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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

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

Introduction: Cardiac arrest, which may result in death without an effective cardiopulmonary resuscitation (CPR), is the unexpected loss of cardiac functions. Sudden cardiac arrest is classified as in-hospital and out-of-hospital depending on the place where the event occurs. Patients and Methods: In this study, 134 patients (age, >18 years) who were admitted or were brought with the help of their relatives or in an ambulance and medical equipment to the Emergency Department of Kosuyolu Cardiac Hospital with the diagnosis of in-hospital or out-of-hospital cardiac arrest between 2013 and 2016 were enrolled. Demographic characteristics of the patients were obtained from the hospital database. Results: In total, 134 patients were included in this study. Of these, 95 (71%) were males and 39 (29%) were females. The mean patient age was 61.7 ± 14.6 years. In a total of 134 cardiac arrests, 58 were in-hospital and 76 were out-of-hospital. Among the patients who exhibited electrical activity with pulse after CPR, 35 (64.8%) experienced in-hospital cardiac arrest and 19 (35.2%) experienced out-of-hospital cardiac arrest, whereas among the patients who exhibited pulseless electrical activity after CPR, 23 (28.7%) experienced in-hospital cardiac arrest and 57 (71.2%) experienced out-of-hospital cardiac arrest (p< 0.001). Conclusion: The most common cause of cardiac arrest in our study cohort was myocardial infarction with ST segment elevation, followed by congestive heart failure and indefinite causes. Asystole was the most common rhythm at admission. The rate of ventricular fibrillation detected in the returning group was found to be higher than the non-returning group and the difference was statistically significant (p< 0.001). Similary to literature in our study, pulsatile electrical rhythm was found to be more prominent in pulsatile rhythms.

Introduction: InappropriateICD shocks may negatively affect the quality of life and lead to arrhythmiasand psychiatric problems. In this study, we investigated demographic andclinical characteristics of patients with ICD shocks and the predictors leadingto inappropriate ICD shocks presented to our emergency department.Patients and Methods:Atotal of 64 patients with ICD shocks presented to the emergency department wereincluded in the study. Clinical data of the patients were retrospectivelyobtained. The clinical features, left ventricular ejection fraction (LVEF),drugs used, and electrocardiographic (ECG) data at the time of implantation ofthe patients were obtained.Results: Of thepatients presented, 82% were male and the mean age was found as 56.6 ± 15.8years. Fourty-nine (76%) and 15 (34%) patients experienced appropriate andinappropriate ICD shocks, respectively. The most common findings in thepatients presented with inappropriate ICD shocks included atrial fibrillationin 8 (53%), supraventricular tachycardia in 6 (40%), and lead sensing problemin 1 (7%) patients. Compared with the patients presented with appropriateshocks, patients with inappropriate ICD shocks were younger, had less coronaryartery disease, had more history of atrial fibrillation before implantation,and shorter time from implantation to first inappropriate shock. Inmultivariate logistic regression analysis, age and a history of atrialfibrillation were found as independent predictors for inappropriate ICD shocks.Conclusion: Presence of atrialfibrillation is the most common rhythm problem that causes inappropriate ICDshocks. History of previous atrial fibrillation and a younger age arepredicting clinical parameters for inappropriate ICD shocks., Giriş: Uygunsuz implante edilen kardiyoverter defibrilatör (ICD) şokları yaşamkalitesini olumsuz etkileyebilir, aritmiye ve psikiyatrik sorunlara yolaçabilir. Biz çalışmamızda acil servisimize ICD şoklamasıyla başvuranhastaların demografik, klinik özeliklerini ve uygunsuz ICD şoklamasına yol açanöngördürücüleri araştırdık.Hastalar veYöntem: Acil servise ICD şoklamasıyla başvuran 64 hastaçalışmaya alındı. Hastalara ait klinik veriler retrospektif olarak elde edildi.Çalışmaya dahil edilen hastaların klinik özelikleri, sol ventrikül ejeksiyonfraksiyonu (LVEF), kullandıkları ilaçlar, implantasyon anındakielektrokardiyogramlarına (EKG) ait veriler elde edildi.Bulgular: Başvuran hastaların %82’si erkek ve ortalama yaş (56.6 ± 15.8) tespitedildi. Kırk dokuz (%76) hastada uygunşoklama tespit edilirken 15 (%34) hastada uygunsuz ICD şoklaması tespit edildi.Uygunsuz ICD şoklama ile başvuranhastalarda sırasıyla en sık atriyal fibrilasyon (AF) 8 (%53), supraventrikülertaşikardi 6 (%40) ve lead algılama sorunu 1 (%7) hastada saptandı. Uygunsuz ICD şoklaması olanhastalar uygun şoklamayla başvuran hastalarla kıyaslandığında daha genç yaşa,daha az koroner arter hastalığına, implantasyon öncesi daha fazla AF öyküsüne ve implantasyondansonra ilk şoklamaya kadar daha kısasüreye sahip olan hastalardı. Multivariate logistik regresyon analizi sonrasıyaş, AF öyküsü varlığı uygunsuz ICD şoklaması için bağımsız öngördürücü olduğubulundu.Sonuç: AF varlığı uygunsuz ICDşoklamasına neden olan en sık ritmsorunudur. Daha önce AF öyküsünün olması ve genç yaşta olmak, uygunsuz ICDşoklaması için öngördürücü klinik parametrelerdir.

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 cm2 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. © 2018 Elsevier Ltd

PubMed ID: 28238569, Objective No studies have been conducted in Turkey to compare the quality of stroke prevention therapies provided in different healthcare settings in patients with atrial fibrillation (AF). Therefore, we aimed to evaluate possible differences between secondary (SH) and tertiary hospital (TH) settings in the effectiveness of implementing AF treatment strategies. Methods Baseline characteristics of 6273 patients with non-valvular AF enrolled in the RAMSES (ReAl-life Multicentre Survey Evaluating Stroke Prevention Strategies in Turkey) study were compared. Results Of the study population, 3312 (52.8%) patients were treated in THs and 2961 (47.2%) patients were treated in SHs. Patients treated in the SH setting were older (70.8 ± 9.8 vs. 68.7 ± 11.4 years, p

WOS: 000398109300008 PubMed ID: 28247458 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

Objective: Although several hypotheses have been suggested, the underlying mechanism of coronary slow flow phenomenon (CSFP) has not been well established yet. The aim of this study was to determine the roles of plasma apolipoprotein-B100 (Apo-B) and apolipoprotein-A1 (Apo-A1) in CSFP which have an atherogenic effect and anti-atherogenic effects respectively. Methods: The study consisted of 31 patients with CSFP (group 1), 28 normal subjects as control group(group 2) and 30 patients with coronary artery disease (CAD) (group 3) detected by coronary angiography. CSFP was diagnosed by the TIMI frame count method. Blood Apo-B, Apo-A1, Apo-B/Apo-A1 ratio, and demographic parameters were compared between the groups. Results: The Apo-B values were 93±25 mg/dL, 90±26 mg/dL, and 106±27 mg/dL in groups 1, 2 and 3, respectively (p=0.048 between group 1 and 3, p=0.041 between group 2 and 3, p= NS between group 1 and 2). TheApo-A1values were 127±14 mg/dL, 125±21 mg/dL and 106±27 mg/dL in groups 1, 2 and 3 respectively (p=0.028 between group 1 and 3, p=0.021 between group 2 and 3, p= NS between group 1 and 2). The apo-B/apo-A1 ratio were 0.73±0.18, 0.69±0.23 and 0.98±0.20 in groups 1, 2 and 3 respectively (p=0.017 between group 1 and 3, p=0.010 between group 2 and 3, p= NS between group 1 and 2). Conclusion: Although lower levels of plasma Apo-A1 and higher levels of Apo-B and the ratio of Apo-B to Apo-A1 are related with CAD, there is no relationship between these apolipoproteins and CSFP.

Patent ductus arteriosus is a congenital heart disease which can cause chronic volume overload leading to congestive heart failure. A 34-year-old woman with rest dyspnea was found to have patent ductus arteriosus and echocardiogram revealed a markedly dilated left ventricle (8.9 cm) and severely-compromised left ventricle systolic functions (ejection fraction~24%). The patent ductus arteriosus was successfully closed percutaneously with Amplatzer occluder device. The patient was discharged on optimal dosages of ramipril, metoprolol, furosemide, spiranolactone and aspirin. On the follow-up after 18 months, the symptoms were found to have regressed and echocardiographic parameters improved (ejection fraction~55%).

Background In patients presenting with ST-elevation myocardial infarction (STEMI), we investigated the relation of left atrial (LA) deformational parameters evaluated by two-dimensional speckle tracking imaging (2D-STI) with conventional echocardiographic diastolic dysfunction parameters and B-type natriuretic peptide (BNP) level. Methods Ninety STEMI patients who were treated with primary percutaneous coronary intervention (PCI) and 22 healthy control subjects were enrolled. STEMI patients had echocardiographic examination 48 hours after the PCI procedure and venous blood samples were drawn simultaneously. In addition to conventional echocardiographic parameters, LA strain curves were obtained for each patient. Average peak LA strain values during left ventricular (LV) systole (LAs-strain) were measured. Results BNP values were higher in MI patients compared to controls. Mean LAs-strain in control group was higher than MI group (30.6 ± 5.6% vs. 21.6 ± 6.6%; p = 0.001). LAs-strain had significant correlation with LVEF (r = 0.51, p = 0.001), also significant inverse correlations between LAs-strain and BNP level (r = −0.41, p = 0.001), E/Em (r = −0.30, p = 0.001), LA maximal volume (r = −0.41, p = 0.001), LA minimal volume (r = −0.50, p = 0.001) and LV end systolic volume (r = −0.37, p = 0.001) were detected. The cut off value of LAs-strain to predict BNP > 100 pg/ml was determined as 19.9% with 55.3% sensitivity and 77.2% specificity (p