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    A new treatment modality for the treatment of unligated thoracic side branch of left internal mammary artery: Underexpanded stent
    (2024) Küçük, Uğur; Kırılmaz, Bahadır; Gazi, Emine; Aşgün, Halil Fatih; Özpınar, Uğur
    The left internal mammary artery (LIMA) is often preferred in coronary artery bypass grafting (CABG). LIMA has additional features such as less fenestration in the endothelial layer, less intercellular permeability, anti-thrombotic activity, rapid lipolysis, and less lipid synthesis, resulting in an excellent long-term patency rate. LIMA side branches or anatomical variations that are not ligated intraoperatively may cause coronary ischemia in the postoperative period. Although various treatment modalities such as coiling, vascular plug embolization, and surgical ligation have been described in treating LIMA side branches, no studies show the superiority of one treatment modality over another. In this case, the advantages, disadvantages, and critical points affecting the success of unligated LIMA side branches treatment methods were discussed.
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    Akut İnferior Miyokard İnfarktüsü ile Prezente Olan Aort Diseksiyonu
    (Çanakkale Onsekiz Mart Üniversitesi, 2019-08-15) Küçük, Uğur; Kırılmaz, Bahadır
    Aort diseksiyonu, aortun intima ve media tabakasının birbirinden ayrıldığı, acil tanı ve tedavi gerektiren kardiyovasküler acillerden biridir. Göğüs ağrısı ile başvuran hastalarda elektrokardiyografilerde akut miyokard infarktüsü bulguları saptanabilir. Bizde acil servisimize göğüs ağrısı ile başvuran akut inferior miyokard infarktüs tanılı akut aort diseksiyonu olan hastayı sunmaya çalıştık.
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    Akut koroner sendromlu hastalarda kalp tipi yağ asid bağlayıcı protein (H-FABP) düzeyinin akut koroner sendrom risk skorları ile ilişkisi
    (Çanakkale Onsekiz Mart Üniversitesi, 2017) Küçük, Uğur; Altun, Burak
    Amaç: Akut koroner sendrom (AKS) tanılı hastalarda kalp tipi yağ asit bağlayıcı proteinin (H-FABP) koroner arter hastalığının (KAH) yaygınlığı, ciddiyeti ile olan ilişkisini ve erken tanı koymada kullanılabilirliğini araştırdık. Yöntem: Biz çalışmamızda Çanakkale Onsekiz Mart Üniversitesi Tıp Fakültesi hastanesi acil servisi ve kardiyoloji kliniğine başvurup evrensel kılavuzlarda (Europan Society of Cardiology ve American Heart Association da) tanımlandığı gibi AKS tanısı almış olan ve yine bu kılavuzlardaki öneriler doğrultusunda tanı ve tedavi amaçlı koroner anjiografi (KAG) yapılması planlanan 110 hasta aldık. Bu hastalardan hastanemize ilk başvuru anı ve 6.saatte kan alınarak tıbbi biyokimya laboratuvarına gönderildi. Elisa yöntemi ile HK401 HUMAN H-FABP kiti kullanılarak H-Fabp düzeyleri ölçüldü. Bulgular: Başvuru anında baktığımız kardiyak markırlar içerisinde sensivitesi en yüksek olarak H-fabp %82,7, spesifitesi %83,3, pozitif prediktif değeri %97,6, negatif prediktif değeri %37,0, test güvenirliği %82,7 idi. 6.saat bakılan H-fabp için sensivite %78,6, spesifite %100,0, pozitif prediktif değer %100,0 negatif prediktif değer %36,4, test güvenirliği %80,9 du.Hastaların başvuru anında bakılan H-fabp'ın pozitif veya negatif olmasına göre sınıflandırdığımızda her iki grupta da Global Registry of Acute Coronary Events (GRACE), SYNergy between PCI with TAXUS™ and Cardiac Surgery (SYNTAX) ve Gensini risk skorları ile istatiksel olarak anlamlı ilişki görülmedi (p: 0,056, p:0,791, p: 0,278). H-fabp pozitif olan grupta Grace risk skoru ve Gensini risk skoru daha yüksek olmasına rağmen; H-fabp negatif hasta grubunda Syntax risk skoru daha yüksekti. Hastaların 6.saat bakılan H-fabp'ın pozitif veya negatif olmasına göre sınıflandırdığımızda H-fabp pozitif olan grupta Grace ve Gensini risk skorları ile istatiksel olarak anlamlı ilişki saptanırken (p: 0,003, p: 0,011); Syntax risk skoru ile istatiksel olarak anlamlı ilişki saptanmadı (p: 0,984). Sonuç: H-fabp'ın kardiyak risk skorları ile olan ilişkisini göstermiş olmakla birlikte, AKS'li hastaların prognozunu değerlendirmede kullanılabilirliğini ve H-fabp'ın hem erken tanıda hem de geç başvurularda spesifitesi %100,0 olduğundan kesin tanıda kullanılabilecek kardiyak markır olduğunu gösterdik. Çalışmamızın bilime katkısı bulunmakla birlikte, bu konuda daha geniş katılımlı çalışmaların yapılmasında gerek duyulmaktadır.
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    Can we medically follow coronary artery aneurysms?; A case report
    (2024) Duygu, Ali; Küçük, Uğur
    Coronary artery aneurysm (CAA) is an enlargement of the coronary vascular lumen that can’t be fixed and is at least 1.5 times the diameter of the normal coronary segment next to or connected to it. They are usually asymptomatic; their clinical presentation ranges from incidental findings on cardiac imaging to myocardial infarction (MI), and they may result in angina, MI, and sudden death, especially when they are very large. An aneurysm was seen in the middle segment of the left anterior descending artery (LAD) in the images obtained from the patient. After the council, coronary artery bypass grafting (CABG) was decided due to the risk of rupture, but the patient and his relatives did not accept the operation. In outpatient clinic visits every 3 months for 9 months, it was observed that her complaints regressed with medical treatment. There is still no clear treatment approach for CAAs and CABG, and percutaneous coronary intervention (PCI) may be preferred or medical therapy may be used.
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    Çanakkale ilindeki Q ateşi olgularının retrospektif olarak değerlendirilmesi
    (2022) Çeviker, Sevil Alkan; Kayta, Safiye Bilge Güçlü; Şener, Alper; Küçük, Uğur; Sıddıkoğlu, Duygu; Çinpolat, Havva Yasemin
    Amaç: Q ateşi, özellikle risk grubundaki bireylerde akut ve kronik formda görülebilen, özgül olmayan semptomları nedeniyle tanısı atlanabilen, zoonotik bir hastalıktır. Önceleri sıklıkla yanlış tanı alan bu hastalık olguları, ülkemizden de son yıllarda bildirilmeye başlamıştır. Bu çalışmada Q ateşi olgularının klinik ve laboratuvar parametrelerini retrospektif olarak değerlendirmeyi ve Q ateşi farkındalığını arttırmayı amaçladık. Yöntem: Retrospektif gözlemsel çalışmamızda, 18 yaş üstü, kesin tanı almış, Q ateşi olguları değerlendirildi. Hastalara ait yaş, cinsiyet, meslek, ikamet edilen yer gibi demografik veriler, kene teması öyküleri, hastalığın geliştiği zaman dilimi (yıl, mevsim, ay), eşlik eden komorbiditeler, semptomlar, fizik muayene ve laboratuvar bulguları, tedaviler, hastaların iyileşme ve mortalite durumları irdelendi. Bulgular: Çalışmaya yaş ortalaması 49.23±12.1 yıl, 7’si (%57) erkek olan 14 olgu dahil edildi. En sık semptomlar ateş yüksekliği (%100), öksürük (%71.4) ve miyalji (%57.1) idi. Olguların tamamı akut Q ateşi olgusu olup, endokardit hiçbir olguda saptanmadı. Sonuç: Ülkemizin Q ateşi hastalığı için olası endemik bölgelerden olması nedeniyle, özellikle kırsal kesimde yaşayan, hayvancılıkla uğraşma, pastörize edilmemiş süt/süt ürünü tüketme gibi risk faktörleri olan hastalarda özellikle pnömoni ve miyalji varlığında akılda tutulmalıdır.
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    Chicken-egg and Cardiomyopathy Ventricular Extrasystole Paradox
    (2024) Altınsoy, Meltem; Küçük, Uğur
    Objectives: Left ventricular ejection fraction (LVEF) may decrease due to frequent ventricular extrasystoles (VESs). This study aimed to investigate whether the site of VES origin and other VES characteristics are associated with a decline in LVEF. Methods: The rhythm Holter records and follow-up files of 400 patients who presented to the outpatient clinic with complaints such as palpitations, presyncope, syncope, and dyspnea between January 2017 and March 2023 and who were prescribed a rhythm Holter as part of their evaluation were retrospectively reviewed. The relationship between reduced LVEF, defined as LVEF <50% on echocardiography, and VES characteristics was examined in patients with normal LVEF and a VES burden above 10%, utilizing 24- and 48-h electrophysiology studies. Results: The study comprised 34 patients with a mean age of 59.8±17.0 (range: 21–87) years. Among them, 55.9% (19 patients) were female, and the mean ejection fraction (EF) % was 49.5±11.3 (range: 25–67). Patients with EF % <50 (n=18) exhibited significantly higher diastolic diameter (5.3±0.5 vs. 4.7±0.5 cm, respectively; p=0.004), VES burden (32.3 vs. 16.7, respectively; p=0.0001), longer coupling interval (CI) measurements (p=0.018), and QRS duration (p=0.0001) compared to patients with EF % >50 (n=16). A positive correlation was observed between VES load and QRS duration in the group with EF <50% (r=0.664; p=0.002). In patients who developed VES-induced cardiomyopathy (CMP), VES originated from the mitral annulus (p<0.001), whereas VES originating from the right ventricular outflow tract was significantly associated with the non-CMP group (p<0.001). Conclusion: The burden of VESs may be associated with CMP, as well as longer QRS duration, CI, and exit location.
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    Comparison of lung ultrasonography, transthoracic echocardiography and clinical findings in assessing volume status in patients receiving renal replacement therapy
    (2024) Baştürk, Gizem; Bakırdogen, Serkan; Küçük, Uğur; Aylanç, Nilüfer; Çelik, Zübeyir; Basturk, Gökhan
    While transthoracic echocardiography and clinical findings are used to assess body volume status, lung ultrasonography (LUS), which is a non-invasive method, has also been used in assessing hypervolemia in recent years. This study aims to compare LUS, transthoracic echocardiography (TTE) and clinical findings in the assessment of body volume status in patients receiving renal replacement therapy (RRT). The study included 99 subjects who received RRT and were followed-up in our hospital. The patients were randomly selected from kidney transplant patients and those who had been receiving peritoneal dialysis (PD) or hemodialysis (HD) for at least the past three months. In addition, a control group consisting of 52 healthy subjects was also enrolled. LUS and TTE were simultaneously performed (within 24 hours). The mean left atrial (LA) diameter was 37.8±2.7 mm, 37.9±3.4 mm, 38.6±3.5 mm and 29.0±4.4 mm in patients who received PD, kidney transplantation, HD and in the control group, respectively. There was a moderate positive correlation between the total number of B-lines and LA diameter (mm) in the combined group consisting of the patient and control groups (p=0.0001, r=0.286). In this study, the number of B-lines on LUS has been found to be higher in patients receiving renal replacement therapy due to the effect of hypervolemia compared to the control group. However, there was no statistically significant difference in terms of the number of B-lines and LA diameter in echocardiography.
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    Does Increased Fructose Consumption Increase Atherosclerosis Burden in Patients with NSTEMI?
    (Galenos Publishing House, 2024) Küçük, Uğur; Taşdelen, Bihter; Pesenli, Kudret
    Background and Aim: The pathophysiological process of coronary artery disease is not completely understood. According to some studies, fructose consumption is associated with coronary artery diameter change and blood flow; however, the relationship between fructose consumption and coronary atherosclerotic burden has not been adequately studied, and the purpose of our study was to investigate this relationship. Materials and Methods: One hundred and fifty patients with non-ST-elevation myocardial infarction (NSTEMI) who underwent coronary angiography were divided into two groups: low (<23) and high (?23) synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) scores. Fructose consumption was calculated for both groups, and the calculated fructose consumption was compared between the groups. Results: Fructose consumption was higher in patients with a high SYNTAX score than in those with a low SYNTAX score (10.75 ± 2.04 and 6.86 ± 1.54, P < 0.001). Receiver operating characteristic curve analysis showed that the cut-off value of fructose consumption was 41.50 (g) for the prediction of high SYNTAX score (area under the curve: 0.891, sensitivity: 94%, specificity: 73%, P < 0.001). Fructose consumption was determined to be a predictor of high SYNTAX score in patients with NSTEMI (odds ratio: 1,239; 95% confidence interval: 1,146-1,339; P < 0.001). Conclusion: Patients with high SYNTAX scores consumed a higher amount of fructose than those with low SYNTAX scores. High intake of fructose may play a role in coronary atherosclerotic burden score in patients with NSTEMI. © 2024 Galenos Publishing House. All rights reserved.
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    Effect of Treatment Regimen on Long-Term Mortality of Geriatric Patients Diagnosed With Stable Coronary Artery Disease
    (Springer, 2021) Küçük, Uğur; Duygu, Ali; Kırılmaz, Bahadır
    Background: Increased life expectancy across the world has resulted in an increase in the proportion of the elderly population who are lost to heart diseases. Advanced age and comorbidities are believed to change the response to treatments. In this study, we aimed to investigate the effects of surgical and medical treatments on the mortality of stable coronary diseases. Methods : A total of 150 geriatric patients who underwent coronary angiography (CAG) were followed up in our cardiology clinic. Patients who decided to undergo coronary artery bypass graft (CABG) surgery after CAG and were willing to undergo the operation were assigned to group 1, whereas those who were unwilling to undergo the operation were not eligible for percutaneous coronary intervention and were followed up medically, and were assigned to group 2. Keeping the primary goal as mortality rates, both the groups were compared using medical records for three years after the treatment. Results : After three years, the overall mortality rate included six patients (16%) in the CABG group versus 63 patients (55%) in the medical therapy group (p < 0.001). The CABG therapy was found to be significantly and independently associated with first- and third-year mortality (risk ratio: 0.064, 95% confidence interval: 0.009-0.467, p = 0.007; risk ratio: 0.305, 95% confidence interval: 0.151-0.615, p < 0.001, respectively). Kaplan-Meier analysis for first- and third-year all-cause mortality rates led to significant results and curves between the groups. Conclusion : Our study revealed that compared to CABG surgery in the treatment of coronary artery disease in geriatric patients, medical treatment is associated with poor outcomes in terms of mortality in long-term follow-up.
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    Evaluation of Brucella pericarditis cases by pooled analysis method
    (Refik Saydam National Public Health Agency (RSNPHA), 2023) Evlice, Oğuz; Yilmaz, Mustafa; Çeviker, Sevil Alkan; Küçük, Uğur
    Objective: Brucellosis is one of the most frequent zoonotic infectious diseases and is a global public health concern, particularly in developing countries. Brucellosis causes systemic symptoms and can affect different parts of the body. Brucellar pericarditis is a rare involvement of the cardiovascular system. This study aimed to investigate the clinical outcomes of Brucella pericarditis cases. Methods: A pooled analysis study was conducted by searching four international online databases with the terms “Brucella” and “pericarditis” and their synonyms. The full texts or abstracts were screened using these keywords. The publications were examined in terms of the age and gender of cases, publication year and country, additional diagnosis, diagnostic methods, treatments, and outcomes. Results: The study included 25 cases (14 males, 56%), with a mean age of 38.84 ± 9.7 (12-79) years. Systemic findings were present in 17 (68%) patients, and 17 (68%) had a cardiac presentation. 10 (40%) patients had retrosternal pain/ chest pain, 10 (40%) patients had pericardial frontman, and five (%10) cases had tachycardia. The most commonly used diagnostic method was a serological test (96%), and a positive blood culture result was determined in 64%. The Rose Bengal test was performed in seven cases, of which six had positive results. Complete recovery was reported for 22 cases, and death in two patients. Conclusion: Although brucellosis is less common in many developed countries, it should be keep in mind differential diagnosis in endemic areas. Brucellosis is a rare cause of pericarditis and requires specific treatment. Standard tube agglutination tests are highly sensitive and specific in the diagnosis of brucellosis. This non-invasive, practical test should be used in the differential diagnosis of pericarditis. © (2023), (Refik Saydam National Public Health Agency (RSNPHA)). All Rights Reserved.
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    Exercise-Induced Atrioventricular Block
    (Çanakkale Onsekiz Mart Üniversitesi, 2019-08-15) Küçük, Uğur; Gazi, Emine
    Complete atrioventricular (AV) block associated with excretion is rare. We describe the case of a 67-year-old woman with normal conduction at rest, who developed AV block during a treadmill test. She gave a history of dizziness during exercise. She had no medical history. The patient’s physical examination was normal. Electrocardiography (ECG) showed normal sinus rhythm, incomplete right bundle branch block and a first-grade atrioventricular block. During treadmill test, ECG showed complete AV block. Electrophysiological study demonstrated rate dependent nodal AV block. Permanent dual chamber pace-maker was implanted to the patient. There is no any symptom after pacemaker.
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    Hidden enemy of pulmonary arteries: COVID-19
    (2024) Duygu, Ali; Küçük, Uğur
    It has been reported that COVID-19 may cause severe endothelial damage. Pulmonary Artery Stiffness (PAS) is a strong predictor of right ventricular function. PAS can reveal important information about the endothelial functions of the pulmonary bed. In this study, we aimed to elucidate the possible effect of COVID-19 on PAS. The study was performed by measuring PAS values with transthoracic echocardiography in 130 patients, 60 of whom had COVID-19 and 70 were controls. COVID-19 patients with positive polymerase chain reaction (PCR) test results were included in the study 3-6 months after their positivity. When the Maximal frequency shift (MFS) (Hz) results were examined, no significant difference was observed between the patient and control groups (2764±279.24 and 2664.8±673.91 p=0.340, respectively). There was a significant difference between the patient and control groups in favor of the patient group in pulmonary acceleration time (PAT) (msec) results (93.18±14.99 and 126.1±17.58, respectively, p<0.001). There was a significant difference between the patient and control groups in favor of the patient group in PAS (Hz/msec) results (30.28±5.07 and 21.57±7.04, respectively, p<0.001). It is possible that COVID-19 may have adverse effects on the pulmonary artery wall and bed. As a result of endothelial damage due to COVID-19, an increase in PAS values can be observed.
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    Identifying early left atrial dysfunction in COPD patients using ECG morphology-voltage-P wave duration score
    (Elsevier B.V., 2025) Küçük, Uğur; Mutlu, Pınar; Mirici, Arzu; Özpınar, Uğur; Özpınar, Selin Beyza
    Background: Chronic Obstructive Pulmonary Disease (COPD) is associated with left atrial (LA) dyfunction, which may contribute to adverse cardiovascular outcomes. This study investigates the predictive value of lately identified morphology-voltage-P wave duration electrocardiography (MVP ECG) score for detecting early LA dysfunction in COPD patients. Methods: In this cross-sectional study, 101 COPD patients were enrolled. All patients underwent speckle tracking echocardiography and were classified into two groups based on their LA functions. Results: Our findings demonstrate significant variations in Peak Atrial Longitudinal Strain (PALS) values among COPD patients, with a mean PALS of 28.74 ± 1.81 % for the group with normal LA function and 18.44 ± 1.87 % for the group with abnormal LA function (p < 0.001). Despite similar LA diameters across groups, these variations indicate subclinical LA pathogenesis. ROC curve analysis indicated that an MVP ECG score greater than 2.5 predicted abnormal LA function with a sensitivity of 65 % and a specificity of 91 % (area under the curve [AUC]: 0.873; p < 0.001), suggesting its utility in identifying atrial damage and remodeling. Conclusions: The MVP ECG score shows promise as a tool for early detection of atrial remodeling in COPD patients. © 2024 Elsevier Inc.
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    In-hospital mortality prediction using dual antiplatelet therapy score in coronavirus disease 2019
    (Bayrakol Medical Publishing, 2021) Küçük, Uğur
    Aim: Mortality rates are high in cases of coronavirus disease 19 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) despite the advances in treatment regimens. The Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) score, an up-to-date scoring system, is frequently used in cardiology practice after stent implantation.This study aimed to investigate the use of the PRECISE-DAPT score to predict in-hospital mortality in patients with COVID-19.Material and Methods: A total of 264 consecutive patients with positive COVID-19 polymerase chain reaction (PCR) tests were enrolled in this study. Patients were divided into three groups according to PRECISE-DAPT scores: low-, intermediate-, and high-score groups (PRECISE-DAPT scores of <17, 17–24, and ≥25; n=170, 57, and 37, respectively). Those who died in the hospital and those discharged after recovery were noted.Results: Among 120 women and 144 men with positive PCR test results, a total of 40 patients (low-score, n=16; intermediate-score, n=11; and high-score, n=13) died in the hospital. Prolonged hospital stay was observed in the high-score group compared with the low-score group (p=0.011). In multivariate analysis, the PRECISE-DAPT score (hazard ratio: 0.962, 95% confidence interval: 0.943–0.982, p<0.001) significantly correlated with in-hospital mortality.Discussion: PRECISE-DAPT scores are associated with mortality in patients with COVID-19. The PRECISE-DAPT scoring system may be useful for predicting in-hospital mortality.
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    Inflammatory and cardiac biomarkers in pulmonary arterial hypertension: The prognostic role of IL-34
    (Elsevier Inc., 2025) Bolayır, Hasan Ata; Karasu, Mehdi; Gelen, Mehmet Ali; Akın, Yusuf; Çeçen, Erkan; Küçük, Uğur; Bulu, Aykut
    Background: Pulmonary arterial hypertension (PAH) is characterized by increased pulmonary artery pressure with significant morbidity and mortality. Inflammatory processes are crucial in PAH pathogenesis, with inflammatory cells and mediators present early in disease progression. IL-34 involvement in inflammatory pathways suggests that IL-34 could be an important player in the progression of PAH, influencing both pulmonary pressures and vascular changes. Objective: The purpose of this study was to investigate the correlation between IL-34 levels and pulmonary arterial hypertension (PAH), aiming to enhance the understanding of the molecular mechanisms underlying PAH and explore IL-34?s potential as a biomarker. Methods: Consecutive PAH patients diagnosed via right-heart catheterization at Malatya Turgut Ozal Eğitim ve Araştırma Hastanesi (Dec 2022 - Apr 2024) were enrolled. Patients were classified into low-risk and high-risk groups based on comprehensive risk assessments that included clinical parameters, hemodynamic measurements and biomarkers, in-line with ESC/ERS guidelines. Serum IL-34, hs-CRP, and NT-proBNP levels were measured and compared with those of healthy controls. Echocardiographic assessments and statistical analyses, including ROC analysis, were conducted to evaluate biomarker significance and predictive capabilities. Results: The mean age of low-risk and high-risk PAH patients was 42 ± 7.2 years and 45 ± 5.5 years, respectively. The mean age of the control group was 40 ± 6.4 years. Males comprised 54.29 % of the low-risk group, 56 % of the high-risk group, and 53.3 % of the control group. IL-34 and hs-CRP levels were significantly elevated in PAH patients compared to controls. IL-34 correlated positively with systolic pulmonary artery pressure, RA area, and NT-proBNP levels. Multivariate analysis revealed that IL-34 and hs-CRP were independent predictors of PAH. IL-34 levels>29.8 pg/mL predicted PAH with 78 % sensitivity and 69 % specificity, while levels >44.4 pg/mL predicted high-risk PAH with 84 % sensitivity and 77 % specificity. Conclusion: Elevated IL-34 and hs-CRP levels are associated with PAH severity and right ventricular dysfunction, suggesting IL-34?s potential as a diagnostic and prognostic biomarker. Further research is needed to validate these findings and explore IL-34-targeted therapies in pH management. © 2024 Elsevier Inc.
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    Investigation of Thromboembolic Events in COVID-19 Infected Patients
    (2023) Şahin, Serpil; Altınışık, Hatice Betül; Çeviker, Sevil Alkan; Küçük, Uğur; Çinpolat, Havva Yasemin; Gönlügür, Uğur
    Aim: In this study, we sought to determine patient characteristics and clinical outcomes of patients who experience this complication, as well as the frequency of thromboembolic events (TEE) in COVID-19 patients hospitalized. Materials and Methods: Between January 2020 and December 2021, all the patients with positive COVID-19 PCR test results were enrolled in this study. The data of the cases that developed TEE with the diagnosis of COVID-19 were evaluated retrospectively. Results:During this time, 2,845 inpatients were admitted with COVID-19. Among this group, 96 patients (3.37%) had COVID-19 - related TEE. The mean age was 63.76±13.85 years (range, 28–80 years) with 46 men (47.92%) and 50 women (52.08%). Of the patients, 46 of 96 (47.92%) had severe COVID-19, and 50 of 96 (52.08%) had only mild respiratory symptoms. Severe COVID-19 group patients were older but there was not statistically significance between the groups. Peripheral venous disease was more common in mild COVID-19 group, while peripheral arterial disease is more common in severe COVID-19 group.CRP, uric acid, troponin, creatinine,D-dimer and leukocyte levels were higher in severe COVID-19 patients with TEE (p<0.05). Peripheral venous disease was present in 81 of 96 (84.37%), peripheral arterial disease in 5 of 96 (5.2%), and pulmonary embolism in 11 (11.45%) cases. One patient (1.04%) had both peripheral venous disease and pulmonary embolism. The overall mortality was 6.25% (6/96). Conclusion: COVID-19-associated thrombotic process affects more frequently veins than arteries. Given the significant observed risk for TEE in COVID-19, diagnostic imaging for TEE should be evaluated with a high degree of clinical suspicion.
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    Patients with Achilles Tendon Rupture Are Prone to Develop Ventricular Arrhythmia
    (Multidisciplinary Digital Publishing Institute (MDPI), 2023) Gür, Volkan; Yapıcı, Furkan; Küçük, Uğur; Subaşı, İzzet Özay; Gökgöz, Mehmet Burak; Karaköse, Reşit; Koçkara, Nizamettin
    Background and Objectives: This study aimed to examine the ventricular repolarization (VR) disturbances of patients operated on for acute spontaneous Achilles tendon ruptures (ATRs), by comparing them with a healthy individual control group. Materials and Methods: Between June 2014 and July 2020, a total of 29 patients (28 males, 1 female; mean age: 40 ± 9.78 years; range, 21–66 years) who presented to the emergency department within the first three weeks of injury, and were diagnosed with acute spontaneous ATRs and treated with an open Krackow suture technique, were retrospectively analyzed. Fifty-two healthy individuals (47 males, 5 females; mean age: 39 ± 11.45 years; range, 21–66 years) were recruited as a control group from the cardiology outpatient clinic. Clinical data (demographic features and laboratory parameters (serum glucose, creatinine, hemoglobin, white blood cell count, and lipid profile)) and electrocardiograms (ECGs) were collected from medical records. ECGs were evaluated for heart rate and VR parameters of QRS width, QTc interval, cQTd interval, Tp-e interval, and Tp-e/QT ratio. The clinical data and these ECG parameters were compared between groups. Results: There was no statistically significant difference between groups, regarding clinical data (all p < 0.05). Among ECG parameters, heart rate, QRS width, QTc interval, and cQTd interval were similar between groups (all p < 0.05). There were two important statistically significant findings of this research: The mean Tp-e interval was longer (ATR group: 72.4 ± 24.7, control group: 58.8 ± 14.5, p: 0.01), and the Tp-e/QT ratio was higher (ATR group: 0.2 ± 0.1, control group: 0.16 ± 0.4, p: 0.027) in the ATR group. Conclusions: According to the ventricular repolarization disturbances found in this study, patients with ATR may be at a higher risk of ventricular arrhythmia than healthy people. As a result, ATR patients should be assessed for ventricular arrhythmia risk by an expert cardiologist.
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    Relationship Between CHA2DS2-VASc Score, Coronary Tortuosity and Atrial Fibrillation in Patients with Coronary Artery Disease
    (2022) Küçük, Uğur; Kırılmaz, Bahadır
    Objectives: Coronary tortuosity (CT) is a common coronary angiography result and the clinical significance of CT is not clearly understood. In this study, the relationship between the presence of CT with CHA2DS2-VASc score and atrial fibrillation (AF) was analyzed. Materials and Methods: Our study included 511 patients who underwent coronary angiography with evidence of coronary artery ischemia. All patients were assessed for the presence and severity of CT. Three or more bends that caused at least 45° changes in the main body of the coronary artery in both systole and diastole were defined as CT. The study patients were divided into groups according to the presence and severity of CT. Results: CHA2DS2-VASc score was higher in the significant (SCT) group (p=0.001). Increased CHA2DS2-VASc score, regardless of age and female gender, was statistically SCT only for the presence of LAD SCT [p=0.003, adjusted odds ratio (OR): 1.95, 95% confidence interval (CI): 1.69-2.20]. Left anterior descending (LAD) SCT (p=0.014, OR: 3.11, 95% CI: 1.25-7.69) was reported to be a possible predictor of AF. Conclusion: Patients who have LAD SCT observed on coronary angiography should be considered for periodic verification with electrocardiography in terms of AF development.
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    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, Burak
    Objective: 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.
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    The crucial importance of diagnosis and treatment of INOCA patients
    (Elsevier Ireland Ltd, 2024) Akşit, Ercan; Küçük, Uğur
    As the incidence of myocardial infarction increases and conventional angiography becomes widespread, cardiology specialists encounter ischemia with no obstructive coronary arteries (aka as MINOCA and INOCA) disease more frequently nowadays.We read with great interest the article by Pelliccia et al. in which they shed light on MINOCA disease [1]. Using adenosine-stress 13 N-ammonia positron emission tomography, Sakai et al. showed that INOCA patients had more deterioration in global coronary flow reserve than obstructive coronary artery disease (CAD) patients.