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Öğe Can Glypican-6 Levels Be Used to Determine Right Ventricular Remodeling After Non-ST Segment Elevation Myocardial Infarction?(Turkish Society of Cardiology, 2024) Küçük, Uğur; Volina, Emir; Arslan, KadirObjective: Myocardial infarction is associated with right ventricular (RV) remodeling. Glypican-6 (GPC6), a member of the membrane proteoglycan family, plays a significant role in cardiac remodeling. This study aims to determine if GPC6 can predict RV remodeling after percutaneous coronary intervention (PCI) in patients with non-ST segment elevation myocardial infarction (NSTEMI). Methods: The study enrolled 164 consecutive patients with NSTEMI and controls. It compared baseline plasma GPC6 levels, echocardiography, and laboratory parameters between the RV remodeling and non-RV remodeling groups with NSTEMI. Echocardiographic data were measured at baseline and at six months. Results: GPC6 levels were higher in the NSTEMI group 11.06 ng/mL (4.61-18.17) vs. 5.98 ng/ mL (3.81-9.83) compared to the control group in the initial phase. RV remodeling, defined as a >= 20% increase in RV end-diastolic area (RV EDA), was observed in 23 patients (30%). After six months, RV EDA increased significantly from baseline 18.68 +/- 1.20 cm2 2 vs. 24.91 +/- 1.08 cm(2),P < 0.001. GPC6 was a significant independent predictor of RV remodeling (hazard ratio [HR]: 1.546, 95% confidence interval [CI]: 1.056-2.245, P < 0.001). Receiver operating characteristic curve (ROC) analyses showed that GPC6 values > 15.5 ng/mL (area under the curve [AUC] = 0.828, sensitivity: 70%, specificity: 74%, P < 0.001) were strong predictors of RV remodeling. Conclusion: NSTEMI patients should be closely monitored for RV remodeling. GPC6 appears useful in detecting RV remodeling following NSTEMI in patients undergoing PCI.Öğe Collateral development from vertebral artery to axil-lary artery in left subclavian artery agenesis(Çanakkale Onsekiz Mart Üniversitesi, 2021) Arslan, Kadir; Küçük, Uğur; Kırılmaz, BahadırSubclavian artery agenesis is the congenital underdevel-opment of the artery supplying the head, neck and upper extremity directly originating from the aorta. This rare benign condition is usually asymptomatic. But it can be symptomatic in 20% of cases. The decrease/absence of flow caused by agenesis may cause weakening in pulses, neurological events (presyncope, syncope) and ischemic changes in upper extremity. These symptoms can be caused by many inflammatory diseases, especially Taka-yasu's arteritisÖğe Is elabela/toddler a poor prognostic marker in heart failure patients?(Lithographia, 2023) Küçük, Uğur; Kırılmaz, Bahadır; Kaya, Hakkı; Akşit, Ercan; Arslan, KadirBackground: Elabela/toddler (ELA-32) is a recently identified endogenous apelin receptor ligand. ELA levels are known to rise in heart failure (HF) patients. However, the association between elevated ELA levels and prognosis in these patients remains unknown. We aimed to investigate whether ELA plasma levels are correlated with prognosis in heart failure patients with reduced ejection fraction (HFrEF). Methods: This case-control cross-sectional study enrolled 150 patients, including 73 HFrEF patients and 77 age- and gender-matched healthy volunteers. We collected a blood sample at hospital admission to measure ELA-32 levels. The study endpoint was cardiovascular mortality or HF-related hospitalization. We followed up all patients in the study for a mean of 7.48 ± 2.73 months. Results: In patients with HFrEF, ELA-32 levels were higher than those in controls. The levels of ELA-32 showed a significant increase at advanced New York Heart Association stages. In the receiver operating characteristics curve analysis, a cut-off value of the serum ELA-32 level of 8.25 ng/mL showed a sensitivity of 76 % and specificity of 82 % for predicting the study endpoint [area under the curve: 0.84; 95 % confidence interval (CI): 0.72-0.98; p <0.001]. Cardiovascular mortality (p =0.042) and HF-related hospitalization (p <0.001) were statistically more significant in patients with ELA-32 levels greater than 8.25. Age [Hazard ratio (HR) =1.023; 95 % CI: 0.964-1.230, p =0.039], N-terminal pro-brain natriuretic peptide (HR =1.300; 95 % CI: 1.017-1.874, p =0.017), left ventricular end-diastolic volume (HR =1.142; 95 % CI 1.022-1.547, p =0.028), and ELA-32 ≥8.25 (HR =2.556; 95 % CI: 1.078-3.941, p <0.001) remained independently associated with the risk of study endpoint. Conclusion: For the first time, HF-related hospitalizations and cardiovascular mortality are independently associated with increased ELA-32 levels in patients with HFrEF. HIPPOKRATIA 2023, 27 (4):126-131.Öğe Relationship of Frontal QRS-T Angle with Coronary Flow Grade and Adverse Events Before Percutaneous Coronary Intervention in Patients with Non-ST-Elevation Myocardial Infarction(Turkish Society of Cardiology, 2023) Küçük, Uğur; Arslan, Kadir; Özpınar, Uğur; Altun, BurakObjective: Electrocardiography is used in the initial risk assessment of patients with non-ST elevation myocardial infarction. The frontal QRS-T angle is an electrocardiography paramete that may be affected by the alterations in the coronary blood flow. This study aimed to explor the relationship of the frontal QRS-T angle with coronary flow grade and adverse events i non-ST-elevation myocardial infarction patients. Methods: A total of 191 non-ST-elevation myocardial infarction patients were divided int 2 groups based on the thrombolysis in myocardial infarction (TIMI) flow level on coronar angiography before revascularization, namely TIMI 0/1 and TIMI 2/3. The frontal QRS-T angl obtained before revascularization was compared between the groups and its relationship wit adverse events was examined. In-hospital all-cause mortality, repeat target lesion revascular ization, new-onset heart failure, ventricular arrhythmias, and atrial fibrillation were defined a adverse events. Results: Frontal QRS-T angle was wider in the patients with TIMI 0/1 flow compared to th patients with TIMI 2/3 flow (P < 0.001). The frontal QRS-T angle was determined to be predictor of TIMI flow grade 0/1 before revascularization in patients with non-ST-elevatio myocardial infarction (odds ratio: 1.51; 95% CI: 1.30-1.75; P < 0.001). The frontal QRS-angle was a predictor of the adverse events during hospitalization in the patients with non-ST elevation myocardial infarction (odds ratio: 1.11; 95% CI: 1.04-1.19; P = 0.002). The cut-o values of the frontal QRS-T angle for TIMI flow grade and adverse events were determined t be 73.5°, based on receiver operating characteristic curve analysis. Conclusion: Increased frontal QRS-T angle may be a useful electrocardiography parameter fo determining TIMI flow grade and the need for an early invasive strategy in patients with non ST-elevation myocardial infarction.
