Search

Objective: The aim of this study was to investigate changes in heart rate variability (HRV) and QT dispersion (QTd) in patients with differentiated thyroid cancer at different TSH suppression levels., Methods: The study included 125 DTC patients, who had been on TSH suppression treatment (TSHST) for at least 1 year. The patients were categorized into three groups: patients with TSH < 0.1 mIU/L (n:30), those with TSH 0.1 to 0.5 mIU/L (n:56), and those with TSH 0.5 to 2 mIU/L (n:39). The first two groups were classified as suppression groups, and the last as replacement (control) group. All patients underwent 12-lead electrocardiogram (ECG) recording and 24-hour rhythm holter echocardiography analysis., Results: The HRV results derived from a 24-hour rhythm holter did not exhibit any significant difference ( p  < 0.05). In dispersion evaluations, the QTd was significantly longer in the suppression groups (groups 1 and 2), than in the replacement group (group 3) ( p  < 0.001 and p:0.002, respectively). The same was found for corrected QT dispersion (QTcd) ( p  < 0.001 and p: 0.008, respectively). In multivariate linear regression analysis, TSH was found to affect QTd (β = -0.299; p = 0.002) and QTcd (β = -0.300; p  = 0.002) values independently., Conclusion: In this study, it was shown that in patients with DTC receiving TSHST, QT dispersion prolonged as the TSH suppression level increased. Especially in high-risk DTC patients, evaluation of QTd may be useful in terms of evaluating cardiovascular risk and regulating TSHST level.

Background: The effect of physiological circulatory changes during pregnancy on hypertrophic cardiomyopathy (HCM) has been reported with limited data. This study aimed to provide information regarding outcomes of pregnant women with HCM and to identify predictors of major adverse cardiac event (MACE)., Methods: A total of 45 pregnancies with HCM were retrospectively reviewed. The primary endpoint was a MACE that occurred within an 8‑week period after delivery, including maternal death, heart failure (HF), syncope, and malignant ventricular arrhythmias (VAs). Baseline and outcome data were analyzed for all patients. Patients with and without MACE were compared, and patients with obstructive HCM were compared with those who had non-obstructive HCM. The study population was divided into two subgroups of patients having or not having an implantable cardioverter defibrillator implantation (ICD)., Results: At least one MACE occurred in 11 patients (24.4%); six patients developed HF (13.3%), six had a ventricular tachyarrhythmia (13.3%), and two had syncope (4.4%). New York Heart Association functional class of ≥ II, presence of HF signs before pregnancy, increased left ventricular outflow tract (LVOT) gradient were significantly associated with MACE. Fatal VAs were seen during pregnancy in one of five HCM patients with ICD. In the ROC curve analysis, an LVOT gradient higher than 53.5 mm Hg predicted the presence of MACE with a sensitivity of 90.9% and a specificity of 73.5%. This study is the largest series in the literature representing pregnant women who had HCM and ICD., Conclusion: The current data suggest that HF and high LVOT gradients are important risk factors for the development of cardiac complications., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: In this study, we investigated whether left atrial functions evaluated by speckle tracking echocardiography , classic echocardiographic and clinic parameters predict appropriate Implantable Cardioverter Defibrillator (ICD) shock in patients who underwent ICD implantation for hypertrophic cardiomyopathy., Methods: Totally 87 patients who received ICD implantation for primary or secondary prevention were included in the study. Patients' clinical, electrocardiographic, 2 dimen- sion classic, and speckle tracking echocardiographic data were collected. Left atrial functions were assessed by speckle tracking echocardiography. Left atrial strain just before mitral valve opening was taken as peak atrial longitudinal strain. Appropriate ICD therapy was defined as cardioversion or defibrillation due to ventricular tachycardia or fibrillation. Patients were divided into 2 groups as occurrence or absence of appropri- ate ICD therapy during follow-up (mean, 50.2 ± 9.3 months). Patients with an European Society of Cardiology (ESC) risk score >6% were considered high-risk patients., Results: A total of 24 (27.5 %) patients were observed to have an appropriate ICD therapy. In patients on whom appropriate ICD therapy was performed, a higher Sudden Cardiac Death risk Score and decreased peak atrial longitudinal strain and global longitudinal peak strain were observed. In patients with high ESC risk score (> 6%), in Cox regres- sion analysis, peak atrial longitudinal strain (odds ratio: 0.806, P = .008), Sudden Cardiac Death risk score (odds ratio: 1.114, P = .03) and global longitudinal peak strain (odds ratio: 1.263, P = .02) were found to be independent predictors of occurrence of appropriate ICD therapy., Conclusion: Easily measurable peak atrial longitudinal strain may provide additional information in predicting ventricular arrhythmias or deciding on prophylactic medical treatment to prevent ventricular arrhythmias or reduce the frequency of appropriate shock in high-risk patients with ICD implanted.

Objective: Contrast-induced nephropathy (CIN) is a serious complication in patients with ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (p-PCI). An interarm systolic blood pressure difference (IASBD) ≥10 mmHg has been identified as an independent risk factor for cardiovascular disease and mortality. The aim of this study was to evaluate the predictive value of the IASBD for the risk of CIN in patients with STEMI who underwent p-PCI., Method: We prospectively investigated 2120 consecutive patients who were hospitalized with a diagnosis of STEMI and underwent p-PCI. A relative increase in serum creatinine levels of ≥ 25% or an absolute increase of ≥ 0.5 mg/dL from baseline within 72 h of contrast exposure was defined as CIN. The IASBD was calculated on admission to the emergency department. The risk of CIN was evaluated., Results: The incidence of CIN was 6.6% (n = 139). The patients were divided into 2 groups based on the development of CIN. Age (p = .001), baseline creatinine levels (p < .001), DM (p < .001), HT (p < .001) and anemia (p = .001) were higher in patients with CIN. An IASBD ≥10 mmHg was noted in 13 (9.3%) patients in the CIN group and 83 (4.1%) (p = .001) in the non-CIN group (Table 1). According to the multivariate analysis, the IASBD was found to be a predictor of CIN development (OR: 2.36, 95% CI: 1.42-3.90, p: 0.001)., Conclusion: The IASBD on admission can be a potential predictor of CIN development in patients with STEMI who underwent p-PCI.

Background: The growing problem of endocardial lead infections and lead malfunctions has increased interest in percutaneous lead-removal technology. Transvenous lead extraction (TLE) via simple manual traction (SMT) is the first-line therapy. When SMT is not successful, TLE from the femoral vein using a gooseneck snare (GS) with a radiofrequency ablation catheter (RFAC) may be an alternative option. The aim of our study was to evaluate the success rate of transvenous extraction of chronically implanted leads via the femoral approach using a GS with RFCA in cases of failure with SMT., Methods: The study included 94 consecutive patients who were referred for lead extraction due to pocket erosion and infection (71 patients) and to lead malfunction (23 patients). Initially, SMT was attempted for all patients. If SMT was not successful, patients underwent TLE using a GS with RFAC., Results: Leads were extracted successfully with SMT in 34 patients (54 leads), while 60 patients (83 leads) underwent TLE using a GS with RFAC. The mean indwelling time of the leads was longer in the femoral approach with GS (87.5 ± 37.9 vs. 31.3 ± 25.8 months; p < 0.001). The procedural success rate was 96.7% in the femoral approach with GS. A preceding implantation lead duration of >51 months predicted an unsuccessful SMT necessitating alternative TLE using a GS with RFAC with 86% sensitivity and 78% specificity (p < 0.001)., Conclusion: Transvenous lead extraction via the femoral approach using GS with RFAC may be an alternative approach to SMT with a high success rate, especially when the indwelling time of the leads is long.

Objective: Acute decompensated heart failure (ADHF) is a life-threatening medical condition and more than 30% of patients hospitalized for ADHF develop acute kidney injury (AKI), which increases the rate of both mortality and morbidity. Previous research has indicated that several biomar- kers may help to predict the development of AKI. The aim of this study was to investigate the relationship between lactate level at the time of admission and AKI in ADHF patients., Methods: A total of 154 consecutive ADHF patients were prospectively enrolled from June 2018 to December 2018, and after applying the exclusion criteria, a total of 91 patients were included in the study. The patients were divided into 2 groups: those with and without AKI., Results: There were 63 patients in the group without AKI and 28 patients in the group with AKI. The AKI group had a higher percentage of a history of chronic kidney disease (CKD), a higher creatinine level, lower glomerular filtration rate level, lower bicarbonate level, higher lactate level, and a lower left ventricular ejection fraction compared with the non-AKI group (p<0.05 for all parameters). Multiple logistic regression analysis determined that CKD history (odds ratio [OR]: 4.003, 95% confidence interval [CI]: 1.295-12.371; p=0.016) and lactate level (OR: 1.545, 95% CI: 1.222-1.954; p<0.001) were independent predictive parameters for developing AKI., Conclusion: An elevated lactate level may help to make an early diagnosis of AKI, an important concern in ADHF.

Objective: The aim of this study was to assess the validity of automated quantitative and semiquantitative visual analysis of total perfusion deficit (TPD) using the IQ SPECT gamma camera system compared to conventional coronary angiographically detected significant coronary artery disease (CAD)., Methods: The study included patients with suspected CAD who underwent myocardial perfusion single photon emission computed tomography and conventional coronary angiography. The summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) (semiquantitative visual analysis results) were assessed using a 5-point scale in a standard 17-segment model, and TPD (stress, rest, and ischemic TPD) was quantified using automated software., Results: In all, 84 patients (Group 1, those who underwent revascularization) had significant coronary artery lesions, and 81 (Group 2) had non-significant lesions. The median interquartile range values were: stress-TPD (sTPD): 16 (3.5- 33.5) vs 9.2 (2-17.9), rest-TPD: 9.4 (2.2-18.8) vs 4 (1-11), and 6.9 (1.9-14.1) vs 3.4 (1-6.1) for ischemic-TPD (iTPD) in Group 1 and Group 2, respectively. To detect ischemia, the optimal cut-off points were 9.5 (sensitivity: 75%, specificity; 60%) for sTPD, and 4.5 (sensitivity: 56%, specificity: 73%) for iTPD. There were significant correlations between quantitative and semi-quantitative methods in detection of significant coronary artery disease (sTPD-SSS: r=0.954, sTPD-SDS: r=0.746, iTPD-SSS: r=0.654, iTPD-SDS: r=0.759; p<0.05 for all)., Conclusion: The quantitative analysis and summed stress scores produced by the IQ SPECT system appear to be a useful and valid method to detect significant CAD.

Coronary artery bifurcation disease of a saphenous vein graft (SVG) is extremely rare. SVG disease remains a challenging lesion to treat because of increased morbidity and mortality with repeated coronary artery bypass graft (CABG) surgery, a high rate of periprocedural complications, and in-stent restenosis or occlusion requiring repeat revascularization with percutaneous coronary intervention. Presently described is use of the simultaneous kissing stent technique to treat inverted Y SVG bifurcation disease in a patient with a prior CABG and new-onset acute coronary syndrome.

Coronary fistulae may lead to coronary steal phenomenon or considerable volume overload on the cardiac chambers, causing significant hemodynamic problems. Coronary fistulae can be closed either surgically or percutaneously. Percutaneous closure is frequently performed with coil embolization or a vascular plug. Although percutaneous closure has significant advantages, such as a shorter duration of hospitalization and no sternal scarring, several complications, including coil embolization or failure to retrieve the device, may occasionally occur. In the current report, a patient with a left coronary to right atrium fistula who declined to have surgery underwent percutaneous coil embolization. However, after release of the coil, the catheter could not be retrieved using the standard anti-torque mechanism.

Endovascular interventions are now used more frequently in the treatment of femoropopliteal occlusions, and antegrade passage through the occlusion is preferred as the first option. However, when antegrade passage fails for any of several reasons, retrograde, or less frequently, collateral passage may be used. Although collateral passage may present serious complications, it can be successfully applied in selected cases in experienced centers. In the present case, a superficial femoral artery occlusion was successfully opened with a collateral approach.

Introduction: Procoagulant activity of heparanase has been recently described in several arterial and venous thrombotic disorders. In this study, we aimed to investigate the role of heparanase with regard to thrombus burden, thromboembolism, and treatment success with unfractionated heparin (UFH) in patients with prosthetic valve thrombosis (PVT)., Methods: This study enrolled 79 PVT patients who received UFH for PVT and 82 controls. Plasma samples which were collected from patients both at baseline and after the UFH treatment and from controls at baseline only, were tested for heparanase levels by heparanase enzyme-linked immunosorbent assay., Results: The PVT group included 18 obstructive and 61 non-obstructive PVT patients who received UFH infusions for a median duration of 15 (7-20) days. The UFH treatment was successful in 37 (46.8%) patients. Baseline heparanase levels were significantly higher in the patient group than in the controls [0.29 (0.21-0.71) vs. 0.25 (0.17-0.33) ng/mL; p = 0.002]. Baseline heparanase levels were significantly higher in obstructive PVT patients. There was a significant increase in heparanase levels after UFH treatment. Post-UFH heparanase levels were higher in patients who experienced treatment failure compared to successfully treated group. Baseline and post-UFH heparanase levels were significantly higher in patients with a thrombus area ≥1 cm 2 and with a recent history of thromboembolism., Conclusions: Increased heparanase levels may be one of the esoteric causes for PVT. UFH treatment may trigger an increase in heparanase levels which may affect the treatment success. Increased heparanase levels may be associated with high risk of thromboembolism and increased thrombus burden in PVT patients., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Percutaneous closure of atrial septal defects is accepted as a safe and effective treatment method. Device embolization is a rare, but potentially fatal complication. While embolized devices are typically removed surgically, in eligible cases, they can also be removed percutaneously at an experienced center. Presently described is the retrieval of an embolized device with a novel percutaneous technique.

Coronary fistulas are defined as the presence of an abnormal connection between the coronary arteries and the low-pressure vascular area or the cardiac cavity. The clinical significance depends on the amount of blood flow through the fistula segment, the volumetric load on the right and left heart chambers, and whether it leads to a coronary steal phenomenon. Although fistula flow can be better visualized by angiographic methods, it can also be seen by echocardiography. In this case, the fistula flow draining to the left ventricle was demonstratively visualized.

: Plasma D-dimer level is an indicator of thrombosis and endogenous fibrinolytic activity. We investigated the association between the D-dimer levels and thrombus burden and cerebrovascular events in patients with obstructive prosthetic valve thrombosis (PVT). This retrospective study included 47 patients with obstructive left-sided PVT and 32 controls in whom PVT was excluded with comprehensive transthoracic and transesophageal echocardiography (TEE). The patient group included 11 aortic, 27 mitral, and 9 aortic and mitral valve PVT patients and the control group included 2 aortic, 25 mitral, and 5 aortic and mitral valve patients. Laboratory analysis including plasma D-dimer levels was performed at the time of admission in all patients. The baseline characteristics were similar between the two groups. The plasma D-dimer levels were significantly higher in patients with obstructive PVT compared with controls [680 (110-3590) vs. 310 (80-380) μg/l; P < 0.001]. By multivariate logistic regression analysis high D-dimer level, low-INR value on admission, high NYHA functional class and recent history of cerebrovascular accident (CVA), and transient ischemic attack (TIA) were the independent predictors of obstructive PVT. A plasma D-dimer level of greater than 365 μg/l predicted the presence of PVT with a sensitivity of 81% and a specificity of 69% (AUC= 0.781, P < 0.001). Plasma D-dimer levels were significantly higher in patients with a recent history of CVA/TIA [2140 (470-2980) vs. 590 (380-830) μg/l; P = 0.021]. In addition to the so-called indicators of PVT including subtherapeutic anticoagulation, increased D-Dimer levels may strengthen the suspicion of PVT. Moreover, higher plasma D-dimer levels were associated with higher thrombus burden and higher prevalence of recent CVA/TIA.

Objective: Bicuspid aortic valve (BAV) is a complex developmental anomaly caused by abnormal aortic leaflet formation during valvulogenesis. The present study is an assessment of the effects of BAV disease on the ascending aorta and pulmonary artery (PA), and an evaluation of the consequences for systolic and diastolic functioning of the left and right ventricles., Methods: Total of 66 patients were eligible for inclusion. Pulmonary artery maximum diameter (PAD) was obtained 1 cm distal to the pulmonary annulus. Using pulsed-wave tissue Doppler imaging, left ventricular (LV) early diastolic velocity (E') measurement was obtained at the annulus with placement of sample volume. Right ventricle (RV) peak global strain rate during systole (RV-SRS), early diastole (RV-SRE), and late diastole (RV-SRA) were calculated., Results: In this study, 40.9% (n=27) of patients were female and average age was 35±11years. RV-SRS values (ß=-.781, t=-2.723; p=0.010) and log-LV tissue Doppler imaging E' (ß=-2.996, t=-5.405; p=<0.001) were negatively correlated, and log-PAD (ß=4.861, t=3.052; p=0.005) was positively and independently correlated with ascending aortic diameter., Conclusion: Ascending aorta diameter is positively correlated with PA diameter in BAV patients, and RV strain rate and LV diastolic parameters are affected before development of the valve disease.

Background: This study aimed to determine the myocardial damage (infarct size provided by cardiac single-photon emission tomography) in early stages of the infarction using longitudinal strain and rotational parameters of the left ventricle., Methods: The study included 66 patients with anterior myocardial infarction (AMI) and 62 patients with inferior myocardial infarction (IMI) who underwent primary percutaneous intervention as well as a control group consisting of 50 healthy subjects. LV rotational parameters based on parasternal short-axis views in basal and apical planes and global longitudinal strain were measured with apical four-chamber, apical two-chamber, and apical long-axis views., Results: There was a significant positive correlation between infarct size and GLPSavg (r=-.55 <.001), GTOR angle (r=-.52, P<.001), apical rotation angle (r=-.40 <.001, and EF (r=-.43, <.001). While cutoff values were GLPSavg: 11.9 (AUC=0.78), GTOR angle: 11.4° (AUC=0.77), apical rotation angle: 7.1° (AUC=0.76) for patients with an infarct size greater than 20%, the cutoff values were GLPSavg: 10.7 (AUC=0.75), GTOR angle: 8.7° (AUC=0.86), apical rotation angle: 4.35° (AUC=0.87) for those with an infarct size greater than 40%., Conclusion: GLPSavg, GTOR angle, and apical rotation angle values may be used to determine the extent of infarction in early post-MI period, thereby allowing precautions to be taken for remodeling in early stages., (© 2017, Wiley Periodicals, Inc.)

Objective: Atrial fibrillation (AF) is the most common arrhythmia following coronary artery by-pass graft surgery (CABG). The value of SYNTAX score to predict postoperative atrial fibrillation (PoAF) has not been clearly addressed. We aimed to evaluate this relationship in patients undergoing isolated CABG., Methods: This study was designed as a single-center, non-randomized, observational, prospective study. Ninety-four patients undergoing isolated on-pump CABG, who had sinus rhythm and were older than 18 years, were enrolled. Demographic characteristics of the patients were recorded; SYNTAX score was calculated preoperatively for each patient. The univariate and multivariate logistic regression analysis were used to determine for predictors of PoAF., Results: The median SYNTAX score of the enrolled patients was 21, (56-5). PoAF was observed in 31 (33.3%) patients. Univariate logistic regression showed that age, chronic obstructive pulmonary disease (COPD), red blood cell distribution width (RDW), urea, initial troponin I, peak postoperative troponin I, interventricular septum, left atrial diameter, and SYNTAX score were significantly associated with the frequency of PoAF following CABG. An independent association was identified with age [ß: 0.088, p:0.023, OR: 1.092, 95% CI (1.012-1.179)], COPD [(ß: 2.222, p:0.003, OR: 9.228, 95% CI (2.150-39.602)], and SYNTAX score [(ß: 0.130, p:0.002, OR: 1.139, 95% CI (1.050-1.235)]., Conclusion: This study showed that a higher SYNTAX score was related to more frequent PoAF in patients undergoing isolated on-pump CABG.

Aims: Estimation of left ventricular (LV) filling pressures is a clinical challenge in patients with preserved ejection fraction (EF). In the present study, we investigated whether LV and atrial longitudinal strain and strain rate (SR) parameters derived by speckle tracking echocardiography (STE) could be used to predict invasively measured LV end-diastolic pressure (LVEDP) in this patient population., Methods and Results: LVEDP was measured before coronary angiography was performed in 65 patients with preserved EF (≥50%) referred to elective cardiac catheterization; besides, patients enrolled underwent comprehensive echocardiographic examination before the procedure. In addition to conventional echocardiographic parameters used to evaluate diastolic function LV longitudinal strain and SR, as well as peak atrial longitudinal strain during LV systole, measurements were performed using STE. Only log-diastolic blood pressure, systolic SR, early diastolic SR, SR during isovolumetric relaxation (SRIVR), and mitral early diastolic flow velocity/SRIVR significantly correlated with LVEDP. When age-adjusted stepwise linear regression analysis was performed, SRIVRT values (β= -20.682, t = -3.292; P = 0.002) and log-diastolic blood pressure levels (β= 21.118, t = 3.784; P < 0.001) were independently correlated with LVEDP., Conclusion: When compared with conventional echocardiographic parameters, other longitudinal strain, and SR indices, SRIVRT independently predicted LVEDP in conjunction with log diastolic blood pressure. We suggest that SRIVRT is a valuable parameter to evaluate diastolic function in patients with preserved EF., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.)