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1.
J Cardiovasc Echogr ; 31(3): 151-156, 2021.
Article in English | MEDLINE | ID: mdl-34900550

ABSTRACT

BACKGROUND: Grading the severity of aortic regurgitation (AR) is very important for clinical follow-up. In AR, left atrial (LA) mechanics can be affected in time and LA strain variations can be illuminating for the grading of AR. The purpose of this study is to determine whether the LA strain parameters are associated with the severity of AR or not. METHODOLOGY: Sixty-four consecutive patients with AR were included in this study. Patients divided into three groups as mild (n: 22), moderate (n: 15), or severe (n: 27). All patients' LA strain measurements were performed and results were compared between groups. RESULTS: Between the groups, LA reservoir (LA-Res) in the mild, moderate, and severe AR groups was 42.0 ± 18.0, 41.4 ± 14.8, and 29.2 ± 6.0, respectively (P: 0.002) and LA pump in the mild, moderate, and severe AR groups was 21.2 ± 8.7, 19.3 ± 7.4, and 13.1 ± 4.4, respectively (P < 0.001), different, while no difference was noticed on LA SRs, LA SRe, and LA SRa. CONCLUSION: This study showed that LA-Res and LA pump parameters of the patients with severe AR significantly decreased compared to those of the mild and moderate AR group. The grading of the LA mechanics in patients with chronic AR might provide a supplementary contribution to the present parameters in the grading of AR.

2.
Turk Kardiyol Dern Ars ; 48(8): 739-745, 2020 11.
Article in English | MEDLINE | ID: mdl-33257614

ABSTRACT

OBJECTIVE: Mitral valve prolapse (MVP) is a heart valve anomaly that affects a considerable segment of the population. Studies of patients with isolated MVP have shown that aortic distensibility decreased as the aortic diameter increased. The aim of this study was to compare evaluations of aortic distensibility in MVP patients using both applanation tonometry and the conventional echocardiographic examination. METHODS: A total of 36 consecutive patients with MVP (16 male and 20 female) and 23 healthy controls (11 male and 12 female) were included in this study. The difference in aortic diameter and distensibility was examined using echocardiography and pulse wave velocity (PWV) was measured with applanation tonometry. RESULTS: According to the echocardiographic measurements, the aortic distensibility was lower in the MVP patients than in the control group (6.2±4.0 cm².dyn⁻¹.10⁻6 vs. 10.0±5.2 cm². dyn⁻¹.10⁻6; p=0.02). The PWV measured with applanation tonometry was significantly higher in the MVP patients than in the control group (9.0±2.4 m/s vs. 7.2±1.4 m/s; p=0.006). CONCLUSION: The results of this study showed that aortic distensibility was reduced in patients with isolated MVP compared with a healthy control group. There was a moderate negative correlation between the results of both methods.


Subject(s)
Aorta/physiopathology , Echocardiography/methods , Elasticity Imaging Techniques/methods , Elasticity/physiology , Manometry/methods , Mitral Valve Prolapse/physiopathology , Adult , Aorta/diagnostic imaging , Carotid Arteries/physiopathology , Case-Control Studies , Female , Femoral Artery/physiopathology , Humans , Male , Mitral Valve Prolapse/diagnostic imaging , Pulse Wave Analysis/methods
3.
Postepy Kardiol Interwencyjnej ; 16(2): 162-169, 2020 Jun.
Article in English | MEDLINE | ID: mdl-32636900

ABSTRACT

INTRODUCTION: Periprocedural myocardial necrosis, which can range from a low level elevation of cardiac biomarkers to a large myocardial infarction (MI), is a common complication after percutaneous coronary intervention (PCI). AIM: We hypothesized that insulin-like growth factor-1 (IGF-1) levels may play a protective role in myocardial injury after coronary stent placement and aimed to investigate the relationship between IGF-1 levels and plaque characteristics assessed by optical coherence tomography (OCT). MATERIAL AND METHODS: Between May 2015 and December 2015 we prospectively enrolled 74 patients with stable angina pectoris in whom single de novo coronary artery stenosis was present. PCI was performed according to standard methods. OCT was applied to all patients. TnT was analyzed at admission, before PCI and at 6, 12, 24 and 48 h after PCI. Serum IGF-1 was measured prior to PCI. RESULTS: A total of 25 (33.7%) patients had periprocedural myocardial injury or type 4a myocardial infarction, and 49 (66.2%) patients had no events. IGF-1 level and reference intimal thickness, medial thickness, and plaque fibrous cap thickness in OCT had strong correlations (r = 0.88, 0.80 and 0.88 respectively, p < 0.001). IGF-1 was an independent predictor of periprocedural myocardial injury or type 4a MI in univariate (OR = 0.929, 95% CI: 0.895-0.964, p < 0.001) and multivariate regression analysis (OR = 0.757, 95% CI: 0.575-0.998, p = 0.04). Based on ROC analysis, the best cut-off value of IGF-1 for predicting periprocedural myocardial injury or type 4a myocardial infarction was 144.5 ng/ml, with a maximum sensitivity of 88% and specificity of 77.6% (AUC = 0.80, 95% CI: 0.69-0.88, p < 0.0001). CONCLUSIONS: The results from this study indicate that low IGF-1 levels are associated with plaque instability assessed by OCT. Low IGF-1 levels may identify patients who are at increased risk for periprocedural myocardial injury/infarction.

4.
Turk Kardiyol Dern Ars ; 47(5): 391-398, 2019 Jul.
Article in English | MEDLINE | ID: mdl-31311898

ABSTRACT

OBJECTIVE: The aim of this study is to assess the prevalence of polypharmacy, inappropriate drug use, and drug-drug interactions (DDIs) in elderly patients presenting at outpatient cardiology clinics in Turkey. METHODS: The EPIC (Epidemiology of Polypharmacy and Potential Drug-Drug Interactions in Elderly Cardiac Outpatients) study will be an observational, real-world, multicenter study conducted to evaluate DDIs and polypharmacy in elderly cardiac outpatients. All consecutive patients (aged ≥65 years) admitted to outpatient cardiology clinics between July 30, 2018 and July 30, 2019 who provide written, informed consent will be enrolled. A total of approximately 5000 patients are to be enrolled in this non-interventional study. All of the data will be collected at one point in time and current clinical practice will be evaluated (ClinicalTrials.gov NCT03370523). RESULTS: Patient demographics, comorbid disease characteristics, laboratory test results, and details of medication use will be collected using self-reports and medical records. The severity of comorbid disease will be recorded and scored according to Charlson Comorbidity Index (CCI) and patients will be divided into 3 groups: mild, those with a CCI score of 1-2; moderate, those with a CCI score of 3-4; and severe, those with a CCI score of ≥5. Polypharmacy will be defined as the use of 5 or more medications at one time. DDIs will be determined using the Lexicomp Online drug interaction screening tool and potentially inappropriate medications will be defined based on the 2015 update of the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Severe drug interactions will be defined as those in category D or X. CONCLUSION: EPIC will be the first large-scale study in Turkey to evaluate polypharmacy, potentially inappropriate medications, and DDIs in elderly cardiac outpatients in a real-world clinical setting.


Subject(s)
Cardiovascular Agents , Clinical Trials as Topic , Drug Interactions , Polypharmacy , Research Design , Aged , Aged, 80 and over , Ambulatory Care , Cardiovascular Agents/adverse effects , Cardiovascular Agents/pharmacology , Cardiovascular Agents/therapeutic use , Heart Diseases/drug therapy , Humans , Potentially Inappropriate Medication List
5.
Coron Artery Dis ; 30(4): 270-276, 2019 06.
Article in English | MEDLINE | ID: mdl-31026233

ABSTRACT

AIM: The aim of this study is to identify the predictors of angiographic no-reflow development in patients who underwent primary percutaneous coronary intervention and to investigate the long-term (median follow-up time=59 months) clinical endpoints. PATIENTS AND METHODS: We retrospectively evaluated 3205 patients (824 females, mean age: 58.6 years) with acute myocardial infarction (ST-segment elevation myocardial infarction) admitted within the first 12 h of chest pain and treated with primary percutaneous coronary intervention between January 2006 and January 2010. The patients were divided into angiographic no-reflow [final Thrombolysis In Myocardial Infarction (TIMI)<3 flow] (n=324) and reflow (final TIMI 3) (n=2881) groups. RESULTS: On multivariate logistic regression analysis age [odds ratio (OR)=1.02, 95% confidence interval (CI): 1.00-1.04, P=0.003], Killip class≥2 (OR=1.99, 95% CI: 1.30-3.04, P=0.002), pain-to-balloon time more than 4 h (OR=3.98, 95% CI: 2.50-6.32, P<0.001), baseline TIMI≤1 flow (OR=2.55, 95% CI: 1.05-6.22, P=0.038), lesion length of at least 15 mm (OR=4.31, 95% CI: 2.89-6.41, P<0.001), reference vessel diameter of at least 3.5 mm (OR=2.83, 95% CI: 1.87-4.27, P<0.001), cutoff occlusion pattern (OR=1.93, 95% CI: 1.03-3.62, P=0.04), and SYNTAX score of at least 19 (OR=1.76, 95% CI: 1.1.23-3.07, P<0.001)] were found as significant predictors for the development of no-reflow phenomenon. In no-reflow patients, in-hospital mortality (10.8 vs. 2.9%), heart failure (32.1 vs. 8.7%), and severe arrhythmias (23.1 vs. 9.3%) were significantly more common (P<0.001), for all. In the long-term follow-up, death (33.3 vs. 13.4%, P<0.001), advanced heart failure (12.5 vs. 5.4%, P<0.001), and stroke (3.5 vs. 1.7%, P=0.035) rates were significantly higher in the no-reflow group. CONCLUSION: The no-reflow predictors that were identified in this study might be useful in the determination of the patients who could benefit from aggressive pharmaco-invasive therapy. Development of no-reflow is associated with both in-hospital and long-term very high morbidity and mortality rates.


Subject(s)
No-Reflow Phenomenon/etiology , Percutaneous Coronary Intervention/adverse effects , ST Elevation Myocardial Infarction/therapy , Coronary Angiography , Coronary Circulation , Female , Humans , Male , Middle Aged , No-Reflow Phenomenon/diagnostic imaging , No-Reflow Phenomenon/mortality , No-Reflow Phenomenon/physiopathology , Percutaneous Coronary Intervention/mortality , Retrospective Studies , Risk Assessment , Risk Factors , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/mortality , ST Elevation Myocardial Infarction/physiopathology , Time Factors , Treatment Outcome
6.
J Ultrasound Med ; 38(11): 2981-2988, 2019 Nov.
Article in English | MEDLINE | ID: mdl-30927311

ABSTRACT

OBJECTIVES: We aimed to determine the effects of normal pregnancy on left atrial (LA) mechanics using 2-dimensional speckle-tracking echocardiography. METHODS: A total of 47 healthy women with singleton pregnancies were prospectively enrolled in this study. A total of 4 visits, including each trimester and postpartum at 6 months, were planned. Echocardiographic studies were performed with a Vivid 7 device equipped with a 2.5-MHz transducer (GE Vingmed Ultrasound AS, Horten, Norway). RESULTS: Although the LA reservoir phase strain showed a gradual decrease from the first trimester to the third trimester during pregnancy, the measurements in the postpartum period were found to return to initial levels (mean ± SD: first trimester, 40.3% ± 11.7%; second trimester, 37.5% ± 12.9%; third trimester, 33.5% ± 9.0%; postpartum, 42.1% ± 11.1%; P < .001). The LA pump function strain was also parallel to the LA reservoir strain and gradually decreased from the first trimester to the third trimester during pregnancy, and it was observed that rose to the initial level in the postpartum period (first trimester, 16.7% ± 7.4%; second trimester, 14.8% ± 5.5%; third trimester, 12.7% ± 4.3%; postpartum, 15.8% ± 5.5%; P < .001). CONCLUSIONS: We prospectively determined normal reference values for LA deformation parameters using speckle-tracking echocardiography in each trimester and the postpartum period in healthy pregnancy. These reference values may help identify subclinical LA dysfunction in several cardiovascular or systemic conditions. According to this study, these parameters decreased toward the third trimester during pregnancy and recovered in the postpartum period.


Subject(s)
Atrial Function, Left/physiology , Echocardiography/methods , Adult , Female , Follow-Up Studies , Heart Atria/diagnostic imaging , Humans , Postpartum Period , Pregnancy , Pregnancy Trimesters , Prospective Studies , Reference Values
9.
Anatol J Cardiol ; 19(1): 50-57, 2018 Jan.
Article in English | MEDLINE | ID: mdl-29339700

ABSTRACT

OBJECTIVE: T-peak-T-end (TPE) interval, which represents the dispersion of repolarization, is defined as the interval between the peak and end of the T-wave, and is associated with increased malignant ventricular arrhythmia and sudden cardiac death (SCD) in patients with ST elevation myocardial infarction (STEMI). Although prolonged TPE interval is associated with poor short- and long-term outcomes, even in patients with STEMI treated with successful primary percutaneous coronary intervention (pPCI), clinical, angiographic, and laboratory parameters that affect TPE remain to be elucidated. The aim of our study was to evaluate the potential relationship between prolonged TPE interval and reperfusion success using ST segment resolution (STR) in patients with STEMI undergoing pPCI. METHODS: In the current study, 218 consecutive patients with STEMI who underwent pPCI were enrolled; after exclusion, 164 patients were included in the study population. RESULTS: Patients were divided into two groups according to the presence of complete (STR%≥70) or incomplete (STR%<70) STR. Preprocedural corrected TPE (cTPEPRE;116±21 ms vs. 108±21 ms; p=0.027), postprocedural TPE (TPEPOST; 107±16 ms vs. 92±21 ms; p<0.001), and postprocedural cTPE (cTPEPOST; 119±19 ms vs. 102±17 ms; p<0.001) intervals were significantly longer in patients with incomplete STR than in patients with complete STR, whereas there was no statistically significant difference between the two groups in terms of pre- and postprocedural and corrected QT intervals. cTPEPRE and cTPEPOST were found to be independent predictors for incomplete STR. CONCLUSION: To our knowledge, this is the first study that evaluated the relationship between TPE interval and no-reflow defined by STR in patients with STEMI who were treated with pPCI.


Subject(s)
ST Elevation Myocardial Infarction/surgery , Aged , Electrocardiography , Female , Heart Conduction System , Humans , Male , Middle Aged , No-Reflow Phenomenon/etiology , Percutaneous Coronary Intervention , Postoperative Complications/etiology , ROC Curve , ST Elevation Myocardial Infarction/physiopathology , Sensitivity and Specificity , Treatment Outcome
10.
J Electrocardiol ; 50(5): 584-590, 2017.
Article in English | MEDLINE | ID: mdl-28623012

ABSTRACT

OBJECTIVES: Coronary no-reflow (NR) following primary percutaneous coronary intervention (pPCI) is associated with worsened prognosis in patients with ST segment elevation myocardial infarction (STEMI). Despite rapid developments in cardiovascular area; there are limited data regarding prediction of NR before pPCI. P wave duration and dispersion (PWD, PWDIS, respectively) have been studied in STEMI patients and found to be associated with reperfusion success; however none of them has been found to predict NR before PCI. In our study we aimed to evaluate whether PWD, PWDIS and a novel parameter P wave peak time (PWPT) could predict NR development in STEMI patients. METHOD: Fifty six patients who were admitted with anterior STEMI constituted study populations. The diagnosis and treatment of STEMI was made on the basis of current guidelines. P wave parameters including PWD, PWDIS and PWPT were calculated from electrocardiograms that were obtained on admission and 60 min after pPCI. RESULTS: Patients were divided into two groups according to the development of NR. We observed that PWPT that were obtained from D2 (PWPTD2) and V1 (PWPTV1) leads were longer in NR group than reflow group. There were significant correlations between PWPT and reperfusion parameters regarding percent of ST segment resolution, peak CKMB level and TIMI frame count of infarct related artery. Preprocedural PWPTD2 was found to be an independent predictor of NR development. CONCLUSION: In our study we observed that PWPT could be a useful parameter in the assessment of reperfusion success and prediction of NR development.


Subject(s)
Electrocardiography , No-Reflow Phenomenon/diagnosis , No-Reflow Phenomenon/physiopathology , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction/physiopathology , ST Elevation Myocardial Infarction/surgery , Aged , Anticoagulants/therapeutic use , Biomarkers/blood , Coronary Angiography , Female , Humans , Male , Middle Aged , Retrospective Studies
11.
Echocardiography ; 34(7): 1110-1111, 2017 Jul.
Article in English | MEDLINE | ID: mdl-28497538

ABSTRACT

Left ventricular aneurysm (LVA) is rare but potentially fatal complication of myocardial infarction. It has been strictly defined as a distinct area of abnormal left ventricular diastolic contour with systolic dyskinesia or paradoxical bulging. It may be asymptomatic. However, complications including thromboembolism, heart failure, valvular regurgitation, arrhythmia, and rarely rupture may be the initial presentation. Diagnosis may be established by transthoracic echocardiography, left ventriculography, computed tomographic angiography, and cardiac magnetic resonance imaging. Here, we report a case of uncommonly located LVA in an adult patient with normal coronary arteries, which was diagnosed with multimodality imaging.


Subject(s)
Computed Tomography Angiography/methods , Coronary Angiography/methods , Echocardiography/methods , Heart Aneurysm/diagnostic imaging , Heart Ventricles/diagnostic imaging , Multimodal Imaging/methods , Coronary Vessels/diagnostic imaging , Female , Humans , Middle Aged
12.
Eur J Clin Invest ; 47(6): 428-438, 2017 Jun.
Article in English | MEDLINE | ID: mdl-28407216

ABSTRACT

BACKGROUND: The data regarding stroke prevention strategies in nonvalvular atrial fibrillation (NVAF) are limited especially in patients with renal impairment (RI). We sought to evaluate management dilemmas in patients with concurrent NVAF and RI in RAMSES (ReAl-life Multicenter Survey Evaluating Stroke Prevention Strategies inTurkey) study. METHODS: We conducted a prospective, multicenter, nation-wide registry in NVAF patients in outpatient cardiology clinics. All consecutive patients with NVAF were enrolled in RAMSES study (ClinicalTrials.gov identifier NCT02344901). The baseline data were collected. Glomerular filtration rate (GFR) was estimated by Cockcroft-Gault equation. RESULTS: A total number of 6273 patients from 29 provinces of Turkey with the contribution of 83 investigators were enrolled to the study. Of the study population, 1964(33%) patients had RI which was defined as GFR < 60 mL/min. Patients with RI had significantly higher CHA2 DS2 VASc and HAS-BLED scores compared to those without RI (3·9 ± 1·5 vs. 2·9 ± 1·5, and 2·0 ± 1 vs. 1·4 ± 1; P < 0·001). Prior history of major bleeding (6·9% vs. 4·1%, P < 0·001) and stroke (16·2% vs. 11·8%, P < 0·001) was significantly higher among individuals with concomitant RI and NVAF. Although RI patients had a higher risk for thromboembolism, number of the patients who did not receive any anticoagulant therapy was higher in patients with RI than without RI (30·1 vs. 26·4%, P = 0·003). CONCLUSION: RAMSES study showed that one-third of the patients with NVAF had RI in the real-world setting. Although it is mandatory in most of the patients with concomitant NVAF and RI, nearly one-third of these patients did not receive any anticoagulant therapy.


Subject(s)
Atrial Fibrillation/complications , Renal Insufficiency, Chronic/complications , Stroke/prevention & control , Administration, Oral , Aged , Anticoagulants/therapeutic use , Female , Fibrinolytic Agents/therapeutic use , Glomerular Filtration Rate/physiology , Humans , Male , Platelet Aggregation Inhibitors/therapeutic use , Prospective Studies , Pulmonary Disease, Chronic Obstructive/complications , Registries , Renal Insufficiency, Chronic/physiopathology , Stroke/complications
13.
Turk Kardiyol Dern Ars ; 45(2): 153-159, 2017 Mar.
Article in Turkish | MEDLINE | ID: mdl-28424437

ABSTRACT

OBJECTIVES: Aim of the present study was to investigate correlation between left atrial (LA) deformation parameters assessed using 2-dimensional (2D) speckle tracking echocardiography (STE) and complexity of coronary artery disease according to SYNTAX score (SXscore) in patients with stable coronary artery disease (SCAD). STUDY DESIGN: Total of 60 moderate-risk SCAD patients (40 men, 20 women) who underwent coronary angiography and 30 healthy controls were included. Measurements of conventional echocardiographic parameters as well as peak LA strain during ventricular systole (LA-RES), peak LA strain during atrial systole (LA-PUMP), peak LA strain rate during ventricular systole (LA-SRS), peak LA strain rate during early diastole (LA-SRE), and peak LA strain rate during atrial systole (LA-SRA) were obtained. RESULTS: Patients were categorized into 2 groups: low SXscore of <20 (Group I) and high SXscore of ≥20 (Group II). Left ventricular (LV) diastolic functions were significantly impaired and LV filling pressure was significantly higher in high SXscore group. LA-RES (Control Group: 42.3±7.9, Group I: 36.4±8.2, Group II: 27.5±8.1; p<0.001) and LA-PUMP (Control Group: 17.6±3.4, Group I: 15.7±2.5, Group II: 13.1±3.2; p<0.001) were significantly lower in high SXscore group compared with low SXscore group. There was no statistical difference in LA-SRS, LA-SRE, or LA-SRA between the 3 groups. Correlation analysis indicated negative correlation between SXscore level and LA-RES function (r=-0.49; p<0.001). CONCLUSION: 2D-STE-based LA deformation parameters are significantly impaired in patients with SCAD who have high SXscore. In addition, evaluation of LA-RES and LA-PUMP functions might be useful in estimating severity of disease in patients with SCAD.


Subject(s)
Coronary Artery Disease/epidemiology , Coronary Artery Disease/physiopathology , Heart Atria/physiopathology , Ventricular Dysfunction, Left/physiopathology , Aged , Case-Control Studies , Echocardiography , Female , Heart Atria/diagnostic imaging , Humans , Male , Middle Aged , Ventricular Dysfunction, Left/diagnostic imaging
14.
Coron Artery Dis ; 28(4): 326-331, 2017 Jun.
Article in English | MEDLINE | ID: mdl-28207567

ABSTRACT

OBJECTIVES: Coronary no-reflow (NR) is observed in nearly half of ST segment elevation myocardial infarction (STEMI) patients who undergo a primary percutaneous coronary intervention (pPCI) despite epicardial coronary vessel patency. Several methods used to define NR include thrombolysis in myocardial infarction grade, corrected thrombolysis in myocardial infarction frame count, myocardial blush grade, ST-segment resolution, contrast echocardiography, and MRI. The aim of our study was to evaluate the relationship between NR and R-wave peak time (RWPT) measured from infarct-related artery leads METHOD: We enrolled 282 consecutive STEMI patients treated with pPCI in Kafkas University Hospital from January 2014 to January 2015. After exclusion, the remaining 233 patients were included in the study population RESULTS: Patients were divided into two groups according to the development of NR. We observed that increased preprocedural (31 (27-37) vs 27 (21-30) p<0,001) and postprocedural RWPT(35±7 vs 22±6 p<0,001) was associated with the development of NR and preprocedural RWPT(OR: 1.254 95% CI: 1.104-1.425 p<0,001) was found to be independent predictor of NR. The association between postprocedural RWPT and angiographic NR was statistically noninferior to that between ST-segment resolution % and NR(difference between area under curves: 0.0232, p= 0.38) CONCLUSION: the present study is the first to report a significant correlation between NR and RWPT in STEMI patients treated with primary pPCI.


Subject(s)
Coronary Circulation/physiology , Electrocardiography , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction/physiopathology , Coronary Angiography , Female , Follow-Up Studies , Humans , Male , Middle Aged , No-Reflow Phenomenon/diagnosis , No-Reflow Phenomenon/physiopathology , Prognosis , Retrospective Studies , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/surgery
15.
Turk Kardiyol Dern Ars ; 45(1): 16-25, 2017 Jan.
Article in English | MEDLINE | ID: mdl-28106016

ABSTRACT

OBJECTIVE: Gender is an important feature in the management of atrial fibrillation (AF). This study investigated gender-related differences in patients with AF in Turkey. METHODS: As a part of RAMSES (ReAl-life Multicenter Survey Evaluating Stroke prevention strategies in Turkey, NCT02344901) study, information of the patients with AF who successively applied to the hospital was analyzed. This cross-sectional, multicenter, nationwide observational study enrolled 6264 non-valvular AF (NVAF) outpatients (55.9% women) from Turkey. RESULTS: Compared with men, women with NVAF were older (71 years [range: 65-78 years] vs. 70 years [range: 62-77 years]; p<0.001), had lower frequency of coronary artery disease (22.0% vs. 38.3%; p<0.001) and congestive heart failure (18.2% vs. 27.2%; p<0.001). Women had higher median CHA2DS2-VASc score (4 [range: 3-5] vs. 3 [range: 2-4]; p<0.001), but similar HAS-BLED score (2 [range: 1-2] vs. 2 [range: 1-2]; p=0.141) when compared with men. Anticoagulant therapy use was higher in women (74.5% vs. 69.9%; p<0.001). Analysis of anticoagulation therapy use revealed that 68.5% of men and 61.6% of women (p=0.204) who had low risk for stroke (CHA2DS2-VASc score: 0 [male], 1 [female]) received anticoagulation therapy, and 30.5% of the men. Meanwhile, 25.3% of the women (p<0.001) with high risk for stroke (CHA2DS2-VASc score: ≥1 [male], ≥2 [female]) had not received any anticogulant therapy. CONCLUSION: Although women with NVAF receive better treatment than men, anticoagulation therapy is suboptimal in large proportion of men and women, with underuse in high-risk patients and overuse in low-risk patients. There is an urgent need to improve optimization of anticoagulation in patients with NVAF.


Subject(s)
Anticoagulants/supply & distribution , Atrial Fibrillation/epidemiology , Brain Ischemia/prevention & control , Practice Patterns, Physicians' , Age Factors , Aged , Atrial Fibrillation/etiology , Atrial Fibrillation/pathology , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Risk Factors , Severity of Illness Index , Sex Factors , Turkey/epidemiology
16.
J Thromb Thrombolysis ; 43(2): 157-165, 2017 Feb.
Article in English | MEDLINE | ID: mdl-27848065

ABSTRACT

The definition of non-valvular atrial fibrillation (NVAF) is controversial. We aimed to assess the impact of valvular heart disease on stroke prevention strategies in NVAF patients. The RAMSES study was a multicenter and cross-sectional study conducted on NVAF patients (ClinicalTrials.gov identifier NCT02344901). The study population was divided into patients with significant valvular disease (SVD) and non-significant valvular disease (NSVD), whether they had at least one moderate valvular disease or not. Patients with a mechanical prosthetic valve and mitral stenosis were excluded. Baseline characteristics and oral anticoagulant (OAC) therapies were compared. In 5987 patients with NVAF, there were 3929 (66%) NSVD and 2058 (34%) SVD patients. The predominant valvular disease was mitral regurgitation (58.1%), followed by aortic regurgitation (24.1%) and aortic stenosis (17.8%). Patients with SVD had higher CHA2DS2VASc [3.0 (2.0; 4.0) vs. 4.0 (2.0; 5.0), p < 0.001] and HAS-BLED [2.0 (1.0; 2.0) vs. 2.0 (1.0; 2.0), p = 0.004] scores compared to patients with NSVD. Overall, 2763 (71.2%) of NSVD and 1515 (73.8%) of SVD patients were on OAC therapy (p = 0.035). When the patients with SVD were analyzed separately, the mean CHA2DS2VASc and HAS-BLED scores were higher in patients with mitral regurgitation compared to patients with aortic regurgitation and aortic stenosis [4.0 (3.0; 5.0), 3.0 (2.0; 4.0), 3.0 (2.0; 4.0) p < 0.001 and 2.0 (1.0; 3.0), 1.0 (1.0; 2.0), 1.0 (0.0; 2.0) p < 0.001, respectively]. In patients with SVD, 65.7% of mitral regurgitation, 82.6% of aortic regurgitation and 88.0% of aortic stenosis patients were on OAC therapy. One out of three NVAF patients had at least one moderate valvular heart disease with the predominance of mitral regurgitation. Patients with SVD were at greater risk of stroke and bleeding compared to patients with NSVD. Although patients with mitral regurgitation should be given more aggressive anticoagulant therapy due to their higher risk of stroke, they are undertreated compared to patients with aortic valve diseases.


Subject(s)
Anticoagulants/therapeutic use , Atrial Fibrillation/drug therapy , Heart Valve Diseases/drug therapy , Practice Patterns, Physicians'/standards , Administration, Oral , Anticoagulants/administration & dosage , Aortic Valve Insufficiency/drug therapy , Cross-Sectional Studies , Female , Hemorrhage , Humans , Male , Middle Aged , Mitral Valve Insufficiency/drug therapy , Stroke/prevention & control
17.
Anatol J Cardiol ; 16(10): 734-741, 2016 10.
Article in English | MEDLINE | ID: mdl-27723665

ABSTRACT

OBJECTIVE: Data regarding stroke prevention strategies in non-valvular atrial fibrillation (NVAF) are limited to vitamin K antagonists (VKAs). This study aimed to evaluate real-life stroke prevention strategies for NVAF patients in the era of non-VKA oral anticoagulants (NOACs). METHODS: We established a cross-sectional, multicenter, nationwide registry of NVAF patients. All consecutive atrial fibrillation (AF) patients and without mechanical heart valves or rheumatic mitral stenosis (but including those with any degree of mitral regurgitation) were enrolled in the ReAl-life Multicenter Survey Evaluating Stroke Prevention Strategies (RAMSES Study; ClinicalTrials.gov identifier NCT02344901) in Turkey. Baseline demographic data, medical history, and medications prescribed for NVAF treatment were collected. Univariate analyses were performed for continuous variables, and the chi-square test was used for categorical variables. RESULTS: In total, 6273 patients from 29 provinces of Turkey were enrolled in the study between February and May 2015, with the contribution of 83 investigators. The mean age was 69.6±10.7 years; 56% of the patients were females, and one-fifth of the patients had at least one comorbid disease, the most common being hypertension (69%). The mean CHA2DS2-VASc and HAS-BLED scores were 3.3±1.6 and 1.6±1.1, respectively. The rate of oral anticoagulant (OAC) therapy use was 72% (37% NOAC and 35% VKA). CONCLUSION: The RAMSES study showed a higher prevalence of OAC use among NVAF patients than that reported in previous studies. Although NOACs were preferred over VKAs in daily cardiology practice, there is a need for improved OAC therapies for NVAF patients.


Subject(s)
Anticoagulants/therapeutic use , Atrial Fibrillation/complications , Stroke/prevention & control , Administration, Oral , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Middle Aged , Risk Factors , Stroke/etiology , Surveys and Questionnaires , Turkey
18.
Medicine (Baltimore) ; 95(35): e4672, 2016 Aug.
Article in English | MEDLINE | ID: mdl-27583892

ABSTRACT

This study aimed to investigate the potential misuse of novel oral anticoagulants (NOACs) and the physicians' adherence to current European guideline recommendations in real-world using a large dataset from Real-life Multicenter Survey Evaluating Stroke Prevention Strategies in Turkey (RAMSES Study).RAMSES study is a prospective, multicenter, nationwide registry (ClinicalTrials.gov identifier NCT02344901). In this subgroup analysis of RAMSES study, patients who were on NOACs were classified as appropriately treated (AT), undertreated (UT), and overtreated (OT) according to the European Society of Cardiology (ESC) guidelines. The independent predictors of UT and OT were determined by multivariate logistic regression.Of the 2086 eligible patients, 1247 (59.8%) received adequate treatment. However, off-label use was detected in 839 (40.2%) patients; 634 (30.4%) patients received UT and 205 (9.8%) received OT. Independent predictors of UT included >65 years of age, creatinine clearance ≥50 mL/min, urban living, existing dabigatran treatment, and HAS-BLED score of <3, whereas that of OT were creatinine clearance <50 mL/min, ongoing rivaroxaban treatment, and HAS-BLED score of ≥3.The suboptimal use of NOACs is common because of physicians' poor compliance to the guideline recommendations in patients with nonvalvular atrial fibrillation (NVAF). Older patients who were on dabigatran treatment with good renal functions and low risk of bleeding were at risk of UT, whereas patients who were on rivaroxaban treatment with renal impairment and high risk of bleeding were at risk of OT. Therefore, a greater emphasis should be given to prescribe the recommended dose for the specified patients.


Subject(s)
Anticoagulants/administration & dosage , Stroke/prevention & control , Vitamin K/antagonists & inhibitors , Administration, Oral , Anticoagulants/adverse effects , Atrial Fibrillation/complications , Cross-Sectional Studies , Guideline Adherence , Hemorrhage/chemically induced , Humans , Practice Guidelines as Topic , Prospective Studies , Registries , Risk Factors , Turkey
19.
Coron Artery Dis ; 27(6): 497-503, 2016 Sep.
Article in English | MEDLINE | ID: mdl-27182772

ABSTRACT

BACKGROUND: Nonvalvular atrial fibrillation (NVAF) frequently coexists with coronary artery disease (CAD). However, the optimal antithrombotic strategy for patients with concomitant CAD and NVAF is controversial. The aim of this study is to assess the prevalence of CAD with NVAF and to determine antithrombotic treatment options in patients with or without a history of CAD. METHODS: ReAl-life Multicenter Survey Evaluating Stroke prevention strategies in Turkey (RAMSES study) was a cross-sectional, multicenter, nationwide observational study carried out in NVAF patients. We studied the clinical data of 6264 Turkish patients participating in the RAMSES study. Demographic properties and antithrombotic therapies were recorded and compared between patients with and without CAD. RESULTS: CAD was present in 1828 (29.2%) of patients with NVAF. Most of the NVAF patients with CAD were men (58%) and comorbid diseases were significantly more common in patients with CAD. Although patients with CAD had higher CHA2DS2VASc scores than those without disease (4.1±1.5 vs. 2.9±1.5; P=0.001), they had lower use of oral anticoagulant (OAC) therapy (66.1 vs. 74.4%, P=0.01). Among OAC drugs, warfarin was the preferred medication in patients with CAD (35.4 vs. 30.6%, P=0.01), whereas nonvitamin K antagonist oral anticoagulants were preferred in patients without CAD (40 vs. 34.3%, P=0.01). Patients with CAD required nearly three-fold higher antiplatelet treatment compared with patients without CAD (57.8 vs. 21.4%, P<0.001). CONCLUSION: CAD affects nearly one-third of patients with NVAF in a real-world setting. Although they merit more aggressive therapy, patients with CAD and NVAF were less likely to receive OAC therapy.


Subject(s)
Atrial Fibrillation/epidemiology , Coronary Artery Disease/epidemiology , Outpatients , Administration, Oral , Aged , Aged, 80 and over , Anticoagulants/administration & dosage , Anticoagulants/adverse effects , Atrial Fibrillation/diagnosis , Atrial Fibrillation/drug therapy , Coronary Artery Disease/diagnosis , Cross-Sectional Studies , Drug Therapy, Combination , Female , Fibrinolytic Agents/administration & dosage , Fibrinolytic Agents/adverse effects , Hemorrhage/chemically induced , Humans , Male , Middle Aged , Platelet Aggregation Inhibitors/administration & dosage , Platelet Aggregation Inhibitors/adverse effects , Practice Patterns, Physicians' , Prevalence , Registries , Retrospective Studies , Risk Factors , Turkey/epidemiology
20.
Turk Kardiyol Dern Ars ; 44(1): 45-52, 2016 Jan.
Article in English | MEDLINE | ID: mdl-26875130

ABSTRACT

OBJECTIVE: The aim of this study was to determine the role of left-sided mechanical parameters in postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass grafting (CABG). METHODS: Ninety patients with coronary artery disease and normal left ventricular (LV) function in sinus rhythm were enrolled in the study. Preoperative LV and left atrial (LA) mechanics were evaluated by two-dimensional (2D) speckle-tracking echocardiography (STE), including strain and rotation parameters, and volume indices. Patients were monitored in order to detect POAF during the postoperative period. RESULTS: Twenty-three of 90 patients (25.6%) developed POAF. Age (p<0.001) and preoperative beta blocker usage (p=0.001) were the clinical parameters associated with POAF. Left atrial maximum volume index (LAV[max]i) increased, and peak left atrial longitudinal strain (PALS) was impaired in POAF patients (p=0.001, p<0.001, respectively). Left ventricular twist (LVtw) and left ventricular peak untwisting velocity (UntwV) were augmented in POAF patients (p=0.013, p=0.009, respectively). Receiver operating characteristic analysis showed N-terminal pro-brain natriuretic peptide (NT-proBNP) levels above 70 pg/ml and predicted POAF with a sensitivity of 74% and specificity of 78% (area under curve: 0.758, 95% confidence interval [CI] 0.631-0.894, p<0.001). Logistic regression analysis demonstrated that age (odds ratio [OR] 1.1, CI 1.01-1.20, p=0.034), preoperative beta blocker usage (OR 8.84, CI 1.36-57.28, p=0.022), NT-proBNP (values >70 pg/ml, OR 22.377, CI 3.286-152.381, p<0.001), PALS (OR 0.86, CI 0.75-0.98, p=0.023), and UntwV (OR 1.02, CI 1.00-1.04, p=0.029) were the independent predictors of POAF. CONCLUSION: The combination of 2D STE, clinical, and biochemical parameters may help predict POAF.


Subject(s)
Atrial Fibrillation/epidemiology , Atrial Fibrillation/physiopathology , Atrial Function, Left/physiology , Heart Atria/diagnostic imaging , Heart Ventricles/diagnostic imaging , Postoperative Complications/epidemiology , Postoperative Complications/physiopathology , Adrenergic beta-Antagonists , Aged , Atrial Fibrillation/diagnosis , Coronary Artery Bypass/adverse effects , Coronary Artery Disease/surgery , Echocardiography , Female , Heart Atria/physiopathology , Heart Ventricles/physiopathology , Humans , Male , Middle Aged , Natriuretic Peptide, Brain/blood , Peptide Fragments/blood , Postoperative Complications/diagnosis , Predictive Value of Tests , Prospective Studies
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