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Öğe Can the Glasgow prognostic score predict ischemic stroke in patients with infective endocarditis?(Assoc Medica Brasileira, 2024) Aydin, Cihan; Demirkiran, Aykut; Aykac, Huseyin; Uslu, Nurullah; Alpsoy, SerefOBJECTIVE: The Glasgow prognosis score is a simple parameter calculated using serum levels of albumin and C-reactive protein. The aim of this study was to examine whether this parameter may predict ischemic stroke in patients with infective endocarditis. METHODS: A total of 80 patients who were diagnosed with definitive infective endocarditis according to Duke criteria between 2016 and 2023 were included in the study. Glasgow prognosis score was based on serum levels of albumin and C-reactive protein. In imaging methods, patients were divided into two groups according to whether they had a stroke or not. These two groups were compared in terms of biochemical parameters, and infective endocarditis findings on echocardiography and Glasgow prognosis score. RESULTS: We found that the results were statistically similar except for serum C-reactive protein (Group 1: 54.9 +/- 71.1 and Group 2: 39 +/- 70.7; p=0.03), neutrophil (Group 1: 19.8 +/- 10.8*10(9)/L and Group 2: 13.3 +/- 7.3*109/L; p=0.014), albumin (Group 1: 2.3 +/- 0.6 and Group 2: 2.8 +/- 0.5; p=0.03), and Glasgow prognosis score (Group 1: median 2, min.-max. (1-2) and Group 2: median 1, min.-max. (0-1); p=0.004). In the receiver operating characteristics analysis, Glasgow prognosis score had 82.4% sensitivity and 58.3% specificity in predicting ischemic stroke if the Glasgow prognosis score cutoff was >= 1. In multivariate logistic regression analysis, chronic renal failure [odds ratio (OR): 1.098; 95% confidence interval: 1.054-1.964; p=0.044], age (OR: 1.050; 95%CI 1.006-1.096; p=0.024), and Glasgow prognosis score (OR: 0.695; 95%CI 0.411-0.949; p=0.035) were independent variables in predicting ischemic stroke. CONCLUSION: High Glasgow prognosis score is an independent predictor of ischemic stroke in patients with infective endocarditis. Glasgow prognosis score, determined using albumin and C-reactive protein levels, is a simple and practical index for predicting the prognosis of patients hospitalized with infective endocarditis.Öğe Cerebral emboli as the predictor of mortality in patients with ‘definite’ infective endocarditis(2021) Gür, Demet Özkaramanlı; Uslu, Nurullah; Akyüz, Aydın; Alpsoy, Seref; Gür, Özcan; Doğan, Mustafa; Dınckal, Mustafa HakanInfective endocarditis (IE) is among the most fatal infectious diseases. Since the introduction of various intracardiac devices and interventions, the clinical aspects of IE have rapidly evolved. In this paper, we aim to define the contemporary characteristics of patients diagnosed with definite IE and to identify the predictors associated with mortality. Through retrospective analysis of patients with TEE proven vegetation, those fulfilling the modified Duke criteria for definite IE were identified. Patient characteristics in relation to clinical outcomes and mortality were analyzed. Out of 50 patients (mean age 57±15.9 years, 34% female), 72% was native-valve endocarditis of which only 32% had a predisposing valve disease such as rheumatic valve. The rate of prosthetic-valve IE was 10% and that of device-related IE was 18%. The most common causative organisms were S. aureus (16%), Coagulase-negative Staphylococci (16%), Enterococci (14%) and Viridans streptococci (12%). In-hospital mortality was 24% and was associated with concomitant diabetes, coronary artery disease, higher baseline creatinine, anemia, occurrence of cranial complications and absence of surgery during the index hospitalization. Regression analyses revealed that cerebral emboli were the only predictor of early mortality, possibly through delayed surgical treatment. In conclusion, our small cohort of definite IE patients showed that contemporary characteristics of IE has evolved with higher rates of device-related IE. Within established prognostic factors, cerebral emboli and timing of surgery are intervening factors, which suggests that the timing of surgical treatment, particularly in patients with neurologic complications, needs to be evaluated when shaping future perspectives on IE.Öğe NATRIURETIC PEPTIDE CONCENTRATIONS AND ECHOCARDIOGRAPHY FINDINGS IN PATIENTS WITH MICRO-ATRIAL FIBRILLATION(Russian Heart Failure Soc, 2024) Aykac, Huseyin; Aydin, Cihan; Demirkiran, Aykut; Uslu, Nurullah; Alpsoy, SerefAim Atrial fibrillation (AF) is a rhythm disorder characterized by very rapid and disorganized atrial-derived electrical activations with uncoordinated atrial contractions. Very short periods of AF-like activity (micro-AF) may be precursors of undetected, silent episodes of atrial fibrillation. Here, we examined the relationship between natriuretic peptide concentrations and echocardiography findings in patients with micro-AF. Material and methods The electrocardiograms (ECGs) of patients complaining of palpitations were recorded with a 24-hour Holter monitor, and the patients were consecutively included in the study. Micro-AF was defined as sudden, irregular atrial tachycardia lasting less than 30 sec with episodes of >= 5 consecutive supraventricular depolarizations with the absolute absence of p-waves. After a G-power test, patients were consecutively included in the study: 45 patients in the micro-AF group and 45 patients in the control group. Laboratory parameters, ECG and echocardiographic findings of the two groups were compared. Results N-terminal pro B-type natriuretic peptide (Pro-BNP) and serum troponin T concentrations were higher in the micro-AF group, (375.5 +/- 63.6 pg / ml vs. 63.1 +/- 56.8 pg / ml, p<0.001; 13 +/- 11.4 ng / dl vs. 4.4 +/- 2.4 ng / dl, p<0.001 respectively.) Each 1 pg / ml increase in serum Pro-BNP increased the risk of micro-AF by 1.8 %. In the ROC analysis, the cut-off value of Pro-BNP for the diagnosis of micro-AF was 63.4 pg / ml, with a sensitivity of 91.1 % and a specificity of 73.3 %. Atrial electro-mechanical delay durations were significantly higher in the micro-AF group. To predict micro-AF, the inter-annulus plane electromechanical delay time (inter-annulus plane AEMD) had a cut-off value of 18.5 sec, with a sensitivity of 93.3 % and a specificity of 91.1 %. Left intra-annulus plane electro-mechanical delay time (intra-annulus AEMD LEFT) had a cut-off value of 11.5 sec with a 95.6 % sensitivity and 75.6 % specificity. In the ECG evaluation, maximum P wave duration (Pmax) (113.+/- 10.2 ms vs. 98 +/- 10.4 ms; p<0.001), minimum P wave duration (Pmin) (73.8 +/- 5.5 ms vs.70 +/- 6.3 ms; p<0.001) and P wave dispersion (PWD) (39.1 +/- 7.9 ms vs.28 +/- 7.6 ms; p<0.001) were longer in the micro-AF group. Conclusions Micro-AF in patients may be predicted by evaluating ECG, echocardiographic, and serum natriuretic peptide data.Öğe Systemic Immune-Inflammatory Index as a Determinant of Atherosclerotic Burden and High-Risk Patients with Acute Coronary Syndromes(Arquivos Brasileiros Cardiologia, 2022) Gür, Demet Özkaramanlı; Efe, Muhammet Mucip; Alpsoy, Şeref; Akyüz, Aydın; Uslu, Nurullah; Çelikkol, Aliye; Gür, ÖzcanBackground: Systemic immune-inflammatory index (SII), which is derived from neutrophil, platelet and lymphocyte counts, represents the homeostatic balance among inflammatory, immune and thrombotic status. The systemic immune-inflammatory index is superior to indices such as neutrophil-lymphocyte ratio in predicting prognosis in various malignancies, while it is shown to predict future cardiac events better than traditional risk factors after coronary intervention. Objectives: Herein, we aimed to evaluate the relationship of the systemic immune-inflammatory index with atherosclerotic burden and in-hospital complications in acute coronary syndrome patients. Methods: The clinical outcomes, such as extent of myocardial damage, atherosclerotic burden, bleeding, acute kidney injury, duration of hospital stay and in-hospital mortality, were evaluated in a retrospective cohort of 309 consecutive acute coronary syndrome patients. The systemic immune-inflammatory index was calculated as (Platelet X Neutrophil)/Lymphocyte count on admission. Study population was categorized into tertiles with regard to systemic immune-inflammatory index. A p value of <0.05 was considered statistically significant. Results: The highest systemic immune-inflammatory index values were within ST elevation myocardial infarction patients (641.4 in unstable angina pectoris, 843.0 in non-ST elevation myocardial infarction patients and 996.0 in ST elevation myocardial infarction patients; p=0.004). Maximal troponin concentration (0.94 vs. 1.26 vs. 3; p<0.001), number of diseased vessels (1 vs. 2 vs. 2; p<0.001), the SYNTAX (synergy between percutaneous coronary intervention with taxus and coronary artery bypass grafting) score (9 vs. 14 vs. 17.5; p<0.001) and duration of hospital stay (2 vs. 2 vs. 3; p<0.001) also increased with increasing SIItertile (tertile1 vs. tertile 2 vs. tertile 3). Systemic immune-inflammatory index was an independent predictor of SYNTAX score (B: 0.232 [0.001 to 0.003]; p<0.001), extent of myocardial damage (B: 0.152 [0 to 0.001]; p=0.005) and duration of hospital stay (B: 0.168 [0.0 to 0.001]; p=0.003). Conclusions: This study has demonstrated that the systemic immune-inflammatory index, a simple hematological index, is a marker of atherosclerotic burden and longer hospital stay on well-known risk factors in high risk acute coronary syndrome patients.Öğe Transradial koroner anjiyografi öncesi gliseril trinitrat içerikli veya lidokain içerikli krem uygulamalarının işlem başarısına ve komplikasyonlarına etkisi(Tekirdağ Namık Kemal Üniversitesi, 2023) Uslu, Nurullah; Demirkıran, AykutAmaç: Radial yaklaşımla koroner anjiyografi öncesi topikal nitrat kullanılmasının ponksiyon süresine ve komplikasyon oranına etkisinin araştırılmasını amaçladık. Materyal ve metod: Şubat 2023-Ağustos 2023 tarihleri arasında üniversite hastanemize koroner anjiyografi endikasyonu ile başvuran tüm hastalar çalışmamıza dahil edildi. İşlemden yarım saat önce radial arter üzerine topikal serum fizyolojik uygulanan hastalar Grup 1, topikal nitrat uygulanan hastalar Grup 2, topikal lidakoin uygulanan hastalar Grup 3 olarak adlandırıldı. Üç grubun verileri karşılaştırıldı. Sonuçlar: Ortalama ponksiyon süremiz 142±122sn olup Grup 1'de 171±131sn, Grup 2'de 88±48sn ve Grup 3'te 157±146sn ölçüldü. Üç grup arasında istatistiksel olarak farklılık olduğu saptandı (p=0.002). Bu farklılığın ikinci gruptan kaynaklandığını saptadık. Birden fazla ponsksiyon oranı da yine Grup 2 de daha az saptandı. Grup1'de 7 hastada, Grup 2'de 1 hastada ve Grup 3'te 3 hastada radial arterden ponksiyon sonlandırıldı ve femoral arter ponksiyonuna geçildi. Sonuç: Radial arter girişiminden yarım saat önce uygulanan topikal nitrogliserin, radial arter ponksiyon sayısını ve prosedür süresini azaltmaktadır, ponksiyon başarısını arttırmaktadır.
