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    The association of hemodynamic markers of right ventricular dysfunction with SII index and clinical outcomes in reduced ejection fraction heart failure
    (Lippincott Williams & Wilkins, 2023) Balci, Kevser; Erbay, Ilke; Demirkan, Burcu; Balci, Mustafa Mucahit; Temizhan, Ahmet
    Heart failure (HF) is a clinical syndrome with various etiologies and presentations. The role of the inflammatory pathway in HF prognosis is not fully understood. We investigated the association between the systemic immune-inflammation index (SII) and HF complicated by right ventricular dysfunction (RVD) and whether the SII is related to compromised hemodynamic volume status. A total of 235 patients with HF with reduced ejection fraction (HFrEF) were enrolled and divided into 2 groups according to the presence of RVD. The relationship between the SII score, hemodynamic parameters, and clinical endpoints was evaluated. Higher SII scores and neutrophil counts (P < .001 and P = .017, respectively) were observed in the RVD group (n = 120). In the high SII score group (=590.4), hospitalization and the need for positive inotrope treatment were significantly higher (P = .026 and P = .009, respectively), and left ventricular ejection fraction (LVEF) was significantly lower (P = .015). In addition, in the high SII score group, right heart catheterization values, including cardiac output and index, were significantly impaired compared with those in the lower SII score group. There was a significant negative correlation between the SII score and the LVEF, cardiac output, and cardiac index in the correlation analyses. A significant relationship was observed between indirect inflammation and RVD in patients with HFrEF. The hemodynamic volume status and functional capacity were impaired in patients with high SII scores. These results indicated that advanced HF with worse outcomes may be related to the inflammatory processs.
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    Edoxaban therapy in non-valvular atrial fibrillation patients: paradoxical effect on mean platelet volume
    (2023) Erbay, Ilke; Aker, Mert; Süner, Ahmet Furkan; Akın, Yesim; Önalan, Orhan
    Introduction: New generation oral anticoagulants (NOACs), which selectively and reversibly block the activity of clotting factor Xa, are now preferred as first-line therapy for preventing ischemic stroke in the treatment of atrial fibrillation (AF). Edoxaban, one of these NOACs, has been shown to be as effective as warfarin in preventing stroke or systemic embolism, while carrying a lower risk of bleeding and cardiovascular death. Mean platelet volume (MPV), as an indicator of platelet activity, is associated with an increased risk of ischemic stroke in patients with AF. Therefore, medical therapies that reduce MPV may play an important role in preventing unwanted ischemic events. Objective: The aim of this study is to determine whether edoxaban has an effect on platelet volume and other platelet indices, in addition to its protective anticoagulant effect against ischemic stroke. Materials and Methods: The study was designed as a retrospective cross-sectional study. Two hundred non-valvular AF patients without a history of oral anticoagulant use were included in the study. Complete blood count (CBC) and basic biochemical parameters (urea, creatinine, electrolytes, etc.) were recorded from the hospital registration system before edoxaban treatment was started, along with basic demographic data. The CBCs of the patients were reevaluated an average of 6 months (184 ± 9 days) after edoxaban treatment initiation, and platelet indices after edoxaban treatment were compared. Results were presented as mean ± standard deviation and percentage. Data were compared using Student's t-test and Wilcoxon test, and p
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    Increased vitamin B12 in heart failure with reduced ejection fraction: A novel marker of disease severity and mortality
    (Bayrakol Medical Publisher, 2024) Erbay, Ilke; Demirkan, Burcu; Akin, Yesim; Balci, Gulcihan Kevser
    Aim: The relationship between elevated vitamin B12 levels and liver damage is well -established, but its association with the severity of heart failure (HF) remains unclear. This study aimed to investigate the prognostic importance of vitamin B12 levels according to disease severity in HF patients with reduced left ventricular ejection fraction (HFrEF). Material and Methods: Two hundred and three consecutive patients with HFrEF were enrolled in this study. Patients were divided into advanced and nonadvanced HF groups based on specific criteria and the primary endpoint was all -cause mortality, which was prospectively assessed. Cox proportional hazards regression analyses were conducted to identify independent predictors of mortality. Results: Of the study patients, 75 (36.9%) had advanced, while 128 (63.1%) had non -advanced HF. The advanced group had significantly higher serum vitamin B12 levels compared to the non -advanced group (p<0.001). Serum vitamin B12 level of > 707.8 pg/mL had a sensitivity of 78.3% and specificity of 76.1% in predicting all -cause mortality (area under the curve=0.863, 95% CI 0.806-0.920, p<0.001). Kaplan -Meier analysis demonstrated that patients with vitamin B12 levels > 707.8 pg/mL had significantly lower survival rates (p < 0.001). In Cox regression analysis, vitamin B12 emerged as an independent predictor of death. Discussion: Elevated serum vitamin B12 levels in HFrEF patients are associated with advanced HF, increased ALT and GGT levels, indicating a cardiohepatic syndrome, and independently predict higher all -cause mortality risk.
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    A novel predictor behind conventional risk factors of new-onset atrial fibrillation after off-pump coronary artery bypass graft surgery: The triglyceride-glucose index
    (Bayrakol Medical Publisher, 2024) Erbay, Ilke; Ozkan, Can
    Aim: Atrial fibrillation (AF), which frequently occurs after coronary artery bypass graft surgery (CABG), raises the risk of adverse events such as stroke and heart failure. Insulin resistance (IR) is a major risk factor for developing postoperative AF (POAF), and the triglyceride-glucose (TyG) index offers a more precise and reliable assessment of IR compared to the homeostasis model. This study investigated the correlation between preoperative TyG index levels and POAF in patients undergoing off -pump CABG. Material and Methods: Four hundred sixteen patients undergoing isolated off -pump CABG were included in the study. The preoperative TyG index and the presence of POAF were evaluated in all patients. Significant variables (P<0.05) from univariate analysis were included in multivariate logistic regression to identify potential POAF risk factors. The TyG index's predictive efficacy for POAF was assessed in two models: one with conventional risk factors and the other adding the TyG index. Results: POAF was detected in 106 patients (25.5%), with significantly higher TyG index levels observed in POAF patients compared to those without POAF [9.8 (8.0-11.7) vs. 9.0 (7.7-11.1), P<0.001]. The TyG index was found to be an independent predictor of POAF (P<0.001) with moderate predictive power (AUC=0.767). Adding the TyG index to the model, which included age and left atrial diameter, significantly improved its predictive capacity for POAF (P=0.038). Discussion: In our retrospective study, we identified the TyG index as an independent predictor of POAF in patients undergoing off -pump CABG.
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    Revitalizing Sexual Function in Heart Failure patients: The Impact of Sodium-Glucose Co-Transporter 2 Inhibitors on Erectile Dysfunction
    (Galenos Publ House, 2024) Erbay, Ilke; Akin, Yesim
    BACKGROUND/AIMS: The prognosis of heart failure (HF) is closely related to the structural integrity of the endothelium. Endothelial dysfunction is observed as a characteristic feature of HF and it plays an important role in the development of erectile dysfunction (ED) in patients with HF. Sodium-glucose co-transporter-2 inhibitors (SGLT-2i) have been shown to increase microvascular endothelial cell function through their pleiotropic effects. Therefore, we aimed to investigate the effects of SGLT-2i treatment on ED in patients with HF. MATERIALS AND METHODS: Forty sexually active HF patients with reduced left ventricular ejection fraction [(LVEF) <40%] and ED were enrolled in this study. In all patients, their functional status was assessed according to the New York Heart Association functional classification, and erectile function was assessed by the Sexual Health Inventory for Men (SHIM) questionnaire at baseline and after three months of SGLT-2i treatment. RESULTS: SGLT-2i treatment resulted in a significant improvement in the SHIM scores (12.7 +/- 5.6 vs. 15.4 +/- 5.5, p<0.001). Predictors of improved SHIM scores with SGLT-2i were assessed using multivariable regression. Age (p=0.002), baseline SHIM scores (p=0.042), and lower extremity peripheral vascular disease (p=0.002) were identified as negative predictors of improvements in SHIM scores, while changes in brain natriuretic peptide levels (p=0.035) emerged as a significant predictor of improvement in SHIM scores. CONCLUSION: This cross-sectional study suggests that treatment by SGLT-2i could potentially provide advantages to patients with HF who also experience ED, enhancing their functional status.