Kocabaş, Umut; Ergin, Işıl; Yavuz, Veysel; Murat, Selda; Özdemir, Ibrahim; Genç, Ömer; Altın, Cihan; Tüner, Haşim; Meriç, Bengisu Keskin; Çoner, Ali

Objective: Oral anticoagulant therapy is the cornerstone of atrial fibrillation management to prevent stroke and systemic embolism. However, there is limited real-world information regarding stroke and systemic embolism prevention strategies in patients with atrial fibrillation. The aim of the ROTA study is to obtain the real-world data of anticoagulant treatment patterns in patients with atrial fibrillation. Materials and Methods: The ROTA study is a prospective, multicenter, and observational study that included 2597 patients with atrial fibrillation. The study population was recruited from 41 cardiology outpatient clinics between January 2021 and May 2021. Results: The median age of the study population was 72 years (range: 22-98 years) and 57.4% were female. The median CHA2DS2-VASc and HAS-BLED scores were 4 (range: 0-9) and 1 (range: 0-6), respectively. Vitamin K antagonists and direct oral anticoagulants were used in 15.9% and 79.4% of patients, respectively. The mean time in therapeutic range was 52.9% for patients receiving vitamin K antagonists, and 76% of those patients had an inadequate time in therapeutic range with <70%. The most common prescribed direct oral anticoagulants were rivaroxaban (38.1%), apixaban (25.5%), and edoxaban (11.2%). The rate of overuse of vitamin K antagonists and direct oral anticoagulants was high (76.1%) in patients with low stroke risk, and more than one-fourth of patients on direct oral anticoagulant therapy were receiving a reduced dose of direct oral anticoagulants. Among patients who were on direct oral anticoagulant treatment, patients with apixaban treatment were older, had higher CHA2DS2VASc and HAS-BLED scores, and had lower creatinine clearance than the patients receiving other direct oral anticoagulants. Conclusions: The ROTA study provides important real-world information about anticoagulant treatment patterns in patients with atrial fibrillation.

Çelik, Aziz İnan; Bezgin, Tahir; Karaaslan, Muhammet Buğra; Coşkun, Reşit; Çağdaş, Metin

Objective: Coronary artery calcification is a cornerstone marker for coronary atherosclerosis. Therefore, the calculation of the coronary artery calcium score has become a routine method in diagnosing coronary artery disease in recent years. Monocyte to high-density lipoprotein cholesterol ratio reflects proatherogenic and antiatherogenic balance, and this ratio is associated with coronary atherosclerosis and cardiovascular events. This study aimed to investigate the value of monocyte to high-densitylipoprotein cholesterol ratio in predicting coronary atherosclerosis, which coronary artery calcium score determines. Methods: A total of 276 patients with chest pain who underwent coronary computed tomography angiography were enrolled in the study. The patients were divided into 3 groups according to coronary artery calcium score [coronary artery calcium score = 0 for very low risk (n = 121), coronary artery calcium score = 1-99 for low risk (n = 100), coronary artery calcium score ≥ 100 for moderate-high risk (n = 55)]. The monocyte to high-density lipoprotein cholesterol ratio, neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, and platelet-to-lymphocyte ratio were calculated from venous blood samples. Results: Monocyte to high-density lipoprotein cholesterol ratio values were significantly higher in patients with moderate-high coronary artery calcium score (1.29 ± 0.59 vs 1.41 ± 0.56 vs 1.56 ± 0.58, P = .009). However, there were no differences between the groups in terms of other inflammatory markers (neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, and platelet-to-lymphocyte ratio). Age (odds ratio: 1.178; 95% CI: 1.107-1.253; P < .001), dyslipidemia (odds ratio: 14.252; 95% CI: 5.459-37.211; P < .001), smoking (odds ratio: 2.893; 95% CI: 1.317-6.358; P= .008), and monocyte to high-density lipoprotein cholesterol ratio (odds ratio: 2.082 per 1-point increase; 95% CI: 1.016-4.268; P= .045) were independent predictors of coronary artery calcium score in multivariate analysis. Conclusion: Our data showed that high monocyte to high-density lipoprotein cholesterol ratio is significantly associated with increased coronary artery calcium score. Monocyte to high-density lipoprotein cholesterol ratio indicates that it can be applied easily and swiftly in clinics to help predicting the coronary artery disease.

Yolcu, Mustafa; Dogan, Ali; Kurtoglu, Nuri; Hancer, Veysel Sabri; Gürbüzel, Mehmet

Objective: Coronary slow-flow phenomenon (CSFP) is defined as the delayed arrival of coronary blood flow to the distal vascular bed in at least 1 major epicardial coronary artery. Cell-free DNA (cfDNA) is a type of DNA that circulates freely in the blood once released from nucleated cells. The aim of this study was to determine if the level of cfDNA, which is an indicator of ischemia at the cellular level, was increased in CSFP. Methods: The study included 46 patients in total: 23 patients with CSFP and 23 with a normal coronary angiogram (NCA). The level of cfDNA, and clinical, biochemical, and angiographic features of the groups were compared. Results: The mean age was 53.8±10.3 years for the CSFP patient group and 56.6±9.4 years for the NCA patient group. There was no statistically significant difference between the groups in terms of basal clinical characteristics or laboratory data. The plasma cfDNA level was 5.04±2.37 ng/µL in the CSFP patients and 2.28±1.09 ng/µL in the NCA group (p<0.001). Conclusion: Several invasive and noninvasive studies conducted on patients with CSFP have revealed myocardial ischemia. The results of this study demonstrated that the level of cfDNA was significantly increased in patients with CSFP as a result of ischemia at the cellular level caused by microvascular disruption.

Topal, Ergün; Kıvanç, Tülay; Çoban, Taha Abdulkadir; Ceyhun, Gökhan; Günay, Murat; Buyuklu, Mutlu; Değirmenci, Hüsnü; Ünver, Edhem; Bakirci, Eftal Murat; Hamur, Hikmet

Objective: The inflammatory process plays an important rolein the development of cardiovascular complications in patientswith obstructive sleep apnea syndrome (OSAS). YKL-40/chitin- ase 3 like protein 1 is a novel biomarker of systemic inflamma- tion. This study aimed to investigate whether carotid intima-me- dia thickness (CIMT), a useful marker for early atherosclerosis,is associated with serum YKL 40/chitinase 3 like protein 1 lev- els in patients with normotensive and nondiabetic OSAS. Methods: The study included 40 OSAS patients and 40 age-sex- and body mass index-matched healthy controls. SerumYKL 40 levels were detected by enzyme-linked immunosor- bent assay. CIMT was measured by B-mode ultrasound. Results: The patients with OSAS had significantly increasedCIMT and higher YKL 40 and high sensitivity C-reactiveprotein (hsCRP) levels than those of the controls. CIMTwas strongly correlated with serum YKL 40 levels (r=0.694,p&lt;0.001), hsCRP (r=0.622, p&lt;0.001), age (r=0.525, p=0.001),and weakly correlated with apnea-hypopnea index (AHI)(r=0.365, p=0.021) and the percentage of recording timespent (PRTS) of oxygen saturation &lt;90% (r=0.488, p=0.001).Moreover, it was detected that serum YKL-40 levels werestrongly correlated with AHI (r=0.617, p&lt;0.001), and weaklycorrelated with SaO2 &lt;90% of PRTS (r=0.394, p=0.012) andhsCRP (r=0.486, p=0.001). In multiple regression analyses,age and serum levels of YKL 40 and hsCRP were found to beindependent predictors of CIMT. Conclusion: In patients with OSAS, CIMT was increased.This increase was associated with serum YKL 40 level. In- creased serum level of YKL 40 may be an early predictor ofatherosclerosis development in patients with OSAS.

Bakirci, Eftal Murat; Ünver, Edhem; Deʇirmenci, Hüsnü; Kivanç, Tülay; Günay, Murat; Hamur, Hikmet; Büyüklü, Mutlu; Ceyhun, Gökhan; Topal, Ergun; Çoban, Taha Abdulkadir

Objective: The inflammatory process plays an important role in the development of cardiovascular complications in patients with obstructive sleep apnea syndrome (OSAS). YKL-40/chitinase 3-like protein 1 is a novel biomarker of systemic inflammation. This study aimed to investigate whether carotid intima-media thickness (CIMT), a useful marker for early atherosclerosis, is associated with serum YKL-40/chitinase 3-like protein 1 levels in patients with normotensive and nondiabetic OSAS. Methods: The study included 40 OSAS patients and 40 age-sex- and body mass index-matched healthy controls. Serum YKL-40 levels were detected by enzyme-linked immunosorbent assay. CIMT was measured by B-mode ultrasound. Results: The patients with OSAS had significantly increased CIMT and higher YKL-40 and high sensitivity C-reactive protein (hsCRP) levels than those of the controls. CIMT was strongly correlated with serum YKL-40 levels (r=0.694, p<0.001), hsCRP (r=0.622, p<0.001), age (r=0.525, p=0.001), and weakly correlated with apnea-hypopnea index (AHI) (r=0.365, p=0.021) and the percentage of recording time spent (PRTS) of oxygen saturation <90% (r=0.488, p=0.001). Moreover, it was detected that serum YKL-40 levels were strongly correlated with AHI (r=0.617, p<0.001), and weakly correlated with SaO2 <90% of PRTS (r=0.394, p=0.012) and hsCRP (r=0.486, p=0.001). In multiple regression analyses, age and serum levels of YKL-40 and hsCRP were found to be independent predictors of CIMT. Conclusion: In patients with OSAS, CIMT was increased. This increase was associated with serum YKL-40 level. Increased serum level of YKL-40 may be an early predictor of atherosclerosis development in patients with OSAS.

Duman, Hakan; Bakirci, Eftal Murat; Karadaʇ, Zakir; Uʇurlu, Yavuz

Esophageal perforation is a serious condition with a high mortality rate. Delayed detection of esophageal perforation may result in devastating complications such as mediastinitis and pericarditis. Esophageal perforation is rarely due to aspiration of foreign bodies. Here we report the case of a 59-year-old male patient with complicated esophageal perforation due to ingestion of a chicken bone, whose first signs are considered to be acute non-specific pericarditis.