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    Changes in Acute Coronary Syndrome Clinic after the Devastating Earthquake in Türkiye
    (Kare Publ, 2024) Akkus, Oguz; Yasdiba, Ramazan; Demirkiran, Ramazan Furkan; Elitas, Veysel; Bekler, Ozkan; Sen, Fatih; Binokay, Hulya
    Background: We aimed to investigate the clinical and angiographic characteristics of patients with acute coronary syndrome (ACS) who survived this devastating earthquake and were admitted to our hospital in Antakya/T & uuml;rkiye. Methods: We retrospectively examined the impact of the earthquake on the occurrences of acute coronary syndromes in Antakya/T & uuml;rkiye. All 248 consecutive patients with ACS, also survivors of the earthquake in Antakya, were enrolled as the earthquake group. The earthquake group was created from patients hospitalized between February and June in 2023 after the earthquake. In total, 209 consecutive ACS patients who were hospitalized in our cardiology clinic in similar months of 2022 named as the control group. Results: Patients admitted before the earthquake were more hospitalized with multi- vessel disease compared to after the earthquake group (P < .001). Myocardial infarction with non-obstructive coronary artery disease (MINOCA) was the main reason for the significant increase rate of ACS after the earthquake. The earthquake patient group had lesser diabetes mellitus than the control group (P < .001). The risk of men suffering from ACS after an earthquake is approximately 2.1 times higher than women (P = .023). Those with a history of revascularization are approximately 1.8 times more likely to have ACS after an earthquake (P = .05). The risk of experiencing ACS after an earthquake is approximately 3.5 times higher for those with a family history than for those without (P < .001). Conclusion: Effects of the devastating earthquake on the heart are the increase in MINOCA patients triggered by great sudden environmental stress and the decrease in diabetes due to worsening nutritional conditions, respectively.
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    Comparison of functional and maximal exercise capacity, respiratory and peripheral muscle strength, dyspnea, and fatigue in patients with heart failure with pacemakers and healthy controls: a cross-sectional study
    (Taylor & Francis Inc, 2021) Guclu, Meral Bosnak; Bargi, Gulsah; Katayifci, Nihan; Sen, Fatih
    Background: Despite major breakthroughs that have recently been made in pacemakers implanted in patients with heart failure (HF), it is clear that functional impairments and symptoms often remain. However, only limited studies have investigated exercise capacity, muscle strength, pulmonary function, dyspnea, and fatigue in these patients. Therefore, we aimed to compare aforementioned outcomes in patients and healthy controls. Methods: A cross-sectional study. Fifty patients with HF with pacemakers (58.90 +/- 10.69 years, NYHA II-III, LVEF: 30.79 +/- 8.78%) and 40 controls (56.33 +/- 5.82 years) were compared. Functional (6-Minute Walking test (6-MWT)) and maximal exercise capacity (Incremental Shuttle Walk test (ISWT)), respiratory (Mouth pressure device) and peripheral muscle strength (Dynamometer), pulmonary function (Spirometry), dyspnea (Modified Medical Research Council Dyspnea scale), and fatigue (Fatigue Severity scale) were evaluated. ClinicalTrial number: NCT03701854. Results: 6-MWT (412.62 +/- 96.51 m versus 610.16 +/- 59.48 m) and ISWT (279.97 m versus 655 m) distances (p < 0.001), pulmonary function (p<0.001), respiratory and peripheral muscle strength (p < 0.001) were significantly lower; dyspnea (p < 0.001) and fatigue (p = .030) scores were higher in patients compared with controls. Conclusion: Maximal and functional exercise capacity is impaired in the majority of patients with HF with pacemakers, respiratory and peripheral muscles are weakened, dyspnea and fatigue perceptions are increased. Patients with pacemakers have to be included in cardiac rehabilitation programs to improve impairments.
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    Comparison of functional exercise capacity, quality of life and respiratory and peripheral muscle strength between patients with stable angina and healthy controls
    (Sage Publications Ltd, 2020) Huzmeli, Irem; Ozer, Aysel-Yildiz; Akkus, Oguz; Katayifci, Nihan; Sen, Fatih; Yurdalan, Saadet Ufuk; Polat, Mine Gulden
    Objective We aimed to compare functional exercise capacity, respiratory and peripheral muscle strength, pulmonary function and quality of life between patients with stable angina and healthy controls. Methods We compared 33 patients with stable angina (55.21 +/- 6.12 years old, Canada Class II-III, left ventricular ejection fraction: 61.92 +/- 7.55) and 30 healthy controls (52.70 +/- 4.22 years old). Functional capacity (6-minute walk test (6-MWT)), respiratory muscle strength (mouth pressure device), peripheral muscle strength (dynamometer), pulmonary function (spirometer) and quality of life (Short Form 36 (SF-36)) were evaluated. Results 6-MWT distance (499.20 +/- 51.91 m versus 633.05 +/- 57.62 m), maximal inspiratory pressure (85.42 +/- 20.52 cmH(2)O versus 110.44 +/- 32.95 cmH(2)O), maximal expiratory pressure (83.33 +/- 19.05 cmH(2)O versus 147.96 +/- 54.80 cmH(2)O) and peripheral muscle strength, pulmonary function and SF-36 sub-scores were lower in the angina group versus the healthy controls, respectively. Conclusion Impaired peripheral and respiratory muscle strength, reduction in exercise capacity and quality of life are obvious in patients with stable angina. Therefore, these parameters should be considered in stable angina physiotherapy programmes to improve impairments.
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    A comparison of the effects of inspiratory muscle strength and endurance training on exercise capacity, respiratory muscle strength and endurance, and quality of life in pacemaker patients with heart failure: A randomized study
    (Mosby-Elsevier, 2022) Katayifci, Nihan; Guclu, Meral Bosnak; Sen, Fatih
    Background: Studies have widely investigated the effects of inspiratory muscle strength training in patients with heart failure (HF). The effects of inspiratory muscle strength or endurance training on outcomes in patients with pacemakers have not been adequately studied. Objectives: The aim was to compare the effects of inspiratory muscle strength and endurance training on exercise capacity, quality of life (QoL), peripheral and respiratory muscle strength, respiratory muscle endurance, pulmonary function, dyspnea, fatigue, and physical activity levels in pacemaker patients with HF. Methods: A randomized, controlled, double-blind study was conducted. Fourteen pacemaker patients with HF received inspiratory muscle strength training (IMST) at 50% of maximal inspiratory pressure (MIP), and 18 patients received endurance training (IMET) at 30% of MIP 7 days/8 weeks. Exercise capacity [6 min. walking test (6MWT) and the Incremental Shuttle Walking Test (ISWT)], pulmonary function, respiratory muscle strength [MIP, maximal expiratory pressure (MEP)], endurance, peripheral muscle strength, dyspnea, fatigue, QoL, and physical activity level were evaluated before and after. Results: Demographic characteristics were similar in IMST (3F/11M, 56.92 +/- 7.61y, EF: 25%, ICD/CRT: 11/3) and IMET (4F/14M, 56 +/- 10.77y, EF: 30%, ICD/CRT:16/2) groups (p > 0.05). Significant improvements were present in MIP, MEP, respiratory muscle endurance, peripheral muscle strength, 6MWT and ISWT walking distances, dyspnea, QoL, physical activity level, fatigue scores within groups (p <= 0.05). However, there were no significant differences between the groups (p > 0.05). There were no significant improvements in FEV1%, FVC%, FEV1/FVC%, and FEF25-75 within and between the groups (p > 0.05). Conclusions: Inspiratory muscle strength and endurance training similarly improves respiratory and peripheral muscle strength, exercise capacity, QoL, physical activity level, and decreases dyspnea and fatigue and are safe and effective in pacemaker patients with HF. (C) 2022 Elsevier Inc. All rights reserved.
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    Effect of Carvedilol Versus Metoprolol on Contrast-Induced Nephropathy in Patients with Acute Coronary Syndrome Undergoing Percutaneous Intervention Therapy
    (Sage Publications Inc, 2024) Uguz, Erkan; Kurtul, Alparslan; Sen, Fatih
    Carvedilol can inhibit inflammation, vasoconstriction, and oxidative stress, which play important roles in the development and progression of contrast-induced nephropathy (CIN). To the best of our knowledge, no studies have investigated the potential effect of carvedilol on the prevalence of CIN after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). The present study aimed to determine whether carvedilol use is associated with the development of CIN. A total of 319 patients (mean age, 59.2 +/- 12.4 years; 77.7% male) with ACS who underwent urgent PCI at our institution between May 2019 and May 2022 were included prospectively. Overall, 100 and 219 patients were assigned to the carvedilol and metoprolol groups, respectively. The prevalence of CIN was significantly lower in the carvedilol group (6.0%) than in the metoprolol group (18.3%; P = .003). Multivariate analysis revealed that carvedilol use (odds ratio [OR] .250, 95% confidence interval [CI] .092-.677, P = .006), amount of contrast agent (OR 1.004, 95% CI 1.000-1.008, P = .031), and admission estimated glomerular filtration rate (OR .978, 95% CI 0.960-.995, P = .014) were independently associated with the development of CIN. The use of carvedilol may be a promising option for the prevention of CIN in patients with ACS undergoing urgent PCI.
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    Effectiveness of Device-Guided Breathing in Chronic Coronary Syndrome: A Randomized Controlled Study
    (Taiwan Soc Cardiology, 2023) Akkus, Oguz; Huzmeli, Irem; Seker, Taner; Bekler, Ozkan; Sen, Fatih; Kaypakli, Onur; Ozer, Aysel Yildiz
    Background: Chronic coronary syndrome (CCS) is one of the most life-restricting coronary artery diseases, and symptom relief is the main goal in CCS patients who suffer from angina.Objectives: To assess the potential benefits of device-guided breathing in CCS patients with angina in this randomized, controlled, single-blinded study.Methods: Fifty-one patients with CCS received device-guided breathing for 7 days/8 weeks. Exercise capacity [exercise stress test], cardiac function [transthoracic echocardiography], and angina severity [Canadian Cardiovascular Society Classification] were evaluated initially and after the training. Device-guided breathing was performed at the lowest resistance of the device (POWERbreathe (R) Classic LR) for the control group (n = 17). The low load training group (LLTG; n = 18) and high load training group (HLTG; n = 16) were trained at 30% and 50% of maximal inspiratory pressure. Baseline characteristics were compared using one-way ANOVA and Kruskal-Wallis test. Categorical data were compared using the chi-square test. ANCOVA was performed to compare changes between three groups. A p value < 0.05 was considered statistically significant.Results: Metabolic equivalent values were significantly improved in both HLTG and LLTG groups (p < 0.001, p = 0.003). The Duke treadmill score significantly improved and shifted to low-risk both in the HLTG (p < 0.001) and LLTG (p < 0.001) groups. Angina severity significantly alleviated after the training in both HLTG and LLTG groups (p < 0.001, p = 0.002).Conclusions: An 8-week long program of short-term respiratory muscle training provided positive gains in exercise capacity and angina severity in CCS patients with angina. The effects of long-term training programs on CCS patients should be investigated clinically because of the possibility of helping to decrease the need for invasive treatments.
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    Effects of aminoethoxyvinylglycine treatment by vacuum infiltration method on postharvest storage and shelf life of tomato fruit
    (Elsevier, 2017) Candir, Elif; Candir, Altan; Sen, Fatih
    The aim of this study was to determine effects of postharvest aminoethoxyvinylglycine (AVG) treatment using vacuum infiltration method on retardation of ripening, storage and shelf life of tomato fruit. In the Experiment-1, beefsteak 'Grando F1' tomato fruit was harvested at breaker stage and treated with AVG at six different doses (0, 62.5,125, 250, 500 and 1000 mg L-1) and three different vacuum pressures (0 kPa, -20 kPa and -30 kPa) using vacuum infiltration method and kept at 20 degrees C for 8 d. The AVG treatment of 1000 mg L-1 at -30 kPa reduced ethylene production rate by 45.53%, delayed color changes and extended the number of days reaching to red ripe stage from 6 to 8 d at 20 degrees C and was confirmed as the optimal treatment for the maximum retardation of tomato fruit ripening by response surface methodology. In Experiment-2, untreated and treated breaker 'Grand F1' tomato fruit with 1000 mg L-1 at -30 kPa were kept at 12 degrees C for 0, 5, 10, 15 or 20 d and for 2 d at 20 degrees C after cold storage. AVG treated fruit had lower ethylene production rate, lycopene content, a* and C* values and higher fruit firmness, chlorophyll content, L* and h degrees values, compared to control during storage and shelf life period. For shipping to distant markets, storage and shelf life of untreated fruit were 10 d at 12 degrees C plus 2 d at 20 degrees C while AVG treatment extended storage and shelf life to 20 d at 12 degrees C plus 2 d at 20 degrees C. (C) 2016 Elsevier B.V. All rights reserved.
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    Increased Rates of Coronary Artery Calcium Score in Patients with Non- Functioning Adrenal Incidentaloma
    (Bentham Science Publ Ltd, 2021) Akkus, Oguz; Akkus, Gamze; Kaypakli, Onur; Ozturk, Fatma Keles; Gurkan, Eren; Bekler, Ozkan; Sen, Fatih
    Aim: We evaluated cardiovascular (CV) risk stratification for nonfunctioning adrenal in-cidentalomas (NFAIs) via the coronary-artery-calcium (CAC) score. Materials and Methods: The participants were patients with NFAI (n = 55). They were compared to patients with chest pain, a low-intermediate Framingham-risk score, and a non-diagnostic tread-mill-exercise test, which served as the control group (n = 49). Subsequently, the NFAI group was subdivided according to a CAC score of <100 Agatston units - mild coronary-artery calcification (n = 40) - and >100 Agatston units - moderate-to-severe calcification (n = 15). Results: Similar rates of traditional risk factors were observed between the NFAI and control groups, and lower low-density lipoprotein cholesterol rates were observed in the NFAI group. The CAC score was significantly higher for the NFAI group than the control group. Glucose, potassi-um, adrenocorticotropic-hormone, and basal-cortisol levels were higher in those with a CAC score of >100. High-density-lipoprotein cholesterol estimated glomerular filtration rate and ejection frac-tion (EF) were higher in those with a CAC score of <100. Adenoma size and location were similar between the groups. Age, EF, and glucose were the most significant variables related to CAC score in patients with NFAI, at >100 Agatston units. Discussion: Patients with a low-intermediate CV risk profile and NFAI have a higher risk of atherosclerosis when compared to patients with a low-intermediate CV risk profile, but no NFAI. Conclusion: In patients with NFAI, CAC score evaluation may be used to predict increased atherosclerosis, especially in patients of an older age with higher glucose and decreased EF.
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    Is Low-free Triiodothyronine (fT3) Associated with Increased Morbidity in Patients Admitted to Coronary Care Units?
    (Bentham Science Publ Ltd, 2024) Akkus, Oguz; Sen, Fatih; Yasdibas, Ramazan; Otegen, Alper Tunga; Huzmeli, Irem; Akkus, Gamze
    Background: The effects of thyroid hormone on patients hospitalized in coronary intensive care units are still controversial. Objective: We retrospectively examined thyroid hormone levels and their impact on cardiovascular morbidity in patients admitted to coronary intensive care units. Methods: A total of 208 (Female/Male; 46.6%/53.4%) patients without any history of thyroid disease were enrolled and screened. Patients with specific heart disease and existing thyroid hormone parameters were included in the study. Low triiodothyronine syndrome is characterized by reduced serum total or free T3 (fT3) concentrations in normal free T4 (fT4) and TSH levels. Results: The common diagnosis of the patients in the coronary care unit is acute coronary syndrome (n=59, 28.2%) and heart failure (n=46, 23.3%). Patients were divided into two groups according to left ventricular ejection fraction percentages (LVEF <= 39% vs LVEF >= 40%). Plasma fT3 levels were significantly correlated with low LVEF (<= 39%) (p =0.002). fT3 (r=-0.183, p =0.013) and hospitalization etiology (r=-0.161, p =0.023) were also the most critical parameters affecting the length of hospitalization. Conclusion: Low fT3 was associated with reduced ejection fraction and prolonged hospitalization, which may lead to potential morbidities in HF patients which may be useful in risk stratification and treatment strategies.
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    Pan-Immune-Inflammation Value Is Independently Correlated to Impaired Coronary Flow After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction
    (Excerpta Medica Inc-Elsevier Science Inc, 2024) Sen, Fatih; Kurtul, Alparslan; Bekler, Ozkan
    Immune-inflammatory biomarkers have been shown to be correlated with impaired coronary flow (ICF) in ST-segment elevation myocardial infarction. In this study, we assessed the relation between a novel comprehensive biomarker, pan-immune-inflammation value (PIV), and ICF after primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction. A total of 687 patients who underwent pPCI between 2019 and 2023 were retrospectively analyzed. Blood samples were collected at admission. PIV and other inflammation parameters were compared. PIV was calculated as (neutrophil count x platelet count x monocyte count)/lymphocyte count. Postprocedural coronary flow was assessed by thrombolysis in myocardial infarction (TIMI) classification. Patients were divided into 2 groups: a group with ICF defined as postprocedural TIMI 0 to 2 and a group with normal coronary flow defined as postprocedural TIMI flow grade of 3. The mean age was 61 +/- 12 years, and 22.4% of the patients were women. Compared with the normal coronary flow group (median 492, interquartile range 275 to 931), the ICF group (median 1,540, interquartile range 834 to 2,909) showed significantly increased PIV (p <0.001). The optimal cutoff for the PIV was 804, as determined by receiver operating characteristic curve. The incidence of ICF was 17.0% in all patients, 6.4% in low-PIV group (<804), and 34.2% in high-PIV group (>= 804). Multivariate analyses revealed that a baseline PIV >= 804 was independently associated with post-pPCI ICF (odds ratio 5.226, p <0.001). PIV was superior to neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in determining ICF. In conclusion, a high-PIV was significantly associated with an increased risk of ICF after pPCI. More-over, PIV was a better indicator of ICF than were other inflammatory markers.(c) 2023 Elsevier Inc. All rights reserved.