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Heart failure (HF) has been classified as reduced ejection fraction (HFrEF), mildly reduced ejection fraction (HFmrEF) and preserved ejection fraction (HFpEF) by the recent HF guidelines. In addition, HF with improved ejection fraction has been defined as a subgroup of HFrEF. In HFrEF, diagnostic workup and evidence-based pharmacological and device-based therapies have been well established. However, HFpEF, which comprises almost half of the HF population, represents significant uncertainties regarding its pathophysiology, clinical phenotypes, diagnosis and treatment. Diagnostic criteria of HFpEF have been changed a few times over the years and still remained a matter of debate. New paradigms including a prominent role of co-morbidities. inflammation, endothelial dysfunction have been proposed in its pathophysiology. As a complex, multifactorial syndrome HFpEF consists of many overlapping clinical and hemodynamic phenotypes. In contrast to HFrEF, clinical outcomes of HFpEF have not improved over the last decades due to lack of proven effective therapies. Although HFrEF and HFpEF have different clinical spectrums and proposed pathophysiological mechanisms, there is no clear defining syndrome postulated for HFmrEF. Clinical characteristics and risk factors of HFmrEF overlap with HFrEF and HFpEF. HFmrEF is also referred as a transitional zone for dynamic temporal changes in EF. So. HFpEF and HFmrEF, both namely HF with non-reduced ejection fraction (HF-NEF), have some challenges in the management of HF. The purpose of this paper is to provide a comprehensive review including epidemiology, pathophysiology, clinical presentation and phenotypes of HF-NEF and to guide clinicians for the diagnosis and therapeutic approaches based on the available data in the literature.

WOS: 000464336000007, PubMed ID: 30982817, Objective: Heart failure (HF) is an important health issue of the 21st century and the prevalence in Turkey has been reported as 2.9%. A national profile, frequency data, characteristics of different phenotypes, and risk factors have not yet been well established. The Snapshot Evaluation of Heart Failure Patients in Turkey (SELFIE-TR) was an analysis of a representative sample of HF patients from Turkey. Methods: A total of 23 centers with at least 2 cardiologists from the 12 NUTS-1 regions of Turkey were invited to participate in the research. The contributing centers shared the data of a consecutive enrollment of HF patients, as confirmed by an investigator, on a pre-selected day of each week for the month of October or November of 2015. Results: The mean age of the entire cohort was 63.3 +/- 13.3 years (male/female ratio: 751/303, 71.3%/28.7%). There were 712 acute HF patients and 342 chronic HF patients. The total number of HF patients with reduced ejection fraction (HFrEF), heart failure with mid-range ejection fraction, and heart failure with preserved ejection fraction was 801 (75%), 176 (16.7%), and 77 (7.3%), respectively. The patients with chronic HF were younger than those with acute HF (61.1 +/- 13.3 years vs 67.9 +/- 12.1 years; p

PubMed ID: 30982817, Objective: Heart failure (HF) is an important health issue of the 21st century and the prevalence in Turkey has been reported as 2.9%. A national profile, frequency data, characteristics of different phenotypes, and risk factors have not yet been well established. The Snapshot Evaluation of Heart Failure Patients in Turkey (SELFIE-TR) was an analysis of a representative sample of HF patients from Turkey. Methods: A total of 23 centers with at least 2 cardiologists from the 12 NUTS-1 regions of Turkey were invited to participate in the research. The contributing centers shared the data of a consecutive enrollment of HF patients, as confirmed by an investigator, on a pre-selected day of each week for the month of October or November of 2015. Results: The mean age of the entire cohort was 63.3±13.3 years (male/female ratio: 751/303, 71.3%/28.7%). There were 712 acute HF patients and 342 chronic HF patients. The total number of HF patients with reduced ejection fraction (HFrEF), heart failure with mid-range ejection fraction, and heart failure with preserved ejection fraction was 801 (75%), 176 (16.7%), and 77 (7.3%), respectively. The patients with chronic HF were younger than those with acute HF (61.1±13.3 years vs 67.9±12.1 years; p

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PubMed ID: 28976403, The specific population-based results of clinical and epidemiologic studies in geriatric patients with cardiovascular disease in Turkey were presented in this paper. The determining of the frequency and distribution of the cardiovascular disease and risk factors in our geriatric population would contribute to following a realistic strategy for management of them.

Bu yazıda Türkiye'deki kardiyovasküler hastalığı olan ileri yaş grubu hastaların klinik ve epidemiyolojik araştırmalarının topluma özgü sonuçları sunulmuştur. Kardiyovasküler hastalıklar ve risk faktörlerinin sıklığı ve dağılımının geriatri popülasyonumuzda belirlenmesi tedavilerinde gerçekçi bir stratejinin izlenmesine olanak sağlayacaktır., The specific population-based results of clinical and epidemiologic studies in geriatric patients with cardiovascular disease in Turkey were presented in this paper. The determining of the frequency and distribution of the cardiovascular disease and risk factors in our geriatric population would contribute to following a realistic strategy for management of them.

Teknolojik gelişmenin hızlı adımları ve piyasada artan küreselleşme nedeniyle yeni bir rekabet ortamı oluşmuştur. Oluşan bu yeni rekabet ortamında firmanın sadece kendi kaynaklarına dayanarak çalışması diğer firmalar tarafından sunulan fırsatlar ve olanakları kaçırmak anlamına gelir. Bu nedenle son yıllarda oluşan Stratejik işbirlikleri önemli bir trend haline gelmiştir.Bu kapsam doğrultusunda araştırmanın amacı Türkiye'de çalışan işletmelerin bulunduğu Tedarikçi- Alıcı işbirliklerindeki ilişkisel risk algısının tedarik zincir performansı üzerinde etkisini incelemektir. Ayrıca bu riskin yönetimi için söz konusu resmi kontrol, sosyal kontrol ve resmi olmayan kontrol (güven) bu çalışmada risk azaltma mekanizmaları olarak ele alınmıştır. Güven konusu, global stratejik işbirliklerinin oluşturulmasındaki en önemli unsurlar birisidir. Stratejik işbirlikleri ilişkilerinde düşük düzeyde bir güven, hem stratejik işbirliğin oluşumundaki cesareti kırar hem de meydana gelen ortaklıkta tarafların birbirlerine şüpheyle yaklaşmalarına neden olur. Because of the rapid pace of technological development and increased globalization of the marketplace a new competitive environment has been created in which competing only with one's own resources abandon opportunities and resources available from others. Therefore, the formation of strategic alliances has become a remarkable trend in recent years. The purpose of this resarch is to measure the effect of relational risk perception on supply chain performance. In this research risk reducing mechanisms inculding formal control (contract), social control (organizational culture) and informal control (trust) have been used to manage relational risk in vertical integrated strategic alliances. Trust is especially valuable in strategic alliances because, in varying degrees, firms have to rely on their partners' performance. A lack of satisfactory level of trust decrease companies tendency to join strategic alliances and causes suspect between partners. 187

WOS: 000273266400002, PubMed ID: 19965312, Acute heart failure syndrome is a heterogeneous group, which requires distinct therapeutic approaches. Diuretics and/or vasodilators for patients with high blood pressure and inotropic agents for patients with low left ventricular ejection fraction and evidence of hypoperfusion are kept in the forefront. Early initiation of therapy along with accurate and early diagnosis in acute heart failure reduces mortality and morbidity significantly. Therefore, it is critically important to develop algorithms, which could easily be followed by all physicians. In this paper, in parallelism with heart failure guidelines and utilizing data of the clinical studies, performed by colleagues of our country in this area, therapeutic algorithms compatible with the conditions of our country are suggested for distinct clinical presentations of acute heart failure. (Anadolu Kardiyol Derg 2009; 9: 436-46)

Acute heart failure syndrome is a heterogeneous group, which requires distinct therapeutic approaches. Diuretics and/or vasodilators for patients with high blood pressure and inotropic agents for patients with low left ventricular ejection fraction and evidence of hypoperfusion are kept in the forefront. Early initiation of therapy along with accurate and early diagnosis in acute heart failure reduces mortality and morbidity significantly. Therefore, it is critically important to develop algorithms, which could easily be followed by all physicians. In this paper, in parallelism with heart failure guidelines and utilizing data of the clinical studies, performed by colleagues of our country in this area, therapeutic algorithms compatible with the conditions of our country are suggested for distinct clinical presentations of acute heart failure. ©Copyright 2009 by AVES Yayincilik Ltd., Zoghi, M.; Ege Üniversitesi Tip Fakültesi, Kardiyoloji Anabilim Dali, Bornova, 35100, Izmir, Turkey; email: mehdi.zoghi@ege.edu.tr

GENEL BİLGİLERDikey Stratejik İşbirlikleri, Tedarik Zinciri Performansı, Risk Azaltma MekanizmalarıTeknolojik gelişmenin hızlı adımları ve piyasada artan küreselleşme nedeniyle yeni bir rekabet ortamı oluşmuştur. Oluşan bu yeni rekabet ortamında firmanın sadece kendi kaynaklarına dayanarak çalışması diğer firmalar tarafından sunulan fırsatlar ve olanakları kaçırmak anlamına gelir. Bu nedenle son yıllarda oluşan Stratejik işbirlikleri önemli bir trend haline gelmiştir.Bu kapsam doğrultusunda araştırmanın amaçı Türkiye’de çalışan işletmelerin bulunduğu Tedarikçi- Alıcı işbirliklerindeki ilişkisel risk algısının tedarik zincir performansı üzerinde etkisini incelemektir. Ayrıca bu riskin yönetimi için söz konusu resmi kontrol, sosyal kontrol ve resmi olmayan kontrol (güven) bu çalışmada risk azaltma mekanizmaları olarak ele alınmıştır. Güven konusu, global stratejik işbirliklerinin oluşturulmasındaki en önemli unsurlar birisidir. Stratejik işbirlikleri ilişkilerinde düşük düzeyde bir güven, hem stratejik işbirliğin oluşumundaki cesareti kırar hem de meydana gelen ortaklıkta tarafların birbirlerine şüpheyle yaklaşmalarına neden olur GENERAL KNOWLEDGEName and Surname:Farzaneh Soleimani ZoghiField of Study:Business AdministrationProgram:Production Management and MarketingSupervisor:Prof. Dr. Müge Fatma ARSLANAwarded Degree and Date of Issue:Ph D - January 2015Anahtar Kelimeler:Relational Risk Perception, Vertical integrated Strategic Alliances, Supply Chain Performance, Risk Reducing MechanismsBecause of the rapid pace of technological development and increased globalization of the marketplace a new competitive environment has been created in which competing only with one’s own resources abandon opportunities and resources available from others. Therefore, the formation of strategic alliances has become a remarkable trend in recent years. The purpose of this resarch is to measure the effect of relational risk perception on supply chain performance. In this research risk reducing mechanisms inculding formal control (contract), social control (organizational culture) and informal control (trust) have been used to manage relational risk in vertical integrated strategic alliances. Trust is especially valuable in strategic alliances because, in varying degrees, firms have to rely on their partners’ performance. A lack of satisfactory level of trust decrease companies tendency to join strategic alliances and causes suspect between partners.

Giriş: Akut inferiyor miyokart enfarktüsü (AİME) tanısıyla hastaneye yatırılan olguların enfarktüsten sorumlu koroner arterlerinin belirlenmesinde elektrokardiyografi (EKG) bulgularının önemini araştırdık.Hastalar ve Yöntem: Merkezimizde Ocak 2004-Ocak 2009 tarihleri arasında AİME tanısı ile takip edilen 132 hastanın (ortalama yaş; 57.3 ± 11, 118 erkek); hastaneye başvuru sırasında çekilen ilk EKG kayıtları ve demografik özellikleri retrospektif olarak değerlendirildi.Bulgular: Koroner anjiyografi tetkikleri değerlendirildiğinde; olguların %70.4'ünde enfarktüsten sorumlu koroner arterin (ESKA) sağ koroner arter (RCA), %29.6'sında sirkumfleks arter (Cx) olduğu saptandı. Sorumlu arterin RCA olduğu olgularda; DIII derivasyonundaki ST segment yükselmesinin, DII derivasyonundan daha fazla olduğu (%94.6 duyarlılık, %75.9 özgüllük, p= 0.001), aVL ve DI derivasyonlarının her ikisinde de ST segment çökmesinin bulunduğu saptandı (%88.2 duyarlılık, %75.2 özgüllük, p= 0.011). Sorumlu arterin RCA olduğu olgulara aVL derivasyonundaki ST segment çökmesinin, DI derivasyonundaki ST segment çökmesinden daha fazla olmasının istatistiksel olarak anlamlı olduğu belirlendi (%95.7 duyarlılık, %73.6 özgüllük p= 0.016). İnferiyor yüz enfarktüse, sağ ventrikül miyokart enfarktüsünün eşlik ettiği hastalarda sorumlu arter anlamlı olarak RCA idi (p= 0.005). Posterior duvar infarktüsünün eşlik ettiği olgularda sorumlu arterin daha çok Cx olduğu gözlense de bu durum istatistiksel olarak anlamlı değildi (p= 0.3). Sorumlu arterin Cx olduğu olguların EKG'lerinde V1-2 derivasyonlarında ST segment çökmesi saptandı (%84.6 duyarlılık, %36.3 özgüllük p= 0.009).Sonuç: AİME geçiren olguların yüzey EKG'lerinden elde edilen bulgular, enfarktüsten sorumlu koroner arterin tahmin edilebileceğini göstermektedir, Introduction: We aimed to investigate the role of electrocardiography (ECG) findings in determining infarct related coronary arteries of patients hospitalized with a diagnosis of acute inferior myocardial infarction (AIMI).Patients and Methods: The first ECG records taken on admission to hospital and demographic characteristics of 132 patients, who were followed with the diagnosis of AIMI (mean age, 57.3 ± 11, 118 men) in our center between January 2004-January 2009, were evaluated.Results: When coronary angiography were evaluated, it was detected that the infarct-related coronary artery (IRCA) was the right coronary artery (RCA) in 70.4% of all patients, whereas it was circumflex artery (Cx) in 29.6% respectively. It was detected that DIII-ST elevation was higher than DII (94.6% sensivity, and 75.9% specifity, p= 0.001) and there was st depression in aVL and DI leads in cases which IRCA was RCA (88.2% sensivity and 75.2% specifity, p= 0.011). Although ST depression in aVL lead was higher than st depression in DI in cases which RCA was IRCA, this finding was defined statistically significant (%95.7 sensivity; %73.6 specifity; p= 0.016). RCA was the IRCA significantly in patients with inferior wall MI accompanied by right ventricular myocardial infarction (p= 0.005). Although Cx was observed as the culprit artery in cases which was accompanied by posterior wall infarction, no statistically finding was detected (p= 0.3). ST-depression was detected in V1-2 leads in ECG of patients whose culprit artery was Cx (%84.6 sensitivity, %36.3 specificity, p= 0.009).Conclusion: The findings based on surface ECG of the patients who underwent AIMI shows that IRCA can be predicted

Amaç: 1998’den 2011 yılına kadar kalp nakli yapılan olgularda kalp yetersizliği etyolojisi, ölüm nedenleri, mortalite ve sağkalım oranlarındaki değişimler geriye dönük olarak değerlendirildi. Çalışma planı: Şubat 1998-Ocak 2011 tarihleri arasında kalp nakli yapılan ardışık 144 hasta (112 erkek, 32 kadın; ort. yaş 40.2±14.3) çalışmaya alındı. Hastalar, Ocak 2006 yılına kadar kalp nakli yapılan 63 olgu (grup 1; ort. yaş 42.5±12.6) ve Ocak 2006-Ocak 2011 arasında kalp nakli yapılan 81 olgu (grup 2; ort. yaş 38.4±15.3) olmak üzere iki grupta incelendi. İkinci dönemde 17 hastaya kalp nakli ameliyatından önce ventrikül destek cihazı uygulanmıştı. Bulgular: Dilate kardiyomiyopati iki grupta da en önemli kalp nakli nedeni idi (grup 1, %71.4; grup 2, %74.1). Genel mortalite %39.6 (n=57) bulunurken, hastaneiçi (, Objectives: We retrospectively analyzed changes iheart failure etiology, causes of death, mortality ansurvival rates in cardiac transplant patients from 199to 2011. Study design: A total of 144 patients (112 men, 32 women; mean age 40.2±14.3 years) underwent cardiac transplantation between February 1998 and January 2011. Thpatients were divided into two groups; hence, 63 patient(group 1; mean age 42.5±12.6 years) receiving transplantation up to January 2006, and 81 patients (group 2; meaage 38.4±15.3 years) receiving transplantation from 200to 2011. In the latter period, a ventricular assist devicwas used in 17 patients before transplantation. Results: Dilated cardiomyopathy was the main cause oheart transplantation in both groups (71.4% vs. 74.1%Overall mortality, in-hospital mortality (

PubMed ID: 21285017, Objective: We retrospectively analyzed case records to identify risk factors for mortality in heart transplant recipients in our center. Methods: Data of 123 patients (mean age 40.6±14 years and 97 male) transplanted from February 1998 to April 2009 were studied and analyzed. Pre- and intra-operative variables of the 73 patients who survived (Group 1, mean age 39.1±14.6, 58 male) and 50 patients who died (Group 2, mean age 42.6±12.9, 39 male) were compared. For statistical analysis Student t, Mann-Whitney U and Chi-square tests were used. Logistic regression analysis was used to determine independent risk factors for mortality and survival analysis was accomplished using Kaplan-Meier analysis. Results: Overall mortality in the entire population was 40.6% (50/123). Actuarial survival was 74%, 65%, 51% and 31% at 1, 2, 5 and 10 years respectively. Major causes of death after heart transplantation were infections (30%), right ventricular failure (18%), rejection (12%) and sudden cardiac death (12%). Total ischemic time was 176.7±63.3 minutes (range 90-410 minutes). The total cardiopulmonary by-pass (CPB) time (114.3±27.7 vs 126.9±42.1 min, p=0.05), pre-operative creatinine clearance (81.0±31.5 vs 67.2±33.0 ml/min, p=0.02), urea (45.2±18.6 vs 57.8±35.2 mg/dl, p=0.02), and creatinine (1.01±0.25 vs 1.17±0.36 mg/dl, p=0.05) were significantly different between survivors and non-survivors. Group 2 patients had higher transpulmonary gradient (TPG) (9.21±5.16 vs 12.50±8.26 mmHg, p=0.02) as compared with group 1 patients. Logistic regres-sion analysis revealed that preoperative creatinine clearance (OR 0.989, 95% CI 0.973-1.005, p=0.044), creatinine level (OR 2.028, 95% CI 0.288- 14.301, p=0.027), total CPB time (OR 1.013, 95% CI 1.000-1.027, p=0.036), and TPG (OR 1.113, 95% CI 0.992 1.249, p=0.045) were the independent predictors of mortality. Conclusion: Our data showed that TPG, total CPB time, pre-transplant renal dysfunction are pre-operative and intra-operative risk factors for mortality after heart transplantation. © 2011 by AVES Yayi{dotless}nci{dotless}li{dotless}k Ltd.

Amaç: Kalp nakli yapılan olgularda mortaliteye etki eden risk faktörlerini belirlemek için merkezimizdeki olguları retrospektif olarak inceledik. Yöntemler: Şubat 1998-Nisan 2009 arasında kalp nakli yapılan 123 hastanın (ortalama yaş 40.6±14 yıl, 97'si erkek) verileri incelendi. Nakil sonrası sağ kalan 73 olgu (Grup 1, ortalama yaş 39.1±14.6, 58'i erkek) ve izlemde kaybedilen 50 olgunun preoperatif ve intraoperatif verileri (Grup 2, ortalama yaş 42.6±12.9, 39'u erkek) karşılaştırıldı. İstatistiksel analiz için Student t, Mann-Whitney U ve Ki-kare testi kullanıldı. Mortaliteyi etkileyen bağımsız risk faktörlerinin saptanması için lojistik regresyon analizi yapıldı, sağkalım analizi de Kaplan-Meier analizi ile gerçekleştirildi. Bulgular: Genel mortalite oranı %40.6 (50/123) ve sırasıyla 1, 2, 5 ve 10 yıllık sağkalım oranı %74, %65, %51 ve %31 olarak saptandı. Kalp nakli sonrası en önemli ölüm sebepleri enfeksiyonlar (%30), sağ ventrikül yetmezliği (%18), rejeksiyon (%12) ve ani ölüm (%12) olarak saptandı. Toplam iskemi zamanı 176.7±63.3 dakika (90 ile 410 dakika arası) olarak bulundu. Toplam kardiyopulmoner baypas (KPB) zamanı (114.3±27.7'ye karşı 126.9±42.1 dak, p=0.05), preoperatif kreatinin klirensi (81.0±31.5'e karşı 67.2±33.0 ml/dak, p=0.02), üre düzeyi (45.2±18.6'ya karşı 57.8±35.2 mg/dl, p=0.02), kreatinin düzeyi (1.01±0.25'e karşı 1.17±0.36 mg/dl, p=0.05) sağ kalan grup ile izlemde kaybedilen grup arasında istatistiksel olarak anlamlı düzeyde farklı bulundu. İkinci grupta transpulmoner gradiyent (TPG) diğer gruba göre anlamlı olarak daha yüksek bulundu (9.21±5.16'ya karşı 12.50±8.26 mmHg, p=0.02). Lojistik regresyon analizinde kreatinin klirensi (OR 0.989, %95 GA 0.973-1.005, p=0.044), preoperatif kreatinin düzeyi (OR 2.028, %95 GA 0.288-14.301, p=0.027), toplam KPB zamanı (OR 1.013, %95 GA 1.000-1.027, p=0.036), TPG’in (OR 1.113, %95 GA 0.992-1.249, p=0.045) mortalitenin bağımsız öngördürücüleri oldukları saptandı. Sonuç: Toplam KPB zamanı, TPG ve nakil öncesi böbrek fonksiyon bozukluğu kalp nakli sonrası mortaliteye yol açan preoperatif ve intraoperatif risk faktörleridir., Objective: We retrospectively analyzed case records to identify risk factors for mortality in heart transplant recipients in our center. Methods: Data of 123 patients (mean age 40.6±14 years and 97 male) transplanted from February 1998 to April 2009 were studied and analyzed. Pre- and intra-operative variables of the 73 patients who survived (Group 1, mean age 39.1±14.6, 58 male) and 50 patients who died (Group 2, mean age 42.6±12.9, 39 male) were compared. For statistical analysis Student t, Mann-Whitney U and Chi-square tests were used. Logistic regression analysis was used to determine independent risk factors for mortality and survival analysis was accomplished using Kaplan-Meier analysis. Results: Overall mortality in the entire population was 40.6% (50/123). Actuarial survival was 74%, 65%, 51% and 31% at 1, 2, 5 and 10 years respectively. Major causes of death after heart transplantation were infections (30%), right ventricular failure (18%), rejection (12%) and sudden cardiac death (12%). Total ischemic time was 176.7±63.3 minutes (range 90-410 minutes). The total cardiopulmonary by-pass (CPB) time (114.3±27.7 vs 126.9±42.1 min, p=0.05), pre-operative creatinine clearance (81.0±31.5 vs 67.2±33.0 ml/min, p=0.02), urea (45.2±18.6 vs 57.8±35.2 mg/dl, p=0.02), and creatinine (1.01±0.25 vs 1.17±0.36 mg/dl, p=0.05) were significantly different between survivors and non-survivors. Group 2 patients had higher transpulmonary gradient (TPG) (9.21±5.16 vs 12.50±8.26 mmHg, p=0.02) as compared with group 1 patients. Logistic regression analysis revealed that preoperative creatinine clearance (OR 0.989, 95% CI 0.973-1.005, p=0.044), creatinine level (OR 2.028, 95% CI 0.288-14.301, p=0.027), total CPB time (OR 1.013, 95% CI 1.000-1.027, p=0.036), and TPG (OR 1.113, 95% CI 0.992 1.249, p=0.045) were the independent predictors of mortality. Conclusion: Our data showed that TPG, total CPB time, pre-transplant renal dysfunction are pre-operative and intra-operative risk factors for mortality after heart transplantation.

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Amaç: Son yıllarda tedavi yöntemlerindeki gelişmelere rağmen kardiyovasküler mortalite ve morbiditenin en önemli nedeni akut kalp yetersizliğidir (AKY). Kalp yetersizliği nedeniyle hastaneye yatırılan hastalar sol ventrikül sistolik fonksiyonundan bağımsız olarak kısa dönem prognozu kötü olan yüksek riskli popülasyonu oluşturmaktadır. Kalp yetersizliği ile ilişkili mortalitenin önemli bir kısmı hastanedeki yatışlar sırasında gerçekleşmektedir. Bu çalışmada AKY hastalarında hastane içi mortalite ile ilişkili faktörler araştırılmıştır. Yöntemler: Çalışmaya Aralık 2005-Mart 2007 arasında ardışık 85 AKY (yaş ortalaması 64±8 yıl, %54’ü erkek) hastası alındı. Retrospektif olarak demografik, klinik, elektrokardiyografik ve ekokardiyografik özelliklerin ve laboratuvar bulgularının hastane içi mortaliteye etkisi değerlendirildi. Bulgular: Hastaların %24.7’si yeni başlayan kalp yetersizliği (KY) olarak değerlendirildi. Koroner arter hastalığı (%61) en sık altta yatan hastalıktı. Hastaların %44.7’sinde hipertansiyon, %37.6’sında diyabetes mellitüs, %21’inde kronik böbrek yetersizliği, %16.4’ünde kronik obstrüktif akciğer hastalığı mevcuttu. Ortalama sol ventrikül ejeksiyon fraksiyonu %35±7 idi. Hastane içi mortalite oranı %11.7 (10 hasta) olarak bulundu. Mortalitenin ana nedeni (%60) KY’nin kardiyojenik şoka ilerlemesiydi. Hastane içinde kaybedilen hastalar sağ kalanlarla klinik, demografik, laboratuvar ve elektrokardiyografik özellikleri ile sol ve sağ ventrikül fonksiyonları açısından karşılaştırıldığında kan üre azotu (45±20 mg/dl’ye karşılık 36±12 mg/dl, p=0.04), kreatinin (2.2±0.8 mg/dl’ye karşılık 1.1±0.5 mg/dl, p=0.001), QRS süresi (130±13 msn’ye karşılık 116±18 msn, p=0.04) anlamlı olarak daha yüksek olup, serum sodyumu daha düşük (128±5 mmol/l’ye karşılık 135±9 mmol/l, p=0.02) ve sistolik kan basıncı kaybedilen hastaların %50’sinde, Objective: Despite impressive advances in therapeutics in the last years, acute heart failure (AHF) remains a major cause of cardiovascular morbidity and mortality. Patients hospitalized because of heart failure (HF), irrespective of left ventricular systolic function, represent a high-risk population with limited short-term prognosis. A substantial component of HF-related mortality occurs during a hospital stay. In this study, we aimed to determine the factors impacting on in-hospital mortality in patients with AHF. Methods: During a 15-month period (December 2005-March 2007), 85 consecutive patients with (mean age: 64±8 years, male: 54%) an episode of AHF were included in this study. The effect of demographic, clinical, electrocardiographic, and echocardiographic characteristics, laboratory findings on in-hospital mortality were evaluated retrospectively. Results: Of 85 patients 24.7% of patients had new-onset HF. Coronary artery disease (61%) was the most common underlying disease. The 44.7% of patients had hypertension, 37.6% had diabetes mellitus, 21% had chronic renal failure and 16.4% had chronic obstructive pulmonary disease. Left ventricular ejection fraction was 35±7%. In-hospital mortality rate was found as 11.7% (10 patients).The major cause of mortality was the progression of HF to cardiogenic shock in 60% of deaths. In comparison with surviving patients in terms of the clinical, demographic, electrocardiographic, and laboratory characteristics and left and right ventricular functions, patients died during hospitalization had higher blood urea nitrogen (45±20 mg/dl vs. 36±12 mg/dl, p=0.04), higher creatinine level (2.2±0.8 mg/dl vs. 1.1±0.5 mg/dl, p=0.001), and wider QRS duration (130±13 ms vs. 116±18 ms, p=0.04) whereas they had lower plasma sodium level (128±5 mmol/l vs. 135±9 mmol/l, p=0.02) and systolic blood pressure (p=0.01). Logistic regression analysis revealed that plasma creatinine level (OR 1.5, 95% CI 1.2 to 2.1, p=0.01), blood urea nitrogen (OR 2.1, 95% CI 1.8 to 3.1, p=0.001), plasma sodium level (OR 1.3, 95% CI 1.1 to 1.7, p=0.02), and systolic blood pressure (OR 2.2, 95% CI 1.9 to 2.8, p=0.01) were the independent predictors of in-hospital mortality. Conclusion: In-hospital mortality increases in patients who had lower systolic blood pressure, lower plasma sodium level, and renal dysfunction on admission.

Akut ST segment yüksekliği olan miyokard infarktüsünde intravenöz trombolitik ajanlarla reperfüzyon tedavisi infarkt alanını sınırlandırmakta, ventrikül fonksiyonlarını korumakta ve dolayısıyla mortaliteyi azaltmaktadır. Deneysel ve klinik çalışmalar başarılı reperfüzyon zamanını, hayatta kalmanın önemli bir belirteci olarak göstermiştir. Bu yazıda çok erken (hastane öncesi) trombolizin önemi, perkütan girişimsel tedavi ile karşılaştırması ve Türkiye’deki uygulanabilirliği tartışılmaktadır. ST segment yüksekliği olan akut miyokard infarktüs hastalarında primer koroner girişimler önerilmesine rağmen hastane öncesinde intravenöz erken bolus trombolitik tedavi primer anjiyoplasti kadar iyi bir tedavi seçeneği olmaktadır. Hastane öncesi trombolitik tedavi için gerekli yasal ve teknik alt yapı tamamlanana kadar kardiyoloji merkezleri tedavi rehberleri ile kendi imkan ve tecrübelerine dayanarak en uygun reperfüzyon stratejisini uygulamak sorumluluğunda olmalıdır., Reperfusion therapy with intravenous thrombolytic agents in acute ST-segment elevation myocardial infarction reduces the infarct size, preserves ventricular function, and therefore reduces mortality. Experimental and clinical studies also showed that time to successful reperfusion is a critical determinant of survival. in this paper the importance of very early (pre-hospital) thrombolysis, its comparison with percutaneous interventional therapy and the feasibility in Turkey are discussed. Although primary coronary interventions are preferred in patients with ST-segment elevation myocardial infarction intravenous, early bolus thrombolysis in the pre-hospital stage provides a therapeutic option as good as primary angioplasty. Until necessary policy and technical substructure are completed cardiology centers should apply the most suitable reperfusion strategy according with the guidelines, feasibilities and their experience.

Amaç: Medikal ve cihazlı destek tedavilerindeki son gelişmelere rağmen UNOS 2 (United Network for Organ Sharing) statüsündeki son dönem kalp yetersizliği hastalarında tedavi stratejileri halen tartışmalıdır. Bu çalışmada, UNOS 2 son dönem kalp yetersizliği olan ve kalp nakli bekleme listesine alınan hastaların bekleme sürecindeki klinik durumları ve prognozları incelendi. Çalışma planı: Çalışmada UNOS 2 statüsünde olan ve kalp nakli programına alınan 78 hasta (62 erkek, 16 kadın; ort. yaş 43±12) incelendi. Nakil programına alındıktan sonra hastaların kalp yetersizliği nedeniyle hastaneye yatış sıklığı, bir üst UNOS sınıfına ilerleme, nakil yapılıp yapılmadığı ve mortalite oranları değerlendirildi. Bulgular: Hastaların listede bekleme süresi ortalama 17±10 ay idi. Kalp yetersizliği nedeniyle hastaneye yatış sıklığı 4±2/yıl bulundu. Yedi hastaya (%9) devamlı ventrikül taşikardisi nedeniyle kardioverter defibrilatör takıldı. Dokuz hastada (%11.5) UNOS 1B’ye ilerleme görüldü. On sekiz hastaya (%23.1) listede altı aylık bekleme süresinden sonra ortotopik kalp nakli uygulandı. Kalp nakli uygulanan hastalarda mortalite oranı %22.2 (4 hasta), bekleme listesinde olan hastalarda ise %25 (15 hasta) bulundu (p=0.03). Nakil listesindeyken kaybedilen hastaların 11’inde (%73.3) neden ani ölüm idi. Nakil uygulanan hastalarla izlemdeki hastalar sonlanım noktası olarak mortalite ve UNOS 1B’ye ilerleme açısından karşılaştırıldığında, nakil yapılmayan grupta oran anlamlı derecede daha yüksek idi (24 hasta, %40 ve 4 hasta, %22.2; p=0.01). Sonuç: UNOS 2 statüsündeki hastalarda ilerideki klinik kötüleşmelerin, sık kalp yetersizliği ataklarının ve kardiyak ölümlerin önlenmesi açısından kalp nakli uygun bir tedavi seçeneğidir., Objectives: Despite recent developments in medical treatments and assist device applications, management strategies for end-stage heart failure patients with UNOS status 2 (United Network for Organ Sharing) are still controversial. We evaluated the clinical condition and prognosis of end-stage heart failure patients with UNOS status 2, who were placed on the waiting list for heart transplantation. Study design: The study included 78 patients (62 men, 16 women; mean age 43±12 years) with UNOS status 2. The patients were assessed in terms of frequency of hospitalization during waiting for transplantation, shift to a higher level of UNOS status, transplantations performed, and mortality. Results: The mean duration of waiting on the list was 17±10 months. The frequency of hospitalization due to heart failure was 4±2/year. An implantable cardioverter defibrillator was used in seven patients (9%) for persistent ventricular tachycardia. Nine patients (11.5%) shifted to UNOS status 1B. Eighteen patients (23.1%) underwent orthotopic heart transplantation following six months of waiting on the list. Mortality rates were 25% (n=15) and 22.2% (n=4) for patients on the waiting list and for transplant patients at the end of the first year of transplantation, respectively (p=0.03). The main cause of mortality was sudden cardiac death (73.3%, n=11) for patients on the transplantation list. There was a significant difference in terms of combined end-point of mortality and shift to UNOS status 1B between transplanted (n=24, 40%) and untransplanted (n=4, 22.2%) patients (p=0.01). Conclusion: Heart transplantation is an appropriate alternative for preventing impending clinical deterioration, frequent attacks of heart failure, and cardiac deaths in patients with UNOS status 2.

B-tipi natriüretik peptid (brain natriüretik peptid), volüm ve basınç yüküne yanıt olarak kardiyak ventriküllerden salgılanan peptid yapısında bir nörohormondur. Son yıllarda yapılan çalışmalarda plazmada ölçülen BNP düzeyinin kardiyovasküler hastalıklarda özellikle de kalp yetersizliği ve akut koroner sendromun tanı ve tedavisinde önemli bir yeri olduğu ortaya konmuştur. Bu yazıda brain natriüretik peptidin fizyolojisi, kalp yetersizliği ve akut koroner sendromlarda tanı, tedavi ve prognoz aşamalarında kullanımı özetlenmiştir., Natriuretic peptide type B (brain natriuretic peptide, BNP) is a neurohormone released by cardiac ventricles in response to volume and pressure load. Recent studies have demonstrated that BNP level measured in the plasma plays an important role in cardiovascular diseases especially in the diagnosis and treatment of heart failure and acute coronary syndrome. This article summarizes the physiology of the brain natriuretic peptide, diagnosis of heart failure and acute coronary syndrome and use of BNP in the treatment and determining the prognosis of cardiovascular diseases.

Kalp naklini takiben gelişen koroner arter hastalığının (TxKAH) araştırılmasında pek çok invazif ve invazif olmayan teknik mevcuttur. Bu çalışmada kalp nakli alıcılarında, intravasküler ultrasonografi (İVUS) yönteminin koroner anjiyografi yöntemi ile karşılaştırıldığında vaskülopati yaygınlığını araştırmak ve İVUS ölçümleri aracılığıyla hücresel doku reddi sıklığı ile intimal koroner kalınlaşma arasındaki ilişkiyi tanımlamak amaçlandı. Bu çalışma Türkiye'de gerçekleştirilen ilk deneyimdir. TxKAH yaygınlığını İVUS ile incelemek için 18 kalp nakli alıcısı 22±12 ay takip sonunda çalışmaya alındı. Tüm hastalarda dobutamin stres ekokardiyografi (DES) ve koroner anjiyografi uygulandı. Koroner anjiyografik olarak %50 üzerinde ki darlık ve İVUS ile saptanılan >0.5 mm intimal kalınlaşma TxKAH olarak tanımlandı. Biyopsi skoru, her histolojik derecelendirmenin rakamsal olarak ortalama değerinin toplam biyopsi sayısına bölünmesiyle elde edildi. Hastalar ayrıca İVUS verilerine göre iki grupta incelendi. Grup I TxKAH saptanılan 8 hastadan ve grup II TxKAH'ı olmayan 10 hastadan oluşmakta idi. Koroner anjiyografik olarak TxKAH %5.5 hastada gözlemlenirken bu oran İVUS ile %44 oranında idi. Tüm hastalarda DES normal idi. Ultrasonografik olarak koroner damarın duvar değişimi vericilerin yaşı ile korelasyon gösterirken (r=0.42, p=0.02), perioperatif iskemi ve koroner arter hastalığının diğer risk fakörleri ile ilişkisi yoktu (p>0.05). İntimal kalınlaşma sol anteriyor desending arter (LAD) segmentlerinde diğer arterlere göre daha fazla izlendi (p, There are several invasive and noninvasive techniques investigating the development of coronary artey disease following heart transplantation (TxCAD). This study attempts to investigate the extent of vasculopathy in heart transplant recipients by using intravascular ultrasonography (IVUS) compared to coronary angiography and to define the relationship between the rate of cellular rejection and intimal coronary thickness which is measured by IVUS. Our study is the first experience in Turkey. To investigate the extent of TxCAD, 18 heart transplant recipients were studied for 22±12 months after transplantation with intravascular ultrasound (IVUS). Dobutamine stress echocardiography (DES) and coronary angiography were performed in all patients. Coronary angiographically narrowing of more than 50% and intimal wall thickness >0.5mm detected by IVUS were defined as TxCAD. Biopsy score was considered as the average numerical value assigned to each grade of rejection divided by the total number of biopsies. According to the IVUS findings the patients were evaluated in two groups. There were 8 patients with TxCAD in group I, and group II consisted of 10 patients without TxCAD. The TxCAD was shown in 5.5% patients angiographically whereas this rate was 44% by IVUS. The results of DES were normal in all patients. The extent of coronary vessel wall alterations on ultrasound correlated with donor age (r=0.42, p=0.02) , but not with perioperative ischemia time and other coronary artery risk factor s (p>0.05). The intimal thickening was more pronounced in segments of the LAD than the other arteries (p

Amaç: Bu çalışmada, kararlı anjina pektoris tanımlayan ve efor testi pozitif bulunan ayaktan hastalardaki serum C-reaktif protein (CRP) düzeyiyle koroner arter hastalığının (KAH) sıklığı ve tedavi seçimi arasındaki ilişkiyi araştırdık. Yöntem: Kararlı anjinası olan ve efor testi pozitif bulunan 134 hasta çalışmaya alındı. Tüm hastalar CRP düzeylerine göre iki gruba ayrıldılar. Birinci grup (Grup 1I), CRP düzeyi >0.50 mg/dl (yüksek CRP düzeyi) olan ve ortalama yaşları 57.8±10.3 yıl olan 41 hastadan oluşmaktaydı. İkinci grupta (Grup 2) ise CRP düzeyi, Objective: In this study we aimed to investigate whether serum C- reactive protein (CRP) levels are related with the incidence of coronary artery disease (CAD) and selection of management approaches in stable angina pectoris (SAP). Methods: Overall 134 patients (pts) with SAP and positive exercise stress test were investigated. All pts were divided into two groups according to the baseline levels of CRP. In group 1 (mean age 57.8±10.3 years) there were 41 pts with the level of CRP >0.50mg/dl (high levels of CRP) and group 2 consisted of 93 pts (mean age 56.0±11.7 years) with the CRP levels