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    Assessment of dyslipidemia management in Turkey using a Delphi panel
    (Nature Research, 2024) Sinan, Ümit Yaşar; Yılmaz, Mehmet Birhan; Temizhan, Ahmet; Yüksel, Uygar Çağdaş; Güngör, Barış; Kemaloğlu Öz, Tuğba; Kuş, Mesut; Özdoğan, Öner; Kayıkçıoğlu, Meral
    This study evaluated the management of dyslipidemia in Turkey with the goal of understanding current diagnosis and treatment patterns, as well as identifying unmet needs in achieving effective low-density lipoprotein cholesterol (LDL-C) targets. Using a Delphi panel consisting of nine expert cardiologists, the study reveals key gaps in dyslipidemia management, particularly in the underutilization of combination therapies, such as statins and PCSK9 inhibitors, which are crucial for achieving LDL-C targets in high-risk patients. The findings indicate that while many patients with very high cardiovascular risk are diagnosed, a significant proportion do not receive optimal treatment to reach LDL-C levels recommended by European guidelines. Addressing these gaps could lead to more effective management of dyslipidemia and reduce the burden of cardiovascular disease in Turkey. The study’s insights provide critical recommendations for clinicians and policymakers to improve clinical practice and health outcomes through more aggressive lipid-lowering strategies. © The Author(s) 2024.
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    Current Use of sodium glucose co-transporter 2 inhibitors in heart failure therapy
    (Turkish society of cardiology, 2024) Çavuşoğlu, Yüksel; Altay, Hakan; Çelik, Ahmet; Güvenç, Tolga Sinan; Kılıçarslan, Barış; Nalbantgil, Sanem; Temizhan, Ahmet; Yıldırımtürk, Özlem; Yılmaz, Mehmet Birhan
    Sodium-glucose cotransporter-2 inhibitors (SGLT2i) inhibit urinary glucose and sodium reabsorption in the proximal tubule of the nephron and result in glucosuria, natriuresis and diuresis. In patients with T2DM who have atherosclerotic cardiovascular (CV) disease or CV risk factors, SGLT2is is have been shown to reduce major CV events and heart failure (HF) hospitalization. The greatest and most consistent effect of SGLT2is in these trials was found to be reduction in HF hospitalization, which raised the possibility of clinical benefit of SGLT2i in HF patients. In DAPA-HF and EMPEROR-Reduced trials in heart failure with reduced ejection fraction (HFrEF) patients with or without T2DM, SGLT2İs, dapagliflozin and empagliflozin treatment on top of standard HF therapy has been shown to have clear clinical benefit in reducing primary endpoint of CV mortality or HF hospitalization and improving quality of life. Recently published EMPEROR-Preserved and DELIVER trials showed that SGLT2is were also very effective in the treatment of heart failure with preserved ejection fraction (HFpEF) (EF >40%). Furthermore, SGLT2is have also been shown to have potential in improving clinical outcomes in hospitalized acute HF patients in EMPULSE and DICTATE-AHF trials. All of this evidence has changed guidelines recommended therapies, not only for HFrEF but also for HFpEF treatment. The aim of this article is to provide a comprehensive overview focused on the role of SGLT2i in the treatment of HF based on the recent evidence.
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    Effect of renal function on the prognostic importance of chloride in patients with heart failure
    (Sage Publications Ltd, 2023) Guvenc, Rengin Cetin; Guevenc, Tolga Sinan; Temizhan, Ahmet; Cavusuglu, Yueksel; Celik, Ahmet; Yilmaz, Mehmet Birhan
    Hypochloremia has recently gained interest as a potential marker of outcomes in patients with heart failure (HF). The exact pathophysiologic mechanism linking hypochloremia to HF is unclear but is thought to be mediated by chloride-sensitive proteins and channels located in kidneys. This analysis aimed to understand whether renal dysfunction (RD) affects the association of hypochloremia with mortality in patients with HF. Using data from a nationwide registry, 438 cases with complete data on serum chloride concentration and 1-year survival were included in the analysis. Patients with an estimated glomerular filtration rate of <60 mL/min/m(2) at baseline were accepted as having RD. Hypochloremia was defined as a chloride concentration <96 mEq/L at baseline. For HF patients without RD at baseline, patients with hypochloremia had a significantly higher 1-year all-cause mortality than those without hypochloremia (41.6% vs 13.0%, log-rank p < 0.001) and the association remained significant after multivariate adjustment (odds ratio (OR): 2.55, 95% confidence interval (CI): 1.25-5.21). The evidence supporting the association was very strong in this subgroup (Bayesian Factor (BF)(10): 48.25, log OR: 1.56, 95% CI: 0.69-2.43). For patients with RD at baseline, there was no statistically significant difference for 1-year mortality for patients with or without hypochloremia (36.3% vs 29.7, log-rank p = 0.35) and there was no evidence to support an association between hypochloremia and mortality (BF10: 1.18, log OR :0.66, 95% CI: -0.02 to 1.35). In patients with HF, the association between low chloride concentration and mortality is limited to those without RD at baseline.
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    How to Use Natriuretic Peptides in Patients with Heart Failure with Non-Reduced Ejection Fraction? A Position Paper from the Heart Failure Working Group of Turkish Society of Cardiology
    (Kare Publ, 2023) Celik, Ahmet; Kilicaslan, Baris; Temizhan, Ahmet; Guvenc, Tolga Sinan; Altay, Hakan; Cavusoglu, Yuksel; Yilmaz, Mehmet Birhan
    Natriuretic peptides are widely used in all types of heart failure. Previously, we defined heart failure with non-reduced ejection fraction as patients with heart failure symptoms and/or signs and who have left ventricular ejection fraction > 40%.(1) For the diagnosis of heart failure with preserved ejection fraction, the presence of raised natriuretic peptides is one of the major components of the diagnosis, and raised natriuretic peptides make the diagnosis more likely in patients with heart failure with mildly reduced ejection fraction.(2) The majority of the existing studies have described the utility of natriuretic peptides in patients with heart failure with reduced ejection fraction, but there is not enough data on natriuretic peptides in heart failure patients with heart failure with non-reduced ejection fraction. Despite the insufficient information regarding the usage of natriuretic peptides in heart failure with non-reduced ejection fraction, it is obvious that there is an unmet need to guide how to use natriuretic peptides in these patients. The main goal of this article is to discuss the role of natriuretic peptides in diagnosis, prognosis, and guidance of heart failure treatment in patients with heart failure with non-reduced ejection fraction. The present review discusses the role of natriuretic peptides in heart failure with non-reduced ejection fraction focusing on: the characteristics of natriuretic peptides, primary prevention of heart failure, diagnosis of heart failure with non-reduced ejection fraction in different patient characteristics and comorbidities, prognosis of heart failure, monitoring of heart failure treatment and, how to use in worsening heart failure.
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    Usefulness of Age, Creatinine and Ejection Fraction- Modification of Diet in Renal Disease Score for Predicting Survival in Patients with Heart Failure
    (Arquivos Brasileiros Cardiologia, 2023) Guvenc, Rengin Cetin; Guvenc, Tolga Sinan; Cavusoglu, Yuksel; Temizhan, Ahmet; Yilmaz, Mehmet Birhan
    Background: While many risk models have been developed to predict prognosis in heart failure (HF), these models are rarely useful for the clinical practitioner as they include multiple variables that might be time-consuming to obtain, they are usually difficult to calculate, and they may suffer from statistical overfitting.Objectives: To investigate whether a simpler model, namely the ACEF-MDRD score, could be used for predicting one-year mortality in HF patients.Methods: 748 cases within the SELFIE-HF registry had complete data to calculate the ACEF-MDRD score. Patients were grouped into tertiles for analyses. For all tests, a p-value <0.05 was accepted as significant.Results: Significantly more patients within the ACEF-MDRD (high) tertile (30.0%) died within one year, as compared to other tertiles (10.8% and 16.1%, respectively, for ACEF-MDRD (low) and ACEF-MDRD (med) , p<0.001 for both comparisons). There was a stepwise decrease in one-year survival as the ACEF-MDRD score increased (log-rank p<0.001). ACEF-MDRD was an independent predictor of survival after adjusting for other variables (OR: 1.14, 95%CI:1.04 - 1.24, p=0.006). ACEF-MDRD score offered similar accuracy to the GWTG-HF score for predicting one-year mortality (p=0.14).Conclusions: ACEF-MDRD is a predictor of mortality in patients with HF, and its usefulness is comparable to similar yet more complicated models.