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Background: Despite the lack of supporting data, many clinics perform sheath removal 4-6 hours after femoral percutaneous coronary intervention to reduce the risk of possible access site complications. This study aims to examine the effects of sheath removal immediately after the procedure on access site complications and patient comfort. Methods: This prospective study included 349 patients who underwent percutaneous coronary intervention via the femoral site and 6 French guiding catheters. The sheath in the early group was removed immediately after the procedure without checking the activated clotting time levels but after 4 hours in the late group. Access site complications were recorded and patient comfort was evaluated using the Visual Analog Scale. Results: Patients were divided into 2 groups: patients in the early removal group (n=171) and in the late removal group (n= 178). There was no statistically significant difference between the 2 groups in terms of access site complications. Three patients in the early removal group and 4 patients in the late removal group developed a hematoma. Six patients in the early removal group and 10 patients in the late removal group showed ecchymosis.TheVisualAnalogScalescorewas statistically significantly lower intheearly removal group compared with that in the late removal group [2 (1-3) vs. 3 (2-4), P < .001]. Conclusion: This study shows that immediate sheath removal is safe and more comfortable for patients with percutaneous coronary intervention who received weightadjusted dose of heparin, regardless of the percutaneous coronary intervention levels after the procedure [ABSTRACT FROM AUTHOR]

Objective: The platelet distribution width (PDW) is one of the parameters of platelet activation. The PDW directly measures the variability in platelet size. However, there has been a limited number of data reported thus far on PDW and postoperative AF in patients undergoing CABG. We aimed to investigate the relationship between the PDW and postoperative AF in patients undergoing CABG. Methods: 124 consecutive patients with sinus rhythm who had undergone CABG between July 2011 and December 2013 were evaluated. AF was defined as any episode of AF lasting longer than 30 seconds. Complete blood count samples were analyzed according to the results obtained within 48 hours of the preoperative and postoperative period. Results: The preoperative PDW levels were significantly lower in patients who had developed AF than in the control group (56.5±14.8 vs. 50.9±10.0, p=0.015). There was no correlation between the postoperative PDW levels and AF. The preoperative white blood cell (WBC) and the neutrophil/lymphocyte ratio (NLR) were found to be similar between the two groups, while the postoperative WBC (13.9±5.7 vs. 10.5±3.6, p=0.000) and NLR (14.4±9.4 vs. 9.0±8.4, p: 0. 001) levels were higher in the group of patients who had AF. An NLR of 8.5 predicted post-CABG AF with a sensitivity of 73% and a specificity of 63%, and a WBC of 10 predicted post-CABG AF with a sensitivity of 77% and a specificity of 48%. Conclusion: These results support the hypothesis that preoperative PDW level predicts new-onset AF after CABG, but suggest that other factors are also important. [ABSTRACT FROM AUTHOR]

ST elevation myocardial infarction is a clinic situation usually presents with total occlusion in the coronary artery. The electrocardiography (ECG) at the presentation helps us to diagnose, to guess the occluded coronary artery and to assess the treatment. However, sometimes the ECG could not be enough to guess the occluded coronary artery. Left anterior descending (LAD) coronary artery occlusion resulting in inferior ST-segment elevation without anterior ST-segment elevation is an extremely rare finding. In this study, we presented a case who admitted to the emergency department with a typically chest pain and inferior ST-segment elevation without anterior ST-segment elevation ECG pattern but a total occlusion in LAD in the coronary angiography. [ABSTRACT FROM AUTHOR]

Objectives: Adiponectin is an adipocyte-secreted protein that modulates insulin sensitivity and whose low circulating concentration is associated with insulin resistance. We evaluated the association between serum adiponectin and blood glucose levels with coronary artery disease severity on the angiogram in patients with stable angina pectoris. Materials and methods: The study included 160 patients (82 males) with stable angina pectoris. The patients were divided into three groups according to the blood glucose levels on admission; thus, 24 had normal glucose group, 53 had impaired glucose tolerance group, and 53 had diabetes mellitus (DM) group. The severity of coronary lesions was assessed using the Gensini score. Serum adiponectin levels were measured in the all group. Results: The hypertension, hyperlipidemia, obesity, and insulin resistance were significantly higher in the DM group. Patients with DM significantly lower serum levels of adiponectin (13.55±7.16, p=0.002). The mean Gensini score was 40.84± 37.25 in the DM group (p=0.006). Conclusion: Serum adiponectin levels may be a clue for severity coronary artery disease in patients with stable angina pectoris. [ABSTRACT FROM AUTHOR]

The article presents information on the case study of an 85-year-old man with non-ST elevation myocardial infarction. Diagnosis of the patient showed totally occluded left anterior descendent (LAD) coronary artery. Coronary angiography showed that ostial and proximal section of circumflex artery (Cx) was having severe stenosis.

Objective: Despite recommendations from heart failure guidelines on the use of pharmacologic and device therapy in patients with heart failure with reduced ejection fraction (HFrEF), important inconsistencies in guideline adherence persist in practice. The aim of this study was to assess adherence to guideline-directed medical and device therapy for the treatment of patients with chronic HFrEF (left ventricular ejection fraction =40%). Methods: The Adherence to guideline-directed medical and device Therapy in outpAtients with HFrEF (ATA) study is a prospective, multicenter, observational study conducted in 24 centers from January 2019 to June 2019. Results: The study included 1462 outpatients (male: 70.1%, mean age: 67±11 years, mean LVEF: 30%±6%) with chronic HFrEF. Renin-angiotensin system (RAS) inhibitors, beta-blockers, mineralocorticoid receptor antagonists (MRAs), and ivabradin were used in 78.2%, 90.2%, 55.4%, and 12.1% of patients, respectively. The proportion of patients receiving target doses of medical treatments was 24.6% for RAS inhibitors, 9.9% for beta-blockers, and 10.5% for MRAs. Among patients who met the criteria for implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT), only 16.9% of patients received an ICD (167 of 983) and 34% (95 of 279) of patients underwent CRT (95 of 279). Conclusion: The ATA study shows that most HFrEF outpatients receive RAS inhibitors and beta-blockers but not MRAs or ivabradin when the medical reasons for nonuse, such as drug intolerance or contraindications, are taken into account. In addition, most eligible patients with HFrEF do not receive target doses of pharmacological treatments or guideline-recommended device therapy. [ABSTRACT FROM AUTHOR]

Objective: The standard transcatheter ventricular septal defects (VSD) closure procedure is established with arteriovenous (AV) loop and is called as antegrade approach. The directly retrograde transarterial VSD closure without using AV loop might be better option as shortens the procedure time and decreases radiation exposure. Methods: Our series consist of twelve sequential adult cases with congenital VSDs (seven with perimembranous, four with muscular, one with postoperative residuel VSD). The mean age was 26.9 (Range 18-58), the mean height was 168.75 cm (Range 155-185cm), and the mean body mass index was 23.4 (Range 17.3-28.4). Maximum and minimum defect sizes were 10 and 5 mm and the mean defect size was 6.24 mm. The procedure was performed with left heart catheterization and advancing the delivery sheath over the stiff exchange wire then VSD occlusion from left side. Results: The defects were successfully closed with this technique in eleven patients. In sixth patient, the defect could not be cannulated by the delivery sheath, as the tip of the sheath did not reach the defect and VSD was closed with same sheath by standard transvenous approach using AV loop. We didn't encounter any complication releated to semilunar or atrioventricular valves. Atrioventricular conduction system was not affected by the procedure in any patients. The median procedure and fluoroscopy times were 66 and 16.5 minutes respectively. Conclusion: Transarterial retrograde VSD closure without using AV loop simplifies the procedure, decreases the radiation exposure, and shortens the procedure time. The only limitation in adult patients is delivery sheath length. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 69-years-old male patient chronic smoker with complaints on orthopnea who has a history of hypertension and myocardial infarction. It mentions that the man was diagnosed with acute pulmonary edema where chest radiography and tomography revealed a spherical mass in the middle lobe of the right lung. It notes that the patient's echocardiographic evaluation showed preserved left ventricular systolic function and restrictive type of diastolic dysfunction.

Objectives: Coronary artery calcification (CAC) is associated with coronary atherosclerosis. There is a significant relation between coronary artery wall calcification and coronary artery disease (CAD). The measure of coronary artery calcification is an indicator of subclinical atherosclerosis. In some studies, it has been shown that coronary artery calcification is independent from conventional cardiovascular risks, which suggests data about prognosis. Matrix Gla protein (MGP) is an important protective modulator against calcification since it is an inhibitor of tissue calcification. In this respect, we aimed to establish the relationship between the distributions of nucleotide alterations found in promoter and coding regions of the MGP gene in patients with CAD and patients with normal coronary. Methods: DNA samples (n=115) were obtained from 58 patients with CAD and 57 healthy controls. The DNA samples obtained were analyzed by a Polymerase Chain Reaction (PCR) method using three sets of primer pairs, which cover the coding (Thr83Ala in exon 4) and promoter regions (T-138C and G-7A) of the MGP gene. Amplified regions were analyzed by a Restriction Fragment Length Polymorphism (RFLP) method for possible polymorphisms. Results: The chi-square analysis of the results revealed that there is no relationship between the observed polymorphisms and CAD. Conclusions: In this study, we investigated the relationship between MGP gene polymorphism and CAD. However, according to our findings, there was no statistically significant difference between the CAD and the control group. [ABSTRACT FROM AUTHOR]

Objective: The neutrophil/lymphocyte ratio (NLR), the platelet/lymphocyte ratio (PLR), and uric acid (UA) are inflammatory markers in cardiovascular disease. However, there are not enough data on infarct-related artery (IRA) patency in ST-segment elevation myocardial infarction (STEMI). We aimed to investigate the association of NLR, PLR, and UA with IRA patency before percutaneous coronary intervention (PCI) in STEMI. Methods: The study was designed as a retrospective study. Three hundred and twenty-four consecutive patients with STEMI were divided into two groups according to pre-PCI Thrombolysis in Myocardial Infarction flow grade (TIMI). Patients with a TIMI flow grade of into the spontaneous reperfusion (SR) group, while patients with TIMI flow grade of 0, 1 and 2 were placed into the non-SR group. The χ² and independentsamples t-test, Mann-Whitney U test, multivariate logistic regression analysis, and receiver-operator characteristic (ROC) curve analysis were used for the statistical analysis. Results: PLR, NLR, and UA values in the SR group were lower than in the non-SR group (p<0.004, p<0.001, p<0.001, respectively). In the multivariate analysis, serum UA level and PLR were found to be independent predictors of pre-PCI IRA patency. In the ROC curve analysis, PLR >190, UA>5.75 mg/dL, and NLR>4.2 predicted non-SR. The sensitivity and specificity of the association between low IRA TIMI flow grade and PLR were 88% and 84%, 72% and 66% for UA, and 74% and 44% for NLR, respectively. Conclusion: We determined that PLR and UA are novel predictors of IRA patency before PCI. We suggest that PLR and UA may be used in riskstratifying STEMI. [ABSTRACT FROM AUTHOR]

Introduction: The thrombolysis in myocardial infarction (TIMI) risk score is calculated as the sum of independent predictors of mortality and ischemic events in ST elevation acute myocardial infarction (STEMI). Several studies show that the neutrophil to lymphocyte ratio (NLR) is a prognostic inflammatory marker. In preliminary studies, platelet to lymphocyte ratio (PLR) has been proposed as a pro-thrombotic marker. The relationship between NLR, PLR and TIMI risk score for STEMI has never been studied. Aim: To evaluate the association between TIMI-STEMI risk score and NLR, PLR and other biochemical indices in STEMI. Material and methods: In this retrospective study, we evaluated 390 patients who presented with STEMI within 12 h of symptom onset. Patients were grouped according to low and high TIMI risk scores. Results: We enrolled 390 patients (mean age 61.9 ±13.6 years; 73% were men). The NLR, platelet distribution width (PDW) and uric acid level (UA) were significantly associated with a high TIMI-STEMI risk score (p = 0.016, p = 0.008, p = 0.030, respectively), but PLR was not associated with a high TIMI-STEMI risk score. Left ventricular ejection fraction was an independent predictor of TIMI-STEMI risk score. A cut-off point of TIMI-STEMI score of > 4 predicted in-hospital mortality (sensitivity 75%, specificity 70%, p < 0.001). We found that NLR, PDW, and UA level were associated with TIMI-STEMI risk score. Conclusions: Neutrophil to lymphocyte ratio, PDW and UA level are convenient, inexpensive and reproducible biomarkers for STEMI prognosis before primary angioplasty when these indicators are combined with the TIMI-STEMI risk score. We believe that these significant findings can guide further clinical practice. [ABSTRACT FROM AUTHOR]

Objective: We aimed to investigate short term effects of oral and infusion dosages of amiodarone on thyroid function. Methods: A hundred and fifty-five prospectively consecutive patients with a diagnosis of atrial or ventricular arrhythmias admitted to our clinic whom amiodarone were applied enrolled to our study. 134 patients received 16 mg/kg amiodarone iv infusion for 24 hours and oral 500±100 mg/day amiodarone as the maintenance dose for one month. 21 patients received only oral 500±100 mg/day amiodarone dose for one month. Follow up visit was performed in the first month of amiodarone therapy. Results: In this study 68% of patients were male and the average age of the patients was 62.8±13.5. The indications for amiodarone treatment were atrial fibrillation (41%), ventricular tachycardia (41%), and preoperative (5%), supraventricular tachycardia (5%), atrial flutter (5%), and ventricular fibrillation (3%). At the first month of follow up 83% of patients were in euthyroid state, 17% of the patients had amiodarone induced thyroid dysfunction (TD), 5% of patients had subclinical hyperthyroidism, 5% of patients had manifest hypothyroidism, 7% of patients had subclinical hyperthyroidism, and 1% of the patients developed overt hyperthyroidism. Conclusion: In this study we showed that amiodarone can cause adverse effects on thyroid function in a short time of period. For this reason patients should be followed in the first, third, sixth and twelfth months of amiodarone therapy and thyroid function should be evaluated. [ABSTRACT FROM AUTHOR]