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Öğe Association Between the Remnant Cholesterol Inflammation Index and Cardiac Syndrome X(Mdpi, 2026) Aktas, Ibrahim; Yasar, Erdogan; Uckac, KadirBackground and Objectives: Cardiac Syndrome X (CSX), a clinical entity within the Ischaemia with Non-Obstructive Coronary Arteries (INOCA) spectrum, is increasingly recognised as an inflammatory and systemic vascular disorder. Remnant cholesterol (RC) and inflammation are emerging contributors to residual cardiovascular risk; however, their combined role in microvascular angina remains unclear. This study aimed to evaluate the association between the remnant cholesterol inflammation index (RCII), integrating RC and high-sensitivity C-reactive protein (hs-CRP), and the clinical presence of CSX. Methods: This single-centre, retrospective observational study included 392 individuals who underwent coronary angiography between January 2023 and January 2025. The study population comprised 197 patients diagnosed with CSX and 195 control subjects with normal coronary anatomy and no objective evidence of myocardial ischaemia. RC was calculated as total cholesterol minus the sum of LDL-C and HDL-C, and RCII was derived as RC & times; hs-CRP. Importantly, invasive microvascular testing (e.g., CFR or IMR) was not performed. Logistic regression analyses were performed to identify independent predictors of CSX, and receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic performance. Results: Patients with CSX exhibited significantly higher levels of hs-CRP, SII, and RCII compared with controls (all p < 0.001). In the multivariable logistic regression analysis, RCII demonstrated an independent association with CSX (odds ratio 1.095, 95% confidence interval 1.060-1.131; p < 0.001). ROC curve analysis showed that RCII provided moderate but significant discrimination for CSX (area under the curve [AUC] 0.765, 95% CI 0.695-0.795). Pairwise comparisons confirmed that RCII had a significantly higher AUC than RC, hs-CRP, or SII individually. Conclusions: Higher RCII levels appear to be significantly associated with the clinical diagnosis of CSX. By integrating atherogenic remnant cholesterol burden and systemic inflammation, RCII may serve as a valuable composite biomarker for identifying residual inflammatory lipid risk. Rather than acting as a definitive diagnostic tool, these findings warrant further validation in large-scale prospective cohort studies.Öğe Interleukin-34 as a Robust Predictor of No-Reflow Phenomenon in ST-Elevation Myocardial Infarction: Insights into Inflammatory Mechanisms and Clinical Implications(Galenos Publ House, 2024) Karasu, Mehdi; Bolayir, Hasan Ata; Aktas, IbrahimObjective: ST-elevation myocardial infarction (STEMI) poses a significant challenge despite advances in reperfusion strategies. The no-reflow phenomenon, characterized by inadequate microvascular blood flow restoration following successful revascularization, remains poorly understood. Inflammation, particularly interleukin-34 (IL-34), is implicated in cardiovascular disease, prompting investigation into its role in no-reflow. Methods: This observational study included 182 patients with STEMI (32 with no-reflow, 150 without) and 100 controls. Clinical and angiographic data were analyzed, and IL-34 levels were measured. Logistic regression and receiver operating characteristic (ROC) analysis assessed IL-34's predictive value for no-reflow. Results: Patients with no reflow exhibited elevated IL-34 levels compared with controls and those without no-reflow. Logistic regression identified IL-34 as an independent predictor of no-reflow (odds ratio: 1,020, p<0.001). ROC analysis showed IL-34's significant predictive value (area under the curve: 0.972, p<0.001). Conclusion: IL-34 emerges as a robust predictor of no-reflow in STEMI, potentially reflecting its role in macrophage activation and the inflammatory response. These findings suggest a novel avenue for understanding and mitigating no-reflow in STEMI, paving the way for targeted therapies. Early identification of high-risk patients could inform tailored interventions, ultimately improving STEMI outcomes. Further research is warranted to elucidate IL-34's mechanistic involvement and validate its predictive value in larger cohorts.Öğe Is the Red Blood Cell Distribution Width-to-Albumin Ratio Sufficient to Predict Cardiovascular Risk?(Kare Publ, 2026) Afin, Abdulmecit; Aktas, Ibrahim[Abstract Not Available]Öğe Neutrophil Percentage-to-Albumin Ratio as a Predictor of Collateral Circulation in Chronic Total Occlusion(Kare Publ, 2025) Aktas, Ibrahim; Bolayir, Hasan Ata; Karasu, MehdiBackground: This study aimed to investigate the relationship between neutrophil percentage-to-albumin ratio (NPAR) and collateral circulation in patientswith chronictotal occlusion (CTO). Chronic total occlusion is an advanced stage of coronary artery disease (CAD) and is characterized by complete occlusion of the coronary arteries. Collateral circulation provides alternative routes that supply blood flow instead of occluded arteries and may affect the prognosis of CTO patients. Neutrophil percentage-to-albumin ratio is recognized as an indicator of inflammation and can be used to predict the prognosis of various diseases. Methods: In this retrospective study, 320 patients with CAD who were diagnosed with CTO by coronary angiography were included. Demographic characteristics, clinical findings, and laboratory test results were recorded. The degree of coronary collateral circulation was classified according to the Cohen-Rentrop method. Neutrophil percentage-to-albumin ratio and other inflammatory parameters were measured. The relationship between NPAR and collateral circulation was evaluated using multivariate analysis. Results: Neutrophil percentage-to-albumin ratio levels were significantly associated with poor collateral circulation. Neutrophil percentage-to-albumin ratio, together with other inflammatory parameters (white blood cell count, neutrophil-to-lymphocyte ratio, C-reactive protein), was identified as an independent marker of poor collateral circulation in CTO patients. Fasting blood glucose levels and diabetes mellitus were also associated with poor collateral circulation. Conclusion: Neutrophil percentage-to-albumin ratio is emerging as a simple and effective inflammatory marker that can be used to predict the quality of collateral circulation in CTO patients. This is important for predicting the prognosis of CTO patients and the success of percutaneous revascularization. However, more extensive studies are needed.Öğe Reply to Letter to the Editor: Neutrophil Percentage-to-Albumin Ratio and Coronary Collaterals: A True Predictor or an Overstated Association?(Kare Publ, 2025) Aktas, Ibrahim; Bolayir, Hasan Ata; Karasu, Mehdi[Abstract Not Available]
