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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 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 Inappropriate Use of Aspirin in Real-Life Cardiology Practice: Results from the Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study (ASSOS) Study(Aves, 2021) Celik, Oguzhan; Cil, Cem; Basaran, Ozcan; Demirci, Erkan; Tanik, Veysel Ozan; Altuntas, Emine; Biteker, MuratBackground: Indications and appropriateness of aspirin use have not been well investigated in Turkey. Aims: To investigate the prescription patterns and appropriateness of aspirin in a real-world clinical setting. Study Design: Cross-sectional study. Methods: The Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study (ASSOS) is a cross-sectional and multicenter study that included 5007 consecutive patients aged 18 or over who presented to 30 different cardiology outpatient clinics from 14 cities throughout Turkey. Only patients using aspirin (80-325 mg) were included. The study population was divided into 2 groups regarding the use of aspirin: primary prevention (PP) group and secondary prevention (SP) group. The indication of aspirin use was evaluated following the 2016 European Society of Cardiology (ESC) and the 2016 United States Preventative Services Task Force (USPTF) guidelines in the PP group. Results: A total of 5007 patients (mean age 62.15 +/- 11.05, 39% female) were enrolled. The PP group included 1132 (22.6%) patients, and the SP group included 3875 (77.4%) patients. Of the 1132 patients, inappropriate use of aspirin was determined in 100% of the patients according to the ESC guidelines, and 71% of the patients according to the USPTF guidelines. Multivariate logistic regression analysis showed age OR: 0.98 CI (0.97-0.99) P=.037, smoking OR: 0.60 CI (0.44- 0.82) P=.001, heart failure OR: 2.11 CI (1.14-3.92) P=.017, hypertension OR: 0.51 CI (0.36-0.74) P<.001, diabetes mellitus OR: 0.34 CI (0.25-0.47) P<.001, oral anticoagulant use OR: 3.01 CI (1.10-8.25) P=.032, and female sex OR: 2.73 CI (1.96-3.80) P<.001 were independent predictors of inappropriate aspirin use in PP patients. Conclusion: Although there are considerable differences between the USPTF and the ESC guidelines with respect to recommendations for aspirin use in PP, inappropriate use of aspirin in Turkey is frequent in real-world practice for both guidelines. Besides, heart failure, oral anticoagulant use, and the female sex of the patients were independent predictors of inappropriate use of aspirin.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.
