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There is growing concern about radiation exposure from nuclear myocardial perfusion imaging (MPI), particularly among younger patients who are more prone to develop untoward effects of ionizing radiation, and hence US and European professional society guidelines recommend age as a consideration in weighing radiation risk from MPI. We aimed to determine how patient radiation doses from MPI vary across age groups in a large contemporary international cohort.Data were collected as part of a global cross-sectional study of centers performing MPI coordinated by the International Atomic Energy Agency (IAEA). Sites provided information on each MPI study completed during a single week in March-April 2013. We compared across age groups laboratory adherence to pre-specified radiation-related best practices, radiation effective dose (ED; a whole-body measure reflecting the amount of radiation to each organ and its relative sensitivity to radiation's deleterious effects), and the proportion of patients with ED ≤ 9 mSv, a target level specified in guidelines.Among 7911 patients undergoing MPI in 308 laboratories in 65 countries, mean ED was 10.0 ± 4.5 mSv with slightly higher exposure among younger age groups (trend p value 0.001). There was no difference in the proportion of patients with ED ≤ 9 mSv across age groups, or in adherence to best practices based on the median age of patients in a laboratory.In contemporary nuclear cardiology practice, the age of the patient appears not to impact protocol selection and radiation dose, contrary to professional society guidelines.

Inflammatory bowel disease [IBD] includes a number of chronic relapsing diseases. In IBD intestinal microvascular endothelial cells are damaged by an abnormal immune response. Several studies have shown that IBD may cause increment in risk of developing atherosclerosis. IBD in activation was related to enhanced risks of worse cardiovascular [CV] outcome, on the other hand no risk increment was seen in remission comparing to control group in those studies. Coronary Flow Reserve [CFR] reflects coronary microvascular circulation. Coronary microvascular dysfunction may be defined as a predictor of CV outcome combined with previous described atherosclerotic risk factors. The present study was purposed to further evaluate whether or not CFR in the left anterior descending artery [LAD] is disturbed in IBD patients with activation in comparison to remission and healthy subjects.62 patients with IBD and 39 healthy volunteers were enrolled into the study. Patients' demographics were recorded. CFR evaluation of patients with IBD in both activation and remission period and control group were performed with transthoracic echocardiography.CFR was significantly lowest in the active period of the IBD [2.26 [2.08-2.55] vs. 2.55 [2.18-3.00] and 3.10 [2.85-3.29] p0.001]. CFR is negatively correlated with disease activity scores of IBD.This study showed that CFR is more prominently disturbed in patients with IBD in activation. The activation of disease may have a major role in the progression of coronary microcirculatory dysfunction and future cardiovascular events.

PubMedID: 27414726 Background/objectives Systemic sclerosis (SSc) is a progressive autoimmune disorder with multi-organ involvement. Patients who have SSc are at risk of developing pulmonary arterial hypertension (PAH) and right heart failure. Impaired right heart hemodynamic function is the most powerful predictor of mortality in these patients. We assessed the interactions between levels of NT-proBNP, cystatin C, and right ventricular functions in SSc patients without significant PAH. Methods Fifty SSc patients without significant PAH (37 women and 13 men, mean age 47.2 ± 10.3), and 44 healthy participants as a control group (29 women and 15 men, mean age 47.9 ± 10.4) were included in the study. Results Cystatin C and NT-proBNP levels were significantly higher in patients with SSc. Both cystatin C and NT-proBNP levels possitively correlate with age, interventricular septum thickness, left ventricular posterior wall thickness, systolic pulmonary artery pressure, the peak late diastolic filling velocity, tricuspid regurgitation velocity, and negatively correlate with pulmonary artery acceleration time in the patients. Conclusions Our results showed that elevated cystatin-C and NT-proBNP levels may be a clue for diastolic impairment in right ventricular functions in SSc. © 2016 Elsevier Ireland Ltd Our study was funded by the scientific research project support unit of Cukurova University.

In human history, certain mathematical figures or concepts had gained a significant reputation largely due to their occult and esoteric meanings. Among these, Golden Ratio and associated concepts, namely golden proportions, had elicited a tremendous breakthrough in our human awareness and perception regarding mundane and spiritual aspects of physical existence. Golden Ratio or Number (with a numerical value of 1.618) that is also referred to as the Greek letter Phi (φ), has been universally expressed on a line partitioned into two unequal lengths (L, the longer and S, the shorter) in such a manner that L/S=(L+S)/L. Besides, appearing in certain number sequences (Fibonacci Series, etc.), golden proportions, to the consternation of observers, appear to be strikingly prevalent across all levels of physical existence from the innermost structures to the colossal galaxies of the universe potentially labeling these concepts as the measures of divine aesthetics. Accordingly, the human body also serves as an epitome of these mysterious concepts as exemplified by its outward appearance including general stature and extremities along with a variety of inner organ systems. Based on preliminary studies, the human cardiovascular system might also be suggested to serve as a major predilection site of divine aesthetics as measured with Golden Ratio and its allies. This appears to be completely in line with the ancient knowledge associating the human heart with the esoteric and spiritual components of human nature including human soul. Within this context, the present paper primarily aims to discuss human manifestations of divine aesthetics as measured with 'Golden Ratio' and associated indices with a particular and detailed emphasis on their potential link with the human cardiovascular system.

Article history: Received 20 November 2015 Accepted 22 November 2015 Available online 23 November 2015 artery dissection and rupture after successful TAVI procedure with axillary artery approach. The patient was admitted to our hospital because of severe and symptomatic aortic valve stenosis. The patient had hypertension, dyspnea and syncope on her history. On physical examination, the arterial blood pressure was 138/65 mmHg, the pulse was 86 bpm. There was a 4/6 systolic murmur on the right sternal border radiating to the right side of the neck. The peripheral arterial

The aim of this study is to investigate the impact of ticagrelor as compared to clopidogrel based dual antiplatelet therapy (DAPT) during post-discharge management on the incidence of left ventricular (LV) thrombus in patients with first acute anterior ST elevation myocardial infarction (STEMI).641 patients who met the inclusion criteria were divided into two groups based on the receipt of either ticagrelor or clopidogrel based DAPT.Left ventricular thrombus was detected in 73 (11.4%) patients at the first month echocardiographic examination. Ticagrelor based DAPT was associated with significantly less incidence of LV thrombus when compared to clopidogrel [20 (7.4%) vs 53 (14.0%) OR: 0.50 (0.29-0.86)]. Penalized maximum likelihood estimation (PMLE) logistic regression analyses were performed to fourteen candidate variables for identifying the independent predictors of LV thrombus, ticagrelor (compared with clopidogrel) [OR: 0.53 (0.28-0.96), p = 0.039], body mass index (BMI) [OR: 0.58 (0.44-0.77), p 0.001], KILLIP class (I vs II-IV) [OR: 0.35 (0.14-0.83), p = 0.017], age [OR: 1.22 (1.08-1.40), p 0.001], poor postprocedural myocardial blush grade (MBG) [OR: 3.35 (1.32-8.15), p = 0.012] and LVEF predischarge [OR: 0.79 (0.72-0.86), p 0.001] were found to be associated with LV thrombus.Our study demonstrated that the incidence of LV trombus was significantly lower with ticagrelor than clopidogrel-based DAPT during postdischarge treatment for anterior STEMI patients.

Article history: Received 11 October 2015 Accepted 18 October 2015 Available online 19 October 2015 Firstly, we decided to try the percutaneous transapical approach with a needle without left minithoracotomy. Under general anesthesia, we performed coronary angiography in order to not puncture the left anterior descending artery in apical region (Fig. 2). After that, under TEE and fluoroscopic angiographic guidance, transapical cannulation of the left ventricle from the sixth intercostal area and midclavicular region with a needle was performed and a 6 F sheath was inserted to

The transapical transcatheter approach for percutaneous interventions is performed in high-risk patients with peripheral vascular disease and when transseptal attempt failed. The apical access is traditionally performed through a left minithoracotomy at the fifth intercostal space under general anesthesia. But, there are some complications and risks like ventricular arrhythmias, ventricular tear and life-threatening surgical bleeding in the apical access even though it is a minimally invasive procedure [1]. Although new apical closure devices have been developed and tested in animals and humans, the apical closure remains a challenge in recent studies [2]. The cardiologists started to use the occluders to closure the percutaneous apical accesses [3–11]. We report a case of a successful percutaneous closure of the apical access with a 4 mm ADO-II device after a standard transapical mitral paravalvular leak closure procedure without minithoracotomy. A67year old femalewas admitted to our departmentwith severe dyspnea (NHYA classes II–III). And she had hemolytic anemia (hemoglobin level 9.0 g/dL, lactate dehydrogenase 1588 IU/L). She had a history of mitral bioprosthesis valve replacement in 1997 and metallic mitral valve replacement in 2005. Transesophageal echocardiography (TEE)

Golden ratio, which is an irrational number and also named as the Greek letter Phi (φ), is defined as the ratio between two lines of unequal length, where the ratio of the lengths of the shorter to the longer is the same as the ratio between the lengths of the longer and the sum of the lengths. The so-called formula is a mathematical ratio and there exist a variety of examples in natural and man-made structures of great beauty. Moreover, golden ratio is expressed throughout the human body in some ways, including digits, uterus, teeth, and cardiovascular system. Although the association of Fibonacci series or golden ratio with systems and organs of human being has not been assessed in depth yet, the mainstream regulation of cardiovascular system seems to be associated with golden ratio. This raises the idea that there might have been a fine and subtle regulator in our body. In this article, we aimed to elaborate the relationship between the existence of golden ratio and the human body and to discuss the golden ratio and its association with cardiovascular system.

Article history: Received 3 November 2015 Accepted 4 November 2015 Available online 5 November 2015 (ACS) [1]. Ticagrelor has more rapid onset of action on platelet inhibition and was superior to clopidogrel. It decreases major adverse cardiac events compared to the clopidogrel. According to the PLATO trial, ticagrelor may lead to increased incidence of asymptomatic ventricular pauses [1–4]. In addition, there are some reports about the side effects of ticagrelor like bradycardia and dyspnea [5–8]. It is considered that the inhibition of the re-uptake of adenosin from the red cells

☆ There is no conflict of interest. ☆☆ This statement is to certify that all authors have see being submitted, have contributed significantly to thewor imacy of the data and its interpretation, and agree to its Journal of Cardiology. ★ We attest that the article is the Authors' original w lication and is not under consideration for publication else ment of ethical publishing as appears in the International ★★ On behalf of all Co-Authors, the corresponding Aut for the submission. Any changes to the list of authors, inclu or removals will require the submission of a new author signed by all the original and added submitting authors. ☆☆☆ All authors are requested to disclose any actual or cluding any financial, personal or other relationships with within three years of beginning the submitted work that c or be perceived to influence, their work. If there are no con read: “The authors report no relationships that could be co ⁎ Corresponding author at: Department of Cardiolog Tevfik Saglam St., 06018 Etlik, Ankara, Turkey. Tel.: +9 3044250. E-mail address: drcengizozturk@yahoo.com.tr (C. O

The transapical transcatheter approach for percutaneous interventions is performed in high-risk patients with peripheral vascular disease and when transseptal attempt failed. The apical access is traditionally performed through a left minithoracotomy at the fifth intercostal space under general anesthesia. But, there are some complications and risks like ventricular arrhythmias, ventricular tear and life-threatening surgical bleeding in the apical access even though it is a minimally invasive procedure [1]. Although new apical closure devices have been developed and tested in animals and humans, the apical closure remains a challenge in recent studies [2]. The cardiologists started to use the occluders to close the percutaneous apical accesses [3–11]. We report a case of a successful percutaneous closure of the apical access with a 4 mm ADO-II device after a standard transapical mitral paravalvular leak closure procedure without minithoracotomy with the computed tomography guidance. This case is the second from Turkey, so the first one was published recently in this journal [12]. In this second case, we used the CT guidance for optimal puncture of cardiac apex. A 44 year old female was admitted to our department with severe dyspnea (NHYA classes II–III). She had hemolytic anemia (hemoglobin level 8.0 g/dL, lactate dehydrogenase level was high). She had a history ofmitralmetallic prosthesis valve replacement in 1994. Transesophageal echocardiography (TEE) showed two severe mitral paravalvular leaks (6 and 9mm) of themitral valve prosthesis. Transesophageal echocardiography (TEE) showed two severe mitral paravalvular leaks (6 and