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Amaç Ayak bileği-kol basınç indeksi (AKİ), noninvaziv ve ucuz bir metod olup yaşlı popülasyonda periferik arter hastalığının (PAH) tanımlanması için kullanılır. PAH’nın bir göstergesi olarak AKİ, koroner arter hastalığını (KAH) tahmin etmek için yaygın bir şekilde kullanılmaktadır. Eritrosit dağılım genişliği (EDG) dolaşımdaki eritrositlerin boyutlarındaki değişkenliğin bir ölçüsüdür. EDG’deki artışlar hem kararlı hem de kararsız haldeki KAH ile ilişkilidir. Bu çalışmada, kararlı anjina pektoris (KAP) hastalarında EDG ve AKİ belirteçlerinin SYNTAX skoru (SS) kullanılarak koroner lezyon şiddeti üzerine prediktif bilgi sağlayıp sağlayamayacağını araştırmayı amaçladık. Sakarya Tıp Dergisi, 2018, 8(2):311-319 ) Gereç ve Yöntem Çalışmaya 109 KAP hastası dahil edildi. Hastalar önce 40 hasta normal koroner arterler ve 69 hasta KAH grubuna ayrılarak değerlendirildi. Sonrasında KAH hasta grubu, KAH şiddetini anjiyografi k olarak derecelendiren SS’na göre iki ayrı alt gruba (SS 1-22 (n=32) ve SS >22 (n=37) ayrılarak incelendi. p22 (n=37)) according to the SS that rated CAD severity as angiography. p

Hamidi, Mehmet (Balikesir Author), Objective: This study aimed to determine the differences in terms of demographic characteristics and preferred stroke prevention strategies for patients with non-valvular atrial fibrillation living in seven geographical regions of Turkey.Methods: In total, 6273 patients were enrolled to this prospective, observational RAMSES study. The patients were divided into seven groups based on the geographical region of residence.Results: In terms of the geographical distribution of the overall Turkish population, the highest number of patients were enrolled from Marmara (1677, 26.7%). All demographic characteristics were significantly different among regions. Preferred oral anticoagulants (OACs) also differed between geographical regions; non-vitamin K OACs were preceded by warfarin in East Anatolia, Aegean, Southeast Anatolia, and Black Sea. Nearly one-third of the patients (28%) did not receive any OAC therapy. However, the number of patients not receiving any OAC therapy was higher in Southeast Anatolia (51.1%) and East Anatolia (46.8%) compared with other geographical regions of Turkey. Inappropriate use of OACs was also more common in East and Southeast Anatolia.Conclusion: This study was the first to show that the demographic differences among the geographical regions may result in different preferences of stroke prevention strategies in Turkey. OACs are still under- or inappropriately utilized, particularly in the eastern provinces of Turkey.

WOS: 000402283900004, PubMed ID: 28407216, BackgroundThe 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. MethodsWe 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. ResultsA 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 CHA(2)DS(2)VASc and HAS-BLED scores compared to those without RI (39 15 vs. 29 +/- 15, and 20 +/- 1 vs. 14 +/- 1; P < 0001). Prior history of major bleeding (69% vs. 41%, P < 0001) and stroke (162% vs. 118%, P < 0001) 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 (301 vs. 264%, P = 0003). ConclusionRAMSES 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.

WOS: 000394997800003, PubMed ID: 27848065, 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 CHA(2)DS(2)VASc [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 CHA(2)DS(2)VASc 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.

Koroner arter delinmesi (KAD), perkütan koroner girişimlerin nadir fakat ölümcül bir komplikasyondur. Bu komplikasyon uzatılmış balon dilatasyonu, koroner stent-greft ve baypas cerrahisi gibi bazı tedavi seçeneklerine sahiptir. Bu olguda, altmış beş yaşında kadın hasta akut koroner sendrom tanısıyla kateter laboratuvarına alındı. Koroner anjiyografide sağ koroner arterin orta bölümünde tam bir tıkanıklık vardı ve buraya bir ilaç kaplı stent, perfüzyon balonu ile öndilatasyonun ardından 12 atmosfer (atm) basınç altında yerleştirildi. Proksimal stent bölgesine kayan trombüsün parçalanmasını sağlamak için stent balonu ile post-dilatasyon yapıldı (4-6 atm). Post-dilatasyon sonrası Ellis Sınıf II delinme gelişti. Kanama kontrolünü sağlamak amacıyla koroner stent-greft delinme bölgesine yerleştirildi. Yırtık kapatıldı. Kırk gün sonraki kontrol koroner anjiyografisinde stent-greft açıktı, fakat sağ ventriküle boşalan bir arteriyo-venöz fistül (AVF) görüldü. Bildiğimiz kadarıyla, bu olgu stent-greft ile tedavi edilmiş KAD'nin geç dönem komplikasyonu olarak AVF'nin görüldüğü ilk olgudur. – Coronary artery perforation (CAP) is a rare, but potentially mortal possible complication of percutaneous coronary intervention. There are several treatment options for this complication, including prolonged balloon dilatation, use of a coronary stent graft, and bypass surgery. In this case report, a 65-year-old female patient who was admitted to the catheter laboratory with a diagnosis of acute coronary syndrome, was presented. Coronary angiography revealed total occlusion in the mid segment of the right coronary artery and a drug-eluting stent was implanted under 12 atm of pressure following pre-dilatation with a perfusion balloon. In order to perform defragmentation of the thrombus shifted into the proximal stent segment, post-dilatation was performed with a stent balloon (4–6 atm). After post-dilatation, an Ellis Class II perforation developed. In order to control the bleeding, a coronary stent graft was implanted at the perforation area. The rupture was sealed. Control coronary angiography 40 days later indicated that the stent graft was patent, but an arteriovenous fistula (AVF) draining to the right ventricle was detected. To the best of our knowledge, this is the first case of AVF seen as a late complication of CAP treated with a stent graft

WOS: 000375095000005 PubMed ID: 27138310 Objective: Atrial fibrillation is the most common arrhythmia and is associated with a five-fold increased risk of thromboembolic events. Vitamin K antagonists (VKAs) have been the mainstay of oral anticoagulant prophylaxis and the data on stroke prevention strategies are limited to VKA era. The purpose of this study is to evaluate the use of VKA, non-Vitamin K antagonist oral anticoagulants (NOAC), and antiplatelet agents in patients with non-valvular atrial fibrillation (NVAF). Methods: The ReAl-life Multicenter Survey Evaluating Stroke prevention strategies in Turkey (RAMSES) is an observational, multicenter, prospective study of patients with NVAF. The study targeted enrollment of 7835 patients from 68 sites in Turkey. All the data will be collected at one point in time and current clinical practice will be evaluated. (ClinicalTrials.gov number NCT02344901). Results: Baseline characteristics of patients, antithrombotic therapies, transition to NOACs and rate/rhythm control strategies will be evaluated. Conclusion: The RAMSES registry will be the largest study in Turkish NVAF patients. The study will provide insights into real-world problems and anticoagulant treatment in patients with NVAF.

Amaç: Bu çalışmada, ciddi kapak işlev bozukluğu olmayan tek başına biküspit aort kapağı (BAK) bulunan hastalarda sol atriyum (SA) mekanik işlevlerini ve atriyal ileti zamanlarını (AİZ) değerlendirdik, ayrıca SA işlevleri ve aort esneklik parametreleri arasındaki ilişkiyi araştırdık.Yöntemler: Çalışma popülasyonumuz tek başına BAK bulunan 34 hasta (ortalama yaş 34±13 yıl) ile yaş ve cinsiyet açısından uyumlu 29 sağlıklı gönüllüden (ortalama yaş 30±10 yıl) oluşmaktaydı. Sol atriyum hacimleri iki düzlemli alan uzunluk yöntemi kullanılarak ölçüldü. Ayrıca SA aktif, pasif boşalma hacimleri ve fraksiyonları hesaplandı. Atriyum içi ve atriyumlar arası AİZ'ler doku Doppler görüntüleme kullanılarak ölçüldü. Aort gerilimi, aort sertlik indeksi, aort gerilebilirliği ve aort esneklik katsayısı gibi aort esneklik parametreleri hesaplandı.Bulgular: Sol atriyum çapı, en yüksek hacmi, atriyum sistolü öncesi hacmi ve SA aktif boşalma fraksiyonu BAK hasta grubunda anlamlı olarak yüksekti (sırasıyla, 33.2±3.2 mm ve 34.9±2.8 mm, p=0.030; 16.2±4.6 mL/m2 ve 19.8±4.8 mL/m2, p=0.004; 10.2±3.7 mL/m ve 12.1±4.9 mL/m2, p=0.029; %30.4±12.0 ve %39.9±11.8, p=0.003). Atriyal ileti zamanları her iki grup arasında benzerdi. Biküspit aort kapağı hasta grubunda; aort gerilebilirliği anlamlı olarak düşükken, aort sertlik indeksi ve aort esneklik katsayısı anlamlı olarak yüksekti (sırasıyla, 8.1±4.6 [10-6cm2dyn-1] ve 5.1±3.6 [10-6cm2dyn-1], p=0.006; 4.1±2.8 ve 7.3±4.9, p=0.003; 3.6±2.8 [dyn.cm-2106] vs 5.9±3.9 [dyn.cm-2106], p=0.010). Korelasyon analizinde SA aktif boşalma fraksiyonu, aort sertlik indeksi ve mitral A dalga hızı ile anlamlı derecede ilişkiliydi (sırasıyla, r=0.431; p

Objective: Cardiac syndrome X (CSX) is characterised by typical exertional chest pain, a positive response to exercise testing, and a normal coronary angiography. The relationship of CSX with myocardial fibrosis and ischemia has been clearly demonstrated in previous studies. In ad-dition, fragmented QRS (fQRS) has been reported in the literature as an indicator of myocardial fibrosis. The aim of this study was to investigate the frequency of fQRS in patients with CSX.Methods: This prospective case-control study included 37 patients (CSX group) with typical complaints of angina, ischemia on an exercise test, and normal coronary arteries as detected by angiography and 47 patients (control group) with normal coronary arteries. Echocardiographic examinations were performed according to the recommendations of the American Society of Echocardiography. Continuous variables were expressed as mean±standard deviation (SD), and the qualitative variables were expressed as a percentage or ratio. Data were compared sta-tistically with Shapiro–Wilk test, Student’s t-test, Mann-Whitney U, chi-square and Fisher exact test.Results: There was no significant difference between the CRX and control groups with respect to basic characteristics such as age and sex. fQRS and the frequency of its presentation with stable angina pectoris at the clinic were significantly higher in the CSX group than in the control group (p values: 0.001 and

Aims: In this study, we aim to evaluate the left atrial global longitudinal strain (LAGLS), total atrial conduction time (TACT) and left ventricle (LV) functions in recently diagnosed pulmonary sarcoidosis (PS) patients. Method: Fifty recently diagnosed PS patients (group 1) and a control group of 50 healthy individuals (group 2) were evaluated in the study. Two-dimensional echocardiography images were obtained from LV apical 4-chamber (4C), long-axis (L) and 2-chamber (2C) views. Peak longitudinal strain and strain rate (SR) were obtained from 4C, L and 2C views. Mean values of the three views were calculated. LV global longitudinal strain and LV-SR torsion were determined as the net differences in the mean rotation between the apical and basal levels. LAGLS and TACT values were calculated. Results: The study found that LAGLS was significantly lower in group 1 than in group 2 (P < 0.05). TACT was also significantly longer in group 1 than in group 2 (respectively group 1: 111.6 ± 15.1 ms; group 2: 103.4 ± 5.8 ms, P < 0.001). There was a significant moderate negative correlation between LAGLS and TACT (r = −0.36, P < 0.05). Patients with sarcoidosis had significantly lower LV longitudinal strain and SR measurements than the control group. Although LV basal rotation (LVR) values were similar in both groups, LVR-apical and LV-torsion (LVTR) values were significantly higher in the patient group (group 1). Conclusion: The identification of left atrial and left ventricular myocardial deformation using speckle tracking echocardiography in patients with PS allows subclinical LV dysfunction and subclinical electrophysiologic changes to be detected earlier.

Aims: Chronic obstructive pulmonary disease (COPD) has been associated with a high frequency of cardiac arrhythmia. While many studies have examined the development of atrial fibrillation (AF) in COPD patients, there is insufficient data about atrial conduction time (ACT) and its relationship with the Neutrophil to Lymphocyte ratio (NLR) in these patients. The aim of the present study was to evaluate atrial conduction features and its relationship with NLR. Materials and methods: The study groups comprised 40 patients with COPD and 40 healthy subjects, who were subjected to pulmonary function tests, 12-lead surface electrocardiograms, echocardiographic examinations and blood sample tests. ACT was measured through tissue Doppler imaging, while NLR was measured by dividing the neutrophil count by the lymphocyte count. Results: Pulmonary function values were significantly lower in COPD patients than in the control group, as would be expected (p

Tez (Yüksek Lisans) -- İstanbul Teknik Üniversitesi, Fen Bilimleri Enstitüsü, 2005, Thesis (M.Sc.) -- İstanbul Technical University, Institute of Science and Technology, 2005, Bu çalışmada, e-devlet projesinin başarılı bir şekilde uygulanabilmesi için gereken anahtar süreçler tanımlanmıştır. Her süreç kendi içinde alt süreçler de içermektedir. Toplam Kalite Yönetimi anlayışının temel prensiplerinin ışığında bahsi geçen süreçler için kalite parametreleri tanımlanmış ve bu parametrelerin uygulanabilmesi için neler yapılması gerektiği incelenmiştir. Farklı ülkelerin e-devlet projesine yaklaşımı ve Türkiye’nin geldiği nokta karşılaştırılarak, elde edilen verilerle güvenilir bir proje oluşturulabilmesi için Kovan Modeli adında bir güvenlik modeli tanımlanmıştır. Model bu konuda uzman kuruluşların kılavuz niteliğindeki çalışmalarının sentezi üzerine kurulmuştur. Bu konuda oldukça başarılı bir proje geliştiren Singapur hükümetinin çalışmaları incelenmiş, bilgi toplumu kavramına yaklaşım ve altyapı çalışmaları açısından Türkiye’ nin daha fazla araştırma ve geliştirme çalışmalarına yer vermesi gerektiği, daha etkin ve yetkili bir e-devlet kurumuna ihtiyacı olduğu gözlenmiştir., In this study the key processes to make the e-gov projects more effective are defined. Also the sub-processes are obtained for every key process. Total Quality Management concepts leaded to define the quality parameters for the pre-defined processes and to make sure what should be done for increasing the appliability of those parameters. The differences between the approaches to the e-government of several countries including Turkey are used to obtain the elements of the security model called Hive Model. The model is based on the synthesis of the studies of organizations working on security subjects related to information systems. Also the works of Singapur government are studied and it is understood that Turkey needs to make more research and develelopment studies. Turkey also needs increasing the power of the organization that will lead to the e-governmet studies and prepare the necessary infrastructure to spread the Information Community concept over the country by using the project., Yüksek Lisans, M.Sc.

Amaç: Koroner arter hastalığı (KAH) tüm dünyada olduğu gibi ülkemizde de mortalite ve morbiditenin başta gelen nedenleri arasında yer almaktadır. Hastaların çoğunda klinik bulgular görülmeye başladığında artık son organ hasarları gerçekleşmiş olmaktadır. KAH'ın önemli bir bölümü ateroskleroz zemininde gelişir. Ateroskleroza bağlı hastalıklar henüz ortaya çıkmadan, subklinik ateroskleroz yaşamın erken dönemlerinde başlar ve yaşam boyu devam eder. Aterosklerozun subklinik evrede tespit edilmesi ile uygulanabilecek yaşam şekli değişikliği ve medikal tedavi gibi yaklaşımlarla hastalığın seyri yavaşlatılabilir ve hastalar yaşamlarını sağlıklı bir şekilde sürdürebilirler. Biz çalışmamızda aterosklerozun erken dönemde tespit edilmesi ve son organ hasarının önlenebilmesi için yeni, invaziv olmayan ve kolay uygulanabilir bir metod olan aortik akım ilerleme hızı (AAİH) ve ayak bileği-kol basınç indeksi (AKBİ) ile KAH kompleksitesi arasındaki ilişkiyi değerlendirmeyi amaçladık.Çalışma planı: Çalışmaya Gaziosmanpaşa Üniversite Hastanesi Kardiyoloji polikliniğine kararlı anjina pektoris kliniği ile başvuran, koroner anjiyografi yapılma kararı alınan 38'i kadın, 52'si erkek olmak üzere toplam 90 hasta alındı. Çalışmaya alınan hastaların, koroner anjiyografiye hazırlık aşamasında KAH açısından risk faktörleri sorgulandı, rutin biyokimyasal ve hematolojik test sonuçları, rutin ekokardiyografi ölçümleri, AAİH ve AKBİ değerleri tespit edildi. Hastaların bağımsız uzmanlar tarafınca femoral arter yoluyla judkins yöntemi kullanılarak koroner anjiyografileri yapıldı. Daha sonra hastalar KAH ciddiyetine göre üç gruba ayrıldı. Birinci grup %50 ve üzeri koroner arter darlığı mevcut olan 40 hastadan, ikinci grup KAH olan ancak koroner arter darlığı %50 altında olan 24 hastadan, üçüncü grup ise normal koroner arter çıkan 26 hastadan oluşturuldu. Üç grubun demografik özellikleri, kan basıncı, ekokardiyografi, laboratuvar, AKBİ, AAİH verileri ve birinci gruptaki hastaların SYNTAX (SYNergy between PCI with TAXUS and Cardiac Surgery) skoru hesaplanarak grup içindeki hastaların AAİH ve AKBİ değerlerinin SYNTAX skoru ile olan ilişkisi karşılaştırıldı.Bulgular: Çalışmamızda gruplar arasında AAİH değeri grup 1'de 55.2±7.4 cm/sn, grup 2'de 69.2±6 cm/sn, grup 3'te 77.2±5.4 cm/sn olup, KAH ciddiyeti arttıkça AAİH değerinin düştüğü görüldü (p