Sürdürülebilir Kalkınma Amaçları

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• Editöre MektupYalnız künye2026/r/kostu/10855
  Beyond metabolic syndrome: the association of mets-ir, tyg index, and epicardial adipose tissue with subclinical atherosclerosis in different vascular beds

  Coşkun, Şenol

  We sincerely thank Dr. Didar Mirzamidinov for his constructive and detailed evaluation of our article. The observations provided highlight the strengths of our study and draw attention to some important methodological issues. We have addressed each point in turn below.

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• MakaleAçık Erişim2026/r/kostu/10852
  Non-kardiyak cerrahi uygulanacak hastalarda preoperatif brain natriüretik peptid seviyeleri komplikasyonları öngördürür mü?

  Coşkun, Şenol; Sahin, Tayfun; Mirzamidinov, Didar; Boyacı, Ali

  Amaç: Bu çalışmada nonkardiyak orta-yüksek riskli hastalarda preoperatif BNP seviyelerinin postoperatif komplikasyonları öngörmedeki etkinliğini araştırmayı planladık. Yöntem: Kocaeli Üniversitesi Tıp Fakültesi Hastanesi’ne bir yıl içinde başvuran, cerrahi kliniklerinde orta ve yüksek riskli cerrahi operasyon amacıyla yatırılan ve ameliyat öncesi kardiyak değerlendirme kapsamında beyin natriüretik peptid (BNP) ölçümü yapılan toplam 102 hasta çalışmaya dâhil edildi. Hastaların intraoperatif ve postoperatif dönemlerdeki takipleri kaydedildi; postoperatif dönemde gelişen komplikasyonlar ile taburculuk sonrası 6 aylık izlem süresinde meydana gelen klinik olaylar değerlendirildi. Bulgular: Kalp yetersizliği öyküsü olanlarda (n = 26) BNP değeri anlamlı olarak daha yüksekti (920±1128 pg/ml, 274±522 pg/ml p<0,001). Hastane içi (n=10) ve toplam ölüm (n=21) ile preoperatif yüksek BNP değerinin (p=0,009, p<0,001) anlamlı derecede ilişkili olduğu saptandı. Sonuç: Preoperatif BNP kalp yetersizliği olsun veya olmasın tüm hastalarda postoperatif kalp yetersizliği gelişimi, hastane içi ölüm, hastane içi toplam olay ve altıncı aydaki toplam ölümü ön gördürebilir.

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• EditoryalYalnız künye2026Scopus SJRQ3/r/kostu/10801
  Single-Session Percutaneous Left Atrial Appendage Occlusion and Atrial Septal Defect Closure Guided by Balloon Occlusion Testing in an Elderly Patient with Recurrent Gastrointestinal Bleeding Under Non-vitamin K Antagonist Oral Anticoagulants Therapy

  Coskun, Senol; Kiliç, Teoman

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• EditoryalYalnız künye2026Scopus SJRQ3/r/kostu/10761
  Transcatheter Management of Clinically Significant Paravalvular Leak After Sutureless Aortic Valve Replacement: A Case Series

  Coskun, Senol; Mirzamidinov, Didar; Sahin, Tayfun; Kiliç, Teoman

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• MakaleAçık Erişim2026Scopus SJRQ4/r/kostu/10736
  Prognostic Value of Myocardial Contraction Fraction for One-Year Cardiac Death After Transcatheter Aortic Valve Implantation in Severe Aortic Stenosis: A Simple Echocardiographic Metric for High-Risk Stratification; [Miyokard Kontraksiyon Fraksiyonunun Prognostik Değeri: Yüksek Riskli Hastaların Belirlenmesinde Basit Bir Ekokardiyografik Ölçüt]

  Coşkun, Şenol; Mirzamidinov, Didar; Karaüzüm, Kurtuluş; Tiryakioğlu, Selma Kenar; Şahin, Tayfun; Kılıç, Teoman

  Objective: Myocardial contraction fraction (MCF) is a volumetric index of myocardial shortening that relates left ventricular stroke volume to myocardial volume. In patients with severe aortic stenosis (AS), left ventricular ejection fraction (LVEF) may remain preserved despite advanced myocardial remodeling. This study aimed to evaluate the prognostic value of MCF for predicting 1-year cardiac death in patients undergoing transcatheter aortic valve implantation (TAVI). Method: This retrospective, single-center study included 419 consecutive patients with severe AS who underwent TAVI at a tertiary center. MCF was calculated by dividing stroke volume by left ventricular myocardial volume and multiplying the result by 100. Left ventricular myocardial volume was derived by dividing left ventricular myocardial mass by the myocardial density, which was assumed to be 1.05g/mL. The primary endpoint was 1-year cardiac death. Receiver operating characteristic (ROC) curve analysis was used to identify the optimal MCF cutoff value, and the patients were divided into low- and high-MCF groups according to this threshold. Results: The ROC-derived MCF cutoff value for predicting 1-year cardiac death was 24, with an area under the curve of 0.783 (95% CI, 0.716-0.851), a sensitivity of 78.1, and a specificity of 71.8. Patients with MCF≤24% had lower LVEF and stroke volume index values, higher myocardial mass index and pulmonary artery pressure values, and larger left ventricular diameters than those with MCF>24%. One-year cardiac death occurred in 32 patients (7.6%) and was significantly more frequent in the MCF≤24% group than in the MCF>24% group (18.7% vs. 2.5%; P < 0.001). In univariable Cox regression analysis, MCF≤24% was strongly associated with 1-year cardiac death. In multivariable analysis, higher MCF, evaluated as a continuous variable, remained independently associated with a lower risk of 1-year cardiac death. Conclusion: Reduced MCF was associated with adverse left ventricular remodeling and increased 1-year cardiac death after TAVI. MCF may provide additional prognostic information beyond conventional echocardiographic parameters in patients with severe AS undergoing TAVI.

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  İncele
• MakaleAçık Erişim2026Scopus SJRQ1/r/kostu/10682
  Percutaneous closure of a giant left ventricular pseudoaneurysm using an Amplatzer muscular VSD occluder in a high-risk patient with recurrent heart failure following multiple myocardial infarctions

  Coskun, Senol; Sag, Saim; Ozdabakoglu, Osman; Kilic, Teoman

  Background – Left ventricular pseudoaneurysm (LVPA) is a rare and potentially fatal complication of myocardial infarction (MI), with mortality reaching 48% in untreated patients. While surgical repair has been the conventional therapy, perioperative mortality of 10%–36% renders it prohibitive in patients with multiple comorbidities. Percutaneous transcatheter closure has emerged as a life-saving alternative for high-risk surgical candidates. Case report – A 75-year-old male with prior coronary artery bypass grafting (2010) and two subsequent myocardial infarctions (2019 and 2020) treated with percutaneous coronary intervention presented with refractory decompensated heart failure, massive left pleural effusion, and markedly elevated NT-proBNP (7, 172 pg/mL). Cardiac magnetic resonance imaging revealed a giant LVPA (61 mm × 28 mm; end-diastolic volume 55 mL) arising from the lateral-to-posterolateral wall, with transmural late gadolinium enhancement confirming a post-infarction etiology. After multidisciplinary heart-team consensus, percutaneous transcatheter closure was performed via a transfemoral retrograde approach under transesophageal echocardiographic guidance using a 16 mm Amplatzer Muscular VSD Occluder. The procedure was uncomplicated, with no significant residual flow. The patient was discharged on postoperative day 2. At 3-month follow-up, he was in NYHA class I-II with marked symptomatic improvement, NT-proBNP reduction to ∼500 pg/mL, and no residual flow. Conclusions – Percutaneous transcatheter closure with an Amplatzer Muscular VSD Occluder is a feasible, safe, and life-saving therapeutic option in selected high-risk patients with post-infarction LVPA presenting with refractory heart failure.

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• MakaleAçık Erişim2026Scopus SJRQ3/r/kostu/10602
  Mapping publication trends in oral anticoagulation in atrial fibrillation: A bibliometric and thematic analysis of 11,039 publications (2006–2025)

  Coskun, Senol; Tiyekli, Erkan

  OBJECTIVE: This study aimed to systematically map the intellectual evolution, thematic development, and collaborative patterns of oral anticoagulation research in atrial fibrillation (AF) from 2006 to 2025. METHODS: This bibliometric study analyzed 11,039 documents indexed in the Web of Science Core Collection (2006–2025) using the Bibliometrix R package (version 4.x) within the R statistical environment (version 4.3.1) for comprehensive science mapping. The analytical workflow comprised descriptive performance analysis, collaboration network analysis, keyword cooccurrence analysis, strategic thematic mapping, and latent Dirichlet allocation (LDA) topic modeling. RESULTS: Publication output increased exponentially from 2 articles per year (2006) to a peak of 960 per year (2021), with subsequent stabilization that may reflect consolidation of the field. The United States produced the highest number of publications (3636; 32.9%). The RE-LY trial received the most citations (n=8788). Thematic mapping revealed two main research clusters: Motor themes (141 keywords), representing direct oral anticoagulant agents, stroke prevention, and clinical outcomes; and emerging/declining themes (43 keywords), including venous thromboembolism and pharmacokinetics. LDA topic modeling identified nine distinct research domains encompassing real-world data, safety reporting, and implementation guidelines. CONCLUSION: The bibliometric patterns observed are consistent with a maturing research field, characterized by a gradual shift from efficacy-focused randomized trials toward real-world effectiveness studies, implementation science, and personalized anticoagulation strategies. Future research may benefit from increased emphasis on long-term adherence, health-economic outcomes, and personalized approaches integrating genetic, clinical, and patient-centered factors.

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  İncele
• Editöre MektupYayıncıda açık erişim2026Scopus SJRQ2/r/kostu/10593
  Statistical concerns regarding the validation of myocardial contraction fraction cut-off in transcatheter aortic valve replacement patients

  Coskun, Senol

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  İncele
• MakaleAçık Erişim2026Scopus SJRQ1/r/kostu/10331
  Comparison of safety and short-term outcomes of septostomy and direct tunnel passage techniques in percutaneous patent foramen ovale closure: a multicenter experience

  Coskun, Senol; Tiryakioğlu, Selma Kenar; Mirzamidinov, Didar; Inan, Duygu; Kilicgedik, Alev; Sahin, Tayfun; Kilic, Teoman

  Background – Percutaneous closure of a patent foramen ovale (PFO) is an established therapeutic strategy for patients with cryptogenic stroke (CS). This study aimed to compare the procedural safety, efficacy, and short-term clinical outcomes of atrial septostomy vs. standard direct tunnel passage techniques for PFO closure. Methods – We retrospectively analyzed consecutive patients who underwent PFO closure for CS at four centers between January 2010 and December 2020. Demographic characteristics, vascular risk factors, Risk of Paradoxical Embolism (RoPE) scores, PFO anatomical features, procedural details, and clinical outcomes were compared between patients treated with atrial septostomy and those undergoing direct tunnel passage. Continuous variables are presented as mean ± standard deviation or median [interquartile range], and categorical variables as counts and percentages. Results – A total of 246 patients were included (mean age 40.5 ± 9.8 years), of whom 69.9% presented with ischemic stroke and 30.1% with transient ischemic attack (TIA). Atrial septostomy was performed in 106 patients (43.1%), while 140 patients (56.9%) underwent direct tunnel passage. Baseline clinical characteristics were comparable between groups; however, the septostomy group exhibited significantly more complex PFO anatomy, including atrial septal aneurysm (69.8% vs. 39.3%), septal hypermobility (62.3% vs. 34.3%), and spontaneous shunting at rest (85.8% vs. 50.7%; all p < 0.001). Procedure duration was similar between groups (41.1 ± 10.2 vs. 40.7 ± 13.8 min; p = 0.83), and technical success was achieved in nearly all cases. No major procedural complications occurred. Minor adverse events were infrequent and comparable (8.4% vs. 4.3%; p = 0.20). At six-month follow-up, residual shunt rates were numerically lower in the septostomy group (6.6% vs. 11.4%; p = 0.27). No TIAs were observed in the septostomy group, whereas a 3.6% incidence was noted in the direct passage group (p = 0.08). New-onset atrial arrhythmia occurred in two patients (1.9%) in the septostomy group and in none of the direct passage group (p = 0.18). Conclusion – Despite being applied in patients with more complex PFO anatomy, atrial septostomy demonstrated comparable procedural safety, technical success, and short-term efficacy to standard direct tunnel passage. Tunnel length emerged as an independent predictor of residual shunt, regardless of closure technique. In experienced centers, atrial septostomy appears to be a safe and practical alternative for anatomically challenging PFO closures.

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  İncele
• MakaleAçık Erişim2025/r/kostu/10901
  Beyond metabolic syndrome: the relationship of mets-ir, tyg index, and epicardial adipose tissue with subclinical atherosclerosis in different vascular beds

  Coşkun, Şenol

  Objective: This study aimed to evaluate the relationship between metabolic insulin resistance indicators (METS-IR and TyG index) and the amount of epicardial adipose tissue (EAT), with subclinical atherosclerosis markers such as coronary artery calcium (CAC) and carotid intima-media thickness (IMT). Methods: Retrospective data from 108 patients evaluated for suspected coronary artery disease were analyzed. METS-IR and TyG scores were calculated using laboratory and anthropometric data. EAT thickness and volume were measured by computed tomography. CAC score and carotid IMT were assessed using standard methods. Correlations and multivariate regression analyses were used to examine associations, and ROC analysis was performed to evaluate diagnostic performance. Results: Epicardial fat thickness (AUC=0.802) and volume (AUC=0.781) showed high discriminative power in predicting the presence of CAC. A threshold value of 5.9 mm for EAT thickness provided 75% sensitivity and 71% specificity. The METS-IR score was independently associated with both CAC (AUC=0.670) and carotid IMT, while the TyG index showed only a weak association with CAC (AUC=0.661). In multivariate analyses, EAT measurements and METS-IR scores were significantly associated with subclinical atherosclerosis markers, independent of conventional risk factors. Conclusion: METS-IR, TyG, and particularly epicardial fat measurements appear to be potential biomarkers for the early detection of subclinical atherosclerosis. Integration of these parameters into individualized cardiovascular risk assessments should be supported by further studies.

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