.2’sinde önceden geçirilmiş miyokart enfarktüsü olduğu görüldü. DEF-KY fenotipi olan kronik KY hastalarında ACEi/ARB, beta bloker ve MRA kullanım oranları sırasıyla %74.7, %89.7 ve %60.9 olarak saptandı. Sonuç: SELFIE-TR çalışması ülkemizdeki KY hastalarının anlık fotoğrafını gösteren ilk çalışma olması sebebiyle önemli bilgiler sunmaktadır. Bu bilgiler, kılavuza uygun önleyici ve tedavi edici yaklaşımların geliştirilmesi açısından faydalı olabilir.
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    Öğe
    The comparison of point-of-care ultrasonography and radiography in the diagnosis of tibia and fibula fractures
    (Elsevier Ltd, 2017) Kozacı, Nalan; Ay, Mehmet Oğuzhan; Avcı, Mustafa; Turhan, Sadullah; Donertas, Eda; Çelik, Ahmet; Ararat, Ertan; Akgün, Emrah
    Objective We aimed to compare the efficacy of Point-of-care ultrasonography (POCUS) with radiography in the diagnosis of tibia fracture (TF) and fibula fracture (FF), and determation of fracture characteristics. Methods Patients aged 5–55 years who were admitted to ED due to low-energy, simple extremity trauma, who had a suspected TF and FF on physical examination were included in this prospective study. One physician performed POCUS examination. Other physician evaluated the radiography images. The obtained results were compared. Results A total of 62 patients were included in the study. TF was detected in 21 patients by radiography and in 24 patients by POCUS. FF was detected in 24 patients by radiography and in 25 patients by POCUS. Ten of the patients had both TF and FF. Compared with radiography, sensitivity, specificity, PPV and NPV of POCUS in the detection of TF were 100%, 93%, 88% and 100% (95% CI, 91–100%), respectively. Compared with direct X-ray imaging, sensitivity, specificity, PPV and NPV of POCUS in the detection of FF were 100%, 97%, 96% and 100% (95% CI, 96–100%), respectively. We determined that POCUS is also successful in detection of fracture features such as angulation, step-off, extension into the joint space that can determine the treatment decision. Conclusion This study demonstrated that POCUS was found to be as successful as direct X-ray imaging in the diagnosis of TF and FF. © 2017 Elsevier Ltd
  • Küçük Resim
    Öğe
    Türkiye'de kalp yetersizliğinin anlık görüntüsü: SELFIE-TR bazal karakteristik özellikleri
    (Türk Kardiyoloji Derneği Arşivi, 2019) Yılmaz, Mehmet Birhan; Çelik, Ahmet; Çavuşoğlu, Yüksel; Bekar, Lütfü; Onrat, Ersel; Eren, Mehmet; Kutlu, Merih; Yalta, Kenan; Temizhan, Ahmet; Kılıçaslan, Barış; Güngör, Hasan; Açıkel, Mahmut; Demir, Mesut; Akdemir, Ramazan; Zoghi, Mehdi; Tokgözoğlu, Lale
    Amaç: Kalp yetersizliği (KY) 21. yüzyılın önemli bir sağlık sorunudur ve ülkemizdeki sıklığı %2.9’dur. Bu hastalığın ülke profili, farklı fenotiplerin sıklığı ve özellikleri, risk faktörleri net olarak ortaya konulmamıştır. Bu çalışmada, ülkemizi temsil eden bir örnekte KY hastaları (SELFIE-TR – Snapshot Evaluation of Heart Failure Patients in Turkey) incelenmiştir. Yöntemler: Ülkemizdeki 12 NUTS-1 bölgesinden en az iki kardiyoloji uzmanının çalıştığı 23 merkez çalışmaya davet edildi. Merkezler, Ekim veya Kasım aylarından tercih ettiği bir tanesinde, tercih edilen ay içindeki 4 haftanın yine tercih edilen bir gününde, tanısı kılavuzlara uygun olarak doğrulanmış KY hastalarını ardışık olarak çalışmaya dahil ettiler. Bulgular: Tüm grubun (n=1054) yaş ortalaması 63.3±13.3 yıl idi (E/K oranı: 751/303, %71.3/%28.7). Tüm kohortta kronik KY/akut KY hasta sayıları sırasıyla 712 ve 342; düşük ejeksiyon fraksiyonlu KY (DEF-KY), sınırda ejeksiyon fraksiyonlu KY (SEF-KY) ve korunmuş ejeksiyon fraksiyonlu KY (KEF-KY) hasta sayıları sırasıyla 801 (%76), 176 (%16.7), 77 (%7.3) olarak tespit edildi. Kronik KY olan hastalar akut KY olan hastalara göre daha gençti (61.1±13.3 yıl ve 67.9±12.1 yıl, p<0.001). Tüm kohortta, KY hastalarının %46’sında hipertansiyon, %27.5’inde diyabet (DM), %12.8’inde kronik ob strüktif akciğer hastalığı ve %45.2’sinde önceden geçirilmiş miyokart enfarktüsü olduğu görüldü. DEF-KY fenotipi olan kronik KY hastalarında ACEi/ARB, beta bloker ve MRA kullanım oranları sırasıyla %74.7, %89.7 ve %60.9 olarak saptandı. Sonuç: SELFIE-TR çalışması ülkemizdeki KY hastalarının anlık fotoğrafını gösteren ilk çalışma olması sebebiyle önemli bilgiler sunmaktadır. Bu bilgiler, kılavuza uygun önleyici ve tedavi edici yaklaşımların geliştirilmesi açısından faydalı olabilir.