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Öğe A rare complication of percutaneous coronary intervention: Coronary pseudoaneurysm formation(Akademiai Kiado Rt., 2017) Çelik, Oğuzhan; Bekar, Lütfü; Yetim, Mücahit; Doğan, Tolga; Çağlar, Alp; Kalçık, Macit; Karavelioğlu, YusufCoronary pseudoaneurysms (CPAs) are rare complications developed after percutaneous coronary interventions. They may cause stent thrombosis, distal embolization, and coronary rupture leading to cardiac tamponade. Therefore, high-risk CPA should be promptly treated after diagnosis. They can be managed with percutaneous or surgical intervention. Herein, we aimed to present a patient who developed CPA 3 weeks after percutaneous coronary intervention and successfully treated with percutaneous intervention using a covered stent. © 2017 The Author(s)Öğe Anafilaktik Reaksiyonda Epinefrin Aşırı Dozuna Bağlı Miyokard Enfarktüsü(2016) Bekar, Lütfü; Sarak, Taner; Yetim, Mücahit; Doğan, Tolga; Çelik, Oğuzhan; Çamkıran, Volkan; Karavelioğlu, YusufEpinefrin anafilaktik reaksiyonun tedavisinde sıklıkla kullanılan bir ajandır. Anafilaktik reaksiyonlarda epinefrin kullanımına bağlı göğüs ağrısı, miyokardiyal enfarktüs ve aritmi olabileceği bildirilmiştir. Biz bu makalede ciddi anafilaksisi olan bir hastada, subkutan olarak order edilen ancak yanlışlıkla intravenöz olarak uygulalan epinefrinin neden olduğu miyokardiyal enfarktüsü sunduk.Öğe Assesment of long term cardiovascular effects of unileteral nephrectomy(Oxford Univ Press, 2017) Özkurt, Sultan; Karavelioğlu, Yusuf; Kalçık, Macit; Doğan, İsmail Çağrı; Musmul, Ahmet; Yetim, Mücahit; Karaarslan, Osman; Çelik, Oğuzhan; Ekinözü, İsmail[Abstract Not Available]Öğe Clinical features of heart failure with mid-range and preserved ejection fraction in octogenarians: Results of a multicentre, observational study(Blackwell Publishing Ltd, 2019) Özlek, Bülent; Özlek, Eda; Tekinalp, Mehmet; Kahraman, Serkan; Zencirkıran Ağuş, Hicaz; Çelik, Oğuzhan; Çil, Cem; Bekar, LütfüObjectives: To compare real-world characteristics and management of individuals aged 80 and older with heart failure (HF) and mid-range ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF) derived from a large cohort of survey and to compare them with those younger than 80 from the same survey.Methods: This is an observational, multicentre and cross-sectional study conducted in Turkey (NCT03026114). Consecutive 1065 (mean age of 67.1 +/- 10.6 years) patients admitted to the cardiology outpatient units with HFmrEF and HFpEF were included.Results: Participants aged 80 and older (n = 123, 11.5%) were more likely to be female (66.7% vs 52.5%, P = 0.003), had a higher prevalence of atrial fibrillation (49.6% vs 34%, P = 0.001), and anaemia (46.3% vs 33.4%, P = 0.005) than those who were younger than 80. N-terminal pro B-type natriuretic peptide levels were higher in those aged 80 and older than in those younger than 80 (1037 vs 550 pg/ml, P < 0.001). The prescription rates of HF medications (including in ACE-Is/ARBs, beta-blockers, MRAs, digoxin, ivabradine and diuretics) were similar (P > 0.05) in both groups. Octogenarians did not significantly differ from younger patients in the prevalence of HFmrEF (24.4% vs 22.9%) and HFpEF (75.6% vs 77.1%). Coronary artery disease was associated with HFmrEF (P < 0.05), whereas atrial fibrillation was associated with HFpEF (P < 0.05) in octogenarians.Conclusions: This study revealed that nearly 12% of the individuals with HFmrEF and HFpEF in this real-world sample were aged 80 and older. Participants aged 80 and older are more likely to be female and have more comorbidities than those who were younger than 80. However, HF medication profiles were similar in both groups. This study also showed that associated factors with HFmrEF and HFpEF were differ in octogenarians.Öğe Design and rationale for the ASSOS study: appropriateness of aspirin use in medical outpatients a multicenter and observational study(Turkish Society of Cardiology, 2018) Çelik, Oğuzhan; Çil, Cem; Özlek, Bülent; Özlek, Eda; Doğan, Volkan; Başaran, Özcan; Demirci, Erkan; Bekar, Lütfü; Kalçık, Macit; Karaarslan, Osman; Yetim, Mücahit; Doğan, Tolga; Demir, Vahit; Kalkan, Sedat; Özkan, Buğra; Hidayet, Şıho; Taylan, Gökhan; Küçüksu, Zafer; Çelik, Yunus; Efe, Süleyman Çağan; Aslan, Onur; Biteker, MuratObjective: The aim of this study was to describe the current status of aspirin use and the demographic characteristics of patients on aspirin for primary and secondary prevention of cardiovascular diseases. Methods: The Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study (ASSOS) trial was a multicenter, cross-sectional, and observational study conducted in Turkey. The study was planned to include 5000 patients from 14 cities in Turkey. The data were collected at one visit, and the current clinical practice regarding aspirin use was evaluated (ClinicalTrials.gov number NCT03387384). Results: The study enrolled all consecutive patients who were admitted to the outpatient cardiology clinics from March 2018 until June 2018. Patients should be at least 18 years old, have signed written informed consent, and on aspirin (80–325 mg) therapy within the last 30 days. Cardiologists from the hospital participates in the study. Patients were divided into 2 categories according to presence or absence of atherosclerotic cardiovascular disease, namely secondary prevention group and primary prevention group, respectively. The appropriate use of aspirin in the primary and secondary prevention groups was assessed according to the European Society of Cardiology guidelines and US Preventive Services Task Force. The patients’ gastrointestinal bleeding risk factors and colorectal cancer risk were evaluated. Conclusion: The ASSOS registry will be the most comprehensive and largest study in Turkey evaluating the appropriateness of aspirin use. The results of this study help understand the potential misuse of aspirin in a real-world setting. © 2018 by Turkish Society of Cardiology.Öğe Echocardiographic reference ranges for normal cardiac Doppler data in healthy Turkish population: ECHO-DOP-TR Trial(Wiley, 2020) Şafak, Özgen; Gürsoy, Ozan; Emren, Volkan; Çelik, Oğuzhan; Yıldırım, Tarık; Argan, Onur; Özkan, MehmetAim Doppler echocardiography has become the standard imaging modality for diastolic function and provides pathophysiological insight into systolic and diastolic heart failure. In this study, we aimed to obtain normal echocardiographic Doppler parameters of healthy Turkish population. Methods Among 31 collaborating institutions from all regions of Turkey, 1154 healthy volunteers were enrolled in this study. Predefined protocols were used for all participants during echocardiographic examination and The American Society of Echocardiography and European Association of Cardiovascular Imaging recommendations were used for echocardiographic Doppler measurements. Results A total of 967 healthy participants were enrolled in this study after applying exclusion criteria. Echocardiographic examination was obtained from all subjects following predefined protocols. Mitral E wave velocity andE/Aratio were higher in females and decreased progressively in advancing ages. E wave deceleration time and A wave velocity were increased with aging. Assessment of tissue Doppler velocities showed that left ventricular laterale ', septale ', and septals ' were higher in younger subjects and in females.E/e ' ratio was increased progressively with advancing decades. Right ventriculare ' ands ' were decreased buta ' was increased with increasing age. Septale ' lower than 8 cm/s was 1.9% in the fifth decade and 13.7% in ages older than 50 years. TheE/e ' ratio greater than 15 (and also 13) was not found. Conclusion This study, for the first time, provides echocardiographic reference ranges for normal cardiac Doppler data in healthy Turkish population which will be useful in routine clinical practice as well as in future clinical trials.Öğe Evaluation of echocardiographic determinants of interatrial block in patients with essential hypertension(Oxford Univ Press, 2019) Kalçık, Macit; Bekar, Lütfü; Çelik, Oğuzhan; Yetim, Mücahit; Doğan, Tolga; Karaarslan, Osman; Karavelioğlu, Yusuf[Abstract Not Available]Öğe Evaluation of ghrelin levels and endothelial functions in patients with coronary slow flow phenomenon(Akademiai Kiado Rt., 2017) Çelik, Oğuzhan; Demirci, Erkan; Aydın, Mustafa; Karabağ, Turgut; Kalçık, MacitBackground: Ghrelin has recently been reported to have beneficial effects on cardiac contractile functions and coronary blood flow. The main purpose of this study was to investigate the role of ghrelin in the pathogenesis of coronary slow flow (CSF) together with endothelial functions. Methods: Twenty-five patients having normal coronary arteries with CSF and 25 controls with normal coronary flow were included into the study. The quantitative measurement of coronary blood flow was performed for each coronary artery using the thrombolysis in myocardial infarction (TIMI) frame count (TFC) method. Ghrelin levels were measured using the enzyme-linked immunosorbent assay method from venous blood samples. Endothelial functions were evaluated from the brachial artery with the flow-mediated dilation (FMD) and nitrate-related dilation methods. Results: There was a significant difference in terms of mean TFC values between the control and CSF groups (p < 0.001 for all coronary arteries). The mean FMD percentage among patients with CSF was lower than that of the control group (5.9 ± 0.8 vs. 10.7% ± 1.1%; p < 0.001). A moderate negative correlation was observed between the FMD percentages and the TFCs. There was no relationship between the TFC and ghrelin levels. Conclusion: Plasma ghrelin levels seem to be uninfluential while impaired endothelial functions play an important role in the etiopathogenesis of CSF. © 2017 The Author(s).Öğe Evaluation of homocystein and asymmetric dimethyl arginine levels in patients with coronary slow flow phenomenon(Akademiai Kiado Zrt, 2019) Demirci, Erkan; Çelik, Oğuzhan; Kalçık, Macit; Bekar, Lütfü; Yetim, Mücahit; Doğan, TolgaBackground: Previous studies have demonstrated that homocysteine and asymmetric dimethyl arginine (ADMA) levels were strongly associated with cardiovascular diseases including coronary artery disease. The aim of this study was to investigate the role of plasma homocysteine and ADMA levels in the pathogenesis of coronary slow flow (CSF) phenomenon. Methods: Twenty-three patients with CSF and 25 controls with normal coronary flow were included in this study. The quantitative measurement of coronary blood flow was performed using the thrombolysis in myocardial infarction frame count method. Plasma homocysteine and ADMA levels were determined using enzymatic assays from venous blood samples. Results: The patients with CSF had significantly higher plasma homocysteine levels than controls (16.2 +/- 7.6 vs. 12.2 +/- 2.2 mu M/L; p = 0.023). The uric acid levels were significantly higher in CSF group than controls (5.4 +/- 1.1 vs. 4.6 +/- 0.9 mg/dl; p = 0.011). Plasma ADMA levels were also higher in the CSF group; however, this was not statistically significant (0.6 +/- 0.1 vs. 0.5 +/- 0.2 mu M/L; p = 0.475). Conclusions: Increased homocysteine and uric acid levels may play an important role in the pathogenesis of CSF. Further large scale studies are required to determine the relationship between ADMA levels and CSF.Öğe Evaluation of perceptions, knowledge and compliance with guidelines in real-life practice: A survey on the under-treatment of hypercholesterolemia(2019) Doğan, Volkan; Başaran, Özcan; Özlek, Bülent; Çelik, Oğuzhan; Özlek, Eda; Çil, Cem; Kayıkçıoğlu, MeralObjective: Few studies have directly assessed suboptimal management of dyslipidemia in Turkey. This study was conducted to assess patients’ understanding and perceptions of high cholesterol as well as physicians’ knowledge and awareness of lipid management strategies. Methods: This was a multicenter, observational study (ClinicalTrials.gov identifier: NCT02608645). Consecutive patients admitted to the participating cardiology clinics who were at least 18 years of age and who had been classified in a secondary prevention (SP) group or a high-risk primary prevention (PP) group were enrolled. The study population included 1868 patients from 40 sites in Turkey. Two-thirds (67.5%) of the patients in the SP group had been prescribed a statin, whereas only 30.1% of the PP group patients received statin therapy (p<0.001). Results: It was determined that 18% of the SP patients and 10.6% of the PP patients had a low-density lipoprotein cholesterol level at the recommended level (p<0.001). A patient survey revealed that almost half of the patients in the PP and in the SP groups were aware that their cholesterol levels were high. Negative information about statin treatment disseminated by media programs was the most common reason (9.4%) given for treatment discontinuation. Conclusion: Perceptions, knowledge and compliance with the guidelines for PP and SP patients in real-life practice have increased, but it remains far below the desired level. Patients and physicians should have more information about the treatment of hyperlipidemia. More accurate media programming could help to prevent the dissemination of misinformationÖğe Fragmented QRS complexes are a marker of myocardial fibrosis in hypertensive heart disease(Turkish Society of Cardiology, 2016) Bekar, Lütfü; Katar, Muzaffer; Yetim, Mücahit; Çelik, Oğuzhan; Kilci, Hakan; Önalan, OrhanObjective: Carboxy-terminal propeptide of type 1 procollagen (PICP) is a marker of extracellular collagen synthesis. Fragmented QRS (fQRS) on a 12-lead electrocardiogram (ECG) has been demonstrated as a marker of myocardial fibrosis. The present objective was to investigate the association between serum PICP concentration and presence of fQRS on ECG in hypertensive patients. Methods: Consecutive patients with previously or newly diagnosed hypertension were included. fQRS was defined as the presence of additional R-wave (R?), or notching of R- or Swaves, or the presence of fragmentation in 2 contiguous ECG leads. Serum PICP levels were measured by ELISA method. Results: The study group consisted of 90 hypertensive patients (74% females, with a mean age of 54.7±8.5 years). Of these patients, 47 (52.2%) had fQRS on ECG. Age (p=0.121) and gender distribution (p=0.625) were similar in patients with or without fQRS. Receiver operating characteristic curve analysis yielded a strong predictive ability of PICP levels for the presence of fQRS (area under the curve: 0.850; 95% CI: 0.772-0.929; p<0.0001). In multivariate logistic regression analysis, PICP levels were strongly and independently associated with the presence of fQRS (OR: 1.938; 95% CI: 1.398-2.688). Conclusion: Serum PICP level is a strong and independent predictor of fQRS. Discriminative performance of serum PICP levels for the presence of fQRS is high. The present results are the first to demonstrate that fQRS may indicate myocardial fibrosis in patients with hypertension. © 2016 Turkish Society of Cardiology.Öğe Gender disparities in heart failure with mid-range and preserved ejection fraction: Results from APOLLON study(2019) Özlek, Bülent; Özlek, Eda; Kahraman, Serkan; Tekinalp, Mehmet; Zencirkıran Ağuş, Hicaz; Çelik, Oğuzhan; Biteker, MuratObjective: This study aimed to examine gender-based differences in epidemiology, clinical characteristics, and management of consecutive patients with heart failure with mid-range ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF). Methods: The APOLLON trial (A comPrehensive, ObservationaL registry of heart faiLure with mid-range and preserved ejection fractiON) is a multicenter, cross-sectional, and observational study. Consecutive patients with HFmrEF or HFpEF who were admitted to the cardiology clinics were included (NCT03026114). Herein, we performed a post-hoc analysis of data from the APOLLON trial. Results: The study population included 1065 (mean age of 67.1±10.6 years, 54% women) patients from 11 sites in Turkey. Compared with men, women were older (68 years vs. 67 years, p<0.001), had higher body mass index (29 kg/m2 vs. 27 kg/m2 , p<0.001), and had higher heart rate (80 bpm vs. 77.5 bpm, p<0.001). Women were more likely to have HFpEF (82% vs. 70.9%, p<0.001), and they differ from men having a higher prevalence of hypertension (78.7% vs. 73.2%, p=0.035) and atrial fibrillation (40.7% vs. 29.9%, p<0.001) but lower prevalence of coronary artery disease (29.5% vs. 54.9%, p<0.001). Women had higher N-terminal pro-B-type natriuretic peptide (691 pg/mL vs. 541 pg/mL, p=0.004), lower hemoglobin (12.7 g/dL vs. 13.8 g/dL, p<0.001), and serum ferritin (51 ng/mL vs. 64 ng/mL, p=0.001) levels, and they had worse diastolic function (E/e'=10 vs. 9, p<0.001). The main cause of heart failure (HF) in women was atrial fibrillation, while it was ischemic heart disease in men. Conclusion: Clinical characteristics, laboratory findings, and etiological factors are significantly different in female and male patients with HFmrEF and HFpEF. This study offers a broad perspective for increased awareness about this patient profile in Turkey. (Anatol J Cardiol 2019; 21: 242-52)Öğe Geographical Variations in Patients with Heart Failure and Preserved Ejection Fraction: A Sub-Group Analysis of the APOLLON Registry(2019) Özlek, Bülent; Özlek, Eda; Aguş, Hicaz Zencirkıran; Tekinalp, Mehmet; Kahraman, Serkan; Çelik, Oğuzhan; Biteker, MuratBackground: Clinical characteristics of patients with heart failure may vary geographically. However, limited data are available regarding the geographical differences of patients with heart failure and preserved ejection fraction. Aims: The present subgroup analysis aims to investigate the geographical differences in clinical characteristics, management, and primary etiology of patients with heart failure and preserved ejection fraction in Turkey. Study Design: A cross-sectional study. Methods: A comPrehensive, ObservationaL registry of heart faiLure with mid-range and preserved ejection fractiON (APOLLON) is a multicenter and observational study conducted in seven regions of Turkey (NCT03026114). The present study is a post-hoc analysis of the APOLLON registry. In this substudy, we compared the clinical characteristics of 819 consecutive patients with heart failure and preserved ejection fraction (mean age, 67 years; 57.8% women) admitted to cardiology outpatient units in different geographical regions. Results: Based on the geographical distribution of the entire Turkish population, the highest number of patients enrolled were from Marmara (271 patients, 33.1%). All demographical characteristics, clinical and laboratory findings, comorbidities, primary etiology, and medications prescribed were significantly different between the regions. Furthermore, inter-regional gender differences were identified. Comparatively, the Aegean and Mediterranean regions had older patients with heart failure and preserved ejection fraction (p<0.001), and the Black Sea, Southeast, and East Anatolia regions had predominantly male patients (51.2, 54.5, and 56.9%, respectively; p=0.002). Notably, the Mediterranean and Southeast Anatolia had more symptomatic patients, and history of hospitalization for heart failure was more prevalent in Southeast Anatolia (33.3%, p<0.001). Prevalence of atrial fibrillation was higher in the Mediterranean and Southeast Anatolia regions (51 and 48.5%, p<0.001), and patients with heart failure and preserved ejection fraction had a higher prevalence of hypertension in the Mediterranean, Southeast Anatolia, and Black Sea regions (p=0.002). Angiotensin-converting enzyme inhibitors were more frequently prescribed in East Anatolia (52.3%, p=0.001), and the prevalence of patients with heart failure and preserved ejection fraction using loop diuretics (48.8%, p=0.003) was higher in the Black Sea region. Conclusion: This study was the first to show geographical differences in clinical characteristics of patients with heart failure and preserved ejection fraction in Turkey. Determination of the clinical characteristics of the heart failure and preserved ejection fraction population based on the geographical region may enables physicians to adopt a region-specific clinical approach toward heart failure and preserved ejection fraction.Öğe Investigation of ICAM-1 levels in hypertensive patients with fragmented QRS complexes(Taylor and Francis Ltd., 2019) Bekar, Lütfü; Kalçık, Macit; Katar, Muzaffer; Yetim, Mücahit; Çelik, Oğuzhan; Doğan, Tolga; Karavelioğlu, Yusuf; Gölbaşı, ZehraObjective: Fragmented QRS (fQRS) detected on a 12-lead electrocardiogram (ECG) has been demonstrated to be a marker of myocardial fibrosis. Intercellular adhesion molecule-1 (ICAM-1) is a protein which plays an important role in fibro-inflammatory processes. In this study, we aimed to investigate the relationship between ICAM-1 levels and the presence of fQRS in hypertensive patients. Methods: Ninety consecutive patients who were diagnosed with hypertension were included in the study. ECG and transthoracic echocardiography were performed to all patients. fQRS was defined as additional R’ wave or notching/splitting of S wave in two contiguous ECG leads. Serum ICAM-1 levels were measured using the enzyme-linked immunosorbent assay method. Patients were divided into two groups according to the presence of fQRS. Results: A total of 90 patients (female, 65%; mean age: 54.6 ± 8.5 years) were included in the study. fQRS was detected on ECG recordings of 47 (52.2%) patients. The demographic characteristics were similar between the groups. Left atrial diameter (p =.003), interventricular septal thickness (p =.013), posterior wall thickness (p =.01), left ventricular mass (p =.002), left ventricular mass index (p <.001), left ventricular hypertrophy (p =.001), and ICAM-1 levels (p <.001) were found to be significantly increased in fQRS(+) group. In multivariate analysis, only high ICAM-1 level was observed to be an independent predictor for the presence of fQRS (odds ratio: 1.029; 95%Confidence Interval: 1.013–1.045, p <.001). Conclusion: A significant association exists between serum ICAM-1 levels and the presence of fQRS in hypertensive patients. The presence of fQRS may be used as an indicator of inflammation in hypertensive patients. © 2019, © 2019 Belgian Society of Cardiology.Öğe Investigation of mindin levels in hypertensive patients with left ventricular hypertrophy and QRS fragmentation on electrocardiography(Taylor and Francis Ltd., 2018) Doğan, Tolga; Yetim, Mücahit; Çelik, Oğuzhan; Kalçık, Macit; Özcan, Oğuzhan; Doğan, İbrahim; Erenler, Ali Kemal; Bekar, Lütfü; Karavelioğlu, YusufPurpose: Mindin was associated with diabetic nephropathy, podocyte injury, colitis, allergic asthma, liver ischaemia and reperpusion injury and ischaemic brain injury. On the other hand, it was reported as a protective factor against obesity, cardiac hypertrophy, fibrosis and remodelling. Fragmented QRS complexes (fQRS) are markers of altered ventricular depolarisation owing to a prior myocardial scar and fibrosis. In this study, we aimed to investigate mindin levels in hypertensive patients with left ventricular hypertrophy and fQRS on electrocardiography. Methods: This observational case-control study enrolled 70 (36 female) hypertensive patients with fQRS and 38 (23 female) hypertensive control patients. All patients were evaluated by transthoracic echocardiography. Mindin levels were measured by the enzyme-linked immunosorbent assay (ELISA). Clinical, echocardiographic and laboratory data were compared between patient and control groups. Results: There was no significant difference between patient and control groups in terms of clinical, echocardiographic and routine laboratory parameters. The mindin levels were significantly higher in the patient group than controls (11.3 (7.21–19.31) vs 4.15 (2.86–6.34); p <.001). Multiple logistic regression analyses defined increased mindin levels as an independent predictor for the presence of fQRS (Odds ratio: 1.733; p =.034). Mindin levels >6.74 predicted the presence of fQRS with a sensitifity of 84.3% and specificity of 79.9% on receiver operating characteristic (ROC) curve analysis (The area under the curve:0.889; Confidence Interval: 0.827–0.951; p <.001). Conclusion: Mindin expressin is upregulated in hypertensive patients with fQRS complexes. In contrary to previous studies, increased mindin levels may be associated with myocardial fibrosis. © 2017, © 2017 Belgian Society of Cardiology.Öğe Myocardial infarction related with epinephrine overdose in anaphylaxis(MEDİTAGEM Ltd. Şti., 2016) Bekar, Lütfü; Sarak, Taner; Yetim, Mücahit; Doğan, Tolga; Çelik, Oğuzhan; Çamkıran, Volkan; Karaarslan, Osman; Erçen Diken, Özlem; Karavelioğlu, YusufEpinephrine is an agent which is often used in the treatment of anaphylactic reaction. It has been reported that chest pain, myocardial infarction and arrhythmia may occur secondary to epinephrine use in anaphylactic reactions. In this report, we presented a case with anaphylaxis who developed myocardial infarction secondary to epinephrine, which was ordered to be administered subcutaneously but administered intravenously by mistake.Öğe Patients with HFpEF and HFmrEF have different clinical characteristics in Turkey: A multicenter observational study(Elsevier B.V., 2019) Özlek, Bülent; Özlek, Eda; Zencirkıran Ağuş, Hicaz; Tekinalp, Mehmet; Kahraman, Serkan; Çil, Cem; Çelik, Oğuzhan; Bekar, LütfüBackground: To determine and compare the demographic characteristics, clinical profile and management of patients with heart failure with mid-range ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF) in a Turkish cohort. Methods: The APOLLON trial (A comPrehensive, ObservationaL registry of heart faiLure with mid-range and preserved ejection fractiON) is an observational and multicenter study conducted in Turkey. Consecutive patients admitted to the cardiology clinics who were at least 18 years of age and had HFmrEF or HFpEF were included (NCT03026114). Results: The study population included 1065 (mean age of 67.1 ± 10.6 years, 54% women) patients from 12 sites in Turkey. Among participants, 246 (23.1%) had HFmrEF and 819 (76.9%) had HFpEF. Compared to patients with HFpEF, those with HFmrEF were more likely to be male (57.7 vs 42.2%; p < 0.001), had higher N-terminal pro-B-type natriuretic peptide levels (853 vs 528 pg/ml, p < 0.001), were more likely to have ECG abnormalities (72.4 vs 53.5%, p < 0.001) and hospitalization history for heart failure (28 vs 18.6%; p = 0.002). HFmrEF patients were more likely to use ?-blockers (69.9 vs 55.2%, p < 0.001), aldosterone receptor antagonists (24 vs 14.7%, p = 0.001), statins (37 vs 23%, p < .001), and loop diuretics (39.8 vs 30.5%, p = 0.006) compared to patients with HFpEF. Conclusions: The results of APOLLON study support that the basic characteristics and etiology of HFmrEF are significantly different from HFpEF. This registry also showed that the patients with HFmrEF and HFpEF were younger but undertreated in Turkey compared to patients in western countries. © 2018 European Federation of Internal MedicineÖğe Presence of fragmented QRS is associated with increased epicardial adipose tissue thickness in hypertensive patients(John Wiley and Sons Inc., 2019) Bekar, Lütfü; Kalçık, Macit; Çelik, Oğuzhan; Alp, Çağlar; Yetim, Mücahit; Doğan, Tolga; Ekinözü, İsmail; Karaarslan, Osman; Çamkıran, Volkan; Karavelioğlu, Yusuf; Gölbaşı, ZehraBackground: Epicardial adipose tissue (EAT) is a cardiometabolic risk factor, and its possible relationship with hypertension has been reported previously. Fragmented QRS (fQRS) detected on electrocardiography (ECG) has been demonstrated to be a marker of myocardial fibrosis. In this study, we aimed to investigate the relationship between the thickness of EAT, and presence of fQRS in hypertensive patients. Methods: Consecutive patients who were diagnosed with hypertension were included in the study. ECG and transthoracic echocardiography (TTE) were performed to all patients. fQRS was defined as additional R ' wave or notching/splitting of S wave in two contiguous ECG leads. Thickness of EAT was measured by TTE. Results: This study enrolled 69 hypertensive patients with fQRS on ECG and 45 hypertensive patients without fQRS as the control group. Age (P =.869), and gender distribution (P =.751) were similar in both groups. Left atrial diameter (P =.012), interventricular septal thickness (P <.001), posterior wall thickness (P <.001), left ventricular ejection fraction (P =.009), left ventricular mass (P =.006), left ventricular mass ındex (P =.014), left ventricular hypertrophy (P =.003), and EAT thickness (P <.001) were found to be significantly increased in patients with fQRS. In multivariate analysis, among these variables only EAT was observed to be an independent predictor of fQRS (odds ratio:3.306 [95% confidence interval, 0.030-0.118], P =.001). Conclusion: A significant association exists between the presence of fQRS and EAT thickness in hypertensive patients. The presence of fQRS, just as EAT thickness, may be used as a cardiometabolic risk factor in hypertensive patients. © 2019 Wiley Periodicals, Inc.Öğe Presence of fragmented QRS may be associated with complex ventricular arrhythmias in patients with essential hypertension(Churchill Livingstone Inc., 2019) Bekar, Lütfü; Kalçık, Macit; Kilci, Hakan; Çelik, Oğuzhan; Yetim, Mücahit; Doğan, Tolga; Önalan, OrhanBackground: Ventricular arrhythmias (VAs)are frequent in hypertensive patients. Myocardial fibrosis is one of the components of left ventricular hypertrophy secondary to hypertension. Fragmented QRS (fQRS)on electrocardiography (ECG)has been shown to be a marker of myocardial fibrosis. In this study, we aimed to investigate the association between fQRS and complex VAs in patients with essential hypertension. Methods: Two hundreds consecutive patients who were diagnosed with hypertension were included in the study. The control group consisted of 153 age and sex matched healthy individuals. ECG and transthoracic echocardiography were performed to all patients. fQRS was defined as additional R' wave or notching/splitting of S wave in two contiguous ECG leads. All patients underwent 24-hour Holter monitoring and VAs were classified using Lown's scoring system. Lown class ?3 VAs were considered as complex VAs. Results: There was no significant difference with respect to age (52 ± 8 vs 52 ± 6 years, p = 0.836)and gender distribution (female: 64% vs 63%, p = 0.907)between the groups. As compared to the healthy individuals, prevalence of fQRS (67% vs 9.2%, p < 0.001)and complex VAs (19% vs 0%, p < 0.001)were significantly higher in patients with hypertension. Furthermore, complex VAs (25.4% vs 6.1%, p = 0.001)were significantly higher in hypertensive patients with fQRS. In multiple logistic regression analysis, left ventricular ejection fraction (OR: 1.11, 95%CI: 1.025 to 1.183; p = 0.006), left ventricular mass index (OR: 1.04, 95%CI: 1.021 to 1.107; p = 0.001)and presence of fQRS (OR: 5.605, 95%CI: 1.427 to 22.019; p = 0.014)were independent predictors for complex VAs. Conclusion: The presence of fQRS may be associated with complex VAs in patients with essential hypertension. Therefore, fQRS may be used in risk stratification of complex VAs and sudden cardiac death especially in hypertensive patients with left ventricular hypertrophy. © 2019 Elsevier Inc.Öğe Rationale, design, and methodology of the APOLLON trial: a comPrehensive, observational registry of heart failure with mid-range and preserved ejectioN fraction(Turkish Society of Cardiology, 2018) Özlek, Bülent; Özlek, Eda; Çelik, Oğuzhan; Çil, Cem; Doğan, Volkan; Tekinalp, Mehmet; Zencirkıran Ağuş, Hicaz; Kahraman, Serkan; Ösken, Altuğ; Rencüzoğulları, İbrahim; Tanık, Veysel Ozan; Bekar, Lütfü; Çakır, Mustafa Ozan; Kaya, Bedri Caner; Tibilli, Hakan; Çelik, Yunus; Başaran, Özcan; Mert, Kadir Uğur; Sevinç, Samet; Demirci, Erkan; Dondurmacı, Engin; Biteker, MuratObjective: Although almost half of chronic heart failure (HF) patients have mid-range (HFmrEF) and preserved left-ventricular ejection fraction (HFpEF), no studies have been carried out with these patients in our country. This study aims to determine the demographic characteristics and current status of the clinical background of HFmrEF and HFpEF patients in a multicenter trial. Methods: A comPrehensive, ObservationaL registry of heart faiLure with mid-range and preserved ejectiON fraction (APOLLON) trial will be an observational, multicenter, and noninterventional study conducted in Turkey. The study population will include 1065 patients from 12 sites in Turkey. All data will be collected at one point in time and the current clinical practice will be evaluated (ClinicalTrials.gov number NCT03026114). Results: We will enroll all consecutive patients admitted to the cardiology clinics who were at least 18 years of age and had New York Heart Association class II, III, or IV HF, elevated brain natriuretic peptide levels within the last 30 days, and an left ventricular ejection fraction (LVEF) of at least 40%. Patients fulfilling the exclusion criteria will not be included in the study. Patients will be stratified into two categories according to LVEF: mid-range EF (HFmrEF, LVEF 40%-49%) and preserved EF (HFpEF, LVEF ?50%). Regional quota sampling will be performed to ensure that the sample was representative of the Turkish population. Demographic, lifestyle, medical, and therapeutic data will be collected by this specific survey. Conclusion: The APOLLON trial will be the largest and most comprehensive study in Turkey evaluating HF patients with a LVEF ?40% and will also be the first study to specifically analyze the recently designated HFmrEF category. © 2018 by Turkish Society of Cardiology.
