Persistent False-Positive Troponin I Elevation Due to Heterophile Antibody Interference: A Case Report Sinan Akıncı, Serap Arıkan, Ertan Akbay, Adem Adar International Journal of the Cardiovascular Academy, 2025 Troponins are important biomarkers in the diagnosis of acute coronary syndrome (ACS). In this case report, we present the clinical course of an 80-year-old female patient who presented with complaints of fever, sore throat, and fatigue. Although the patient was initially diagnosed with non-ST elevation myocardial infarction and coronavirus disease-2019 infection, detailed examinations revealed that elevated troponin I levels were due to heterophile antibodies and that the diagnosis of ACS was excluded. It was understood that the consistently elevated troponin I levels in the patient, who had previously undergone coronary angiography and long-term dual antiplatelet therapy with a diagnosis of ACS, were due to the presence of these antibodies. This case report demonstrates that clinicians should be aware of potential false-positive troponin results due to heterophile antibodies, particularly in patients with persistently elevated troponin levels without typical clinical and diagnostic findings.
Increased para-aortic adipose tissue on echocardiography may closely be related with fragmented QRS. Fahri Çakan, Si̇nan Akıncı, Adem Adar, Uğur Köktürk, Ertan Akbay, et al. Colombia Medica, 2024 Background: The association of fragmented QRS (fQRS) with many cardiac pathologies such as cardiac fibrosis has been described previously. Paraaortic adipose tissue (PAT) is thought to be associated with many cardiac diseases and there is only one publication on its echocardiographic evaluation. This study aims to describe the possible relationship between fQRS and PAT. Methods: Patients presenting to the cardiology outpatient clinic were evaluated for inclusion in the study. Presence of additional R' wave or notching/splitting of S wave in two contiguous ECG leads was defined as fragmented QRS (fQRS) and patients were divided into two groups according to fQRS status on ECG. The hypoechoic space in front of the ascending aorta was considered as PAT in the parasternal long-axis view. The medical history and routine laboratory parameters of the participants were recorded. Univariate and multivariate binary regression analysis was used to determine the relationship between PAT and fQRS. Results:A total of 221 patients were enrolled and divided into two groups according to fQRS status. PAT was significantly higher in the fQRS group [9.2mm (7.1/12.3) vs 6.8mm (1.2/10.9), p=0.001]. Univariate analysis showed significant association between fragmented QRS and PAT size (OR 1.122, p= 0.001). Binary regression analysis revealed an independent and strong association between aortic size (OR 1.4, CI 1.012-1.938, p=0.042), paraaortic adipose tissue (OR 1.483, CI 1.084-2.029, p=0.014) and fragmented QRS. Conclusions: The presence of fQRS is associated with PAT, a newly defined parameter in echocardiography.
Clinical characteristics of atrial fibrillation in nonagenarian population and relationship with mortality Fahri ÇAKAN, Orhan ÖNALAN, Adem ADAR, Ertan AKBAY, Inci T. ÇÖLLÜOĞLU, Uğur KÖKTÜRK, Yeşim AKIN, Emre ÖZÇALIK Minerva Cardiology and Angiology, 2024 BACKGROUND There is a considerable amount of literature available on well-known risk factors for atrial fibrillation (AF); however, available data specifically focused on the ninth decade are scarce. The main objective of this study was to assess the demographic and clinical characteristics of AF and sinus rhythm in a nonagenarian population. METHODS All individuals aged >90 years who were admitted to the Cardiology outpatient clinic between April 2018 and January 2019 were enrolled in the study. The demographic and clinical characteristics of all patients were recorded. All deaths that occurred during the two-year follow-up period were recorded. RESULTS In total, 112 nonagenarian individuals were included in the study. Of these patients, 50 (44.6%) had AF. The groups showed similarities in demographic and clinical characteristics. During a mean follow-up period of 596±44 days, 39 patients (78%) in the AF group and 35 patients (56.5%) in the sinus group died. Patients with AF showed a lower overall survival distribution than those with sinus rhythm (P=0.005, log-rank test χ2=7.734). AF was associated with an increased risk of mortality (P=0.002, hazard ratio [HR] =2.104, 95% confidence interval [CI] = 1.326-3.339) in multivariate Cox regression analysis, while waist circumference and total cholesterol (P=0.003, HR=0.969, 95% CI=0.949-0.989 and P=0.046, HR=0.993, 95% CI=0.986-1.000, respectively) showed a decreased risk of mortality. CONCLUSIONS Atrial fibrillation is very common in individuals over the age of 90 years (44.6%). Well-known risk factors do not appear to be effective in this age group, and AF is associated with a 2.1-fold increase in the risk of mortality.
Role of basal autonomic functions in patients with increased morning blood pressure surge Ertan Akbay, Sinan Akinci Blood Pressure Monitoring, 2023 Background Morning blood pressure (BP) surge (MS) is associated with cardiovascular events. The autonomic nervous system plays an active role in the regulation of BP and its function can be evaluated by heart rate variability (HRV) analysis. This study aimed to evaluate autonomic nervous system functions in patients with increased MS. Methods Patients who underwent ambulatory BP monitoring (ABPM) and 24-h rhythm Holter in our hospital during the same period between 2017 and 2022 were evaluated. HRV parameters were obtained from 24-h rhythm Holter recordings. MS values of the patients were calculated from ABPM records and patients were divided into four groups according to the MS quartiles. HRV parameters and other parameters were compared between the groups. Results A total of 129 patients were included in the study. The mean age of the patients was 57.2 ± 18.2 years, and 63 (48.8%) were male. HF, the square root of the mean squared differences of successive normal-to-normal intervals (rMSSD), and the proportion of adjacent RR intervals differing by >50 ms in the 24-h recording (pNN50) were statistically significant between the groups (P = 0.039, P = 0.013, P = 0.011, respectively). In univariate regression analysis, low-frequency/high-frequency ratio was positively associated with MS and HF, SDNNi, rMSSD, and pNN50 were negatively associated (β = 0.207, P = 0.019; β = −0.272, P = 0.002; β = −0.201, P = 0.022; β = −0.265, P = 0.002; β = −0.278, P = 0.001, respectively). Multiple linear regression analysis showed an independent association between HF, low-frequency/high-frequency ratio, rMSSD, pNN50, and MS (β = −0.247, P = 0.005; β=0.206, P = 0.017; β = −0.209, P = 0.005; β = −0.227, P = 0.008, respectively). Conclusion We found an independent association between HRV parameters associated with vagal tone and MS. The findings of our study suggest that the increased sympathetic activity detected in patients with high MS in previous studies may be due to a decrease in basal vagal tone.
Association of the Atherogenic Index of Plasma with C-Reactive Protein and Urinary Albumin Excretion in a Normotensive Nondiabetic Population Sinan Akıncı, Ali Çoner, Ertan Akbay, Adem Adar, Haldun Müderrisoğlu Metabolic Syndrome and Related Disorders, 2022 Background: The atherogenic index of plasma (AIP) is an indicator of atherogenic dyslipidemia and is significantly associated with the development of atherosclerotic cardiovascular disease. Previous studies showing the association of AIP with C-reactive protein (CRP) and microalbuminuria included hypertensive and diabetic patients. We aimed to determine the association of AIP with CRP and albuminuria in a normotensive and nondiabetic population. Methods: The study was conducted retrospectively. Two hundred thirty-three individuals without hypertension, diabetes, cardiovascular disease, malignancy, systemic inflammatory disease, nephrological disease, and active infection were determined and included in the study. Urinary albumin excretion was calculated from the albumin-creatinine ratio in fresh spot urine [urinary albumin-creatinine ratio (UACR)]. AIP risk groups were compared in terms of clinical and laboratory findings, and the correlation between AIP and CRP and UACR was evaluated. Results: A total of 233 people, with a mean age of 45.4 years and 139 (69.7%) of whom were male, were included in the study. One hundred thirty-eight (59.2%) individuals were found to be in the low-risk group, 29 (12.5%) in the medium-risk group, and 66 (28.3%) in the high-risk group, according to the AIP value. CRP and UACR were not different between the AIP risk groups (P: 0.141 and 0.441, respectively). A mild correlation was found between AIP and CRP (r: 0.192; P: 0.003), but no correlation was found between AIP and UACR (r: 0.086; P: 0.193). The stepwise linear regression analysis with model adjusted for possible confounders and AIP revealed that only body mass index was a significant predictor of CRP (β: 0.308; P < 0.001), while only systolic blood pressure was a significant predictor of UACR (β: 0.19; P: 0.004), but AIP was not. Conclusions: AIP was not associated with CRP and UACR in normotensive and nondiabetic individuals. This finding suggests that the relationship found in previous studies is related to the presence of hypertension or diabetes rather than the AIP.
Periaortic adipose tissue index: A new approach to the relationship between coronary stenosis severity/lesion complexity and periaortic adipose tissue Ertan AKBAY, Sinan AKINCI, İbrahim UYSAL, Adem ADAR, Ali ÇONER, İbrahim Haldun MÜDERRİSOĞLU Journal of Experimental and Clinical Medicine Turkey, 2022 Periaortic adipose tissue (PAT) is associated with atherosclerosis. The severity of coronary stenosis with PAT has not been evaluated with conventional coronary angiography (CAG). The aim of the study is to determine the relationship between PAT and coronary stenosis severity/ complexity, and to evaluate it with the periaortic adipose tissue index (PATI), a new index derived from PAT. Patients who underwent CAG and thoracic computed tomography (CT) between January 2017 and January 2022 were included in the study. PAT volume was calculated by evaluating CT images, and PATI was calculated by dividing the PAT volume by the circumference of the descending aorta. Patients were divided into two groups according to the presence of ≥50% stenosis on CAG. The correlation of PAT and PATI with the SYNTAX score was evaluated. In our study, 263 patients [mean age 64.5(54/72), male 164 (62.4%)] were evaluated. Severe coronary artery disease (CAD) was observed in 181 patients (68.8%). PAT volume and PATI were significantly higher in patients with severe stenosis (p<0.001, for both). When PAT and PATI were evaluated alongside CAD risk factors, an independent association between PATI and severe CAD was discovered (β:0.581, p:0.97, β:0.968, p:0.006, respectively). No correlation was found between SYNTAX score and PAT and PATI (r:-0.026, p:0.73, r:-0.019, p:0.19, respectively). In our study, PAT and PATI were higher in patients with severe coronary stenosis, and there was an independent relationship between PATI and severe stenosis. We found no relationship between PAT and PATI and the SYNTAX score.
