A. Kaya

Education Training And Research

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Klinikten Pratiğe Kardiyoloji

Deniz Demirci Deniz Demirci A. Kaya Hakkı Kürşat Çetin Ahmet Yılmaz

Tüm yazarlarımızla birlikte "Klinikten pratiğe kardiyoloji" kitabının ilk baskısını okuyucuları ile buluşturmanın heyecanını taşıyoruz. 'Klinikten pratiğe kardiyoloji' kitabında hem kardiyoloji hem de kardiyovasküler cerrahi alanlarındaki güncel bilgileri ve yenilikleri okurlarına iletmek amaçlanmıştır. Bu kitapta kardiyolojik ve cerrahi bakış açıları bir araya getirilmiştir. Aynı zamanda pratik hayatta hastaların yandaş sorunlarına yaklaşım açısından da ilgili uzmanlık alanlarından, yazdıkları bölümlerle katkılar alınmıştır. Sağlık kuşkusuz ki bütüncül yaklaşımlarla geliştirilebilir. Ancak artan bilgi birikimi ve gelişen yeni teknikler alt konu başlıklarında uzmanlaşmayı da zorunlu kılmıştır. Günümüzde sağlıkta bütüncül yaklaşım, farklı konularda uzmanlaşmış kişilerin birikimlerini ortak platformlarda paylaşmaları ile sağlanabilir. Bu kitapta kardiyoloji ve kardiyovasküler cerrahi konusundaki bilgi ve tekniklerin bütüncül olarak bir araya getirilmesi hedeflenmiştir. Tüm yazarlarımızca ortak düşümüz kitabın tekrar eden baskılarında bu yaklaşımı güncel bilgilerle daha da geliştirmektir.

10.37609/akya.1301

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A Rare Cause of Transient Complete Atrioventricular Block: Aortic Dissection

Koşuyolu Heart Journal (2018)

Hasan Kaya A. Kaya Mustafa Oylumlu Sinan Demirtaş

A 62-year-old male patient with no known cardiovascular disease was admitted to the emergency department with abdominal pain and dizziness.Electrocardiogram showed complete atrioventricular block with 50 beats per minute (Figure 1A).The patient was transferred to the coronary care unit.On physical examination, his left-arm blood pressure was 90/60 mmHg, whereas the right-arm blood pressure could not be measured.Electrocardiogram showed spontaneous return to sinus rhythm (Figure 1B).On physical examination, a grade 3/6 diastolic heart murmur was heard at the aortic area.Chest X-Ray showed enlarged mediastinum (Figure 1C).Transthoracic echocardiography revealed ascending aorta dilatation (53 mm) with an intimal flap, suggesting acute aortic dissection (Figure 1D).Color Doppler imaging showed moderate aortic regurgitation.Transesophageal echocardiography showed the dissection flap beginning above the aortic valves extending into the descending aorta (Figure 1E).Contrastenhanced computed tomography revealed aortic dissection, starting 1 cm above the aortic cusps and extending distal to the renal arteries (Stanford type A; Figures 1F,G).The patient was immediately transferred to the operating room.The aortic dissection was resected and reapproximated using Dacron tube graft (Figure 1H).Subsequently, the patient recovered well from the surgery and was discharged on postoperative day 7.

Atrioventricular block

Transient (computer programming)

10.5578/khj.66558

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The Relationship Between Achilles Tendon Thickness and Instent Restenosis in Patients with Carotid Stents

Clinical and Experimental Health Sciences (2024)

Cemalettin Yılmaz Büşra Güvendi Şengör Mehmet Hasan Özdil A. Kaya Lütfi Öcal

Objective: Considering that atherosclerosis and Achilles tendon thickening share common mechanisms, the aim of this study to reveal the relationship between Achilles tendon thickness (ATT) and carotid in-stent restenosis (ISR). Methods: In this study, 89 patients who had carotid stenting for carotid artery disease at our institute between 2016 and 2020 were included. Subjects were divided into two groups as restenosis (+) and restenosis (-) based on the ultrasonographic and/or angiographic findings. The development of 50% or more restenosis in the carotid stent was defined as ISR. Bilateral ATT was measured for all patients who satisfied the inclusion criteria. Results: In our study, 16 (17.9%) patients constituted the restenosis group and 73 (82%) the no-restenosis group. ATT values were similar between groups (4.90.8 vs 4.70.6, p=.27). However, in the marginal effect graphic, it has been demonstrated that the probability of carotid stent restenosis increases with the increase in the mean ATT. The probability of restenosis was 14% when the mean ATT value was 4.16 mm (mean -1 SD) and the probability of restenosis was 22% when the mean ATT value was 5.36 mm (mean +1 SD). Conclusion: No significant difference was found in ATT between the restenosis and no-restenosis group, however, the probability of restenosis increased with increasing ATT. In addition, ultrasonographic measurement of ATT is an easy, inexpensive and safe method that can be used to identify patients at high risk for carotid stent restenosis.

10.33808/clinexphealthsci.1320825

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OP-209 THE EFFECT OF INCREMENTAL ENDURANCE EXERCISE TRAINING ON LEFT VENTRICULAR MECHANICS

International Journal of Cardiology (2012)

Enbiya Aksakal Mustafa Kurt Ersin Öztürk İbrahım Halıl Tanboğa A. Kaya

Endurance Training

10.1016/s0167-5273(12)70133-x

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Investigation of the relationship between nutrition and coronary slow flow-coronary ectasia in patients with acute coronary syndrome

Journal of Cardiology & Cardiovascular Surgery (2024)

A. Kaya

Aims: It is known that malnutrition is associated with various diseases and poor prognosis, but the relationship of this condition with slow coronary flow and coronary ectasia is not clearly known. In our study, we tried to examine the relationship between malnutrition and slow flow-coronary ectasia in ACS (acute coronary syndrome) patients. Methods: We examined the relationship between CONUT score, NRI score and PNI score in patients who underwent coronary angiography due to ACS and were found to have coronary ectasia-slow flow. Results: According to the Conut score, malnutrition was not detected in 57% of the patients, but mild malnutrition was detected in 30%, moderate malnutrition in 10% and severe malnutrition in 1 patient; according to the PNI score, malnutrition was not detected in 61% of the patients, but moderate malnutrition was detected in 19%, severe malnutrition was detected in 18% and coronary slow flow-ectasia was detected in 44% of these patients. (p=0.003, p=0.002) Conclusion: Malnutrition is associated with slow flow and coronary ectasia in patients with acute coronary syndrome. Nutritional assessment and corrective measures are vital for this patient group. Clinical studies are needed to prospectively evaluate these patients.

Ectasia

Coronary artery ectasia

10.51271/jccvs-0045

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Is There a Relationship between Anxiety-depression Level and SYNTAX Score in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention?

Koşuyolu Heart Journal (2024)

A. Kaya Cemalettin Yılmaz Mehmet Hasan Özdil Serdar Söner Mehmet Özbek

Objectives: The SYNergy between percutaneous coronary interventions with TAXUS and Cardiac Surgery (SYNTAX) score is a quantitative scoring system used to evaluate the severity and extent of the disease in patients with coronary artery disease. Hospital Anxiety and Depression Scale (HADS) is a scale that measures the anxiety and depression levels of patients. The relationship between psychosocial stress and atherosclerosis is well known. In this study, we aimed to examine the relationship between SYNTAX score and HADS in patients who performed percutaneous coronary intervention due to acute coronary syndrome (ACS). Methods: A total of 130 subjects with ACS were included in our study. The SYNTAX score, which was calculated by two independent interventional cardiologists, was divided into three groups: 0–22, low; 23–32, moderate; 33 and above, high. In our study, patients’ anxiety and depression levels were evaluated with HADS 1 month after ACS. Results: Of the total subjects, 68, 39, and 23 patients were determined in SYNTAX scores of 0–22, 23–32, and >33 groups, respectively. A significant relationship was observed between the high SYNTAX score and the HADS-depression and anxiety scale (p<0.001, p<0.001, respectively). In the correlation analysis found that, a moderate positive correlation between the SYNTAX score and depression level, and a weak positive correlation between the SYNTAX and anxiety level (r=0.642, r=0.538, respectively). Conclusion: In our study, we found that HADS and SYNTAX scores were significantly correlated in ACS patients who performed percutaneous coronary intervention.

Depression

10.51645/khj.2024.390

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THU0497 Serum Antimicrobial Peptides in Patients with Familial Mediterranean Fever

Annals of the Rheumatic Diseases (2013)

Abdurrahman Tufan Rıdvan Mercan Berivan Bıtık Mehmet Engin Tezcan A. Kaya

Background

Familial Mediterranean fever (FMF) is characterized by recurrent febrile inflammatory attacks of serosal and synovial membranes. Although genetic disorder leading to disease is almost the same, clinical phenotype is quite variable suggesting role of other pathogenetic factors. Serum antimicrobial peptides (AMPs), cathelicidin and defensins, are naturally occurring peptides produced from epithelial tissues and neutrophils. Beside their direct antimicrobial activity, AMPs have immunomodulatory functions including chemotaxis, opsonisation, cytokine, chemokine and compleman activation that may produce or promote inflammation. Their pathogenetic role in numerous autoinflammatory diseases has been reported.

Objectives

To investigate the serum antimicrobial peptides in patients with FMF and its clinical associations.

Methods

twenty-three newly diagnosed FMF patients (14 female, mean age 35.6 years) were enrolled and prospectively followed for six months. Demographic data, disease characteristics and MEFV genotypes were obtained with standardized questionnaires. Age- and sex- matched 24 healthy subjects were constituted control group. Serum alpha defensin (HNP1), beta defensins (hBD1 and hBD2) and cathelicidin (LL37) levels were measured with ELISA, before and six months after treatment and if there was an attack in this time period.

Results

pretreatment concentrations of HNP1, hBD1 and LL37 were significantly higher in FMF patients compared to healthy control subjects and remained throughout after colchicine treatment. HNP1 concentration was reduced to pretreatment levels with colchicine. In six-months follow up period 13 patients experienced at least one attack. During attacks any significant difference observed in any of the serum AMP concentrations. Interestingly, none of serum AMPs correlated with acute phase reactants. Likewise, none of AMPs correlated with frequency of attacks.

Conclusions

Increased levels of serum AMPs in FMF patients suggest that neutrophils are active in the course of disease despite colchicine treatment. We did not find any correlation between FMF disease characteristics and serum AMPs suggesting they are not associated with clinical phenotype of FMF.

Disclosure of Interest

None Declared

Cathelicidin

MEFV

Beta defensin

Colchicine

10.1136/annrheumdis-2013-eular.1025

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AB0043 COMPARATIVE ANALYSIS OF GSDMD LEVELS IN FMF AND APPENDICITIS: SHARED PYROPTOTIC PATHWAYS IN INFLAMMATORY CONDITIONS

Annals of the Rheumatic Diseases (2024)

Ozgur Can Kilinc Yonca Senem AKDENIZ Zuleyha Taskin M. Karabulut A. Kaya

Background:

Familial Mediterranean Fever (FMF) is an autosomal recessive disease caused by gain of function mutations in MEFV gene which in turn leads to overactivation of pyrin inflammasome. Activated pyrin inflammasome promotes proinflammatory cytokine release and pyroptosis [1]. GSDMD, a pore forming protein, when activated enhances proinflammatory cytokine release and is an indicator of pyroptosis [2].

Objectives:

This study aimed to explore the role of GSDMD and hence pyroptosis in the pathogenesis of FMF and its reliability at monitoring subclinical inflammation and disease activity, and at differentiating FMF attacks from appendicitis, the most common misdiagnosis among FMF patients.

Methods:

We collected 75 blood samples from FMF patients (n=20) during attack (n=20) and attack-free period (n=14), patients with appendicitis (n=24), and healthy volunteers (n=17). We determined serum levels of GSDMD in duplicate with enzyme-linked immunosorbent assay (ELISA).

Results:

Within the group of FMF patients, the average age was 36.6 ± 13.5 years, and 40% were women. The average age for patients with appendicitis was 37.8 ± 14.5 years, with females making up 41.7% of this group. Females comprised 64.7% of the healthy control group, and the average age was 35.7 ± 7.8 years. Median serum GSDMD levels (ng/mL) among healthy volunteers were 1.9 (IQR, 1.55-2.6). Patients with acute appendicitis had median serum GSDMD levels of 3 (IQR, 2.35-6.5). Median serum GSDMD levels among patients with FMF were 2.9 (IQR, 2.55-4.2) during attacks and 3 (IQR, 2.2-6.5) in the attack-free period. Median serum GSDMD levels of FMF patients with and without attack, and patients with appendicitis were significantly higher compared to healthy volunteers (p-value: 0.001). Serum GSDMD levels of FMF patients with attack and patients with appendicitis did not differ significantly. FMF patients exhibited similar GSDMD levels during attack and attack-free period. There was a positive correlation between GSDMD and CRP only among FMF patients without attack (p-value: 0.003, r:0.366). Across all study population and subgroups, age and sex were non-significant variables regarding serum levels of GSDMD.

Conclusion:

The results indicated increased levels of GSDMD among FMF patients during attack and attack-free period. Since GSDMD is an indicator of pyroptosis we believe that it is possible to speculate that there is increased pyroptosis among FMF patients during attack and attack-free period. Moreover, among FMF patients without attack there was a positive correlation between GSDMD levels and CRP supporting the evidence that GSDMD and hence pyroptosis contributes to the proinflammatory state in FMF. Additionally, the results indicated increased GSDMD levels among patients with appendicitis indicating increased pyroptosis. GSDMD levels did not differ between patients with appendicitis and FMF. Therefore, we believe that pyroptosis is not a specific pathway for FMF but rather it is a common pathway that is shared by many inflammatory conditions with distinct etiologies. GSDMD levels did not differ during attacks and did not correlate with CRP among FMF patients during attacks. Thus, GSDMD is not an appropriate marker for monitoring disease activity. On the other hand, GSDMD levels remained increased among FMF patients without attack which might help clinicians to detect ongoing subclinical inflammation among patients with FMF.

REFERENCES:

[1] Schnappauf O, Chae JJ, Kastner DL, Aksentijevich I. The Pyrin Inflammasome in Health and Disease. Front Immunol. 2019;10:1745. Published 2019 Aug 7. doi:10.3389/fimmu.2019.01745. [2] Nagai H, Kirino Y, Nakano H, et al. Elevated serum gasdermin D N-terminal implicates monocyte and macrophage pyroptosis in adult-onset Still's disease. Rheumatology (Oxford). 2021;60(8):3888-3895. doi:10.1093/rheumatology/keaa814.