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    Circumportal pancreas: prevalence, subtypes and vascular variations of 55 patients
    (Springer France, 2018) Yilmaz, Erdem; Celik, Ahmet
    To determine the frequency of circumportal pancreas (CP), and accompanying ductal and vascular anatomy variations. Thin-section multidetector computed tomography of 6813 consecutive patients was retrospectively reviewed. Two radiologists evaluated CP presence with consensus. Concomitant pancreatic ductal and vascular variations were recorded. The course of the pancreatic duct was classified according to the portal vein as anteportal and retroportal, and pancreas fusion level classified according to splenic vein as suprasplenic, infrasplenic and mixed type. A total of 55 (0.8%) CP cases were detected. Six suprasplenic subtype cases were excluded from the classification, because the pancreatic ducts were not clearly distinguishable. Suprasplenic anteportal (45/49, 92%), infrasplenic anteportal (2/49, 4%), suprasplenic retroportal (1/49, 2%), and mixed anteportal subtypes (1/49, 2%) were detected. There were vascular variations in 16 cases (29%). 13/16 (81%) of vascular variations were detected on suprasplenic anteportal subtype. Most of them were replaced right hepatic artery from the superior mesenteric artery (n: 6). CP is a rare but important pancreatic fusion anomaly. Suprasplenic anteportal CP is the most common subtype and other subtypes are very rare. Replaced right hepatic artery from the superior mesenteric artery is the most frequent vascular variation associated with CP. Identifying the CP and defining the pancreatic duct and vascular variations are important to prevent possible complications in patients undergoing pancreatic surgery.
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    Natriuretic Peptides in Clinical Practice
    (Kare Publ, 2019) Cavusoglu, Yuksel; Alper, Ahmet Taha; Altay, Hakan; Celik, Ahmet; Demirkan, Burcu; Guvenc, Tolga Sinan; Kucukoglu, Mehmet Serdar
    Natriuretic peptides have long been introduced into clinical practice. These biomarkers have certainly been shown to provide useful information in the diagnosis, prognosis and risk stratification in heart failure and also may have a role in the guidance of heart failure therapy. Although, there are some limitations in using of these markers such as lack of specificity, aging, renal dysfunction or obesity, among the huge number of candidates for heart failure biomarkers, only natriuretic peptides are currently widely used in daily clinical practice in heart failure. Recent heart failure guidelines recognize natriuretic peptides as an essential tool in the new diagnostic and therapeutic algorithms. Furthermore, natriuretic peptides are not only used in the diagnosis or prognosis of heart failure, but also these biomarkers are referred to have some potential role in primary prevention, cardio-oncology, advanced heart failure, assessment of response to cardiac resynchronization therapy, pulmonary arterial hypertension, acute coronary syndromes, atrial fibrillation and valvular heart disease. In this article, natriuretic peptides have been reviewed for their updated information and new recommendations in heart failure and also potential role of these biomarkers in the management of various clinical conditions have been addressed in the form of expert opinion based on the available data in the literature.
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    Obstructive Sleep Apnea and Cardiovascular Disease: Where Do We Stand?
    (Kare Publ, 2023) Peker, Yuksel; Akdeniz, Bahri; Altay, Servet; Balcan, Baran; Basaran, Ozcan; Baysal, Erkan; Celik, Ahmet
    Obstructive sleep apnea is common in adults with cardiovascular disease. Accumulating evidence suggests an association between obstructive sleep apnea and cardiovascular disease independent of the traditionally recognized cardiovascular disease risk factors. Observational studies indicate that obstructive sleep apnea is a risk factor for development of cardiovascular disease and that alleviation of obstructive events with positive airway pressure may improve cardiovascular disease outcomes. However, recent randomized controlled trials have not supported the beneficial effect of positive airway pressure in cardiac populations with concomitant obstructive sleep apnea. Some evidence suggests that the relationship between obstructive sleep apnea and traditionally recognized cardiovascular disease risk factors is bidirectional, suggesting that patients with cardiovascular disease may also develop obstructive sleep apnea and that efficient treatment of cardiovascular disease may improve obstructive sleep apnea. Recent data also indicate that the apnea-hypopnea index, which is commonly used as a diagnostic measure of obstructive sleep apnea severity, has limited value as a prognostic measure for cardiovascular disease outcomes. Novel markers of obstructive sleep apnea -associated hypoxic burden and cardiac autonomic response seem to be strong predictors of adverse cardiovascular disease outcomes and response to treatment of obstructive sleep apnea. This narrative review and position paper from the Turkish Collaboration of Sleep Apnea Cardiovascular Trialists aims to update the current evidence about the relationship between obstructive sleep apnea and cardiovascular disease and, consequently, raise awareness for health professionals who deal with cardiovascular and respiratory diseases to improve the ability to direct resources at patients most likely to benefit from treatment of obstructive sleep apnea and optimize treatment of the coexisting cardiovascular diseases. Moreover, the Turkish Collaboration of Sleep Apnea Cardiovascular Trialists aims to contribute to strengthening the efforts of the International Collaboration of Sleep Apnea Cardiovascular Trialists in this context.
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    Snapshot evaluation of heart failure in Turkey: Baseline characteristics of SELFIE-TR
    (Turkish Soc Cardiology, 2019) Yilmaz, Mehmet Birhan; Celik, Ahmet; Cavusoglu, Yuksel; Bekar, Lutfu; Onrat, Ersel; Eren, Mehmet; Kutlu, Merih
    Objective: Heart failure (HF) is an important health issue of the 21st century and the prevalence in Turkey has been reported as 2.9%. A national profile, frequency data, characteristics of different phenotypes, and risk factors have not yet been well established. The Snapshot Evaluation of Heart Failure Patients in Turkey (SELFIE-TR) was an analysis of a representative sample of HF patients from Turkey. Methods: A total of 23 centers with at least 2 cardiologists from the 12 NUTS-1 regions of Turkey were invited to participate in the research. The contributing centers shared the data of a consecutive enrollment of HF patients, as confirmed by an investigator, on a pre-selected day of each week for the month of October or November of 2015. Results: The mean age of the entire cohort was 63.3 +/- 13.3 years (male/female ratio: 751/303, 71.3%/28.7%). There were 712 acute HF patients and 342 chronic HF patients. The total number of HF patients with reduced ejection fraction (HFrEF), heart failure with mid-range ejection fraction, and heart failure with preserved ejection fraction was 801 (75%), 176 (16.7%), and 77 (7.3%), respectively. The patients with chronic HF were younger than those with acute HF (61.1 +/- 13.3 years vs 67.9 +/- 12.1 years; p<0.001). Among the whole cohort, hypertension was observed in 46%, diabetes mellitus was present in 27.5%, chronic obstructive pulmonary disease was present in 12.8%, and previous myocardial infarction was noted in 45.2%. In patients with HFrEF, the use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, a beta blocker, or a mineralocorticoid receptor antagonist was noted in 74.7%, 89.7%, and 60.9%, respectively. Conclusion: The SELFIE-TR findings provide important insight, since it is the first study to make a snapshot of HF patients in our country. These data may help to create standardized prevention and treatment strategies.