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    Comparison of the GRACE risk score and the TIMI risk index in predicting the extent and severity of coronary artery disease in patients with acute coronary syndrome
    (Kare Publ, 2015) Bekler, Adem; Altun, Burak; Gazi, Emine; Temiz, Ahmet; Barutcu, Ahmet; Gungor, Omer; Ozkan, Muhammed Turgut Alper
    Objective: The prognostic value of the Global Registry of Acute Coronary Events (GRACE) risk score (GRS) and the Thrombolysis In Myocardial Infarction (TIMI) risk index (TRI) has been reported in coronary artery disease (CAD) patients. We aimed to evaluate the relationship between the GRS, TRI, and severity of CAD evaluated by SYNTAX score (SS) in patients with acute coronary syndrome (ACS). Methods: Patients with ACS who were admitted to the coronary care unit of our institution were retrospectively evaluated in this study. A total of 287 patients with ACS [154 non-ST elevated ACS (NSTE-ACS), 133 ST elevated myocardial infarction (STEMI)] were included in the study. The GRS and TRI were calculated on admission using specified variables. The severity of CAD was evaluated using the SS. The patients were divided into low (GRS<109)-, intermediate (GRS 109-140)-, and high (GRS>140)-risk groups and group 1 (TRI<17), group 2 (TRI 17-26), and group 3 (TRI>26) according to GRS and TRI scores. A Pearson correlation analysis was used for the relation between GRS, TRI, and SS. Results: Patients with a history of coronary artery bypass surgery, those who had missing data for calculating the GRS and TRI, and those whose systolic blood pressure (SBP) was more than 180 mm Hg or whose diastolic blood pressure (DBP) was more than 110 mm Hg were excluded from the study. Were excluded from the study. There were significant differences in mean age (p<0.001), heart rate (p<0.001), SS (p<0.001), TRI (p<0.001), rate of NSTE-ACS (p<0.001), and STEMI (p<0.001) in all patients between the risk groups. There was a positive significant correlation between the GRS and the SS (r=0.427, p<0.001), but there were no significant correlation between the TRI and SS (r=0.121, p=0.135). The area under the ROC curve value for GRS was 0.65 (95% CI: 0.56-0.74, p=0.001) in the prediction of severity of CAD. Conclusion: The GRS is more associated with SS than TRI in predicting the severity of CAD in patients with ACS.
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    Fragmented QRS and prediction of paroxysmal atrial fibrillation episodes
    (Professional Medical Publications, 2014) Temiz, Ahmet; Gazi, Emine; Gungor, Omer; Altun, Burak; Barutcu, Ahmet; Bekler, Adem; Tan, Yusuf Ziya
    Objective: Prior studies have demonstrated the relationship between cardiovascular diseases and fragmented QRS (fQRS). fQRS was also associated with ventricular arrhythmias. Our objective was to find out the relationship between fQRS and paroxysmal atrial fibrillation (PAF). Method: A total of 301 patients without overt structural heart disease were prospectively included in the study. Patients were divided in to 2 groups according to presence of fQRS. Multivariate logistic regression analysis was used to assess the predictive value of fQRS for predicting PAF. Results: One hundred and three patients had fQRS. Patients with fQRS were older (53 +/- 16.8 vs 45.3 +/- 17.2, p < 0.001), with larger left atrium (LA) (33.2 +/- 5.9 vs 30.1 +/- 5.9 mm, p=0.001), with thicker interventricular septum (IVS) (10.2 +/- 1.9 vs 9.5 +/- 2.3 mm, p=0.032), more diabetic (19.8 vs 10.6%, p= 0.029) and have more PAF episodes (22.3 vs 4.1%, p < 0.001) in comparison with patients without fQRS. fQRS was an independent predictor of detecting PAF episode (odds ratio, 9.69; 95% confidence interval, 2.46-38.15, p= 0.001). Hypertension and diabetes mellitus were also predictive. Conclusion: The presence of fQRS independently predicted PAF episodes in holter monitoring (HM). Further studies are needed to clarify the clinical implications of this finding.
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    Fragmented QRS is associated with frequency of premature ventricular contractions in patients without overt cardiac disease
    (Turkish Soc Cardiology, 2015) Temiz, Ahmet; Gazi, Emine; Altun, Burak; Gungor, Omer; Barutcu, Ahmet; Bekler, Adem; Tan, Yusuf Ziya
    Objective: In this study, we aimed to demonstrate whether the presence of fragmented QRS (fQRS) is associated with the frequency of premature ventricular contractions (PVCs). Methods: We retrospectively analyzed 282 cases by 24-hour Holter monitorings (HMs) between August 2012 and February 2013. Firstly, the patients were divided into 2 groups with respect to presence of fQRS and then divided into 3 groups with respect to frequency of PVCs as Group 1: seldom PVC (<120 PVCs/day), Group 2: moderate-frequency PVC (120-720 PVCs/day), and Group 3: frequent PVC (>720 PVCs/day). We investigated the predictors of frequent PVCs by using multinomial logistic regression analysis. Results: Ninety-eight patients had fQRS. There was no difference between the 2 groups with respect to body mass index, gender, hypertension, and diabetes mellitus. Patients with fQRS were older (54.9 +/- 15.6 vs. 47.0 +/- 16.3, p<0.001) and had more family history of coronary artery disease (25% vs. 13%, p=0.012). Patients with fQRS was more likely to be on aspirin therapy (28.6% vs. 10.4%, p<0.001) and have a larger left atrium diameter (33.5 +/- 5.7 vs. 30.4 +/- 5.8, p=0.001). Presence of fQRS was significantly associated with the frequency of PVCs (for frequent PVC 27.7% vs. 7.6%, p<0.001; for moderate-frequency PVC 18.4% vs. 11.4%, p=0.012); 26.2% of Group 1 (n=202) had fQRS, 46.2% of Group 2 (n=39) had fQRS, and 65.9% of Group 3 (n=41) had fQRS. In the multinomial regression analysis, only age (odds ratio: 4.24, 95% confidence interval 2.08-8.64, p=0.001) and fQRS (odds ratio: 2.11, 95% confidence interval 1.00-4.45, p=0.05) were predictors of frequent PVCs. Conclusion: This study demonstrated that the presence of fQRS is associated with frequent PVCs in patients without overt structural heart disease.
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    Is abnormal glucose metabolism during pregnancy related to endothelial dysfunction?
    (Taylor & Francis Ltd, 2015) Gungor, Omer; Gazi, Emine; Ozkececi, Gulay; Gungor, Ayse Nur Cakir; Cevizci, Sibel; Hacivelioglu, Servet; Temiz, Ahmet
    Objective: Endothelial dysfunction is an independent risk factor for cardiovascular events. We aimed to investigate the relationship between endothelial dysfunction and gestational diabetes mellitus and impaired glucose tolerance. Methods: Pregnant women who had impaired glucose metabolism in the 75-g oral glucose tolerance test (OGTT) and their age-and body mass index-matched controls were included in the study and assessed for flow-mediated vasodilatation to evaluate endothelial dysfunction. Results: A total of 51 patients participated in the study. There were 20 patients in the control group, 13 in the impaired glucose tolerance group and 18 in the gestational diabetes mellitus group. Flow-mediated vasodilatation measured at the 60th and 120th seconds were significantly lower in the impaired glucose tolerance and gestational diabetes mellitus groups than in the control group (8.5 +/- 5.7 and 8.9 +/- 6.5 versus 14.9 +/- 9.0, p = 0.022 and 6.2 +/- 6.7 and 5.2 +/- 5.0 versus 12.0 +/- 8.3, p = 0.011, respectively). Conclusions: Patients with gestational diabetes mellitus and impaired glucose tolerance have impaired endothelial dysfunction. Delivery might have protective effects on endothelial functions. The significance of impaired endothelial dysfunction for pregnant women must be investigated, and if needed, lifestyle changes might be suggested, according to the determined importance of the endothelial dysfunction.
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    Platelet/lymphocyte ratio and risk of in-hospital mortality in patients with ST-elevated myocardial infarction
    (Int Scientific Information, Inc, 2014) Temiz, Ahmet; Gazi, Emine; Gungor, Omer; Barutcu, Ahmet; Altun, Burak; Bekler, Adem; Binnetoglu, Emine
    Background: Platelet-to-lymphocyte ratio (PLR) is a new prognostic marker in coronary artery disease. We aimed to evaluate the relationship between PLR and in-hospital mortality in patients with ST-elevated acute myocardial infarction (AMI). Material/Methods: The present study included 636 patients with ST-elevated AMI. The study population was divided into tertiles based on their admission PLR. Patients having values in the third tertile was defined as the high PLR group (n=212) and those having values in the lower 2 tertiles were defined as the low PLR group (n=424). Results: Risk factors of coronary artery disease and treatments administered during the in-hospital period were similar between the groups. Male patient ratio was found to be lower in the high PLR group (73% vs. 82.8%, p=0.004). In-hospital mortality was increased in the high PLR group when compared to the low PLR group (12.7% vs. 5.9%, p=0.004). The PLR > 144 was found to be an independent predictor of in-hospital cardiovascular mortality (HR: 2.16, 95% CI: 1.16-4.0, p=0.014). Conclusions: This study showed that PLR is an independent predictor of cardiovascular mortality in patients with ST-elevated AMI.
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    The association between serum uric acid level and heart failure and mortality in the early period of ST-elevation acute myocardial infarction
    (Turkish Soc Cardiology, 2014) Gazi, Emine; Temiz, Ahmet; Altun, Burak; Barutcu, Ahmet; Bekler, Adem; Gungor, Omer; Yener, Ali Umit
    Objectives: Uric acid (UA) is a strong marker of cardiovascular disease. Therefore, we aimed to determine the relationship between serum UA levels and cardiovascular events in patients in the early period of their acute myocardial infarction. Study design: This retrospective study included 586 consecutive patients with ST-elevated myocardial infarction (STEMI) who were admitted to the hospital between March 2010 and February 2012. The study population was divided into two groups; the first group included hyperuricemic patients (n=107; uric acid level >6 mg/dl in women and >7 mg/dl in men), and the second group included patients with normal UA level (n=479). Multivariate analysis was used to demonstrate the predictive value of UA levels in groups. Results: Patients in the hyperuricemic group were older (median 66 years vs. 60 years, p=0.001), and the ratio of female patients was higher (35.5% vs. 16.9%, p=0.001). Patients with hyperuricemia had a significantly higher incidence of in-hospital cardiovascular mortality than the normal group (15.9% vs. 3.1%, p<0.001). Advanced heart failure (class =3) was more frequent among hyperuricemic patients (17.8% vs. 8.8%, p=0.006). Age =70 years, chest pain duration >6 hours and hyperuricemia (hazard ratio (HR): 1.83, 95% confidence interval: 1.02-3.27; p=0.041) were found to be independent predictors of advanced heart failure. Hyperuricemia was found to be an independent predictor of in-hospital cardiovascular mortality in multivariate analyses (HR: 5.32, 95% confidence interval: 2.4611.49; p=0.001). Conclusion: This study showed that a high serum UA level is an independent predictor of cardiovascular mortality and morbidity during the in-hospital period of STEMI.
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    The effect of on/off molecular switching on the photophysical and photochemical properties of axially calixarene substituted activatable silicon(IV)phthalocyanine photosensitizers
    (Royal Soc Chemistry, 2016) Gungor, Omer; Ozpinar, Gul Altinbas; Durmus, Mahmut; Ahsen, Vefa
    Silicon(IV) phthalocyanines (4 and 5) bearing two calixarene groups as axial ligands were synthesized. Surprisingly, both phthalocyanines were obtained as two different isomers (4a-b and 5a-b) depending on the distance between calixarene benzene groups and the phthalocyanine ring. DFT and TD-DFT computations were performed to model plausible structures of these isomers and to simulate electronic absorption spectra. These isomers converted into each other depending on the polarity of the used solvent, temperature and light irradiation. The photophysical and photochemical properties of each isomer were investigated in dimethylsulfoxide (DMSO) for the determination of photodynamic therapy (PDT) activities of these compounds. The more blue-shifted isomers (4b and 5b) showed higher fluorescence quantum yields and singlet oxygen generation compared to more red-shifted counterparts (4a and 5a). This behavior is extremely important for developing activatable photosensitizers for cancer treatment by PDT. Although these photosensitizers produce lower singlet oxygen in normal cells, they produce higher singlet oxygen (six times higher for 5b) in cancer cells since these photosensitizers converted to more blue-shifted isomers by using light irradiation.