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    Comparison of subclinical neuronal injury by measuring neuron-specific enolase in patients with severe aortic stenosis treated with transcatheter aortic valve replacement or sutureless aortic valve replacement
    (2021) Yilmaz, Ahmet Seyda; Kahraman, Fatih; Erkan, Hakan; Korkmaz, Levent; Akyuz, Ali Rıza
    Aim: Severe aortic valve stenosis (SAVS) which causes angina pectoris, syncope, arrhythmias, and sudden cardiac death, may be treated with transcatheter aortic valve replacement (TAVR) or sutureless aortic valve replacement (SU-AVR). We aimed to predict subclinical neuronal injury (SNI) by measuring neuron-specific enolase (NSE) in patients who underwent the TAVR and the SU-AVR.Materials and Methods: This clinical trial was carried out between January 2015 and January 2017. A total of 53 patients who had severe aortic valve stenosis (SAVS) and underwent TAVR and SU-AVR were included. The Serum NSE level was measured just before and 24 hours after the procedure. Demographic variables, neurologic assessment findings, clinical and echocardiographic data, carotid ultrasounds reports, and laboratory findings were recorded.Results: A total of 53 patients were included the study. The mean age was 78.4±8.6 and 20 were man (37.7%). The mean age of the TAVR group was significantly higher than the SU-AVR group (82.9±4.7 vs 71.5±8.7, p0.001). The NSE level was significantly higher in the SUAVR group compared to the TAVR group after the procedure (21.15±10.25 vs 35.32±12.64, p0.001). Differences between before and after the procedure the National Institutes of Health Stroke Scale (NIHSS), demographic and echocardiographic variables were similar between the two groups.Conclusion: Serum NSE level was significantly higher in the SU-AVR group than the TAVR group Therefore, we may consider the SNI rate is higher as well. In patients who are at higher risk for neurological damage or have neurologic disease, TAVR may be a better treatment option instead of SUAVR.
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    Rationale, Design, and Methodology of the MORCOR-TURK Trial: Predictors of In-hospital MORtality in CORonary Care Patients in Turkey
    (Kare Publ, 2023) Kahraman, Fatih; Ersoy, Ibrahim; Yilmaz, Ahmet Seyda; Atici, Adem; Tekin, Alpin Mert; Acar, Burak; Kaya, Caglar
    Background: Coronary care units are sophisticated clinics established to reduce deaths due to acute cardiovascular events. Current data on coronary care unit mortality rates and predictors of mortality in Turkey are very limited. The MORtality predictors in CORonary care units in TURKey (MORCOR-TURK) trial was designed to provide information on the mortality rates and predictors in patients followed in coronary care units in Turkey. Methods: The MORCOR-TURK trial will be a national, observational, multicenter, and noninterventional study conducted in Turkey. The study population will include coronary care unit patients from 50 centers selected from all regions in Turkey. All consecutive patients admitted to coronary care units with cardiovascular diagnoses between 1 and 30 September 2022 will be prospectively enrolled. All data will be collected at one point in time, and the current clinical practice will be evaluated (ClinicalTrials.gov number NCT05296694). In the first step of the study, admission diagnoses, demographic characteristics, basic clinical and laboratory data, and in-hospital management will be assessed. At the end of the first step, the predictors and rates of in-hospital mortality will be documented. The second step will be in cohort design, and discharged patients will be followed up till 1 year. Predictors of short- and long-term mortality will be assessed. Moreover, a new coronary care unit mortality score will be generated with data acquired from this cohort. Results: The short-term outcomes of the study are planned to be shared by early 2023. Conclusion: The MORCOR-TURK trial will be the largest and most comprehensive study in Turkey evaluating the rates and predictors of in-hospital mortality of patients admitted to coronary care units.
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    Relation of apolipoprotein E gene polymorphism with the severity of coronary artery disease in patients with stable ischemic heart disease
    (2021) Yilmaz, Ahmet Seyda; Duman, Hakan; Citli, Senol; Gurbak, Ismail; Kahraman, Fatih
    Aim: Atherosclerosis begins from an early age and manifests in later years as Coronary artery disease (CAD). This inflammatory process is aggravated by age, smoking, hypercholesterolemia, hypertension, diabetes mellitus, and genetic factors. We aimed to investigate which isoform of APOE is related to extensive coronary lesions in patients with stable coronary heart disease.Materials and Methods: This study was carried on single center. One hundred and ten patients diagnosed with stable coronary artery disease by coronary angiogram were enrolled consecutively. Syntax score was calculated by a tool of website calculator (www.syntax.com). According to the Syntax score, patients were split into three groups. APOE genotyping was performed through blood samples. Patients split into three groups according to the APOE genotypes: E4 (3/4 and 4/4 genotypes), E3(3/3 genotype), E2 (2/2 and 2/3 genotypes). APOE groups were compared according to baseline characteristics and syntax scores.Results: Coronary angiography and APOE genotypes of 98 patients were analyzed. 81 of patients (%82.6) had E3E3 allele; 6 of patients (%6.1) had E2E3 allele; 10 patients (%10.2) had E3E4 allele and 1 patient (%1) had E2E4 allele. Due to the contrast effect of E2 and E4 on CAD, we excluded patients with E2E4 allele from the study. Firstly, we assessed distribution of APOE genotype E2 (E2E3), E3 (E3E3 and E3E4), E4 (E3E4) within 3 groups of syntax scores. Total of 6 patients of E2 allele was at low syntax score group. 83 patients of E3 allele were at the low-risk group of syntax score. 10 patients of E3 allele were at the mid group and 4 patients were at the high-risk group of syntax score. 7 patients of E4 allele subjects were at the low-risk and 1 patient was at the high-risk group of syntax score. Compared to syntax score groups and APOE genotypes, E2 alleles were in lower syntax score group versus E3 (P=0.046) and E4 (P=0.003) alleles. However E4 alleles were in higher syntax score group versus E3 alleles (P= 0.034). The Syntax score was seemed to be lower in the E2 allele group versus E4 and E2 groups (P=0.013).Conclusion: we reported the first study that E2 allele was related with less and E4 allele was more extensity and severity of CAD in patients with stable ischemic coronary disease.